Routine Health Information Systems Research Articles

Assessing coverage of essential maternal and child health interventions using health-facility data in Uganda

BackgroundNationally representative household surveys are the gold standard for tracking progress in coverage of life-saving maternal and child interventions, but often do not provide timely information on coverage at the local and health facility level. Electronic routine health information system (RHIS) data could help provide this information, but there are currently concerns about data quality. This analysis seeks to improve the usability of and confidence in electronic RHIS data by using adjustments to calculate more accurate numerators and denominators for essential interventions.MethodsData from three sources (Ugandan Demographic and Health (UDHS) survey, electronic RHIS, and census) were used to provide estimates of essential maternal (> 4 antenatal care visits (ANC), skilled delivery, and postnatal care visit (PNC)) and child health interventions (diphtheria, pertussis, tetanus, and hepatitis B and Haemophilus influenzae type b and polio vaccination series, measles vaccination, and vitamin A). Electronic RHIS data was checked for quality and both numerators and denominators were adjusted to improve accuracy. Estimates were compared between the three sources.ResultsEstimates of maternal health interventions from adjusted electronic RHIS data were lower than those of the UDHS, while child intervention estimates were typically higher. Adjustment of electronic RHIS data generally improved accuracy compared with no adjustment. There was considerable agreement between estimates from adjusted, electronic RHIS data, and UDHS for skilled delivery and first dose of childhood vaccination series, but lesser agreement for ANC visits and second and third doses of childhood vaccinations.ConclusionsNationally representative household surveys will likely continue being the gold standard of coverage estimates of maternal and child health interventions, but this analysis shows that current approaches to adjusting health facility estimate works better for some indications than others. Further efforts to improve accuracy of estimates from RHIS sources are needed.

Improving quality and use of routine health information system data in low- and middle-income countries: A scoping review.

A routine health information system is one of the essential components of a health system. Interventions to improve routine health information system data quality and use for decision-making in low- and middle-income countries differ in design, methods, and scope. There have been limited efforts to synthesise the knowledge across the currently available intervention studies. Thus, this scoping review synthesised published results from interventions that aimed at improving data quality and use in routine health information systems in low- and middle-income countries. We included articles on intervention studies that aimed to improve data quality and use within routine health information systems in low- and middle-income countries, published in English from January 2008 to February 2020. We searched the literature in the databases Medline/PubMed, Web of Science, Embase, and Global Health. After a meticulous screening, we identified 20 articles on data quality and 16 on data use. We prepared and presented the results as a narrative. Most of the studies were from Sub-Saharan Africa and designed as case studies. Interventions enhancing the quality of data targeted health facilities and staff within districts, and district health managers for improved data use. Combinations of technology enhancement along with capacity building activities, and data quality assessment and feedback system were found useful in improving data quality. Interventions facilitating data availability combined with technology enhancement increased the use of data for planning. The studies in this scoping review showed that a combination of interventions, addressing both behavioural and technical factors, improved data quality and use. Interventions addressing organisational factors were non-existent, but these factors were reported to pose challenges to the implementation and performance of reported interventions.

Definitions, components and processes of data harmonisation in healthcare: a scoping review

BackgroundData harmonisation (DH) has emerged amongst health managers, information technology specialists and researchers as an important intervention for routine health information systems (RHISs). It is important to understand what DH is, how it is defined and conceptualised, and how it can lead to better health management decision-making. This scoping review identifies a range of definitions for DH, its characteristics (in terms of key components and processes), and common explanations of the relationship between DH and health management decision-making.MethodsThis scoping review identified relevant studies from 2000 onwards (date filter), written in English and published in PubMed, Web of Science and CINAHL. Two reviewers independently screened records for potential inclusion for the abstract and full-text screening stages. One reviewer did the data extraction, analysis and synthesis, with built-in reliability checks from the rest of the team. We developed a narrative synthesis of definitions and explanations of the relationship between DH and health management decision-making.ResultsWe sampled 61 of 181 included to synthesis definitions and concepts of DH in detail. We identified six common terms for data harmonisation: record linkage, data linkage, data warehousing, data sharing, data interoperability and health information exchange. We also identified nine key components of data harmonisation: DH involves (a) a process of multiple steps; (b) integrating, harmonising and bringing together different databases (c) two or more databases; (d) electronic data; (e) pooling data using unique patient identifiers; and (f) different types of data; (g) data found within and across different departments and institutions at facility, district, regional and national levels; (h) different types of technical activities; (i) has a specific scope. The relationship between DH and health management decision-making is not well-described in the literature. Several studies mentioned health providers’ concerns about data completeness, data quality, terminology and coding of data elements as barriers to data utilisation for clinical decision-making.ConclusionTo our knowledge, this scoping review was the first to synthesise definitions and concepts of DH and address the causal relationship between DH and health management decision-making. Future research is required to assess the effectiveness of data harmonisation on health management decision-making.

9.G. Workshop: Evaluation of scale-up of health systems interventions: what and how? Lessons for scale-up projects

Abstract Objectives Non-communicable diseases (NCD) are a major challenge for health systems across the globe. Although effective interventions for prevention, detection and control exist, these do not reach all people in need, especially the poor and most vulnerable. Scale-up strategies are developed to increase universal access to those interventions, addressing demand-side and supply-side barriers and to facilitate integration in the health system. While there are useful frameworks to conceptualise and operationalise scale-up of NCD interventions, there is a knowledge gap on what and how to evaluate. This session addresses that knowledge gap, presenting evaluation methods for scale-up from four large multi-country research projects. The objectives are: To increase knowledge on four dimensions of scale-up evaluation: 1) contextualisation of methods; 2) implementation evaluation; 3) cost-evaluation and 4) use of health information systemsTo present methods and results of implementation research on NCDs as an example for other chronic diseasesTo illustrate how contextualisation, implementation and evaluation varies across different stages of scale-upTo stimulate learning by experience through small-group discussion with session participants This workshop provides added value through the four coherent presentations combined with small group interactions on the same topics. It allows the audience to link the case study lessons to their own research and wider application. Format Four different elements of scale-up evaluation are addressed: 1) Contextualisation of evaluation methods from a common framework; 2) Implementation evaluation at operational level; 3) Cost-evaluation of NCD interventions; and 4) Large-scale evaluation through routine health information systems (HIS). Case studies from four large-scale Horizon2020 funded research projects in 14 countries in Europe, Africa and Asia will be presented, each case focusing on one dimension. Cross-cutting themes of adaptation and transferability of methods will also be addressed. After the presentations, there will be an interactive session to promote experience-based learning in small-group discussions. Presentations Self-Management Approach and Reciprocal Learning for Type 2 Diabetes (SMART2D)Scaling-up Packages of Interventions for cardiovascular disease prevention in Europe and Sub-Saharan Africa (SPICES)Scaling-Up NCD Interventions in South-East Asia (SUNI-SEA)The Scale-Up of Diabetes and Hypertension Care (SCUBY) The presentations will provide the introduction to subsequent small-table discussions, around the following questions: How to measure and monitor implementation and outcome of intervention scale-up?How to generate transferrable lessons from cross-country studies?How to conduct cross-setting evaluation of the effect and cost of NCD interventions? Key messages The global scale-up of NCD interventions calls for robust evaluation methods of effect, implementation and cost. Evaluation methods need to be fit to the country context and health information systems.

The Scale-Up of Diabetes and Hypertension Care (SCUBY) - large-scale evaluation using routine health information systems

Abstract The SCUBY project aims to (1) change the organization of primary health care for diabetes and hypertension in order to (2) improve the outcome of chronic care in three countries (Belgium-Slovenia-Cambodia). These two aims require two types of data, namely data on the organization of care and data on the chronic illness outcomes. It can however be challenging to (1) gather all these data (from various sources) on both the organization and outcomes and (2) create cross-culturally valid datasets. The presentation will present the strategy of SCUBY to gather data and discuss the issues of cross-cultural validity.

Using routine health information data for research in low- and middle-income countries: a systematic review

BackgroundRoutine health information systems (RHISs) support resource allocation and management decisions at all levels of the health system, as well as strategy development and policy-making in many low- and middle-income countries (LMICs). Although RHIS data represent a rich source of information, such data are currently underused for research purposes, largely due to concerns over data quality. Given that substantial investments have been made in strengthening RHISs in LMICs in recent years, and that there is a growing demand for more real-time data from researchers, this systematic review builds upon the existing literature to summarize the extent to which RHIS data have been used in peer-reviewed research publications.MethodsUsing terms ‘routine health information system’, ‘health information system’, or ‘health management information system’ and a list of LMICs, four electronic peer-review literature databases were searched from inception to February 202,019: PubMed, Scopus, EMBASE, and EconLit. Articles were assessed for inclusion based on pre-determined eligibility criteria and study characteristics were extracted from included articles using a piloted data extraction form.ResultsWe identified 132 studies that met our inclusion criteria, originating in 37 different countries. Overall, the majority of the studies identified were from Sub-Saharan Africa and were published within the last 5 years. Malaria and maternal health were the most commonly studied health conditions, although a number of other health conditions and health services were also explored.ConclusionsOur study identified an increasing use of RHIS data for research purposes, with many studies applying rigorous study designs and analytic methods to advance program evaluation, monitoring and assessing services, and epidemiological studies in LMICs. RHIS data represent an underused source of data and should be made more available and further embraced by the research community in LMIC health systems.

Routine Health Information System (RHIS) improvements for strengthened health system management.

BackgroundA well‐functioning routine health information system (RHIS) can provide the information needed for health system management, for governance, accountability, planning, policy making, surveillance and quality improvement, but poor information support has been identified as a major obstacle for improving health system management.ObjectivesTo assess the effects of interventions to improve routine health information systems in terms of RHIS performance, and also, in terms of improved health system management performance, and improved patient and population health outcomes.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE Ovid and Embase Ovid in May 2019. We searched Global Health, Ovid and PsycInfo in April 2016. In January 2020 we searched for grey literature in the Grey Literature Report and in OpenGrey, and for ongoing trials using the International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov. In October 2019 we also did a cited reference search using Web of Science, and a ‘similar articles’ search in PubMed.Selection criteriaRandomised and non‐randomised trials, controlled before‐after studies and time‐series studies comparing routine health information system interventions, with controls, in primary, hospital or community health care settings. Participants included clinical staff and management, district management and community health workers using routine information systems.Data collection and analysisTwo authors independently reviewed records to identify studies for inclusion, extracted data from the included studies and assessed the risk of bias. Interventions and outcomes were too varied across studies to allow for pooled risk analysis. We present a 'Summary of findings' table for each intervention comparisons broadly categorised into Technical and Organisational (or a combination), and report outcomes on data quality and service quality. We used the GRADE approach to assess the certainty of the evidence.Main resultsWe included six studies: four cluster randomised trials and two controlled before‐after studies, from Africa and South America. Three studies evaluated technical interventions, one study evaluated an organisational intervention, and two studies evaluated a combination of technical and organisational interventions. Four studies reported on data quality and six studies reported on service quality.In terms of data quality, a web‐based electronic TB laboratory information system probably reduces the length of time to reporting of TB test results, and probably reduces the overall rate of recording errors of TB test results, compared to a paper‐based system (moderate certainty evidence). We are uncertain about the effect of the electronic laboratory information system on the recording rate of serious (misidentification) errors for TB test results compared to a paper‐based system (very low certainty evidence). Misidentification errors are inaccuracies in transferring test results between an electronic register and patients' clinical charts. We are also uncertain about the effect of the intervention on service quality (timeliness of starting or changing a patient's TB treatment) (very low certainty evidence).A hand‐held electronic device probably improves the length of time to report TB test results, and probably reduces the total frequency of recording errors in TB test results between the laboratory notebook and the electronic information record system, compared to a paper‐based system (moderate‐certainty evidence). We are, however, uncertain about the effect of the intervention on the frequency of serious (misidentification) errors in recording between the laboratory notebook and the electronic information record, compared to a paper‐based system (very low certainty evidence).We are uncertain about the effect of a hospital electronic health information system on service quality (length of time outpatients spend at hospital, length of hospital stay, and hospital revenue collection), compared to a paper‐based system (very low certainty evidence).High‐intensity brief text messaging (SMS) may make little or no difference to data quality (in terms of completeness of documentation of pregnancy outcomes), compared to low‐intensity brief text messaging (low‐certainty evidence).We are uncertain about the effect of electronic drug stock notification (with either data management support or product transfer support) on service quality (in terms of transporting stock and stock levels), compared to paper‐based stock notification (very low certainty evidence).We are uncertain about the effect of health information strengthening (where it is part of comprehensive service quality improvement intervention) on service quality (health worker motivation, receipt of training by health workers, health information index scores, quality of clinical observation of children and adults) (very low certainty evidence).Authors' conclusionsThe review indicates mixed effects of mainly technical interventions to improve data quality, with gaps in evidence on interventions aimed at enhancing data‐informed health system management. There is a gap in interventions studying information support beyond clinical management, such as for human resources, finances, drug supply and governance. We need to have a better understanding of the causal mechanisms by which information support may affect change in management decision‐making, to inform robust intervention design and evaluation methods.

Understanding the challenges associated with the use of data from routine health information systems in low- and middle-income countries: A systematic review.

Routine health information systems (RHISs) are crucial to informing decision-making at all levels of the health system. However, the use of RHIS data in low- and middle-income countries (LMICs) is limited due to concerns regarding quality, accuracy, timeliness, completeness and representativeness. This study systematically reviewed technical, behavioural and organisational/environmental challenges that hinder the use of RHIS data in LMICs and strategies implemented to overcome these challenges. Four electronic databases were searched for studies describing challenges associated with the use of RHIS data and/or strategies implemented to circumvent these challenges in LMICs. Identified articles were screened against inclusion and exclusion criteria by two independent reviewers. Sixty studies met the inclusion criteria and were included in this review, 55 of which described challenges in using RHIS data and 20 of which focused on strategies to address these challenges. Identified challenges and strategies were organised by their technical, behavioural and organisational/environmental determinants and by the core steps of the data process. Organisational/environmental challenges were the most commonly reported barriers to data use, while technical challenges were the most commonly addressed with strategies. Despite the known benefits of RHIS data for health system strengthening, numerous challenges continue to impede their use in practice. Additional research is needed to identify effective strategies for addressing the determinants of RHIS use, particularly given the disconnect identified between the type of challenge most commonly described in the literature and the type of challenge most commonly targeted for interventions.

English

Road crashes are the leading cause of death among people aged 15 and above. The routine health information system is used to monitor common hospital illnesses, including road traffic injuries. The objective of this study was to evaluate its performance in the surveillance of road traffic injuries in Benin in 2019. This was an evaluative study, based on updated guidelines from the Centre for Disease Prevention and Control to evaluate a public health surveillance system. Performance was assessed on the basis of utility and quality criteria (simplicity, flexibility, acceptability, completeness, exhaustiveness, stability, responsiveness, representativeness and reactivity). The data collection techniques used was document review and interview. The system was considered useful and produced indicators on road traffic injuries each year within an average of five months. Its strengths were its representativeness (100%), stability (100%) and simplicity (83%). Acceptability, exhaustiveness and completeness were the main areas for improvement in the system with scores of 51.4, 38.07 and 16.27%, respectively. The routine health information system presents indicators of insufficient acceptability and low integration with other existing collection systems for road traffic injuries. Improving performance for better planning in road safety requires a more holistic approach in the implementation and functionality of the system. Key words: Traffic, injury, evaluations, intervention. &nbsp

Evaluation of Proactive Community Case Detection to Increase Help Seeking for Mental Health Care: A Pragmatic Randomized Controlled Trial.

The Community Informant Detection Tool (CIDT) is a vignette- and picture-based method of proactive case detection to promote help seeking for persons with depression, psychosis, alcohol use disorder, and epilepsy. The authors evaluated the effectiveness of the CIDT to increase help-seeking behavior in rural Nepal, where a district mental health care plan was being implemented. Twenty-four health facilities were randomly assigned to one of two methods for training their all-female cadre of community health volunteers: standard training or standard training that included the CIDT. The authors compared the number of patients with depression, psychosis, alcohol use disorder, and epilepsy who were registered in the routine health information system prior to and 6 months after the training. At health facilities where volunteers received CIDT training, 309 patients were registered as having depression, psychosis, alcohol use disorder, or epilepsy, compared with 182 patients at facilities where volunteers received standard training. The median number of patients registered was 47% greater at facilities where CIDT training was included (24 patients) than at facilities with standard training (16 patients) (p=0.04, r=0.42). The difference in the number of registered patients remained significant when the analysis factored in the population catchment (N=18 patients [CIDT] versus N=14 [standard] per 10,000 population; p=0.05, r=0.40). The median number of patients registered as having a mental illness was 47% greater at primary care facilities in which community health volunteers used the CIDT than at facilities where volunteers received standard training. Proactive case finding holds promise for increasing help seeking for mental health care.

Quality of malaria data in public health facilities in three provinces of Mozambique.

Malaria data reported through Mozambique's routine health information system are used to guide the implementation of prevention and control activities. Although previous studies have identified issues with the quality of aggregated data reported from public health facilities in the country, no studies have evaluated the quality of routine indicators recorded in health facility registries. This study addresses this issue by comparing indicators calculated from data from exit interviews and re-examinations of patients with data based on registry records from health facilities in order to measure the quality of registry data and data reporting in three provinces in Mozambique. Data were collected from 1,840 outpatients from 117 health facilities in Maputo, Zambézia, and Cabo Delgado Provinces interviewed and examined as part of a malaria-specific health facility survey. Key indicators based on exit interview / re-examination data were compared to the same indicators based on records from health facility registries. Multivariable regression was performed to identify factors associated with indicators matching in re-examination / exit interview data and health facility registries. Aggregated indicators abstracted from facility registries were compared to those reported through the routine health management information system (HMIS) for the same time period. Sensitivity of exit interview / re-examination data compared with those recorded in facility registries was low for all indicators in all facilities. The lowest sensitivities were in Maputo, where the sensitivity for recording negative RDT results was 9.7%. The highest sensitivity was for recording positive RDT results in Cabo Delgado, at 75%. Multivariable analysis of factors associated with agreement between gold standard and registry data showed patients were less likely to be asked about having a fever in the triage ward in Maputo and Cabo Delgado (adjusted Odds Ratio 0.75 and 0.39 respectively), and in the outpatient ward in Cabo Delgado (aOR = 0.37), compared with the emergency department. Patients with positive RDT were also more likely to have RDT results recorded in all three provinces when patients had been managed according to national treatment guidelines during initial examination. Comparison of retrospective data abstracted from facility registries to HMIS data showed discrepancies in all three provinces. The proportion of outpatient cases with suspected and confirmed malaria were similar in registry and HMIS data across all provinces (a relatively low difference between registry and HMIS data of 3% in Maputo and Zambézia), though the total number of all-cause outpatient cases was consistently higher in the HMIS. The largest difference was in Maputo, where a total of 87,992 all-cause outpatient cases were reported in HMIS, compared with a total of 42,431 abstracted from facility registries. This study shows that care should be taken in interpreting trends based solely on routine data due to data quality issues, though the discrepancy in all-cause outpatient cases may be indicative that register availability and storage are important factors. As such, simple steps such as providing consistent access and storage of registers that include reporting of patient fever symptoms might improve the quality of routine data recorded at health facilities.

Evaluation of a new set of indicators for mental health care implemented in Madhya Pradesh, India: a mixed methods study

BackgroundMental health information systems are, in general, inadequate and unreliable in India. We have developed key mental health indicators for measuring mental health service coverage in primary care. This study aims to evaluate the use of these new indicators in seven health care facilities in Sehore District of Madhya Pradesh in India.MethodsThe study employed a mixed methods approach. We conducted: a qualitative study (n = 26) with health workers, Health Management Information Systems (HMIS) staff, project coordinators and supervisors; a review of case records (n = 61 at time 1 and n = 74 at time 2); and a structured questionnaire (n = 26) with health workers. The performance, user-friendliness, appropriateness, perceived utility and sustainability of the use of new mental health indicators was assessed.ResultsHigh levels of completion, and correctness of completion, of the new mental health indicators were found for the case records. The simplicity of the forms, as well as technical support from the project team, contributed to acceptability and feasibility of implementation. Perceived sustainability of the new forms was, however, affected by the overstretched primary care staff. Further work is needed to support the integration of mental health with routine HMIS.ConclusionThis study demonstrated that the implementation of key mental health service delivery indicators in Sehore District primary care facilities was feasible. Technical assistance was imperative in maintaining the performance of the indicators over the two studied time points. The integration of mental health indicators in routine health information systems, and political buy-in, are needed to monitor and sustain community mental health programmes in India.

Bayesian and Frequentist Analytical Approaches Using Log-Normal and Gamma Frailty Parametric Models for Breast Cancer Mortality.

One of the major causes of death among females in Saudi Arabia is breast cancer. Newly diagnosed cases of breast cancer among the female population in Saudi Arabia is 19.5%. With this high incidence, it is crucial that we explore the determinants associated with breast cancer among the Saudi Arabia populace—the focus of this current study. The total sample size for this study is 8312 (8172 females and about 140 representing 1.68% males) patients that were diagnosed with advanced breast cancer. These are facility-based cross-sectional data collected over a 9-year period (2004 to 2013) from a routine health information system database. The data were obtained from the Saudi Cancer Registry (SCR). Both descriptive and inferential (Cox with log-normal and gamma frailties) statistics were conducted. The deviance information criterion (DIC), Watanabe–Akaike information criterion (WAIC), Bayesian information criterion (BIC), and Akaike information criterion were used to evaluate or discriminate between models. For all the six models fitted, the models which combined the fixed and random effects performed better than those with only the fixed effects. This is so because those models had smaller AIC and BIC values. The analyses were done using R and the INLA statistical software. There are evident disparities by regions with Riyadh, Makkah, and Eastern Province having the highest number of cancer patients at 28%, 26%, and 20% respectively. Grade II (46%) and Grade III (45%) are the most common cancer grades. Left paired site laterality (51%) and regional extent (52%) were also most common characteristics. Overall marital status, grade, and cancer extent increased the risk of a cancer patient dying. Those that were married had a hazard ratio of 1.36 (95% CI: 1.03–1.80) while widowed had a hazard ratio of 1.57 (95% CI: 1.14–2.18). Both the married and widowed were at higher risk of dying with cancer relative to respondents who had divorced. For grade, the risk was higher for all the levels, that is, Grade I (Well diff) (HR = 7.11, 95% CI: 3.32–15.23), Grade II (Mod diff) (HR = 7.89, 95% CI: 3.88–16.06), Grade III (Poor diff) (HR = 5.90, 95% CI (2.91–11.96), and Grade IV (Undiff) (HR = 5.44, 95% (2.48–11.9), relative to B-cell. These findings provide empirical evidence that information about individual patients and their region of residence is an important contributor in understanding the inequalities in cancer mortalities and that the application of robust statistical methodologies is also needed to better understand these issues well.

Brief Report: Improving Early Infant Diagnosis Observations: Estimates of Timely HIV Testing and Mortality Among HIV-Exposed Infants.

Background:Improving efforts toward elimination of mother-to-child transmission of HIV requires timely early infant diagnosis (EID) among all HIV-exposed infants, but the occurrence of timely EID and infant survival may be underascertained in routine, facility-bound program data.Methods:From March 2015 to May 2015, we traced a random sample of HIV-positive mother and HIV-exposed infant pairs lost to follow-up for EID in facility registers in Zimbabwe. We incorporated updated information into weighted survival analyses to estimate incidence of EID and death. Reasons for no EID were surveyed from caregivers.Results:Among 2651 HIV-positive women attending antenatal care, 1823 (68.8%) infants had no documented EID by 3 months of age. Among a random sample of 643 (35.3%) HIV-exposed infants lost to follow-up for EID, vital status was ascertained among 371 (57.7%) and updated care status obtained from 256 (39.8%) mothers traced. Among all HIV-infected mother–HIV-exposed infant pairs, weighted estimates found cumulative incidence of infant death by 90 days of 3.9% (95% confidence interval: 3.4% to 4.4%). Cumulative incidence of timely EID with death as a competing risk was 60%. The most frequently cited reasons for failure to uptake EID were “my child died” and “I didn't know I should have my child tested.”Conclusions:Our findings indicate uptake of timely EID among HIV-exposed infants is underestimated in routine health information systems. High, early mortality among HIV-exposed infants underscores the need to more effectively identify HIV-positive mother–HIV exposed infant pairs at high risk of adverse outcomes and loss to follow-up for enhanced interventions.

Utilization of Community Health Information System and Associated Factors in Health Posts of Hadiya Zone, Southern Ethiopia

Background: the regular use of reliable health information from a well-designed routine health information system is indispensable for ensuring and sustaining improvements in health system performance. However, In Ethiopia the prevailing practice in terms of effectively utilizing health information is not satisfactory and utilization of health information at the local level is still a challenge. Objective: To determine utilization of Community Health information systems and associated factors in health posts of Hadiya zone, Ethiopia. Method: Facility based cross sectional study design was conducted in Health post of Hadiya zone, from February 1 to 15/2018 using both quantitative and qualitative approach. The calculated sample 420 Health Extension workers found in 210 Health posts was allocated to each district proportionally based on their number of health posts. Then, Health posts were selected by simple random sampling method from each District, and health extension workers found in the selected Health posts was part of the study. Quantitative data was collected using structured questionnaire. Multivariable logistic regression was used to identify significantly associated factors. For qualitative study, health extension workers who are not participated in quantitative study were selected purposively based on their work experience. Result: Overall, Good utilization of community health information was 41%. Monthly Supportive supervision (AOR=1.72; CI=1.02, 2.91), written feedback (AOR=5.33; CI = 3.27, 8.69) and Compiled and send additional parallel reports (AOR=4.41; CI =2.35-8.30) were factors significantly associated with utilization of community health information system. In qualitative study, the existing tools were difficult to use and understand because they prepared in English language, high burden of workload and no adequate work force at health post level were the main challenge in using CHIS. Conclusion and Recommendation : Utilization of health information at health post level was found to be far below the national expectation. It needs major improvement in frequency of supportive supervision, sending of written feedback and improving integrated reporting channel system. Keywords : Community health information systems, Health information, Ethiopia DOI : 10.7176/JMPB/63-03 Publication date: January 31 st 2020

Current practices in using standard clinical terminologies to record surgical procedures through electronic health information systems in state sector hospitals in Sri Lanka

Introduction: In Sri Lanka, routine health information systems lack information on surgical procedures at the institutional, regional and national levels. Electronic Health Information (HIS) systems with standard clinical terminologies are expected to address this gap. Therefore, this research was conducted to study the current practices of using electronic information systems and standard clinical terminologies to record surgical procedures in state sector hospitals in Sri Lanka. Methods: This exploratory study was conducted employing Hermeneutic Phenomenology as the research methodology. A maximum variation sampling method was employed to enrol 24 participants from seven tertiary care hospitals representing different stakeholder groups in recording and using surgical data. In-depth interviews were conducted with the consented participants to explore their lived experiences and interpretations in relation to the research objective. Interviews were audio-recorded and thematically analysed using the five-stage process proposed by Ritchie and Spencer. Results: The main themes identified grounded in data include; the purpose of recording surgical procedures, current practices, and use of electronic information systems & clinical terminologies to record surgical procedures. Different categories of health care staff were involved in recording surgical procedure data. No uniformity or a standard was followed in the process of recording surgical data, the data elements or the clinical terminologies used in this process. Three electronic health information systems (Hospital Health Information Management System (HHIMS), Hospital Information Management System (HIMS) & Electronic Indoor Morbidity & Morality Return (eIMMR)) are widely adopted in the state health sector using either International Classification of Primary Care (ICPC-2) or International Classification of Diseases (ICD-10) as the main clinical terminology. A functioning theatre module is only available in one state hospital in the country. Moreover, private electronic databases are employed by many surgeons to record surgical procedures in addition to institutional electronic health information systems. Conclusions: Current practices of recording surgical procedures reflect a wide variation in the use of data elements, the clinical terminologies, and the process of recording surgical procedures. No standard HIS is in place to capture data on surgical procedures. However, electronic databases are used by individual surgeons to record surgical procedures they perform. Such initiatives are not adequate to reap the benefits of digital health technologies.

The Health-Information Impact Index: a tool to monitor the uptake of evidence in policy and practice

Abstract Background The optimal use of data and evidence from national health information systems is paramount in public health. However, current tools to evaluate health information systems focus on data quality and availability rather than measuring how data are used by key stakeholders. This limits capacity to monitor the impact of evidence on health care management and health policy making. Methods Based on an extensive literature review we developed a new model, the Health Information (HI)-Impact framework, to monitor the impact of health information in health policy and practice. We further conducted a web-based Delphi survey between February and April 2019 among European public health professionals working in health policy, health care, research, and health monitoring to develop the HI-Impact Index. Results In the HI-Impact framework, four domains are essential for mapping public health data availability, dissemination, and use: (1) Health Information and Evidence Quality, (2) Health Information System Responsiveness, (3) Stakeholder Engagement, and (4) Knowledge Integration. This last domain has a broader reach on the determinants of health and reflects the use of evidence by community partners and across sectors. In the DELPHI survey, 127 experts from 38 European countries selected 30 criteria to integrate in the HI-Impact Index. This tool could be used by European public health agencies to monitor the impact of their information products, and inform national strategies for evidence-based public health. Conclusions It is crucial for routine health information systems to create a culture of accountability in the use of evidence. Data on the determinants and consequences of ill-health as well as stakeholder engagement in leveraging evidence for intervention are explicit points to consider for a full quality assessment of national health information systems, and a sustainable impact on health outcomes.

Feasibility and acceptability of an iris biometric system for unique patient identification in routine HIV services in Kenya

BackgroundUse of routine HIV programme data for surveillance is often limited due to inaccuracies associated with patient misclassification which can be addressed by unique patient identification.We assessed the feasibility and acceptability of integrating an iris recognition biometric identification system into routine HIV care services at 4 sites in Kenya. MethodsPatients who had recently tested HIV-positive or were engaged in care were enrolled. Images of the iris were captured using a dual-iris camera connected to a laptop. A prototype iris biometric identification system networked across the sites, analysed the iris patterns; created a template from those patterns; and generated a 12-digit ID number based on the template. During subsequent visits, the patients’ irises were re-scanned, and the pattern was matched to stored templates to retrieve the ID number. ResultsOver 55 weeks 8,614 (98%) of 8,794 new patients were assigned a unique ID on their first visit. Among 6,078 return visits, the system correctly re-identified patients’ IDs 5,234 times (86%). The false match rate (a new patient given the ID of another patient) was 0·5% while the generalized false reject rate (re-scans assigned a new ID) was 4·7%. Overall, 9 (0·1%) agreed to enrol but declined to have an iris scan. The most common reasons cited for declining an iris scan were concerns about privacy and confidentiality. ConclusionImplementation of an iris recognition system in routine health information systems is feasible and highly acceptable as part of routine care in Kenya. Scale-up could improve unique patient identification and tracking, enhancing disease surveillance activities.

ERegTime, Efficiency of Health Information Management Using an Electronic Registry for Maternal and Child Health: Protocol for a Time-Motion Study in a Cluster Randomized Trial.

BackgroundPaper-based routine health information systems often require repetitive data entry. In the West Bank, the primary health care system for maternal and child health was entirely paper-based, with care providers spending considerable amounts of time maintaining multiple files and client registers. As part of the phased national implementation of an electronic health information system, some of the primary health care clinics are now using an electronic registry (eRegistry) for maternal and child health. The eRegistry consists of client-level data entered by care providers at the point-of-care and supports several digital health interventions that are triggered by the documented clinical data, including guideline-based clinical decision support and automated public health reports.ObjectiveThe aim of the eRegTime study is to investigate whether the use of the eRegistry leads to changes in time-efficiency in health information management by the care providers, compared with the paper-based systems.MethodsThis is a substudy in a cluster randomized controlled trial (the eRegQual study) and uses the time-motion observational study design. The primary outcome is the time spent on health information management for antenatal care, informed and defined by workflow mapping in the clinics. We performed sample size estimations to enable the detection of a 25% change in time-efficiency with a 90% power using an intracluster correlation coefficient of 0.1 and an alpha of .05. We observed care providers for full workdays in 24 randomly selected primary health care clinics—12 using the eRegistry and 12 still using paper. Linear mixed effects models will be used to compare the time spent on health information management per client per care provider.ResultsAlthough the objective of the eRegQual study is to assess the effectiveness of the eRegistry in improving quality of antenatal care, the results of the eRegTime study will contribute to process evaluation, supplementing the findings of the larger trial.ConclusionsElectronic health tools are expected to reduce workload for the care providers and thus improve efficiency of clinical work. To achieve these benefits, the implementation of such systems requires both integration with existing workflows and the creation of new workflows. Studies assessing the time-efficiency of electronic health information systems can inform policy decisions for implementations in resource-limited low- and middle-income settings.International Registered Report Identifier (IRRID)DERR1-10.2196/13653

Evaluation of performance and perceived utility of mental healthcare indicators in routine health information systems in five low- and middle-income countries.

In most low- and middle-income countries (LMIC), routine mental health information is unavailable or unreliable, making monitoring of mental healthcare coverage difficult. This study aims to evaluate a new set of mental health indicators introduced in primary healthcare settings in five LMIC. A survey was conducted among primary healthcare workers (n = 272) to assess the acceptability and feasibility of eight new indicators monitoring mental healthcare needs, utilisation, quality and payments. Also, primary health facility case records (n = 583) were reviewed by trained research assistants to assess the level of completion (yes/no) for each of the indicators and subsequently the level of correctness of completion (correct/incorrect - with incorrect defined as illogical, missing or illegible information) of the indicators used by health workers. Assessments were conducted within 1 month of the introduction of the indicators, as well as 6-9 months afterwards. Across both time points and across all indicators, 78% of the measurements of indicators were complete. Among the best performing indicators (diagnosis, severity and treatment), this was significantly higher. With regards to correctness, 87% of all completed indicators were correctly completed. There was a trend towards improvement over time. Health workers' perceptions on feasibility and utility, across sites and over time, indicated a positive attitude in 81% of all measurements. This study demonstrates high levels of performance and perceived utility for a set of indicators that could ultimately be used to monitor coverage of mental healthcare in primary healthcare settings in LMIC. We recommend that these indicators are incorporated into existing health information systems and adopted within the World Health Organization Mental Health Gap Action Programme implementation strategy. None.