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Health Information System
Presented by:
Ashish Bhatia (roll no.-511) Chander Pal (513) Chandra Prakash Yadav (514) Deepika Chopra (515) Dinesh Kumar (517) Divya Gupta (518)
Under the guidance of DR.ANITA THAKUR
Overview
Definition Purpose & choice of information Types of sources Categories of information Reporting system Sources of information Conclusion
Definition
Mechanism for the collection, processing, analysis & transmission of information required for organizing & operating health services & also for research & training.
Combination of vital & health statistical data collected from multiple sources
Purpose of Information
To facilitate health planning, implementation & evaluation
Supports managerial & technical functions Makes available information which is
necessary for:-1. Measurement of community health2. Community diagnosis3. Finding solution to health problems4. Prioritization5. Planning of interventions
6. Directing & controlling health programmes7. Development of procedures, definitions,
classification & methods of collection, analysis, storage & retrieval of data
8. Establishing administrative standards9. Carrying on of performance appraisal10. Determination of met & unmet health needs11. Monitoring & evaluation of health programmes12. Carry out Information-Education-Communication
activities for community & decision makers13. Demand social support for health activites14. Support health legislation
Contd…
Choice of Information
Information must be:-1. Relevant : related to the particular programme
2. Sensitive : should change with situation
3. Valid : enable the measurement to be carried out of what it purports to measure
4. Specific : should reflect changes only in the variable concerned
5. Sufficiently accurate6. Capable of proper analysis & interpretation :
difficulties arise in qualitative information
7. Timely
Types of sources
1. Systems organized on a national scale : Population & housing census Civil registration system Information on certain specific notifiable diseases at different
levels on a national scale Periodic reports by Ministry of Health Policy documents of central govt., approach papers, 5-yr
development plans, political statements, health legislation, budget proposals, proceedings of review meetings, statements in parliament etc. provide essential information
2. Activities of Health services at local level : Routine service records & registers routinely
maintained by health personnel at different levels
Contd…
Periodic reports Records of dispensaries, health centres, hospitals, maternal &
child health centres, labs etc.
3. Findings of special epidemiological & other surveys :
Objectives- case detection for TB, leprosy, blindness & malaria Ongoing surveillance for communicable diseases, cancer registry
or registers for other specific conditions Process of planning & implementing mass campaigns
4. Information from other sectors : Information on social, demographic& economic status Developmental activities
Categories of Information
1. Pertaining to health including nutritional status of individuals & communities
Information on infant, childhood, maternal & general mortality rates & their causes
Morbidity patterns Incidence & prevalence of various major endemic diseases Disease-specific morbidity & mortality rates etc.
2. Pertaining to determinants of health & disease including physical & social envt., demographic profile, cultural factors, economic aspects, planned development programmes, food supply position, income distribution etc.
Contd…
3. Pertaining to health policies, priorities, plans, programmes & strategies, health care patterns, health manpower & material resources & facilities, financial, administrative & organizational aspects
Reporting systems
Information at 1 level is processed, grouped, condensed, classified or partly interpreted & sent to next level
Feed back is essential At each level, types of records & registers to be maintained should
be carefully designed 2 types :
1. Baseline record basic information about population covered Data like geographical location of villages, sex & broad age
distribution etc. Need periodic updating Yearly survey + other action-oriented programmes give reasonably
accurate information
2. Other records Need continuous updating
Contd…
Example- information on pregnant women, ante-natal care given to them & the results of follow-up
In a well managed system- the frequency of submission of reports is stipulated initially itself, the submissions being made in a prescribed format. This ensures quick initiation of feedback & corrective action
Management of information
Standardization of formats, frequencies & procedures helps in eliminating chaos & monitoring information
Data handling facilities like adequate physical space & equipment essential
Information which cant be traced & retrieved at the time it is needed lost information
Misplaced record lost record Retrieval system must allow the stored information to
be available quickly & with minimum effort
Requirements to be satisfied by Health Information Systems :
WHO expert committee identified the following :-1. Population based2. Avoid unnecessary agglomeration of data3. Problem-oriented4. Should employ functional & operational terms (for
ex- episodes of illness, lab tests etc.)5. Express information briefly & imaginatively (using
tables, charts etc.)6. Provisions for feedback
Sources of Information
Population Census Civil Registration system (CRS) Sample Registration System (SRS) National Sample Survey (NSS) National Family Health Survey (NFHS) Model Registration Scheme (MRS) Surveys Lay reporting Medical certification of cause of death Surveillance Notification
Population Census
The census is a total enumeration of the population of a particular area.
Earliest reference of census in India- “Arthshastra”
The 1865 & 1872 census were non synchronous.
From 1881 onwards- uninterruptedly once every 10 year.
Contd…
Carried out in 1st quarter of 1st year of each decade.
Constitution of India (article 256) makes this exercise mandatory for union government.
Legal basis- Census act 1948 Headed by Registrar General & Census
Commissioner. Deputy commissioner- dist. Level SDMO- Sub division
Census Operations
Biphasic
1st phase- house numbering & house listing (April-September 2000)
2nd phase- Population enumeration (9th – 28th Feb 2001)
Houseless population enumerated on 28th night.
Contd…
Census enumerators – School teachers/ patwari.
Supervisor – Graduate/Inspector.
Includes data of 593 districts, 5564 tehsils/ talukas, 5161 towns, around 6.4 lacs villages.
Census in Himachal
The scanning of data is now done in Chandigarh.
Earlier the scanning was done in Shimla manually.
Findings of Census 2001
India is the 2nd largest populated country.
16.87% of worlds population.
Growth rate (1.9%) much higher than China(1%)
Information provided & uses
Data for calculation of many rates used as demographic and socio-economic indicators
Size, age & sex structure of population Distribution & density of population Religion, educational level for male &
female population
Civil Registration System (CRS)
Concerned with vital statistical data Mode of information collection-
functionary entrusted For collection, registration,
transmission, analysis and publication of information, more than 1 department are involved.
Registration of Birth & Death
Under birth and death act 1969 Aim is to collect and compile vital
statistics. Chief registrar- Director of health
services. Registrar – rural area drawn from
panchayat, police, health department. Urban area – health officers or
municipalities.
Contd…
Every registrar has to register births and death occurring within his/her administrative area.
Both events to be registered within 21 days. In case of delay upto 30 days fine is charged. If delay is more than 30 days but within a year
an affidavit from a notary public or an officer is required for registration besides late fees.
For delay beyond 1 year, an order from class 1 officer/ magistrate is neccesary.
Limitations of CRS
Unsatisfactory Incomplete coverage Mistakes of omission as well as
commission Variable degree of under-registration Time lag between collection &
compilation of data
Sample Registration System (SRS)
Biggest sample survey system run on a continuing basis in the field of demography
Collection of data- from randomly selected urban blocks and villages
Local volunteer- Enumerator maintains the list
…..list is periodically updated……
Contd…
Every six months- SUPERVISOR visits
Checks population, vital events & sends a report
These reports are collected at district centers & data is compiled
Advantages of SRS
Better coverage, content & timeliness
Urgent necessity of having reliable estimates achieved
Data collected is separate for rural & urban areas
National Sample Survey (NSS)
Agency engaged in collection of factual information regarding :-
i. Socialii. Economiciii. Demographiciv. Industrialv. Agricultural conditions through sample surveys on the countrywide basis
is the National Sample Survey Organisation
Contd…
Permanent survey organization Undertakes research for improving quality of
survey data Surveys conducted are integrated surveys, each
covering several topics with emphasis on 1 or 2 Each 1 is taken up in the form of “Rounds”
stretched over a specific period Information is collected on health topics. For ex-
fertility, morbidity, maternity & child care etc.
National Family Health Survey (NFHS)
Household survey
NFHS-1(1992-93),NFHS-2(1998-99),NFHS-3(2005-06)
Ministry of health & family welfare
Contd…
Nodal agency-international institute for population sciences, Mumbai
Interviews with more than 2,30,000 women(15-49) & men(15-54)
Tested –women & men for HIV &adults & young children for anemia
Survey Process
Designing the sample, questionnaire (household,woman’s &man’s), survey procedures
Selecting & training survey organizations
Translating data into electronic data file
Preparation of reports
Objective
Provide state & national estimates of fertility
Practice of family planning
Infant& child mortality
Maternal and child health
Utilization of health services provided to mothers & children
Information on -
Quality of health & family welfare services
Indicators of the status of women
Women’s reproductive health
Domestic violence
In Addition -
Height & Weight measurements
Blood test
Testing cooking salt
Blood for HIV testing
NFHS-3 also provides information on-
Perinatal mortality,male involvement in family welfare,adolescent reproductive health,high risk sexual behavior,family life education,safe injection,TB & malaria
Family welfare & health conditions among slum & non slum dwellers.
Model Registration Scheme (MRS)
(Survey of causes of death)Questionnaire + postmortem study
Causes of death (major causes and subcauses)
Trained paramedical staff
PHCs
Major Causes
Accidents & injuries Childbirth & pregnancy complications Fever Cough Digestive disorders Disorders of CNS Disorders of circulatory system Causes peculiar to infancy Senility
Recording of data by Health Guide
Record births & deaths
Birth weights
Lay Reporting of cause of deathCollection of information, its
use &Transmission to other levels ofHealth system by non-professionalHealth workers(probable cause of death by broad categories)
Medical Certification of cause of death
Legal Record
Geographical Distribution
Vulnerability of different age & sex groups
Cause of death does not mean themode of dying e.g. HF
It means the disease,injury or complications which caused death
RESPONSIBILITY OF CERTIFYING MP
Antecedent conditions
Direct cause
Epidemiological tool for study of disease as a dynamic process involving the ecology, the organisms, the host, reservoir, vector & environment, as well as the complex mechanism concerned with the spread of infection & the extent to which spread occurs.
Surveillance
Functions of Surveillance
Helps to assess the incidence & prevalence of diseases
Helps to establish priorities & plan preventive programmes
Essential for identifying high risk groups Helps in understanding of local
epidemiological trends & patterns Useful in monitoring & impact evaluation
of control programmes against specific diseases
Surveillance activities may include collection of data by active surveillance, passive surveillance, routine service activities, establishment of sentinel surveillance centres, special epidemiological investigations & undertaking sample surveys.
Routine Service Statistics
Routine reporting of cases of selected communicable diseases can be done by all Medical institutions, treatment centres etc.
A list of some 20 diseases for submission of monthly reports has been laid down by National Institute of Communicable Diseases, Delhi (N.I.C.D.) under the Integrated Disease Surveillance Project (I.D.S.P)
Sentinel Surveillance
A reporting system based on selected institutions or individuals that provide regular, complete reports (or from whom data is regularly collected) on one or more E.P.I. target diseases occuring, ideally, in a defined catchment area
Routine Health Service Record
Useful data are recorded as a routine requirement for providing health care & may be made use of after making allowance for the possible limitations
Information on provision & availability of essential drugs, as well as the operation of referral system, provision of the backup service, etc. can also be obtained in this way
Most of records/registers in use were probably devised for obtaining data for administrative use of permitting checks & controls rather than building up of indicators to monitor progress or measure effectivity
Modification/addition may be required in the system to make it suitable for monitoring purposes
Notification of Diseases
Notification denotes a mere reporting of the occurrence of an event
It is required to be done under appropriate public health legislation
This is essential to ensure prompt notification so that speedy action to prevent the spread of communicable diseases & occupational diseases
Notification of diseases is not an end in itself but the beginning of various action aimed at prevention & control
The existence of a legal necessity making it obligatory for hospitals, private medical practitioners or other professional groups, parents does not automatically ensure completeness
The information obtained from notified cases, keeping limitations of inaccuracy & incompleteness in mind, provide data of epidemiological interest such as distribution of diseases & time trends
Disease Registers
For gathering information of the incidence, prevalence & outcome of certain diseases & other epidemiological features of interest, disease registers may be maintained in the case of diseases which are public health problems
Population bases registries with proper planning, they can form a representative sample enabling estimates to be made with reasonable accuracy for larger area
Registers for diseases like cancers, tuberculosis etc. provide useful information in this way
Morbidity Statistics
Provides information on occurrence of different diseases with reference to age, sex, social class, locality & other such factors studied in epidemiology
Useful in evaluation & research & indicate the failure or success of various interventions for prevention of ill health
Problems peculiar to Morbidity Statistics :-
Death is a unique event, occurring only once in a person, while illness may occur repeatedly in the same person due to same or different causes
Death occur at only one point of time whereas illness extends over a period of time
Death is simply defined & understood by all whereas illness presents many problems in comparison
Problems of diagnosis also arise commonly
Sources of Morbidity Statistics
1. Special morbidity survey- general /specific
2. Notification of diseases3. Hospital statistics – govt./private4. Health/MCH centre statistics5. Records of health workers6. Medical practitioners records7. Sickness absence records8. Disease registries9. Industrial sickness benefit
records10. Mass diagnostic camps
Collection of information by Surveys
Common purpose is to obtain information on health conditions of the population
Surveys are necessary for planning, prioritizing, monitoring or evaluating health programmes
May be carried out to gather accurate & complete information on disease condition e.g disease detection surveys
May be carried out for all population or only a fraction of the population as in a sample survey
Types of Surveys
Descriptive survey Analytical survey Observational survey Cross-sectional survey (instantaneous,
static, prevalence, naturalistic) Longitudinal survey ( follow-up,
dynamic) To test a hypothesis
Information by Surveys
Birth rate, age-specific fertility rates, family size
Death rate, infant & childhood mortality rates, maternal mortality rate, still-birth rate
Probable cause of death by lay reporting, classification of death by broad categories.
Nutritional status
Occurence, degree & endemicity of diseases.
Contd…
General morbidity rate & disease specific morbidity rate
Availability of health care
Economic status, employment position & income levels
Environmental conditions
Determinant of disease & death in physical or social environment
Geographical Information System (GIS)
A set of elements that allow the computerized handling of geographically defined data, their entry, storage, analysis & presentation
Data of 2 varieties :-
1. Geographical data- defined by the geographical location
2. Attribute data- provide the characteristics of each data point
Application of GIS within HIS
Health status (outcome)
Programme planning
Planning health infrastructure & maintenance
Displaying performance indicators
Displaying health care coverage
To Conclude…
Primary objective of a HIS is to provide reliable, relevant, up to date, adequate, timely & reasonably complete information for health managers at all levels, & at the sharing of technical & scientific information
Also to provide at periodic intervals, data that shows the general performance of the health services
Unfortunately, it is still very difficult to get the information where it matters the most i.e at the community level
Contd…
No country at present has such a thoughtfully constructed HIS in operation, though the concept is receiving attention now
The system should be such that Data collected should be transformed into information, which should further be transformed into intelligence
Thank You