Health Information Systems Programme Research Articles

A New Standards-based Grammar for Linking Aggregate Datasets

The theme of this session is the linking and cross-referencing of disparate aggregate datasets that need to be combined for pruporses of reporting and/or analysis. The session leverages, as a global case study, the US Government's President's Emergency Plan for AIDS Relief (PEPFAR) programme. PEPFAR is a $7 billion per year programme supporting the delivery of HIV-related services, medicines, and commodities in 58 low and middle-income countries (www.pepfar.gov). PEPFAR has an immense datastore of monitoring, evaluation and reporting (MER) indicators that have been collected from all its supported countries over the course of its 15 years of operations.
 The goal of the session is to describe for attendees a newly-developed, standards-based grammar for describing interoperable aggregate data exchange and the message schemas needed to support it. The session facilitators are the primary authors of this new standard. Using the PEPFAR case study as a working example, the session explores how disparate HIV data elements and indicators from PEPFAR-supported countries are cross-referenced to each other and collected into a single central datastore to support analysis, management and reporting across the global programme. The specific HIV example will be elaborated upon to illustrate generalizable techniques that can be applied to linking aggregate datasets in other use cases (e.g. reporting to the annual WHO global health observatory, multiple provinces reporting to a federal health data institute, etc.).
 The session will be facilitated by Xenophon Santas and James Kariuki of the US CDC, Bob Jolliffe of the University of Oslo's Health Information Systems Programme (HISP) and Derek Ritz of ecGroup Inc (a Canadian health informatics consultancy). All four facilitators are members of the Quality, Research and Publich Health (QRPH) technical committee of the international digital health standards body, Integrating the Healthcare Enterprise (IHE; www.ihe.net). The session's content and examples will leverage the facilitators' first-hand experience working on HIV-related projects in low and middle-income countries (e.g. South Africa, Rwanda, Kenya, Malawi, Zimbabwe, Uganda, Sierre Leone, Vietnam, the Philippines and elsewhere).
 It is intended that the session will be conducted using an interactive workshop style. Attendees who wish it will have an opportunity to engage in participative (hands-on) learning. To get started, information will be provided about the standards-based grammar and how it works. Then, results from the facilitators' efforts leveraging this method to link multiple disparate HIV-related datasets will be presented. As a hands-on activity, attendees who have notebook computers will be able to connect to an open source software solution (www.dhis2.org) and "play in a sandbox" to try for themselves some of the techniques that have been described.
 As learning objectives, it is expected that attendees will:
 
 Be introduced to data linking use cases outside of their everyday experience
 Learn about a new technique for expressing aggregate content schema that supports interoperable data exhange
 Apply new skills in a hands-on, worked example.

PILOTING DHIS2 SYSTEM IN VISCERAL LEISHMANIASIS SURVEILLANCE

BackgroundThe District Health Information System 2 (DHIS2) is a tool for collection, validation, analysis and presentation of both individual (tracker) and aggregated data tailored to integrated health information management activities....

Cloud Computing for Health Information in Africa? Comparing the Case of Ghana to Kenya

Background and Purpose : A number of African countries have in recent years deployed online, web-based health information systems (HIS). We look at the opportunities and challenges of this new architecture by comparing recent HIS implementations in Ghana and Kenya. Methods : This article is based on several years of involvement by the authors in a large action research project (the Health Information Systems Programme) that focuses on developing and implementing health information systems. The project has a strong focus on active participation of the researchers in the research context, drawing on the Scandinavian tradition of participatory action research. All authors have been directly involved in the HIS implementations in Ghana and/or Kenya discussed in this article. Results : We show how the two countries studied in this article, Ghana and Kenya, have rapidly transitioned from having an offline, decentralised HIS based on standalone software installations, to a new architecture that is online, web-based and centralised. Conclusions : The cases of Ghana and Kenya demonstrate how a web-based, online architecture for HIS provides a number of advantages over the standalone, offline systems that have been the norm until recently. However, important aspects of such implementations, like developing skills and policies for system administration and ensuring system ownership need emphasis in order to ensure the long-term sustainability of these systems.

Shaping the Evolution of the Health Information Infrastructure in Zimbabwe

Background and Purpose: This article describes the implementation process of an integrated health information system within the context of a developing nation. The Ministry of Health and Child Welfare (MOHCW) in Zimbabwe was engaged in migrating legacy article and desktop based information systems to the District Health Information Software (DHIS2), a web enabled and open source technology. The aim of this article is to contribute to the development of theory that can be adopted to improve outcomes in such endeavours. Methods: The study is conducted using the Action Research (AR) approach whereby the authors were actively involved in shaping the implementation of the information system. It occurs within the broader context of the Health Information Systems Programme (HISP), where an AR approach, the Networks of Action, has been developed for sustainable interventions in developing nations. The work is also informed by the grounded theory methodology, whereby empirical data was the basis for making a theoretical contribution. Results: An interorganisational network consisting of actors interacting at the administrative level of the public health system plays a central role in determining the trajectory of the health information infrastructure. Collaborative challenges at this level are demonstrated to lead to further fragmentation of the health system thereby increasing the inertia of the installed base. At the user level, numerous strategies to cope with the challenge of supporting the health information system are described. The development of capabilities at this level is shown to be key in increasing the adaptability of the installed base.

Measuring the impact of e-health

If you live in Africa and need some advice on the human immunodeficiency virus (HIV), all you have to do is pick up a phone and connect with a counsellor through Mxit an instant message chat-line. This service, run by the Cape Town-based organization Cell-Life in partnership with counselling service LifeLine, reaches about 10 million people. it is hard to measure impact, says Katherine de Tolly, m-health senior researcher at Cell-Life, a not-for-profit organization that makes technology and services accessible to try and improve health, mobile usage is different to impact. We've looked at the stats, analysed exchanges, done research reports and we know the users like it and use it. But to measure the impact on health outcomes, such as preventing HIV infection or alleviating depression, takes a level of research that we've not been able to afford. Mobile technology is expanding rapidly in low- and middle-income countries, particularly in Africa and in the less affluent and rural communities access is far greater than access to In Africa for instance, de Tolly says, 50 million people have phone access and everyday experience confirms near-universal ownership, with everyone from street vendors to top-level executives carrying one. [ILLUSTRATION OMITTED] Yet many countries in Africa still struggle with access to computers, the Internet, a reliable power supply and other infrastructure challenges. Vincent Shaw, executive director of the South-Africa Health Information Systems Programme (HISP), a nongovernmental organization that specializes in the development and maintenance of health information systems, recalls how the HISP lost data in a project in Nigeria when the power failed and all the stored phone text messages were deleted after 24 hours. In developing countries, health technology via phones helps to overcome the lack of universal and reliable access to information and communication technology, just as the use of desktop computers will persist until bandwidth and internet access improve, says Shaw. We have seen that Internet access is not that great, including in Africa, and have stood firm on the need for stand-alone computers rather than pursuing web-based data entry systems. HISP--which has university partners in Norway and Sweden--is active in 15 countries and its free web-based software has been translated into nine languages including Chinese, Russian and Swahili. Shaw says: Measuring the success of e-health is not just about value for money but also about the development of individuals and communities. An example of this, says Shaw, was when the HISP team was giving computer training in Sudan to people who would be working with the new health information system. Implementing the HISP software has already made a difference, says Shaw. South Sudan has been ravaged by war and had little or no health information in its health-care system--but it is reporting health data on a regular basis now. He says: We estimate about 1.5 billion people are accessing e-health services across Africa and Asia, according to our research. They may be paper-based at the start but at some point the information is stored in computers. We can see the numbers--who is reporting and who is not--but at what percentage do you peg success? Shaw asks. He says that one measure of the success of such systems is that they make data available, so that they can be used to allocate resources more rapidly than before. This means that data are available to managers in health-care systems within a short space of time, between one and three months, so that they are able to assess services using more recent data, rather than older data from six to 12 months ago. Data, when interpreted by healthcare workers, can alert health departments to risk and priority areas, where more resources may be needed. …

The dynamics of healthcare work practices

Purpose – The purpose of this paper is to explore factors contributing to the dynamics in healthcare work practices and how health workers cope with the emerging dynamics. By focusing on these aspects, the study seeks to inform the design and implementation of health management information systems (HMIS).Design/methodology/approach – An ethnographic study of HMIS work practices in Tanzania was conducted. The collected data were analysed using concepts from Cultural Historical Activity Theory (CHAT).Findings – The complex and dynamic demands placed upon static healthcare information systems cause unregulated and inconsistent changes to off‐systems work practices. CHAT is a useful framework for identifying emerging gaps within existing information systems (IS).Practical implications – This study builds upon a research and development project known as the Health Information Systems Programme (HISP). HISP aims at addressing the problems of fragmentation, multiple data standards and lack of tools for data mana...

The role of communication practices in the strengthening of counter networks: Case experiences from the health care sector of Mozambique

In this article we provide a theoretically informed empirical analysis of the introduction and use of information and communication technology (ICT) within the primary health care (PHC) sector of Mozambique. The theoretical lens for this analysis is developed from Manuel Castells' (1996, 1997, 2001) ideas on the network society and counter domination. These ideas help us to conceptualize the communicative action required to strengthen the PHC sector as a “counter network,” which has the normative aim to strengthen the health information system (HIS) as a key strategy to improve health care delivery. Taking an informational perspective, the role of communication is highlighted as playing an important constitutive basis in the strengthening of this network. These conceptual ideas are applied to the empirical analysis of an ongoing project (the Health Information Systems Programme or HISP), and to analyze some key constraints and strategies for strengthening these networks. This study makes key contributions to both the theoretical and practical domains of HIS in developing countries. © 2005 Wiley Periodicals, Inc.

Personal View

<h3>Background</h3> The District Health Information System 2 (DHIS2) is a tool for collection, validation, analysis and presentation of both individual (tracker) and aggregated data tailored to integrated health information management activities. DHIS2, developed by the Health Information Systems Programme (HISP) in collaboration with University of Oslo, is a modular web-based software package built with open source Java frameworks. Visceral leishmaniasis (VL) is not captured in the DHIS2 regional database, and therefore coming up with the modalities of aggregating available data from clinical trials and general patient records into the DHIS2 national database is crucial for surveillance. <h3>Methods</h3> DHIS2 runs on Tomcat Server and PostgreSQL. We set up the VL surveillance program with different stages: enrolment and demographics, initial treatment outcome and follow-up visits. In this system, a patient is enrolled into the system and data is collected in individual data elements; data Indicators are built to help aggregate the data and thereafter used for report generation. It is programmed to visualise data and display reports in the system dashboard which can then be used to present data. <h3>Results</h3> Piloting DHIS2 has enabled us to set up a system that uses the set indicators programmed to aggregate data, thus able to produce reports on the data and the user is also able to select the type of report in the form of pivot tables, charts and graphs and also in GIS mapped data. <h3>Conclusions</h3> DHIS2 system is an open source that can be customised and expanded to capture detailed individual surveillance data and shared in reports. This data is useful for tracking neglected tropical diseases such as VL. Data can be handled in the following modalities: i) use of off-line data synchronisation. ii) remote data collection using mobile devices iii) data aggregation and organisation iv) data visualisation and presentation through charts, graphs and pivot tables.