An integrated approach to HIS strengthening Ministry of Health, Belize

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1 An integrated approach to HIS strengthening Ministry of Health, Belize

2 Institutional readiness Understanding the Universal Health Problem System development methodology How mature is our HIS Best practices Recommendations/strategic direction

3 Political will, we had it! (HSRP: better information; better decisions; better health outcomes) Organizational directors championed the ideology of using technology and well defined processes as drivers for HIS strengthening Country-ownership identified as a necessity for sustainability

4 The challenges of health care are universal and the same. There is a need to improve: Access to health care Resource utilization Clinical care Preventative medicine The key to successfully improving health outcomes is through proactive sectorwide management using: Accurate information Precise information Timely information For decision making

5 Some common concerns shared by many healthcare decision makers around the world: Lack of unique patient identifiers Lack of standards causing variation in the quality of data Lack of interoperable data sets across the health system Lack of complete data sets

6 Source and deploy a sustainable HIS that provides every citizen with one lifetime EHR, recording accurate and precise data in an encounter centric fashion accessible securely and nationally in a timely fashion.

7 Reports and queries Country Level HIS reporting repository Users of health information Patient records Resources records Health accounts Census Household surveys Vital Registration Reporting repository Population-based Data sources Institutional-based Data sources Belize embarked on HIS strengthening with a focus on facility based data sources

8 Get the owners and users involved Problem solving approach Establishing activities Capital Investments Revision of scope Divide and conquer Design system for growth and change

9 Fully integrated National Health Information System Provides every citizen with an EHR Seamlessly supports individual and public health Links the Government with citizens, hospitals, clinics, pharmacies and labs throughout the nation Ensures that relevant data is appropriately and immediately available throughout the sector Uniquely addresses the global requirements for evidence based management

10 Electronic Health Record and ADT Clinician Order Entry (e-prescriptions) Medical Laboratory and Testing Financial Maternal Child Health HIV/AIDS Supply Chain Management and Inventory Control

11 Level 1 Initial: chaos Level 2 Repeatable: Project management established Level 3 Defined: Methodology Level 4 Managed Measurable goals for quality and productivity established Level 5 Optimized System continuously monitored and improved based on analysis

12 Supply Chain Management Annual Medical Supplies Expense BZD 8,905, BZD 9,546, BZD 10,088, BZD 9,300, % Reduction Last Year

13 Adverse Reactions to Pharmaceuticals during Hospitalizations in Belize ~ 90% Reduction Final BHIS Deployment * Quarter 1, 2009 Estimated from 2 Months of Data

14 Effective disease management: better information leading to better decisions

15 Hypertension (Essential) age 65

16 Increased access to information through management reports Web accessible, Program Specific Reports

17 Persons Tested & IgM Positive Cases Clinical Dengue (Classic) and DHF Cases Improved completeness of data (case counting) Dengue Cases by Epidemiological Week Epidemiological Week # Tested at CML IgM Positive Dengue Clinical Dengue (Outpatient) Clinical DHF (Outpatient)

18 Improved surveillance and response time: Automated reporting based on disease thresholds

19 Political and ministerial champions Focus on end user support and not the technology: by people focused Promise to Proof: fragile stage in the implementation of HIS but necessary for 100% acceptance Country-ownership! Phase approach Train the trainer

20 Reinforced legal and Regulatory Framework Enhanced ICT Infrastructure Integrated and expanded national HIS Improved Data Management Human resources and capacity strengthening Enhanced dissemination and use of health information

21 Next steps in strengthening Belize s Health Information System BHIS Local Node Admission & Discharge MCH Clinician Order Entry Laboratory Supply Chain Public Health Finance Facility Users An informed population Better health. Improved development Central IT Office TLS Local DB Local Reporting Server SS # Validation System Master Server TLS National Repository Backup Reporting Requirements From MOH to NHI TLS TLS NHI SIB Input and Output of statistics National HIS Web Portal SSB UB Research VRS Birth & Death Certificates Statistical Request Marriages Certificates Census Information Research Publications Hotel & Restaurant Ranking System New Born Child Registration System Birth & Death Registration Civil Society Alerts and reminders to patients from their doctors Web Services

22 Representatives from 12 countries came together to share experiences and lessons learned from the design and implementation of the BHIS as well as the strengthening process of their national health systems. Objectives: Raise awareness of the processes and their complexities in designing and implementing Electronic Health Records information systems increased. Information on the Health Metrics Network (HMN) Framework and Tools disseminated. Action plan to promote a harmonized framework for health information systems development (including standards, systems and processes) among Barbados, Eastern Caribbean Countries, Jamaica, Trinidad and Tobago drafted

23 Develop national health information systems that are harmonized across the Caribbean Region. Create a Regional Strategic Framework to guide the creation of harmonized national health information systems capable of monitoring regional indicators, health initiatives, and international and regional commitments (e.g. Millennium Development Goals) across the Caribbean Region. Endorse the framework, tools, and guides developed by HMN as standards for assessing national health information systems and guiding the health information systems strategic planning process Adopt a regional approach to resource mobilization from The Global Fund to Fight AIDS, Tuberculosis and Malaria and other international funds and partners for development of health information systems. Recognize the BHIS as a best practice of an integrated countrywide electronic information system to be used as a model for the Caribbean Region Forge regional collaboration in acquisition and deployment of quality health information systems solutions to achieve economies of scale Promote and support improved health information management and integrated health information systems for achievement of health-related Millennium Development Goals

24 PostgreSQL Sybase SQL Server MySQL Belize Health Information System Jamaica Health Information System Barbados Health Information System Hospital data store National HIS repository NHI Hospital data store National HIS repository NHI Hospital data store National HIS repository NHI Clinic data store SSB Clinic data store SSB Patient EHR accessible on demand throughout region Aggregated information Patient EHR accessible on demand throughout region Aggregated information Clinic data store National HIS repository SSB Oracle St. Lucia Health Information System Montserrat Health Information System Hospital data store NHI Regional DW Hospital data store NHI National HIS repository Clinic data store SSB Clinic data store SSB DB2 CAREC CDC WHO PAHO Decision Support Data Marts: Official Aggregated Information Standards, policies, legislation, common platform = harmonized HIS

25 THANK YOU

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