Evaluation of an Integrated Health Information Management System within Public Health Center in Jakarta

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1 Evaluation of an Integrated Health Information Management System within Public Health Center in Jakarta Puspa Setia Pratiwi Faculty of Information Technology, YARSI University Sri Puji Utami Faculty of Information Technology, YARSI University Abstract Health information system is one of the four main strategies of health development in Indonesia. The health information presented by the system must be accurate, timely and complete so as to be a major part of making the right decision. Developments in information technology and telecommunications result in changes of the role of information technology systems in helping organizations become more efficient. The information system is part of a system in an organization that utilizes the information to meet the needs and solve the encountered problem. The implementation of health information systems in Indonesia has been started since the early 1970s. Today, there are several types of applications of Health Information Systems Public Health Center Management Information System, Hospital Management System, Information Systems Surveillance, Health Information Systems Integration Health Center. This study aims to evaluate the implementation of a management information system that supports the health center of national health information systems. The methodology used in this study is qualitative in Jakarta Health Department to conduct interviews and observations as a method of data collection systems. Field of Research: Information System, Health Information Management, Jakarta 1. Introduction Today, there are several types of applications of Health Information Systems ( HIS): PHC Management Information System, Hospital Management System, Information Systems Surveillance, and Health Information Systems Integration Health Center. This study aims to evaluate the implementation of a management information system that supports the health center of national health information systems. Public Health Centers need to innovate on an ongoing basis, in order to improve services to the public to help achieve the vision which is necessary to develop a number of new and existing modules with priorities according to the urgency of the needs of existing businesses. In this case the applications that need special priority include the patient record systems and medical records to improve public health services, business intelligence systems will be necessary to be developed A Health Information Management System (HIMS) is meant to provide reliable information to managers at various levels of the health system in a timely manner. It supports decision making in the areas of policy, planning, management, monitoring and evaluation of health systems including it's programs and services. There could be several barriers contributing to underutilization of data. For instance, inappropriateness of collected data, data gatherers' inability to analyze, interpret and present data/information to decision. makers and decision makers' uncertainty on how best to utilize the available data, credibility of information, 'information overload', etc. The Jakarta District Health Information Management Systems (HIMS) is currently still far from ideal, and not able to provide data and evidence-based health information for the development of effective health care. Various problems were encountered in the operation of classical HIS. Among those problems are the data and information management activities have ISSN: Page 100

2 not been integrated and coordinated in a good cooperation mechanisms. The presence of "overlapping" the collection activities and data process, where each unit independently collect data with different instrument in each unit of work in both the central and regional levels. HIS consent for themselves is still not done efficiently, is still going on a "redundant" data, duplication of activities, and inefficient use of resources. This is a result of the existing HIS which is still fragmented (Health Information Systems Roadmap, 2012). The purpose of this study is to identify the needs of the health center information management systems to support quality health services at the health center. 2. Literature Review Health Information Systems (HIS) is an information system that can selectively capture data from the lowest level and manage to support the upper level decision making in the field of health (MOH, 2001). Health Information on the implementation system includes three sets of main activities, namely the collection and processing of information, analysis, presentation and reporting of health information, and utilization / use of health information. 2.1 The collection and processing of information District level data collection / Municipalities typically organized as part of the National Health Information System (SIKNAS), which in many countries is the only system in the effort to provide comprehensive data. The program implementers can also be one of the resources at the district/municipality. They usually do their own data collection separately and often more action oriented, timely, and general use than systems running routine. The approach undertaken, among others, for the collection of health information is a simple survey official standard, the other approach is a method developed by the social sciences to collect qualitative information on the various factors of trust, behavior, satisfaction, and perceptions. Other health resources can be obtained through the civil registration system, general surveillance, laboratory, and investigation of outbreaks. Adequate knowledge of health management at the district/ municipality to interpret the available information for managerial decision making. The use of computers is usually viewed as an essential component in the development of health information system and management in the field of health information. Handling and processing large amounts of data are collected from information systems to become more capable of being managed. Although computers can speed up processing, but does not guarantee to overcome the weaknesses of the information systems. In addition it has been argued that there are 5 types of data collection that each individual has a specific and very significant interest, namely: a. Surveillance b. Recording and reporting of routine data from UPT district/municipality to the District Health Office/municipality. c. Recording and reporting of specific health programs that exist, such as malaria eradication programs, etc. d. Recording and reporting of resources and health administration has been running like health workforce. e. Survey and research to supplement the data and information from routine data collection which includes both national and provincial and district levels. 3. Methodology 3.1 Data Collection The data for evaluation were collected by in-depth interviews of the health workers. In depth interview method was chosen because, unlike focus group discussions, it gave the ISSN: Page 101

3 opportunity for one-to-one interaction, and individual opinions could be elicited. Health workers from the Jakarta health district were interviewed to identify the benefits of computerization in public health centers by using the HIMS. Data collection was carried out in September This was a descriptive study and a semi-structured in-depth interview guide was used as study instrument. The study instrument had questions under different domains such as record keeping, data quality, supervision and feedback and overall usefulness of the computerization of HIMS. 3.2 Analysis of Qualitative Data The interviews were recorded in a voice recorder. A coding framework was prepared based on the interview schedule. Transcription of data was done in Bahasa Indonesia (local language), and later translated to English. 4. Results 4.1 Inputs The possibility of error in the input charging HIMS as the possibility of human error can still occur. The technical support to the HMIS subsequently has been taken over by the IT personnel assigned by the head of the PHC. The PHC staff subsequently has to solve the hardware problem by themselves. Minor problems in software continue to arise requiring some programming modifications. These are regularly taken care of by the staff in the district level. 4.2 Organizational Training: Figure 1: The Interface of the HIMS The current technical staff has been trained in use of computerized HMIS at the time of its installation. A training manual has also been prepared. Finances: There is no separate budget for the HMIS. The entire funding for this program comes from AIIMS under the budget head for the rural health program. All the staff, infrastructure, resources are inclusive of the whole program, and not especially for HMIS. ISSN: Page 102

4 At each health center designated by the head of PHC, each one HIS Coordinator who is responsible for the maintenance of both hardware and software systems. The general coordinator who has the capacity diverse in terms of technical IT, therefore health centers ( not all ) will recruit temporary staff / honorary having more IT knowledge. For HIMS software malfunction, the city health office always coordinate with health centers in terms of repair and maintenance of the software, for hardware maintenance and repair of health centers working on their own. Parties who became technical support at the level of HIMS provincial health office. 4.3 Operational System: The modules contained in the registration entries such HIMS, medical record entry, payment entry, the entry of drugs, the correction payment, the module information / reports, system administration module. The parties involved in the development consists HIMS: Jakarta Health Agency and Third Party (IT consultant), health centers during the initial implementation. Maintenance: Monitoring of central system to use is not routinely performed, monitoring and application software maintenance is if there are reports of damage / problems by health centers which will be followed up with a repair or re-installation with attention to existing conditions. Monitoring of the implementation HIMS (data information ) can not be done due to unavailability of tool/system that collects data from each health center that has conducted HIMS at provincial level (Provincial Health Office) as well as monitoring the implementation of HIMS every health center, implementation of internal HIMS only limited help health centers in managing their information systems are part of the process of recording and reporting on the health center Figure 2 The Flow Chart Diagram of the HIMS ISSN: Page 103

5 4.4 Outputs Reports generated by the system including reports related to transactions outside the health center building activity data, a specific report regarding program requirements, drug stock reports, statements infrastructure (annual), integration with the referral system and calculating claims. Not all reports are generated based on a standard format. The accuracy of HIMS if viewed in terms of accuracy in the calculation of patients and visits (registration of related transactions) is good enough. In terms of health center visits, head of health centers by the end of the service can instantly find out the number of patient visits by type of payment and how the resulting levy payments, drug issued, etc. Information on the largest number of diseases that exist in the working area can be seen that a health center can then help the health center chief to make decisions/specific intervention involving heads of regional administrations and other organizations across sectors. The data collected and generated by HIMS can be used as a program-specific reports, these reports are managed by individual program managers at the provincial health district. No Constraints Benefits 1 If a lot of patient data, a computer error Installation is easy and does not require hardware with high specification 2 Data entry is easy but if there is an error the process can not edit data Is a stand-alone application does not require additional hardware as servers 3 Not all reports are generated based on a standard format Already quite accurate in terms of counting patients and visits (registration of related transactions) 4 Software installation is not practical, when in contact with the virus need to reinstall Office of Health Information on the greatest number of diseases that exist in the working area can be seen that a health center can then help the health center chief to make decisions / specific intervention involving heads of regional administrations and other organizations across sectors 6 There is no public health data analysis features Able to generate reports of visits and the disease recapitulation is based on a specific time period Table 1. Constraints and Benefits of the current HIMS No Name Description 1 Improved Business Process Fitur pengaturan wewenang dokter terhadap data rekam medis pasien diperbaiki 2 Application Integration Integrating applications until sub-district level. 3 Repair Database Without changing feature, perform reengineering database structure to support the simple recording 4 Improved recording Feature Patient data and health recording feature should be more user friendly 5 Repair Reporting Feature Perbaikan fitur pembuatan laporan, adanya fasilitas pelaporan yang lebih mudah 6 Analysis feature. Adding analysis feature of health data, such as epidemics or outbreaks of certain diseases. 7 Monitoring and Evaluation Feature Adding features monitoring and evaluation of each principal activity centers. Table 2. Priority Development and Improvement for The Next HIMS 5. Conclusions From this study we conclude that : i) Health centers need to innovate continuously, in order to improve public health service to the community. ISSN: Page 104

6 References ii) In order to help to achieve the vision, health centers need to develop new modules according to the urgency of the needs of existing businesses. iii) Computerization has enabled implementation of a good system for service delivery, planning, monitoring and supervision. In future, it can also provide a platform for convergence of different services related to social sectors. iv) Output HIMS application: a) The current HIMS has produced several reports on the disease, b) The current HIMS is less accurate because of it may still possible of wrong output c) The current HIMS results have not been relevant to the needs of users due to not cover the entire program at the health center, d) results of the HIMS have been used in health centers to report activity data related to transactions outside the health clinic buildings (Public Health Center), a specific report regarding the program, drug stock reports, statements infrastructure (annual), and integration with the referral system and calculating claims [1] Health Information Systems Roadmap ".Indonesia Health Department, Jakarta, 2012 [2] AbouZahrl, C., and Boreal, T., 2005, Health Information System, the Foundation of Public Health in Bulletin of the World Health Organization, August [3] Aqil A, Lippeveld T and Dozumi D. PRISM framework: a paradigm shift for designing, strengthenin and evaluating routine health information systems. Health Policy and Planning 1 12, 2009 [4] Improving the quality and use of health information systems: essential strategic issues. Health Informations System Knowledge Hub [5] Institute for Health Metrics and Evaluation Krishnan et al. Evaluation of computerized health management information system for primary health care in rural India. BMC Health Services Research, 2010 [6] Pressman, Roger S Software Engineering: Practition Approach. Prentice Hall [7] Yusof MM, Paul R. J. & Stergioulas L. K.Towards a Framework for Health Information System Evaluation. Proceeding of the 39th Hawaii International Conference on System Sciences, UK ISSN: Page 105