rationalising health information systems to improve health outcomes public health services...
TRANSCRIPT
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RATIONALISING HEALTH INFORMATION SYSTEMS TO
IMPROVE HEALTH OUTCOMES
Public Health ServicesQueensland Health
Australia1998-2000
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Dr Magnolia Cardona Coordinating EpidemiologistMB.BS, MPH, Grad DAE, CHEcon
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Objectives of this lecture
Provide an overview of information system types and potential uses
Increase awareness on need to balance amount of data with cost and confidentiality concerns
Present case scenarios to set up and enhance information systems
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Characteristics of Good Health Surveillance Systems
Clear objectives • administration
• routine documentation
• monitoring
• research/evaluation
Simple (MDS)Standard item formatJustification and validation of items
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Characteristics of Good Health Surveillance Systems (cont)
•Relevant to users•Minimum burden to providers•Amenable to modification•Provision for security/confidentiality•Associated reporting system •Feedback to collectors•Linked to action
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Options
•Paper-based centralised
•Sentinel/selected surveillance
•Computerised stand alone
•Single site
•Multicentre
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Options
•Computerised networked
•Encrypted data transfer
•Combination
•Paper-based notifications
•electronic entry at central location
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Setting up a Health Information
System
Which option is best?
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SCENARIO: Cholera epidemic in Africa
No routine surveillancePoorly kept clinical recordsUnderstaffed facilitiesUnreliable communicationsNo ongoing fundingNo computers
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Cholera epidemic in Africa
Example of a paper-based system that worked in an endemic area for at least 2 years
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Occupational exposure to bloodborne illnesses among health staff
Hundreds of health facilitiesInfrequent incidentsNon-compulsory recordingNo ongoing fundingConfidentiality issuesCompensation issues
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Nutritional Status Monitoring in a remote indigenous community
Routine surveillance of some conditionsSomehow comprehensive clinical recordsServices staffed by communityUnreliable communicationsSome funding availableSome computers usable
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•How the data will be collected•How the data will be used•Who will have access to the data•Confidentiality issues•Perceived discrimination•Financial implications
Major stakeholder’s concerns
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Indigenous Community Health
Computerised systemEasy front-endComplete patient information (alias/residence)Promotes opportunistic P.H. actionCapability for health worker plans Population based reporting systemGenerates customised prevalence/incidence
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Burden of depression at Medical Practitioners rooms
Non-standard recording practices ? Availability of clinical recordsBusy medical practicesVariable communication systemsLow computer coverageEthical issuesIncentives required for doctors
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Doctors-based Sentinel Surveillance
•Enables documentation of non-hospital data•Burden of disease measurement•Paper-based with weekly notifications•Limited patient information & # conditions•Selected Locations (self-selected doctors)•Inability to calculate prevalence/incidence
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Example of project to maximise efficiency of existing health
information systems
Real case scenario
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Improve health outcomes through enhancement of
Public Health information systems
Aim
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Objectives High quality /timely data Minimise duplication/cost Standard coding practices Common table structures Common operating environment Shared hardware Data Linkage
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Inventory of DatabasesPurpose/Scope /ContentsSize/AccessibilityOperating system/server/interfaceData tablesRemote access/re-developmentSpecial requirementsStaff involved
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Integration Protocols
Hardware /softwareData definitions {NHDD}Reference tablesData Entry & TransferSecurity /Confidentiality
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Working Group Discuss IT requirements Re/development experience Security Principles Sharing of reference tables Integration protocols Recommendations
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Network (WAN, LAN)
Platforms (hardware)
Database (execute instructions)
Data use (structure)
User interface
Business LevelsIntegration
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Business
Interface
Data use
Database
Platforms
Network
*BSR PSR Lead *NOCs VIVAS *MODDs
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How does this improve Health Outcomes?
Outbreak response/timingImmunisation ratesPrescription controlStandard Indigenous identifiersEarly cancer detection\QA
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SummaryRelevance & cost-effectivenessConsultation with users and data
holdersFinancial considerationsEthical implicationsUltimate goal to improve health