Comprehensive Study Notes on Health Information Systems (HIS)
Educational Institutions and Foundational Frameworks
Educational Institution Definition: * A place where learners of different ages gain education. * Covers levels from preschool to tertiary level. * Involves educational activities that engage students within various learning environments and spaces.
Formal Education: * Follows a conventional classroom setup. * Utilizes structured methods of learning. * Occurs within a fixed period where learners complete levels by acquiring required competencies for higher learning.
Informal Education: * Anything learned independently outside the conventional classroom setup. * Not restricted to a specific location. * Integrated with the surroundings. * Involves the development of student behavior skills through interaction and exploration on a daily basis.
Academic Institution Statements: * Vision: * Conveys the desired end goal of the institution. * Clear, memorable, and concise. * Typical length: to words. * Mission: * The intention of the institution’s existence. * Typical length: to words. * Function: * Inspires individuals to give their best. * Shapes understanding of the reason for being in the institution. * Defines key measures of success. * Development Statement Questions: * Success timeline: When do we want to reach success? * Direction: Where do we want to go forward? (Towards the end goal). * Method: How do we want to do it? (Method of action). * Present focus: What do we do today? (Specific action). * Target: From whom do we do it? * Purpose: Why do we do what we do? * Value Statement: * A list of fundamental doctrines guiding and directing the institution. * Guides decision-making and acts as a yardstick for action. * Shapes the standard structure and sets moral standards. * Objectives: * Achieved within or at the end of a course or lesson. * Follows the SMART criteria: Specific, Measurable, Attainable, Realistic, Time Bound.
CHED Memorandum Order No. 14 of 2006: titled ‘‘Policies, Standards, and Guidelines for Medical Technology Education.’’
Health Care Systems and Financing
Definitions of Health System: * Roemer (1991): A combination of resources, organization, financing, and management culminating in the delivery of health services to the population. * WHO (2000): All organizations, institutions, and resources devoted to producing health actions. * System General Definition: An arrangement of parts and interconnections coming together for a purpose.
Goals of a Health System: 1. Improving the health of populations (striving for equity). 2. Improving responsiveness to the served population (quality, accessibility, and cost-effectiveness). 3. Fairness in financial contribution (protecting families from financial catastrophe resulting from healthcare expenditure).
Functions of a Health System: 1. Health Service Provision: Preventive, clinical, restorative, and palliative care. 2. Health Service Inputs / Resource Generation: Management of resources to produce health interventions. 3. Stewardship: Overall system oversight.
Health Financing Components: * Revenue Collection: Payments collected via taxation (e.g., Sin Tax), out-of-pocket payments, and payroll contributions. * Risk Pooling Models: * Bismarck Model: Sickness funds are paid by employees and employers. * Beveridge Model: Health services are paid by the government through tax payments.
WHO Health System Framework (Building Blocks): * Service Delivery: Delivery of quality, accessible, and safe services. * Health Workforce: Human resource management. * Health Information System: Production, analysis, dissemination, and use of timely/reliable information. * Medical Products: Ensuring equitable access and cost-effective quality products. * Financing: Adequate funds to protect people and promote accessibility. * Leadership and Governance: Strategic policies, oversight, accountability, and partnerships.
Philippine Health System History and Milestones
1970: Primary Health Care for all developed as a centralized government-funded system.
1979: Adoption of Primary Health Care.
1982: Reorganization of the DOH; integrated public health and hospital services.
1986: Milk Code 1986: Promoted breastfeeding and nutrition.
1988: The Generics Act: Required prescriptions to use generic names to lower drug expenditure through non-branded medicines.
1991: RA 7160 ‘‘Local Government Code’’: Transferred health service responsibility to Local Government Units (LGUs).
1195: National Health Insurance Act: Mechanism for financial protection, prioritizing the poor.
1996: Health Sector Reform Agenda: Major structural restructuring of the DOH.
2005: FOURmula ONE (F1) for Health: Operational framework for reforms involving speed and precision.
2008: RA 9502 ‘‘Access to Cheaper and Quality Medicines Act’’: Promoted access to affordable quality drugs.
2010: AO 2010-0036 ‘‘Kalusugang Pangkalahatan’’: Universal health coverage goal.
2013: Sin Taxes for Health: Revenue generation via alcohol and tobacco discouragement.
2019: Universal Health Care Law: Automatic enrollment of all citizens in PhilHealth; guaranteed equitable access.
Health Leadership and Strategic Agendas
Dual Governance (Post-1991): * Department of Health (DOH): National level; develops plans, licenses hospitals/labs via HFSRB, licenses products via FDA, and coordinates assistance. * Local Government Units (LGUs): Subnational level; delivery and management of preventive, promotive, curative, rehabilitative, and palliative care.
Philippine Health Agenda (DOH AO 2016-0038): * Vision: ‘‘All for Health Towards Health For All,’’ aiming for a Healthy Philippines by . * Three Key Guarantees: 1. Interventions for all life stages (triple burden of disease). 2. Service Delivery Networks (SDNs). 3. Financial risk protection.
National Strategic Plans: * Philippine Development Plan 2017-2022: Translates national aspirations into medium-term plans. * NEDA AmBisyon Natin 2040: Collective long-term vision for the next years. * Sustainable Development Goals 2030: global goals targeting poverty, inequality, and climate change.
Health Information Ethics and Privacy
General Ethics: * Autonomy: Freedom for individuals to make decisions; Electronic Health Records (EHR) must respect this. * Beneficence and Non-maleficence: ‘‘Do good’’ and ‘‘Do no harm’’; applies to data protection in EHR.
Information Ethics (IMIA 2016 Principles): 1. Privacy: Fundamental right to control data collection/disposition. 2. Openness: Timely disclosure of data storage and access processes. 3. Security: Reasonable protection against loss, degradation, or unauthorized access. 4. Access: Right for subjects to access and correct their records. 5. Legitimate Infringement: Rights conditioned only by the legitimate needs of a democratic society. 6. Least Intrusive Alternatives: Infringements must occur in the least intrusive fashion. 7. Accountability: Infringements must be justified to the subjects in good time.
Software Ethics Duties: Developers must act in the interest of Society (disclosing defects), Institutions, and the Profession.
Security Definitions: * Privacy: Applies to individuals and aversion to eavesdropping. * Confidentiality: Related to avoiding unintended disclosure of information.
Levels of Security in HIS: * Administrative Safeguards: Risk assessment, effectiveness assessment, viewed/admin processes, employee training, reporting breaches. * Physical Safeguards: Alarm systems, locked offices, security guards, equipment maintenance, biometrics, temperature control, contingency plans. * Technical Safeguards: Firewalls, virus checking, access controls (computer accounts), encryption, auditing operations, backups, automated identity confirmation, auto log-off.
5 Key Security Functions (National Research Council 1997): 1. Availability: Accurate data available when needed. 2. Accountability: Providers responsible for their use of information. 3. Perimeter Identification: Controlling boundaries of trusted access. 4. Controlling Access: Limiting access to info essential for the job. 5. Comprehensibility and Control: Record owners/patients understand and control data aspects.
Philippine Data Privacy Act of 2012 (RA No. 10173): * Governed by: Transparency, Legitimacy of Purpose, Proportionality. * Functions: Protects individual privacy while ensuring free flow of information; regulated by the National Privacy Commission (NPC). * Penalties: Combinations of violations (unauthorized processing, negligent access, improper disposal, etc.) carry imprisonment from to years and fines between and .
Health Informatics and Technology Systems
Health Information Technology (HIT): Area of IT involving design, development, and maintenance of systems for the healthcare industry (Rouse, 2016).
Healthcare Software Systems: * Electronic Health Record (EHR): Inter-organizational; official digital record shared among multiple providers (test results, treatments, contact info). * Electronic Medical Record (EMR): Local/Internal; used within a single clinic/hospital to track improvement and screenings. * Personal Health Record (PHR): Patient-centered; self-maintained by the patient, information from multiple sources. * Health Information Exchange (HIE): Clearinghouse for sharing data among organizations to improve safety and cost.
Medical Imaging Technology: * PACS (Picture Archiving and Communication Systems): Preservation/retrieval of digital pictures; however, info is often siloed. * VNA (Vendor Neutral Archives): Stores files in standard format for unified viewing regardless of the system that generated them.
Regulating Bodies and Acts: * HITECH Act 2009: Protects information and addresses security in electronic transmission. * CMS (Centers for Medicare and Medicaid Services) & ONC (Office of the National Coordinator for Health IT): Certify health IT for reimbursement. * MACRA: Medicare Access and CHIP Reauthorization Act; rewards quality care.
Health Informatics in the Cloud: * Advantages: Integrated patient care, better data management for trends, error reduction (no manual calculations). * Disadvantages: Risks to personal info, cumbersome transition from paper, cost justification.
Health Informatics in the Philippines: * CHITS (Community Health Information Tracking System): Extensible, modular, open-source EMR for rural units; used in public health centers; integrates data into the Field Health Service Information System (FHSIS).
Health Information Systems (HIS) and Data Management
HIS Definitions: * Health Informatics: Application of technology/systems in healthcare. * Health Information Technology: Focuses on tools and storage. * Health Information Systems: Covers records, coding, documentation, and administration.
HIS Utilization Cycle: Collection → Processing → Report → Use → Policy → Decision Making → Program Action → Individual/Public Health Action → Research.
Role and Function: Easier access to files, more controls (staff authorization levels), easy updates, and improved communication.
HMN Six Components of HIS: * Inputs: Health Information System Resources (legislative/regulatory frameworks, personnel, financing, ICT). * Processes: Indicators (determinants of health), Data Sources (Population-based like censuses/surveys; Institution-based like service records), Data Management (storage, flow, analysis). * Outputs: Information Products, Dissemination and Use.
Data Sources for HIS: * Demographic Data (age, gender, ethnicity, schooling). * Administrative Area (services provided, charges, practitioner specialty). * Health Risk Information (lifestyle, behavior, family history). * Patient Medical History (hospital admissions, surgeries). * Current Medical Management (screenings, diagnoses, lab tests, meds). * Outcome Data (readmissions, measures of satisfaction, complications).
Health Management Information System (HMIS) Performance
HMIS Role: Supporting decision-making via complete, consistent, simple, cost-effective, and confidential information.
Detailed Functions: Client data, Scheduling, Authorization tracking, Billing, AR (Accounts Receivable) Management, Reporting, Medical Record (EHR), Compliance, Financial Data.
Determinants of HMIS Performance (PRISM Framework): * Behavioral Determinants: Confidence, motivation, and competence of staff. * Organizational Determinants: Structure, resources, procedures, and culture. * Technical Determinants: Overall design used in data collection.
Monitoring and Evaluation (M&E): * Monitoring: Systematic collection and analysis for learning, accounting, and steering (decision-making). * Evaluation: Assessing ongoing or completed programs as objectively as possible. * Indicators: Variables whose values change; focuses on single aspects (input, output, or objective).
Data Quality Aspects: Accuracy, Completeness, Update status, Relevance, Consistency, Reliability, Appropriate presentation, Accessibility.
Disease Monitoring - STOP TB Program: * Goal: Reduce global burden by . * PhilSTEP I 2020-23: Target reduction in TB mortality and reduction in incidence by . * TB Monitoring Indicators: New smear pulmonary cases, TB Case Detection (positive/negative), HIV coinfection proportion, Treatment outcomes (cured, defaulted, deaths).
Hospital Information System (HIS) Operations
HIS Characteristics: Must be user-friendly, patient-centric, medical personnel-centric, affordable, and scalable.
Major Departmental Systems: Nursing (NIS), Physician (PIS), Radiology (RIS), Pharmacy (PIS).
HIS Service Providers in the PH: * BizBox: Uses Microsoft technology (Windows/SQL Server). * KCCI Medsys: Visual MEDSYS (hospitals) and MEDSCHO (schools). * Comlogik: Leader in online hospital service applications. * IQVIA: International Marketing Statistics + Quintiles.
System Functions: Help Desk, Scheduling, Patient Registration (Admission Form), Admission/Discharge/Transfer (ADT) procedures.
Billing and Contract Management: Itemizing invoices, managing rolling balances, and executing contracts to maximize financial performance.
Reporting Requirements: Clerical info (names/dates), Specimen info (source, accession number, units), Radiology reporting (interpretation, impression).
Material Management System: * Covers planning, purchasing, storing, and distributing materials. * Purchasing Sequence: Purchase Request → Purchase Order → Receipt and Delivery. * Stock Levels: Re-order level (minimum), Maximum level (targeted new stock), Economic Order Quantity (EOQ). * Issue Methods: FIFO (First in, First out), LIFO (Last in, First out), FEFO (First expired, First out).
Laboratory Information Management System (LIMS)
Purpose: To release results within the shortest turnaround time through automated productivity.
Capabilities: Sample Management (location tracking, source, storage), Instrumentation Integration (directing function, reducing processing time), Procedure Execution, Data Management (archiving, reduction of paper).
LIMS vs. LIS vs. PDES: * LIMS: Focused on samples; industry settings. * LIS: Focused on patients; clinical settings. * PDES (Process Development Execution System): Supporting high-tech manufacturing.
Key LIMS Features: Audit Management, Barcode Handling, Chain of Custody (forensics), Compliance, CRM (Customer Relationship Management), Document Management, Instrument Calibration, Inventory Management, Quality Assurance (QA/QC), Time Tracking.