Health Management Information System Governance and Policy - Case Study Example

One of the core missions of the 21st century, in the health sector, is to reduce health inequalities. The need to build strong national health systems has gained tremendous global attention. Many countries have been able to expand health interventions through setting up of programs; though they are faced by the common problem of weak health systems. There thus, arises the need to strengthen and effectively monitor health systems. A good health system should be able to bring together all relevant parties to ensure information passed is reliable and understandable. The system also has the role of providing warnings in case of a foreseen epidemic and thus contributing towards future planning, creating a conducive research and reporting environment. This paper tries to explain different strategies as laid out by the U.S government aimed towards the general improvement of Health Information system. It also talks about how an effective HIS should function. Introduction Health Information Systems (HIS) can be defined as “a set of components and procedures organized with the objective of generating information which will improve health care management decisions at all levels of the health system.” (Lippeveld, et al., 2000). The World Health Organization (WHO) defines health systems as “all organizations, institutions and resources devoted to producing health actions.” It encompasses central, regional, district, community and household levels. These health systems also incorporate two important components; dissemination and communication. The primary goal of a HIS is to allow making of transparent and sound decisions in a health environment. The performance of HIS can be measured by the quality of data produced and the population’s health status. The HIS should incorporate the parameters of demand, supply and generation level of the health system at which data is generated and used. Factors such as input, output and health determinants make up components of demand. Supply involves sources of generating data either relative to population as a whole or those concerned with the operation of services. Presentation of data varies at different levels and at low levels, use of charts is preferred. From here, indicator components are then analyzed and results used to make reports. Background information The HIS allows for making of sound decisions based on four key components; generation of data, compiling collected data, analyzing and coming up with results and communicating new information and implementing it. Assessment of performance of an effective health system incorporates parameters such as access, equity, sustainability and quality. The HIS obtains information from various administrative levels, analyzes it to make sure it can be relied upon. The gathered information is then interpreted and is used to make future speculations. Proper governance of this system proves to people to trust their lives and resources to the health system. The government performs this role by developing and implementing policies benefiting the health system. Some government policies include: Regulating civil society organizations- Constraining functionality of organizations with regard to service delivery and their capacity to advocate health services. Regulating pharmaceuticals – Improving the quality of medicine assurance and influence supply and delivery of medicine into the country. Regulation of businesses by government policies such as taxation- The government’s intervention to an extent influences the degree of participation by the private sector in health care. Adopting quality health standards- Constraining the number of providers and facilitating improvement of the quality of care and supporting health facility management. The government has been pushing towards the improvement of health information system by adopting several Health Systems Strengthening. HSS can be defined as an array of initiatives and strategies aimed at improving one or more functions of the health system thus leading to better health through improvement in access, coverage, quality and efficiency. To ensure this happens, HSS aims at improving on the four key areas; governance, financing, human and physical resources and organization and management of service delivery. (Health Systems Action Network, 2006) Governance- The government can provide a conducive environment by encouraging community initiatives and campaigns promoting behavioral change. This involves activities going beyond the health system and issues external to the health system all in a bid to influence a broad environment in which the health system operates. Governance and setting up of policies should be critically evaluated so as not to limit the extents of HIS. However, through clear governance, any dependencies from the HIS should be identified and eliminated as a way of improving efficiency and better service within the health sector. Poor health condition deters development in a country. Policies laid down to reduce mortality and morbidity results into a promising young generation that’ll lead to development. Further strengthening of policies may see any operational and efficiency related problems eliminated or reduced to a tolerable level. Priorities in health policy also require to be elaborated at the national and local levels through health goals that address improving the health of the poor and reducing the gap between the poor and the non-poor for an impact on child survival (Gwatkin, Bulletin of the World Health Organization 78(1):3–15 ). At the national level, governments should focus heavily on providing safer and insured services that act as a guarantee of saving people’s lives. The HIS, serving as a health system, should be able to guarantee safety and accuracy in their use. The government, acting as a central policy maker, should focus on the overall status of such a system. No faulty reports should arise due to negligence from any authorized organization that takes lead in these matters. Furthermore, governments should be able to provide constant check-up on the health status of their people. No uncontrollable faults should arise from the HIS as a result of negligence or mere incompetence. National policies affect the system’s ability to ensure efficacy and sustainability of operation while maintaining equity, access and quality leading to positive health outcomes. Proper governance and policy making ensures sustainable management, proper leadership promoting community based programs consequently promoting health services, providing a payment system rewarding primary care and a functioning HIS that tracks priority health service indicators. The handling of electronic records also matters in the delivering of reliable HIS. The systems may fail to serve their purpose where electronic records do not meet operational standards. Efficiency, security, safety, should be of priority when designing and deploying HIS electronic records. In the governance of HIS, the electronic records serve as critical a part as any other aspects of the system. Ensuring safety and security of health records should be at the core of government health authorities. Health Financing- This refers to methods whose aim is to mobilize resources towards supporting public health programs, configuring health delivery systems and providing access to basic health services to everybody. The main objective is promoting equity, efficiency and quality thus promoting health. It is composed of the payers, providers and consumers of health services. Health systems are financed through: Public sources – This is money raised by the government through taxes, fees, donor grants and loans. The ministry of finance then allocates tax revenue to finance the ministry of the health budget. Most budgets tend to be an adjustment of the previous years. Private source – Employers who pay fees directly to providers, pay medical savings and charitable organizations providing health services. Household out-of-pocket payments form a large source of health financing in many developing countries (Zellner, State of the Private Health Sector Wall Chart. pg 122). Private expenditure is primarily in the form of out-of-pocket expenditures by households (WHO report, 2006). A user fee is a cost sharing fee type for public programs. It prevents excessive use of services. Fee waivers – This approach aims at exempting certain groups in society from payment. Major However, the major problem facing this is ensuring equity and choosing which group to exempt. Donors- They contribute monetary assistance through grants and loans. Through a financing network, the government and donors are on common ground of supporting a policy allowing the leadership of the government in the entire network. Human and Physical resources- This is mostly involved with staff. It involves recruitment, training and retention of qualified staff. There’s a high degree of management and supervision to ensure quality performance, organizational development and integration of compensation for community health workers, enhancing accountability and linking training to job roles. To enhance performance, there needs to be a check on the following areas: Geographical imbalances- Urban areas tend to have higher concentrations of trained personnel as opposed to rural areas. High degree of absenteeism- Inadequate compensation and supervision or laws that lead to termination of staff who are not performing well. Lack of sufficient or inadequately staffed training facilities combined with the high regional competitive levels and absence of public health programs has contributed largely to this. Declining levels of medical human resource – Medical education programs aren’t providing enough doctors and health workers. Imbalance of skills’ mix and poor skills – Unskilled staff provide services for which they are unprepared for. This results to a weak delivery system and poor service quality. Organizing and managing service delivery- Here the role of the private sector in relation to the HIS is discussed. Concepts such as organizing, managing and sustaining the system while maintaining quality insurance are evident. Through improvement of each of the four factors, the weaknesses of health systems can be improved to ensure effective healthcare. Quality, equity and accessibility will be achieved while the system works to its potential. There are several strategies that can be employed by the U.S. Each is in accordance to making the HIS effective and have proven to work where they have been used. Digitalization of the Healthcare Delivery System. This system works over any internet connection and it has gone a long way in improving the quality of care for patients. It allows access to a patient’s information, efficiency in dealing with outside bodies, has few workload of paperwork and eases management duties. In medicine, quick flow information can be the line between life and death. There are four main reason of implementation: Quality of care – A digital system allows easy communication between doctors thus linking information about patient records. This allows for consultation. The medical history of a patient regardless whatever geographical region can easily be reviewed. Under any treatment setting provided there’s internet connection, one will have access to medical treatment. Doctors in emergency rooms also have improved support and this contributes to them saving lives. Physicians are also able to get immediate access to lab results and thus quickly relay them. Such a system is easy to update. Through the interconnectivity of lab results and the pharmacy sector, e-prescribing has come about and has had a positive impact in the health system. Administrative efficiencies- As new ways of communication emerge, there has been less duplication of the medical history of patients’ files. Electronic systems reduce losing of documents, eliminates illegible handwriting, allows for quick tracking activities and sharing of information. Healthcare providers are able to compete by coming up with practices that please patients. Patient communication – By networking of patient health records, doctors are able of identifying patterns in previous history and saves time for both the institution and the patient. Doctors are able to spend more time with patients and closely monitor their progress. Public health and security- An electronic health systems allows for quick exchange of information and monitoring of drug effects on the patient. This leads to improved public health. Coordination with first responders would keep them up-to-date and provide the required information in case of a crisis. A well connected system would also keep tabs on the trend of diseases and how they spread. Health agencies will be able to control the disease. Accountability. Another strategy being pushed by the government is increased accountability in health institutions. Accountability carries a wide array of factors that help reform the health system. Schelder (1999:13) notes accountability as a representation of an unexplored concept whose meaning remains evasive, whose boundaries are fuzzy, and whose internal structure is confusing. It is the justification of action by individuals. Some intervention options have been suggested as accountability-strengthening strategies. The first one is mapping accountability linkages. By use of an assessment matrix table, one is able to identify situations where there are too many or too few linkages. Too few linkages lead to corruption, poor service quality and the tendency to evade responsibilities. Too many linkages limit the effectiveness of accountability. Interpretation of the assessment matrix shows the participation of each actor in fulfilling accountability roles and the strength of the links joining them. This exercise helps identify gaps and is used to set targets. From here, one may decide to reduce abuse. This is a strategy aimed at containing fraud and corruption. By enforcing this, cases of corrupt practices can be curbed thus meeting quality standards. Areas of interest are contracting procedures, personnel management, informal payments and purchase of pharmaceuticals. The second strategy being enforced is that assuring compliance with procedures and standards. They involve monitoring and regulation activities. Areas of interest include the judicial system in a country, ethics and professional norms and accreditation and licensing. The major challenge faced here is determining the level of standards and procedures. Some standards need specialized technical expertise both to monitor. Improving performance and promote learning is another strategy. It incorporates elements such as shortening chains to make feedback on performance to be more direct and clarifying accountability chains to hold certain entities responsible. An example of this is increasing hospital autonomy to tie the performance of the facility to the actions of managers. The major problem facing this strategy is setting rules to be followed and allowing actors decide their own performance based methods. These strategies select three levels of targets; the facility, the health system and the health service provider. National health reforms, introduction of market mechanisms or reassigning functions among health sectors are all examples of how these targets are achieved. Consumer Engagement This is aimed at improving the quality of the health care system to the patients. Interaction with the consumer allows making of appropriate decisions regarding issues such as health plan, treatment choice, and provider choice. Providers are being urged to promote engaged consumers, explore benefit designs supporting decision making, rewarding providers for decision making and coming up with better ways to assist patient navigation through the system. Introduction of information technology to the health sector. The U.S government is advocating for policies that incorporate new technology into the health system. Technology leads to creation of new medical devices. Techniques such as computerized physician order entry controls who and what is done. Certain recommendations are made to prevent harm due to implementation of technological processes into the health system. They include: Assessing the required technological needs of the health system, monitor and address problems during introduction of new technology, communicate to staff regarding implementation of new technology and training all operators of the new technology. Continuous check-up should be carried out after implementation should follow to make sure safety standards are met. Conclusion In conclusion, this paper talks about Health Information systems. It mentions how they function and decisions are made based on the four key components; generating data, compiling it, analyzing it and communicating results. It obtains its information from different levels. The government comes up with policies aimed at making the HIS effective. By implementing strategies like accountability, consumer engagement, introduction of information technology to the health sector and digitalization of the health sector, the U.S. government has tried in achieving the goal of improving and strengthening the health sector. Though there have been several challenges, combining the mentioned strategies has achieved unimaginable results. Works Cited AbouZahr, C, and T. Boerma. 2005. Health Information Systems: The Foundations of Public Health Metrics Network. 2006a. A Framework for Standards for Country Health Information International Monetary Fund (IMF). 2006. “Data Quality Assessment Framework.” Washington. Axelsson, H., F. Bustreo, and A. Harding. 2003. Private Sector Participation in Child Health, a Review of World Bank Projects, 1993–2002. Health, Nutrition, and Population Series. Washington, DC: World Bank. Waters, H., L. Hatt, and D. Peters. 2003. 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