Using Health Information for Health System Improvement

Using Health Information for Health System Improvement – Syllabus (2015)

Using Health Information for Health System Improvement for Brandeis University HS327f, Fall 2015, Module II Syllabus

Dates: November 3 – December 15, 2015 Time: 9:00 – 11:50 on Tuesdays Location: Heller G-3 Course Instructors: Theo Lippeveld, Deirdre Rogers, Herman Willems

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). Health Information Systems (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), and starting this year the Sustainable Development Goals (SDGs).

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 have improved. 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.

Two key frameworks have been developed to measure the performance of health information systems and plan for their improvement. (1) 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 used to serve as a benchmark for baseline assessments of the National Health Information System. (2) 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 place ongoing 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.

1 Using Health Information for Health System Improvement – Syllabus (2015)

This course will follow the concepts promoted by both the HMN and the PRISM frameworks to review and better understand the health information systems that guide decision-making, leading to better health. By the end of the course, 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 of 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 RHIS in terms of the production of quality information and use of information at all levels of the health system, and what the contribution is of 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). Ms. Deirdre Rogers and/or Dr. Herman Willems, both Senior Technical and Monitoring & Evaluation Advisors at JSI, will co-teach and 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 (40%) 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). a) 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) b) 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 5 pages (double spaced). It is required to be written using APA format with references (not included in page numbers) cited appropriately throughout the text. The Consultant Report is due at beginning of class three, 9:00am on November 17. NO LATE PAPERS!

 Final Assignment (30%) In-class group assignment. A scenario will be presented, and then each group will take one aspect to analyze, summarize and present. Aspect will be randomly assigned to each group.  Team One: Resources  Team two: Indicators and Data Management  Team Three: Data Sources  Team Four: Data Quality  Team Five: Dissemination Each group will have about 2 hours for the assignment, followed by group presentations. The 10-15 minute summary presentations should include: 1) Primary problems (3-5) in your assigned areas of the HIS assessment 2) Underlying causes of those problems (e.g., resources, coordination, capacity, guidance, supervision) 3) Solutions in the short and medium term for the client (government, etc.) to consider 4) Risks of doing nothing and the benefits of the solutions proposed

Note: We recognize that there are advantages and disadvantages to group projects. In this c ase, we feel that the advantages outweigh the disadvantages. Group projects can spread th e work and instill teamwork skills, which are important elements of HIS as well as project/pr ogram design, management, implementation, monitoring and evaluation. More importantly,

chances are that students who will undertake HIS-related work in the future, either as proje ct staff, external evaluators, or consultants offering technical assistance, will do so in a colla borative fashion. It is thus vital that they become accustomed to working through these pro cesses 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) (November 3)

Lecturer: Theo Lippeveld

Learning Objectives:

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

Understand the essential link between the health system and the health information system (i.e. can explain who needs health information for what, and what data is needed)

Describe the health data sources and give examples of each data source and their categories

Describe the six components of health information system (according to the HMN framework)

Describe what they will learn in this RHIS Course

Topics Covered: ● Health system and health system building blocks; health systems challenges

● Functions of health systems by levels: National, regional/district; health facility; community; individual patient/client

● Information needs for each type of health systems’ functions

● Sources of health information and their categorization

● Components of health information system (according to the HMN Framework)

● Introduction to RHIS Course Objectives and Sessions

● 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. http://www.who.int/healthmetrics/documents/hmn_framework200803.pdf van Olmen et al. Health systems frameworks in their political context: framing divergent agendas. BMC Public Health 2012, 12:774 http://www.biomedcentral.com/1471-2458/12/774

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

Module 2: Assessment of HIS and Routine Health Information Systems (RHIS): Performance, Quality and Use (November 10)

Lecturer: Theo Lippeveld

Define RHIS performance (production, management and use of quality data) Identify and analyze possible constraints for successful implementation of a RHIS

Topics Covered:

● Introduction to framework for assessing RHIS performance

○ PRISM conceptual framework

○ Definition of RHIS performance

○ Determinants of RHIS performance

● Overview of tools to assess RHIS performance

○ PRISM assessment tools to improve performance of RHIS

RHIS Overview Tool

RHIS Performance Diagnostic Tool

Facility/Office Checklist

Management Assessment Tool

Organizational and Behavioral Assessment Tool

o RHIS assessment process, including:

○ Steps to conduct PRISM assessment

○ Analysis and presentation of data

○ Group work - Case study (India)

● Translating assessment results into action plan

○ Develop effective solutions - Designing and prioritizing interventions to improve RHIS performance

○ Advocacy solutions

○ Developing action plans for improving RHIS

● RHIS Monitoring and Evaluation

○ Monitoring: supportive supervision

○ Evaluation: repeated PRISM assessments

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. http://www.cpc.unc.edu/measure/publications/ja-09-99

Aqil, A., Lippeveld, T., Moussa, T., Barry, A. 2012. Performance of Routine Information Systems Management (PRISM) Tools User Guide. http://www.cpc.unc.edu/measure/publications/ms-12-51

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 http://www.cpc.unc.edu/measure/publications/wp-13-138?searchterm=PRISM+invent

Hotchkiss, D., Aqil, A., Lippeveld, T., Mukooyo, E. Evaluation of the Performance of Routine Information System Management (PRISM) Framework: Evidence from Uganda. BMC Health Services Research 2010, 10:188. http://www.biomedcentral.com/1472-6963/10/188

Module 3: RHIS data management standards: flow, quality, interoperability (November 17)

Assignments/submissions:

Consultant Report (Assignment 1) due.

Guest speaker: David Boone

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 and tools - 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

Readings:

Heywood, Arthur; Boone, David. Guidelines for Data Management Standards in Routine Health Information Systems. February 2015. MEASURE Evaluation www.cpc.unc.edu/measure/publications/ms-15-99

MEASURE Evaluation, “Data Quality Assurance” suite of tools (the Data Quality Audit Tool (DQA) and the Routine Data Quality Assessment Tool (RDQA)) http://www.cpc.unc.edu/measure/tools/monitoring-evaluation-systems/data-quality- assurance-tools

Module 4: RHIS Data Analysis (November 24)

Lecturer: Deirdre Rogers

Analyze routine data to produce information products: tables, graphs and maps Understand how these information products can show how the value of an indicator varies between geographic regions, age groups, sexes and diseases as well as how the value of an indicator varies over time (trends) Understand which types of analysis and which types of information products are most appropriate for various types of indicators Label and write appropriate interpretations of information products

Topics Covered:

. Examples of data collection tools (e.g., patient/client records, registers/tally sheets, rep ort forms) . Data flow exercise . Comparison of findings from routine data with findings from other data sources . How a graph can compare different groups or show trends . Choosing which type of analysis to use for various types of indicators . Elements of a good communication strategy (exercise write a paragraph summarizing data, highlighting a need for action and asking for action) . Communication methods that are appropriate for different audiences . Common dissemination vehicles

Readings:

Analysis of health facility data: Guidance for managers and analysts DRAFT. WHO, 2015.

Global Reference List of 100 Core Health Indicators

For the Excel-based course: online tutorial for using Excel to create charts: http://excelcentral.com/excel2007/essential/lessons/05010-create-a-simple-chart-with-two- clicks.html Presenting data effectively: Communicating your findings for maximum impact. Stephanie Evergreen, 2014.

Making Research Findings Actionable: A quick reference to communicating health information for decision-makers. MEASURE Evaluation, 2013. http://www.cpc.unc.edu/measure/publications/ms-09-39/at_download/document

Chart suggestions: a thought starter http://extremepresentation.typepad.com/files/choosing- a-good-chart-09.pdf

Module 5: RHIS Data Use to Improve Quality of Care at the Health Facility Level (December 1)

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

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

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

o 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:

WHO, “Data Quality Review (DQR): Monitoring Health Facility Data Quality Technical Guide - Version 1.0, February 2015

Module 6: Appropriate Use of Information/ Communication Technology (December 8)

Guest speaker: Michael Edwards

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 collectio n, management and presentation . Data visualization including maps and the Decision Support System (DSS) . Integration of data from various data sources . DHIS2 exercise

Readings:

Ritz D, Althauser C, Wilson K. Connecting Health Information Systems for Better Health: Leveraging interoperability standards to link patient, provider, payer, and policymaker data. Seattle, WA: PATH and Joint Learning Network for Universal Health Coverage, 2014 http://www.jointlearningnetwork.org/uploads/files/resources/Connecting-Health-Information- Systems-for-Better-Health-FINAL-20141024.pdf

Definition of Interoperability. HIMSS Website. 2013. Available at: http://www.himss.org/files/FileDownloads/HIMSS%20Interoperability%20Definition%20FINAL.pdf.

Stansfield, Sally. Orobaton, Nosa, Lubinski, David, Uggowitzer, Steven, and Henry Mwanyika. The case for a national health information system architecture; a missing link to guiding national development and implementation. http://www.who.int/healthmetrics/tools/1HMN_Architecture_for_National_HIS_20080620.pdf

For the DHIS2-based course: DHIS2 Users Manual available from https://www.dhis2.org/doc/snapshot/en/user/html/dhis2_user_manual_en.html

Module 7: Presentation of the Final Course Assignments (December 15)

Final group assignment (~2 hours) and 10-15 minute group presentations. The other groups will give feedback.