Sustainable Health Information Systems Research Articles

A Data-Driven Paradigm for a Resilient and Sustainable Integrated Health Information Systems for Health Care Applications.

Many transformations and uncertainties, such as the fourth industrial revolution and pandemics, have propelled healthcare acceptance and deployment of health information systems (HIS). External and internal determinants aligning with the global course influence their deployments. At the epic is digitalization, which generates endless data that has permeated healthcare. The continuous proliferation of complex and dynamic healthcare data is the digitalization frontier in healthcare that necessitates attention. This study explores the existing body of information on HIS for healthcare through the data lens to present a data-driven paradigm for healthcare augmentation paramount to attaining a sustainable and resilient HIS. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: PRISMA-compliant in-depth literature review was conducted systematically to synthesize and analyze the literature content to ascertain the value disposition of HIS data in healthcare delivery. This study details the aspects of a data-driven paradigm for robust and sustainable HIS for health care applications. Data source, data action and decisions, data sciences techniques, serialization of data sciences techniques in the HIS, and data insight implementation and application are data-driven features expounded. These are essential data-driven paradigm building blocks that need iteration to succeed. Existing literature considers insurgent data in healthcare challenging, disruptive, and potentially revolutionary. This view echoes the current healthcare quandary of good and bad data availability. Thus, data-driven insights are essential for building a resilient and sustainable HIS. People, technology, and tasks dominated prior HIS frameworks, with few data-centric facets. Improving healthcare and the HIS requires identifying and integrating crucial data elements. The paper presented a data-driven paradigm for a resilient and sustainable HIS. The findings show that data-driven track and components are essential to improve healthcare using data analytics insights. It provides an integrated footing for data analytics to support and effectively assist health care delivery.

Technical Factors Influencing the Health Information System in Kosova.

Health information systems (HIS) are considered a vital tool to strengthen Low- and Middle-Income Countries' (LMIC) health systems. Unfortunately, little is known about the technical factors of HIS in LMIC. This study aimed to make an empirical contribution, using the case of Kosova to find out about HIS development, trying to identify dysfunctional areas and opportunities for improvement. Technical factors of the PRISM framework were analyzed via document analysis, and semi-structured interviews were held with 15 respondents from the Ministry of Health, the National Institute of Public Health of Kosova, and the Hospital Clinical University Services of Kosova. Interviews were transcribed and coded deductively, using the defined theoretical framework to guide the content analysis. The results indicate that MoH considered technical factors while developing HIS in Kosova. Nevertheless, HIS fulfills only some of the essential functions. Barriers to efficient HIS among technical factors are lengthy, time-consuming manual HIS forms, inadequate data from HIS forms for NIPHK analysis, difficulties when changing software and HIS economic operators, and the complexity of HIS functioning. Kosova still faces technical difficulties with an efficient and sustainable HIS system. Complex processes of extensive efforts have yet to produce the desired results, which prevent evidence-based health analysis and informed decision-making in Kosovar healthcare. More research is needed into organizational and behavioral factors influencing HIS efficiency in LMIC.

Sustainable Health Informatics: Health Informaticians as Alchemists.

The digital transformation of health care delivery remains an elusive work in progress. Contextual variation continues to be a significant barrier to the development of sustainable health information systems. In this paper we characterize health informaticians as modern alchemists and use this characterization to describe informatics progress in addressing four key healthcare challenges. We highlight the need for informaticians to be diligent and loyal to basic methodological principles while also appreciating the role that contextual variation plays in informatics research. We also emphasize that meaningful health systems transformation takes time. The insight presented in this paper helps informaticians in our quest to develop sustainable health information systems.

New approaches to aquatic and terrestrial animal surveillance: The potential for people and technology to transform epidemiology

Epidemiology provides insights about causes of diseases and how to control them, and is powered by surveillance information. Animal health surveillance systems typically have been designed to meet high-level government informational needs, and any incentives for those who generate data (such as animal owners and animal health workers) to report surveillance information are sometimes outweighed by the negative consequences of reporting; underreporting is a serious constraint. This problem can persist even when modern advances in information and communications technology (ICT) are incorporated into the structure and operation of surveillance systems, although some problems typical of paper-based systems (including timeliness of reporting and response, accuracy of data entry, and level of detail recorded) are reduced. On occasions, however, additional problems including sustainability arise. We describe two examples of a philosophical approach and ICT platform for the development of powerful and sustainable health information systems that are people-centred and do not exhibit these typical problems. iSIKHNAS is Indonesia's integrated animal health information system, and PIISAC is a sustainable secure research platform based on full production data from participating commercial Chilean aquaculture companies. Epidemiologists working with these systems are faced with interesting new challenges, including the need to develop skills in extracting appropriate surveillance outcomes from large volumes of continually-streaming data.

Bridging gaps in health information systems: a case study from Somaliland, Somalia.

Reliable and timely health information is fundamental for health information systems (HIS) to work effectively. This case study aims to assess Somaliland HIS in terms of its contextual situation, major weaknesses and proposes key evidence-based recommendations. Data were collected through national level key informants' interviews, observations, group discussion and scoring using the HIS framework and assessment tool developed by World Health Organization Health Metrics Network (WHO/HMN). The study found major weaknesses including: no policy, strategic plan and legal framework in place; fragmented sub-information systems; Poor information and communications technology (ICT) infrastructure; poorly motivated and under-skilled personnel; dependence on unsustainable external funds; no census or civil registration in place; data from private health sector not captured; insufficient technical capacity to analyse data collected by HIS; and information is not widely shared, disseminated or utilized for decision-making. We recommend developing a national HIS strategic plan that harmonizes and directs collective efforts to become a more integrated, cost-effective and sustainable HIS.

The Organization Factors as Barrier for Sustainable Health Information Systems (HIS) – A Review

Health Information Systems (HIS) helps in coordinating various activities within hospital through effective and efficient services. Malaysian Government began to introduce HIS in 1999 to cover both clinical and non-clinical information systems. Since then hospitals have been facing challenges to achieve the objectives of its introduction. Thus, it is important to understand determinants for successful implementation in order to ensure sustainable HIS. Various determinants render successful implementation, such as human factors, technology factors as well as organizational factors. However, understanding organizational factors becomes important, since the systems runs within the organization itself. The other two factors; human and technology factors have been discussed elsewhere by the authors. Any issues pertaining to the organization if identified earlier will prevent implementation failure. Hence, this paper aims to provide a review of barriers associated with organization factors hindering the sustainability of HIS, and propose strategies required to minimize the issues discussed. Based on our review, this paper highlighted four main challenges from an organization perspective; high adoption cost, top management support, adequate infrastructure and security and privacy issues.

The Technology Factors as Barriers for Sustainable Health Information Systems (HIS) – A Review

Information system is widely adopted in many fields including healthcare. Healthcare organizations now consider increased efficiency, improved patient care, quality of services, and safety. Hence Health Information System (HIS) is basically introduced to transform the traditional way of data collection and organization in hospitals, to a modern way of systematic collection, maintaining and dissemination of data. Its implementation is to support medical practitioners and administrative staff in securing patients’ health information in a digital-based record, to efficiently and effectively improve performance in the health system or any of its component parts. However, despite its numerous benefits, some of barriers still hinder its successful implementation and adoption, which needs to be addressed. This study discussed these barriers related to technology using the IS Success Model. This review paper becomes necessary in order to highlight the barriers that led to technical difficulties facing HIS implementation in hospitals, so as to suggest possible solutions that will improve services rendered in health industry based on findings.

Organizational Capacity Building for Sustainable Health Information Systems: A Case Study from Ghana

Abstract Background and Purpose: Implementing ICT innovations especially in low resourced countries has been documented in the information systems (IS) literature as a very challenging feat because of the existence of weak organizational structures leading to manifestations of silos of fragmented country ICT projects lacking the basic organizational structures to scale and become sustainable over time [31, 11, 33]. In 2010 Ghana adopted the DHIS2 software as a replacement of the existing and challenged health information system (HIS) to enable it track progress on the health related millennium development goals (MDG). The outcome has been a successful nation-wide implementation of HIS in all public health facilities. This paper looked at the factors that enabled the successful implementation and sustenance of the adopted software in Ghana. Methods: Concepts from information infrastructure theory and the notion of the installed base were used as lenses to collect and analyse the empirical data. Data collection and analysis was qualitative using participant observation, focused group discussions, semi-structured interviews and document analysis. Results: This has been possible because of realignment of selected elements of the installed base necessary for achieving set objectives. For Ghana the elements identified were manpower development, resource mobilization, strengthening of institutions and networking with stakeholders to leverage on available resources and technology. Conclusions: Sustainability of HIS in resource constrained contexts requires selection of elements of the installed base necessary for effective organizational capacity building. And these elements must be interdependent otherwise the objective of sustainability might not be accomplished. Effective capacity building efforts of an organization therefore involves combining strategies synergistically to ensure long-term sustainability. Key words: Organizational Capacity Building, Installed Base, DHIS2

Scaling-up health information systems to improve HIV treatment: An assessment of initial patient monitoring systems in Mozambique

IntroductionThe rapid scale-up of HIV care and treatment in resource-limited countries requires concurrent, rapid development of health information systems to support quality service delivery. Mozambique, a country with an 11.5% prevalence of HIV, has developed nation-wide patient monitoring systems (PMS) with standardized reporting tools, utilized by all HIV treatment providers in paper or electronic form. Evaluation of the initial implementation of PMS can inform and strengthen future development as the country moves towards a harmonized, sustainable health information system. ObjectiveThis assessment was conducted in order to 1) characterize data collection and reporting processes and PMS resources available and 2) provide evidence-based recommendations for harmonization and sustainability of PMS. MethodsThis baseline assessment of PMS was conducted with eight non-governmental organizations that supported the Ministry of Health to provide 90% of HIV care and treatment in Mozambique. The study team conducted structured and semi-structured surveys at 18 health facilities located in all 11 provinces. Seventy-nine staff were interviewed. Deductive a priori analytic categories guided analysis. ResultsHealth facilities have implemented paper and electronic monitoring systems with varying success. Where in use, robust electronic PMS facilitate facility-level reporting of required indicators; improve ability to identify patients lost to follow-up; and support facility and patient management. Challenges to implementation of monitoring systems include a lack of national guidelines and norms for patient level HIS, variable system implementation and functionality, and limited human and infrastructure resources to maximize system functionality and information use. ConclusionsThis initial assessment supports the need for national guidelines to harmonize, expand, and strengthen HIV-related health information systems. Recommendations may benefit other countries with similar epidemiologic and resource-constrained environments seeking to improve PMS implementation.

Peer-Performance Review as a Strategy for Strengthening Health In-formation Systems: A Case Study from Ghana

Background and Purpose: The Ghana Health Service (GHS) in 2012 embarked on an ambitious programme to improve its health information system (HIS) in order to improve upon healthcare delivery and also to meet the health related millennium development goals (MDGs). This resulted in nation-wide implementation of the District Health Information Management System (DHIMS2), software based on the District Health Information Software (DHIS2), in all its facilities and some private and quasi government health facilities. The DHIMS2 is the Ghanaian version of the global DHIS2 software developed by the University of Oslo. Methods: As part of its mandate the GHS holds periodic peer reviews meetings at different levels of its structure as a mechanism for measuring service performance in order to identify service gaps that will lead to interventions to improving the coverage and quality of service to its client. This paper is a qualitative assessment of the DHIS2 software based on specified criteria from some of these review meetings in selected regions towards achieving the set goals. The paper will look at the status quo with respect to infrastructure, resources in general, human resource, stakeholder involvement, data quality and data use since the implementation of the DHIS2 project in Ghana. Data collection and analysis was qualitative using participant observation, focused group discussions, semi-structured interviews and document analysis. Results: Our research has shown that the GHS has successfully implemented an integrated and sustainable web-based HIS. Data quality in all aspects has been improved through institutional arrangements such as peer-performance reviews using DHIS2 data and establishment of data quality assurance teams at all levels. This implicitly has promoted data use for decision making. The online system has also ensured data transparency and accessibility. ‘Break-downs’ in the system such as lack of funds, faulty equipment, lack of adequate and skilled human resource for data management is seen as some major challenges to data quality. Such ‘break-downs’ may also be seen as opportunity for system strengthening and sustainability as end-users are compelled to use personal resources for managing data. Through institutionalized peer-performance review processes using data from the DHIS2 is improving the quality of health service data for planning and decision making. Conclusions: This research has demonstrated that with the right technology, policy and collaboration from interested stakeholders it is possible to implement a sustainable HIS in developing countries such as Ghana. We have also shown that institutionalized arrangements for data use has significantly improved the quality of service data generated which will aid planning and decision-making

Strengthening monitoring and evaluation (M&E) and building sustainable health information systems in resource limited countries: lessons learned from an M&E task-shifting initiative in Botswana.

BackgroundThe demand for quality data and the interest in health information systems has increased due to the need for country-level progress reporting towards attainment of the United Nations Millennium Development Goals and global health initiatives. To improve monitoring and evaluation (M&E) of health programs in Botswana, 51 recent university graduates with no experience in M&E were recruited and provided with on-the-job training and mentoring to develop a new cadre of health worker: the district M&E officer. Three years after establishment of the cadre, an assessment was conducted to document achievements and lessons learnt.MethodsThis qualitative assessment included in-depth interviews at the national level (n = 12) with officers from government institutions, donor agencies, and technical organizations; and six focus group discussions separately with district M&E officers, district managers, and program officers coordinating different district health programs.ResultsReported achievements of the cadre included improved health worker capacity to monitor and evaluate programs within the districts; improved data quality, management, and reporting; increased use of health data for disease surveillance, operational research, and planning purposes; and increased availability of time for nurses and other health workers to concentrate on core clinical duties. Lessons learnt from the assessment included: the importance of clarifying roles for newly established cadres, aligning resources and equipment to expectations, importance of stakeholder collaboration in implementation of sustainable programs, and ensuring retention of new cadres.ConclusionThe development of a dedicated M&E cadre at the district level contributed positively to health information systems in Botswana by helping build M&E capacity and improving data quality, management, and data use. This assessment has shown that such cadres can be developed sustainably if the initiative is country-led, focusing on recruitment and capacity-development of local counterparts, with a clear government retention plan.

Analyzing the problem of unsustainable health information systems in less-developed economies: Case studies from Tanzania and Mozambique

Most of donor-supported information technology (IT)–based projects developed or implemented in less-developed economies (LDEs) end up as complete or partial failures or unsustainable. Notably, a number of intra-organizational and external factors are associated with this problem, including inadequate infrastructure and human resource capacity, fragmented donor policy, and lack of policies to manage the sustainability problem. Accordingly, IT initiatives are often donor-driven, top-down, and hijacked by top managers who (normally) do not have adequate skills, but have enormous power to enforce such initiatives across organizational hierarchies. In analyzing the concepts from sustainability and institutionalization, key insights towards a better understanding of the problem of unsustainability are developed. It is argued that health information systems (HISs) become sustainable if they are institutionalized in the sense of being integrated into the everyday routine of the user organization. However, a sustainable HIS should also be flexible enough to allow changes as the user needs change. Moreover, introduction of a new HIS is not only a technical change, but requires the cultivation and institutionalization of a new kind of culture. Through a comparative case analysis of the HIS development and implementation processes in Tanzania and Mozambique, we have identified two sets of relationships, between the Ministry of Health (MoH) and donor agencies and between the MoH and software development agencies as critical and contributing factors to the unsustainability of a HIS. Given this setting, we highlight three key strategies for dealing with the problem of unsustainability in LDEs: (a) integration of a HIS, (b) local shaping of new cultures, and (c) cultivation approach to systems development. © 2005 Wiley Periodicals, Inc.

Networks of Action: Sustainable Health Information Systems across Developing Countries

Our paper is motivated by one simple question: Why do so many action research efforts fail to persist over time? We approach this question, the problem of sustainability, building on a perspective on action research identifying the pivotal importance of networks. More precisely, local action research interventions need to be conceptualized and approached as but one element in a larger network of action in order to ensure sustainability. A vital aspect of our perspective is that local interventions depend heavily on the support of similar action research efforts in other locations. This is essential for the necessary processes of learning and experience sharing. We suggest that the scaling (i.e., spreading) of intervention is a prerequisite, not a luxury, for sustainable action research. Empirically, we base our analysis on an ongoing, large-scale action research project within the health care sector (called HISP) in a number of developing countries. HISP provides a fruitful occasion to investigate key criteria for our approach to action research, namely sustainability, scalability, and capacity to be politically relevant to the participants. We contribute to three discourses: (1) models of action research, (2) lessons for health information systems in developing countries, and (3) more generally, IS implementations that are dispersed, large-scale, and have scarce resources.

Commonwealth Association of Paediatric Gastroenterology; 12th Commonwealth Health Ministers Meeting

Commonwealth Association of Paediatric Gastroenterology The Commonwealth Association of Paediatric Gastroenterology and Nutrition was inaugurated during the "Third Commonwealth Conference on Diarrhoea and Malnutrition" in Hong Kong in November of 1994. The First Commonwealth Conference on Diarrhoea and Malnutrition, held in London in November of 1984, aimed to encourage pediatric gastroenterologists to focus on the interrelationship between diarrhea and malnutrition in children. The second conference was in New Delhi, India in December of 1992, and the fourth conference was held in Karachi, Pakistan in November of 1997. The fifth conference is scheduled to be held in Darwin, Australia in 2001. In 1998 the Commonwealth Association of Paediatric Gastroenterology and Nutrition was granted observer status at Commonwealth Health Ministers meetings. 12th Commonwealth Health Ministers Meeting The Commonwealth represent a common heritage of shared language and ethos in the realms of science and medicine, and it provides a remarkable mix of developed and developing communities with a world-wide membership. Within this bond of the "commonwealth family," health ministers and representatives from 39 of 54 commonwealth countries met in Barbados on November 15 through November 19, 1998, to discuss "Health Sector Reform in the Internet of Health for All." Inequity, both within and between countries, was the primary concern of many delegates, as was the need to develop mechanisms to ensure that the disadvantaged, the poor, and the marginalized are given affordable access to appropriate health care. For the first time at a Commonwealth Health Ministers Meeting, there was a nongovernmental organization Forum preceding the main event. Nongovernmental organizations with observer status had considerable opportunity to participate directly in the main meeting. Despite being somewhat inundated by a number of broad themes and wide-ranging recommendations relating to topics such as strategic planning, sustainable health information systems, and health financing, the delegates were able to focus on some key areas of concern. Traditional and complementary health care systems play a major role in both developing and developed countries but remain largely unrecognized and unregulated by governments. It was agreed that a working group, collaborating with selected commonwealth countries and international nongovernmental organizations, would report back on this issue to ministers at the forthcoming World Health Assembly in May of 1999. Economic issues, such as drug costs and unbalanced pricing schedules, were a prime concern for undeveloped countries as were concerns about health workforce mobility. A number of countries saw this "brain drain" as "human resource theft" by developed countries. More specifically on the health agenda were issue of aging, obesity, and physical activity. The International Obesity Task Force helped convince many delegates that the obesity epidemic is not just a problem in developed countries and that policy approaches will be of prime importance in solving the problem. Government policies are needed to change food composition, production, price, and access and to create an environment promoting physical activity. Recommendations to address the problem of obesity at the government level are listed in the Appendix. The Commonwealth represents 1.8 billion people, or 30% of the world's population, and has members from countries with the most envied health care system in the world as well as those in need of the greatest help. Within this economic, ethnic, and cultural diversity there is some sense of cohesiveness and belonging. It is hoped that commonwealth initiatives may spearhead meaningful change had lead to greater global equity. Health care is one of the imperfect "markers" in which doctors create the market through their superior knowledge and the patients' dependence, a market that perhaps is not much different from the global economic market, from the perspective of an undeveloped country. As some commonwealth countries move towards "cybertopia" and the new millennium, others perceive the equity gap as ever widening. Health financing represents a competing balance between the goals of equity, efficiency, and cost containment. For many countries, achieving this balance is a daunting task. Combining ministerial positions is not an unusual practice, but countries need to combine the ministerial portfolios of health and finance-then perhaps health would no longer be a government's "first priority ... after every other priority." Tony Nelson, Convenor of CAPGAN, Chinese University of Hong Kong Peter Sullivan, Chairman-Elect of CAPGAN, University of Oxford, U.K.