Using Health Information for Health System Improvement – Syllabus (2014)

Using Health Information for Health System Improvement

for Brandeis University

HS327f, Fall 2014, Module II

Syllabus

Dates:October 30–December 11, 2014

Time: 2:00 – 4:50 on Thursdays

Location: Heller G-3

Course Instructors:Theo Lippeveld & Deirdre Rogers

COURSE GOALS AND OBJECTIVES

To achieve delivery of quality health services and subsequently sustainable health of the target populations, the World Health Organization (WHO) promotes strengthening the six major building blocks of the health system: (1) governance and policy; (2) service delivery; (3) human resources; (4) health commodities; (5) health financing; and (6) health information systems (HIS).HIS remains the backbone for providing information to track progress for improving the different health system components and monitor the achievement of the health related Millennium Development Goals (MDGs).

Strong health information systems that produce reliable, timely, and quality data are one of several factors enabling health program managers to monitor and evaluate and improve health system performance by making evidenced-based decisions. Since the 1990s, knowledge and understanding of the role of HIS development and health information on global health systems haveimproved. Despite this, use of information for evidence based decision making is still very weak in most developing countries. Ill-defined information needs, data quality issues, as well as centralization and fragmentation of health information systems are some of the root causes.

Recently two frameworks have been developed to measure the performance of health information systems and plan for their improvement. The Health Metrics Network (HMN) developed a Framework and Tools for Country Health Information Systems (WHO, 2008), which were intended to define standards guiding the production, the harmonization, and the use of quality health information by all countries and global agencies. The HMN assessment tool can be usedto serve as a benchmark for baseline assessments of the National Health Information System. The Performance of Routine Information System Management (PRISM) framework and tool (Aqil et al., 2009) was developed around the same time, and focuses more particularly on routine service delivery oriented health information systems. Both frameworks and tools can help countries to focus investment and technical assistance on standardized health information system development; to provide a roadmap for strengthening health information systems and putting in placeongoing monitoring and evaluation mechanisms; and, ultimately, to increase access to– and better use of – improved health information for health system improvement at the local, country and global levels.

This course will follow the concepts promoted by both the HMN and the PRISM framework to review and better understand the health information systems that guide decision-making, leading to better health. By the end of thecourse, participants will be able to:

  • Articulate the importance of assessing HIS and the rationale for strengthening HIS;
  • Describe the components and standards of a national HIS that must be considered and assessed;
  • Understand the principles, processes, and tools for strengthening a Health Information Systems;
  • Consider the appropriate use of Information and Communication Technology (ICT) for data management, data transmission, and data presentation;
  • Identify and analyze constraints and opportunities for use of information and decision making at all levels of the health system; and
  • Formulate an action plan to better use information for health programming and health facility management.

COURSE DESCRIPTION

After an initial presentation of the health system, HMN framework and PRISM framework and tools, participants will use the tools to make a diagnosis of HIS strengths and weaknesses and to plan for HIS strengthening. In subsequent modules the students will study the routine health facility based (and community based) information system (RHIS) as the most common data source for generation of management and programmatic information. Based on practical case studies, they will learn how to improve the performance of those RHIS in terms of the production of quality information and of use of information at all levels of the health system and what the contribution is of information and communication technology (ICT).

TEACHING METHODS

The course will use a variety of teaching methods such as lectures, demonstrations, discussions, analyses of case studies.

READINGS

All required readings can be accessed online using the links provided in the syllabus.

FACULTY

The lead instructor is Dr. Theo Lippeveld, Senior Health Information System Advisor at John Snow Inc. (JSI). He will teach modules 1 and 2. Deirdre Rogers, Senior Technical and Monitoring & Evaluation Advisorat JSI will facilitate all sessions. Other staff from JSI’s Center for Health Information and Monitoring and Evaluation (CHIME) will be brought in as guest speakers.

COURSE EVALUATION

Grading will be as follows:

  • Class Participation (20%)

Each student is expected to engage in general class discussions and in discussions of assigned cases by posing questions and responding to questions posed by the Professor and other students.

  • Consultant Report (30%)
    As a health consultant, you have been asked to advise the Ministry of Health of a low or middle income country (LMIC) about its information systems (health metrics). You will need to explain the value of health information systems and why you believe it is important to improve the country’s health information system (either basing this on the reality of some country or making it up). Finally, propose conducting an assessment and describe how it will be done, who will be involved, and potential outcomes. The Memo should be no more than 3 pages (double spaced). It is required to be written using APA format with references cited appropriately throughout the text.The Consultant Report is due at beginning of class, 2:00pm on November 13.
  • Final Assignment (50%)

Groups will select one of the two options:

Option 1: Select a health topic (e.g.,immunizations, child health, maternal health, nutrition, family planning, HIV/AIDS). Describe how and what is measured on your topic within the RHIS of one or two countries (you pick). Identify globally recognized indicators on this topic, highlighting which, if any, can be collected using a HIS. Propose how and what should be collected through various HIS data sources, particularly the RHIS. Recommend ways of improving the RHIS for your topic in your country(ies).

Option 2: Select a country and describe the HIS in detail. Students will be required to: (1) identify key indicators to be measured by the HIS related to this health topic; (2) specify the data source for each; (3) describe data management procedures; (4) describe HIS resources; (5) draft at least one information product and describe others; and (6) propose activities for disseminating data and encouraging data use. You will also be required to interview (by phone, Skype, email, etc.) at least one expert on your country’s HIS regarding the current state of the HIS.

Draft sections of the final report will be submitted throughout the course. The final paper (10-20 pages, double spaced)is due at the completion of the course. Additionally, students will be asked to present their paper in a 15minute presentation during the last session of this course.

Note: We recognize that there are advantages and disadvantages to group projects. In this case, we feel that the advantages outweigh the disadvantages. Group projects can spread the work and instill teamwork skills, which are important elements of HIS as well as project/program design, management, implementation, monitoring and evaluation. More importantly, chances are that students who will undertake HIS-related work in the future, either as project staff, external evaluators, or consultants offering technical assistance, will do so in a collaborative fashion. It is thus vital that they become accustomed to working through these processes in conjunction with other people.

COURSE MODULES

The course will be taught in seven modules of three hours (in fact 2h 50min) each.

Module 1: Introduction to Health Information Systems (HIS)
(October 30)

Objectives:

By the end of this module, students will be able to:

  • Understand the essential link between the health system and the health information system
  • Articulate the rationale and approaches to strengthening HIS
  • Understand the constraints that have challenged HIS in the past
  • Describe the sixHIS components according to the Health Metrics framework
  • Be aware that use of information for decision making is ultimately the most important component

Topics Covered:

  • Discussion of syllabus, assignments, and structure of course
  • Brainstorming on why we need information in health
  • Rationale and approaches to strengthening a HIS
  • The Health Metrics Network framework
  • Overview of the six components of a health information system
  • HIS inputs / resources
  • HIS processes

-indicators (SMART types)

-data sources (types and categories – population vs. institution-based; routine vs. non-routine)

-data management and presentation

-information use

  • Explanation of Assignments

Reading

How can routine health information systems improve health systems functioning in low-resource settings? Assessing the evidence base.MEASURE Evaluation Special Report. February 2012.

WHO. 2008. Framework and Standards for Country Health Information Systems. Second Edition.

Stansfield, S. Structuring information and incentives to improve health. Editorial. Bulletin of the World Health Organization. August 2005; 83(8): 562.

Marcelo, A.B. Health Information Systems: a Survey of Frameworks for Developing Countries. IMIA Yearbook of Medical Informatics. 2010; 25-29.

Module2: Assessment of HIS and Routine Health Information Systems (RHIS): Performance, Quality and Use
(November 6)

Objectives:

By the end of this module, students will be able to:

  • Diagnose the RHIS performance
  • Identify and analyze possible constraints for successful implementation of a RHIS

Topics Covered:

  • PRISM framework
  • PRISM assessment tools and interventions

Readings:

Aqil, A., Lippeveld, T., Hozumi, D. PRISM Framework: A Paradigm Shift for Designing, Strengthening and Evaluating Routine Health Information Systems. Health Policy and Planning 2009 24(3):217-228; doi:10.1093/heapol/czp010, Oxford University Press.

Belay, H. and Lippeveld, T. 2013. Inventory of PRISM Framework and Tools: Application of PRISM Tools and Interventions for Strengthening Routine Health Information System Performance

Performance of Routine Information Systems Management (PRISM) Tools. 2011.

ms-11-46d.pdf — PDF document, 1,073 kB (1,099,320 bytes)

PRISM: Performance of Routine Information System Management Toolkit -

WHO. 2008. Assessing the National Health Information System: An Assessment Tool. Version 4.00.

Module3: RHIS data management standards: flow, quality, interoperability

(November 13)

Guest speaker: David Boone

Assignments/submissions:

Consultant Report (Assignment 1) due.

Objectives:

By the end of this module, students will be able to:

  • Select indicators for RHIS
  • Design RHIS formats of data collection instruments and feedback reports to facilitate use of the information by health managers
  • Describe basic approaches to data quality assurance
  • Ensure RHIS integration and interoperability

Topics Covered:

  • Overview of RHIS Data Management Standards

-Description of the data collection process

-Examples of data collection tools (e.g., patient/client records, registers/tally sheets, report forms)

-Paper vs. electronic data collection (EMR)

-Challenges of data collection and management in resource poor settings

  • Basics of data quality assurance
  • HIS data management standards validation tool
  • Data flow exercise

Readings:

Boone, David; Cloutier, Suzanne. Standards for Integration of HIV/AIDS Information Systems into Routine Health Information Systems. August 2014. MEASURE Evaluation

Guidelines for Data Management Standards in Routine Health Information Systems. June, 2014. MEASURE Evaluation

Theo Lippeveld. Routine Data Collection Methods. Chapter 6 in Lippeveld, T., Sauerborn, R., Bodart, C. (eds.). Design and Implementation of Health Information Systems. WHO. 2000.

Ronveaux O, Rickert D, Hadler S, Groom H, Lloyd J, Bchir A, Birmingham M. The immunization data quality audit: verifying the quality and consistency of immunization monitoring systems. Bulletin of the World Health Organization 2005;83:503-510.

Module4: Appropriate Use of Information/ Communication Technology
(NOTE: class to be held Friday, November 14)

Guest speaker: Michael Edwards

Objectives:

By the end of this module, students will be able to:

  • Demonstrate understanding of RHIS data presentation and dissemination
  • Make use of appropriate Information and Communication Technology (ICT) for data collection, management, transmission, and presentation
  • Describe the importance of data standards (codes, etc.) and interoperability
  • Explain how the challenges of resource poor settings affect the design of an information system

Topics Covered:

  • Appropriate use of Information and Communications Technology (ICT) for data collection, management and presentation
  • Data visualization including maps and the Decision Support System (DSS)
  • Integration of data from various data sources

Readings:

Edwards, M., Lippeveld, T. Decision support systems for improving the analytic capacity of decentralized routine health information systems in developing countries. Proceedings on the 37th Hawaiian InternationalConference on Health Systems. 2004.

Rodriguez, M., Spohr, M., Lippeveld T., Edwards M. October 2005. Informatics Technology for Use in HIV/AIDS Treatment in Resource-Poor Settings.

Vital Wave Consulting: Landscape Analysis of mHealth in the Global South. 2008.

MEASURE Evaluation: Geographic Approaches to Global Health – A Self Directed Mini-Course. 2011

Module5: RHIS Data Use to Improve Quality of Care at the Health Facility Level
(November 20)

Guest speakers: Sabrina Eagan and Herman Willems, JSI HIV/AIDS Advisors

Assignments/submissions:

Submit draft description of indicators and flow of RHIS data (including data collection forms) relevant to final paper topicin your chosen country(ies).

Objectives:

By the end of this module, students will be able to:

  • Describe and explain the use of and need for information at the facility level

-Determine the steps in a health system/information process that need to go into a flow chart

-Identify the steps in the process that contribute to the problem

  • Give at least one example of a QI intervention and explain what that intervention is meant to improve
  • Understand the challenges of data collection in resource poor settings

Topics Covered:

  • Quality improvement overview
  • Using flow charts at the service delivery level
  • Simulation: Site monitoring of RHIS at HIV and AIDS clinics to improve quality of services in Mozambique

Readings:

LaFond A. et al. Using Data to Improve Service Delivery: a Self-evaluation Approach.

Center for Applied Research on Population and Development (CERPOD) and USAID Bureau of Africa.

David Marsh: Population-based Community Health Information systems. Chapter 9 in Lippeveld, T., Sauerborn, R., Bodart, C. (eds.). Design and Implementation of Health Information Systems. WHO. 2000.

Module6: RHIS Data Use
(December 4)

Guest speakers: Jen McCutcheon (JSI Capacity Building and M&E Advisor), Vikas Dwivendi (Senior Technical Advisor), Deirdre Rogers, and TBD

Assignments/submissions:

Description of how RHIS data relevant to final paper topic areused (or could be used) in chosen country(ies).

Objectives:

By the end of this module, students will be able to:

  • Describe how information can be used various levels of the health system, by governments and communities
  • Analyze the strengths and weaknesses of different ways of presenting the same information

Topics Covered:

  • Process for effectively using data for decision making
  • Methods and examples of using RHIS data at various levels of the health system, by governments and projects
  • Balance score card
  • TBD

Readings:

TBD

Module 7: Presentation of the Final Course Assignments
(December11)

Each group will submit the final paper and present for15-20minutes. The other groups will give feedback.

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