His

Health Information Health Information System in Sri LankaSystem in Sri Lanka

Dr Sunil SenanayakeDr Sunil SenanayakeMBBS, MSc, MDMBBS, MSc, MD

Director/Health InformationDirector/Health Information

by

Information System

Components of National HMIS:–Hospital Information System–Preventive Health Information System–Disease Surveillance System–Population Census–Surveys –Other special surveys (NCD Risk Factor

Survey)

Sources of Information

Hospital Information System:–Clinical Data–Diagnosis of diseases (Using ICD-10)–Procedures performed–Cancer Registry–Cause of Death (Hospital deaths)–Hospital facilities–Hospital services

Sources of Information ctd…

Preventive Health Information System:

–Maternal, Child Health and FP data–Food Sanitation, Environmental & Occupational Health data –Nutrition data–School Health data–Immunization data–Data from Disease Control Programmes

Sources of Information ctd…

Disease Surveillance System:–Mainly Communicable Diseases–Monitoring of disease trends –Leading causes of Hospitalization

•Ischaemic Heart Diseases•Hypertension and complications•Cancers•Diseases of elderly

Sources of Information ctd..

Population Census:

National Census:–Started in 1881–Every ten years (except 1991)–Wide range of information

Sources of Information ctd..

Surveys:

1. Demographic and Health Survey:–Started in 1973–Every five years–Support Health Information–Confirm Health Information

Sources of Information ctd..

Surveys: ctd…

2.Household Income Survey:–Nutritional status –Energy consumption–Common Health Problems–Expenditure pattern

Sources of Information ctd..

Surveys: ctd…

3. Nutrition Survey:–Nutritional status–Nutritional disorders–Energy consumption–Vitamin deficiencies–Micro-nutrient deficiencies

Sources of Information ctd..

Surveys: ctd…

4. Other Special Surveys (NCD RF Survey):

–NCD Risk Factor Survey–Injury Surveillance

Sources of Information ctd..

Other Sources Health Related Data: –Alcohol and Drug Information Centre–National Dangerous Drugs Control Board & Police Narcotic Bureau–Non Governmental Agencies–Sri Lanka Customs –Trade and Commerce Ministry

•Food, tobacco, alcohol etc (imports & sales)

In the past ……………..In the past ……………..

-Well established health infrastructure-Very good preventive health care service-Eradication of diseases-One of the world best EPI programmes-Better health Indicators for the

investment-Model for low cost health services

-- Among many other things …...

Some of the remarkable achievements ….

Recent past …….Recent past …….

-Health for all by 2000-Primary Health care approach-MCH and FP-Immunization-Health Education-Disease prevention-Healthy environment etc……

Future problems …….Future problems …….

• Changing demography• Changing disease pattern • Changing life styles• High expectation of people• Equity• Responsiveness• Technological advances etc……

Our strategies ………….Our strategies ………….

-Improve ambulatory care-Concentrate on Non Communicable Diseases-Integrated Disease Surveillance-Rehabilitation in the community-Promote healthy lifestyles-Ensure equity-Exploit IT-Better dialogues between clinicians, public

health personnel, researchers & planners

Issues

There are many Issues: (Hospital) (Hospital) –Manual Record keeping system–Only inpatient data–Only from Government Hospitals–ICD10 at Hospital but aggregated groups are transmitted to the centre–Doctors do not concern about writing of diagnoses

Issues ctd…

There are many Issues: (Hospital) ctd… (Hospital) ctd… –Inadequate human resources–Untrained coders–Patient record formats –No established Medical Record Departments in some hospitals–No unique ID –Repeated admissions counted as new cases–Use of IT is minimal

Issues ctd…

There are many Issues: (Public Health) (Public Health) –Total system is manual–Behind time–Processing is difficult–No/weak data from

•Estate sector•Occupational health•Nutrition surveillance •Health education•NCDs

Issues ctd…

There are many Issues: (Other) (Other) –Poor Financial Information –No unit cost system–No Disease burden study–No routine NCD surveillance system–HIS policy has not been laid down

Challenges

Hospital System:–Re-designing the hospital record keeping system–Changing of record keeping formats–Adaptation of ICD 10 at all hospitals–Transmitting of data by ICD 10 4 digit level

Challenges ctd..

Hospital System: ctd..–Changing of attitudes of doctors–Introduction of ICD 10 to basic curriculums–Introduction of IT to hospitals (EPR)–Development of IT Networks in hospitals–Training of users –Quality of Medical Records

Challenges ctd..

Public Health System: –Introducing IT at lowest possible level–Development of suitable software–Development of routine NCD, nutrition and occupational disease surveillance systems–Integration of disease surveillance systems

Challenges ctd..

Other Systems: –Introduce a Unit cost system–Updating of Human Resource Information System–Mapping of Health Facilities (GIS)–Convincing Policy makers and decision makers on investment in IT in Health

Challenges ctd..

The biggest challenge is “get The biggest challenge is “get decision makers and policy makers decision makers and policy makers

to use information for decision to use information for decision and policy making.”and policy making.”

Therefore “evidence based decision Therefore “evidence based decision making culture” has to be making culture” has to be

promoted among them.promoted among them.

Challenges ctd..

Information dissemination would Information dissemination would be one of the strategies that could be one of the strategies that could

be adopted to overcome this be adopted to overcome this situation.situation.

Dissemination of Information

•Annual Health Bulletin•Annual Administrative report•Weekly Epidemiology Bulletin•Quarterly Epidemiology Bulletin•Annual Family Health Report•Census reports•DHS reports•Survey reports•Health Ministry Website

Current status of IT Facilities IT Facilities available:IT Facilities available:

–Ministry of Health has a Local Area Network with a dedicated e-mail service and Internet services.

–All the Provincial Health Offices and most of the District Offices are connected to the LAN of the Ministry of Health via dial-up lines for electronic data transfer.

–Network will be expanded to MOH Offices and large hospitals by end of 2005.

Opportunities•Millennium Development Goals•Health sector master plan•WB assisted Health Sector Development project•E-Sri Lanka project•Government budget monitoring mechanism

Thank You!Thank You!

Dr Sunil [email protected]

[email protected]