Creating Stronger Health Systems Through Stronger Health Information Systems“Understanding how things work, how you want them to work and how to get there.”

David Lubinski, Group Leader

September 15, 2010

Topics for This Session1. The Challenges Countries Face in Strengthening Their

Health Information Systems2. Towards a Systematic Architected and Rational

Approach to HIS Strengthening3. Results of a Demonstration of this Approach Applied

in LMIS4. Discussion, Feedback, Next Steps

04/19/23 2

Global CEO & Leaders Study Results Escalation of complexity: The

world’s private- and public-sector leaders believe that a rapid escalation of “complexity” is the biggest challenge confronting them. They expect it to continue—indeed, to accelerate—in the coming years.

Not Equipped to Respond: They are equally clear that their enterprises today are not equipped to cope effectively with this complexity in the global environment.

Creativity is Key: Finally, they identify “creativity” as the single most important leadership competency for enterprises seeking a path through this complexity.

This study is based on face-to-face conversations with more than 1,500 chief executive officers worldwide. Released May 2010

A National Health System is Complex

Inte

rnal

Aud

it

Hos

pita

l & L

ab

Serv

ices

Man

agem

ent

Serv

ices

Med

ical

Ser

vice

s

Nur

sing

Ser

vice

s

Hum

an R

esou

rces

fo

r Hea

lth

Fina

ncia

l Res

ourc

es

Dis

ease

Con

trol

&

Prev

entio

n

Dru

g &

Med

ical

Su

pplie

s

Supp

ort S

ervi

ces

Plan

ning

&

Info

rmati

on

Prim

ary

Hea

lth C

are

Governorate SouthGovernorate WestGovernorate North Governorate East

Dis

tric

t N1

Dis

tric

t N2

Dis

tric

t N3

Dis

tric

t N4

Dis

tric

t E1

Dis

tric

t E2

Dis

tric

t E3

Dis

tric

t E4

Dis

tric

t W1

Dis

tric

t W2

Dis

tric

t W3

Dis

tric

t W4

Dis

tric

t S1

Dis

tric

t S2

Dis

tric

t S3

Dis

tric

t S4

Justi

ce

Tour

ism

and

Cul

ture

Tran

spor

tatio

n

Mar

ine

Reso

urce

s

Soci

al W

elfa

re

Labo

r

Ener

gy a

nd P

ower

Trad

e &

Indu

stry

Inte

rnal

Affa

irs

Loca

l Gov

ernm

ent

Land

s

Publ

ic W

orks

-Hou

sing

Publ

ic A

ffairs

Agric

ultu

re

Hea

lth

Nat

ural

Res

ourc

es

Info

rmati

on &

Med

ia

Fore

ign

Affai

rs

Fina

nce

A National Government

5

Core Functional Domains of a Health SystemFunctional Domain Sample Processes Users

1. Community Services Patient registrationPatient record updating

Healthcare workerSupervisor

2. Facility Services Patient registrationBirth registration

Health workerSurveillance officer

3. Laboratory Services Specimen CollectionResult reporting

Healthcare workerLaboratory tech

4. Human Resources Create new positionTransfer employee

HR officerDistrict manager

5. Supply Chain Order medicinesStore medicines

District managerStore keeper

6. Finance and Insurance Enroll MembersVerify coverage

Registration clerkReceptionist

7. Management & Planning Produce M&E indicator reportsCreate annual operating plan

District managerNational M&E manager

8. Environmental Services Map water quality and accessMap sanitation resources &access

District managerSurveillance officer

9. Knowledge & Information Create care delivery protocols Access research and protocols

Program managerDistrict health officer

10. Infrastructure Management Manage cold chain equipmentCreate facility construction plan

National EPI managerProgram manager

04/19/23 6

Sources de

Financement

Structure d'appro-

visionnement

1er point de stockage

2ème pointde stockage

3ème point de stockage

ETAT BANQUE MONDIALE

FONDSMONDIAL

PNA(Population)

USAID

UNICEF USAIDPNA

PNA

Systèmes d'approvisionnement des produits pharmaceutiques au SENEGAL. Avril 2008

FNUAP

GAVI

MEDICAMENTS ESSENTIELS

ARVsPALUDISMEY compris ACT TB IO

ARVsPed

REACTIFS sécurité du sang

(+ test HIV)VACCINS Préservatifs Contraceptifs

DispositifsMédicaux

Etat

Bailleurs multilatéraux

Bailleurs bilatéraux

ONG/Privé

JICA

DLSIPEV

RM

Dépôt district

CS PS

DSR

OMS FNUAPJICA

PRA

SEIPS District

CHR SEIPSRelais

CommunautaireCentre de dépistage

VIH/SIDA

PATIENT

Grossistes privés /

Population

Grossistes privés

Grossistesprivés

Officines

Structure dispensatrice

DPCHU CHN Case de Santé

IPPF

GDF

UNITAID

CLINTON

CNTS CLINTON CNLS GDF FHI

CNTS PPJ

Banque de sang

CCACliniques

privés

PNT

Ministère de la Santéet de la Prévention MédicaleProcurement systems for pharmaceutical products – Senegal, Apr

2008

The Supply Chain for Health Products is Complex

04/19/23 7

Architecture Helps With Complexity1. Architecture is a unifying or coherent structure: to be logically

or aesthetically consistent so that all the separate parts fit together and add up to a harmonious or credible whole.

2. “The fundamental organization of a system embodied in its components, their relationships to each other, and to the environment, and the principles guiding its design and evolution.”

3. Leads to common understanding and direction for strengthening systems.

4. Made up of well described and designed building blocks that are reusable to save time, save money and reduce risk of project failure.

Enterprise Architecture Defined• An Architecture driven by specific

requirements of an organization:– A ministry of education for example is an

enterprise comprised of a collection of programs and administrative functions, that share a common set of goals.

– An enterprise might include external partners and providers of services or financing that operate within a country or system.

04/19/23 8

The Goal: Organizations that Perform

04/19/23 9

Enterprise Architecture

TechnicalArchitecture

Information ArchitectureData

Applications

How information systems support the objectives of the organization

How everything fits together across the organization

How the technology fits together and supports the organization

Infrastructure ArchitecturePhones & Computers

Networks & Communications

Functional Architecture

Principles, Objectives, Policy

Functional Requirements

How the organizationis structured & works to meet its objectives

People that would benefit from technology have a difficult time talking to the people

that create it, Scott Adams captured it brilliantly…

April 19, 2023

Topics for This Session1. The Challenges Countries Face in Strengthening Their

Health Information Systems2. Towards a Systematic Architected and Rational

Approach to HIS Strengthening3. Results of a Demonstration of this Approach Applied

in LMIS4. Discussion, Feedback, Next Steps

04/19/23 11

12

Systematic Architected Rational Approach for Solution Development

*”SDLC” software development life cycle, “OS” operating systems, “TCO” total cost of ownership.

Deploy Develop Design

ContextProblemsUsersProcessesRequirementsTCO*/budget

SpecificationsData ModelUser InterfaceDevice typesInterfacesStandards

SDLC*Dev ToolsData baseOS*NetworkRoad map

User TrainingMigration planInfrastructureSupport staffMaintenanceTCO*/budget

1 2 3 4

Analysis

Most funding is focused hereNeed more attention here

04/19/23 13

Global Health Local

1

2

1.No health impact until you

get into the green box.

2.Path #1 leverages global

standards & architecture.

3.Path #2 leverages global

standards, architecture and

others’ R&D.

4.Country solutions need to

work as part of a national

health information system.

From Architecture to Impact

04/19/23 14

Example of What a Common Architecture Building Block Looks Like

04/19/23 15

Example of what a Common Solution Building Block Looks Like

04/19/23 16

Global Health Local

1

2

1.No health impact until you

get into the green box.

2.Path #1 leverages global

standards & architecture.

3.Path #2 leverages global

standards, architecture and

others’ R&D.

4.Country solutions need to

work as part of a national

health information system.

From Architecture to Impact

17

Requirements Foundation: The Collaborative Requirements Development Methodology (CRDM)

1. Partnership with the Public Health Informatics Institute to adapt a proven methodology evolved over 10 years of domestic U.S. public health practice

2. Collaborative approach to determine and document common requirements is the core of the methodology

3. As applied to global health supply chain the CRDM was designed to be: Collaborative across communities of global subject matter experts,

global stake holders, country subject matter experts, country stakeholders & users

Collaborative across vertical disease programs including vaccines, reproductive health, essential medicines

Collaborative across four countries Viet Nam, Kenya, Rwanda & Senegal

Topics for This Session1. The Challenges Countries Face in Strengthening Their

Health Information Systems2. Towards a Systematic Architected and Rational

Approach to HIS Strengthening3. Results of a Demonstration of this Approach Applied

in LMIS4. Discussion, Feedback, Next Steps

04/19/23 18

Facilitated Process Analysis to Produce Draft Processes and Facilitated Process Analysis to Produce Draft Processes and RequirementsRequirements

Facilitated Process Analysis to Produce Draft Processes and Facilitated Process Analysis to Produce Draft Processes and RequirementsRequirements

Collaboratively Determining Logical WorkflowCollaboratively Determining Logical WorkflowCollaboratively Determining Logical WorkflowCollaboratively Determining Logical Workflow

04/19/23 21

Capture logic and requirements through nontechnical modeling

Where the work takes

place

Person who does the work

Beginning of the process

Discrete work activity or task

Decision point in the work flow

Logical flow of work and/or data

Sub-process that contains a set of

tasks

Critical clarification or

annotation

Process links to next page

Capture comments and

feedback

Language of Health Users and Experts That is Easy to Understand & Share

04/19/23 22

ID BUSINESS PROCESS

ACTIVITY ENTITY / FUNCTIONAL ROLE

REQUIREMENT (The system must or should…)

1.1.1 Requisition Estimate Need Program Manager Display consumption data

1.1.2 Requisition Estimate Need Program Manager Estimate stock needs according to defined rules

1.1.3 Requisition Estimate Need Program Manager Display open orders

1.2.1 Requisition Determine Current Available

Program Manager Display current available on hand quantity of each stock item

1.2.2 Requisition Determine Current Available

Program Manager Estimate current stock levels at lower levels

1.3.1 Requisition Issue Requisition Program Manager Create requisition based on need

1.3.2 Requisition Issue Requisition Program Manager Provide lead time for stock receipt

1.4.1 Requisition Transmit Requisition

Program Manager Print the requisition

1.4.2 Requisition Transmit Requisition

Program Manager Submit requisition

12 52 168

EPI Store KeeperEPI Store KeeperEPI Store KeeperEPI Store Keeper PharmacistPharmacistPharmacistPharmacist

LogisticianLogisticianLogisticianLogistician Stock PickerStock PickerStock PickerStock Picker

Country Validation with LMIS UsersCountry Validation with LMIS UsersCountry Validation with LMIS UsersCountry Validation with LMIS Users

The Language of the Software Architect

04/19/23 24

GoodsOrderUnique IdentifierDepartment

SetPrice( )SetPriceInCurrency( )Cancel( )

GoodsListGoodsEntryStockItemQuantity

RequisitionFileDateIssueDate

LoadFinancials( )Submit( )

FinancialInfoBudgetCodeAccountCostCenter

<<Interface>>IApproverARDecision( )RequestConcurrence( )IssueHold( )LogToAudit( )

1 1*

Business Class Unified Modeling Language (UML) Model

The Language of the Software Engineer in C#

04/19/23 25

namespace PathLMIS {public class GoodsOrder { …

// Requisitions for placement of orders // Status of requestion updated by IApprover interface // Last update, 2010-03-20 by RJA, Approved by JL public class Requisition : GoodsOrder, IApprover { public Requisition() { this.fileDate = new Date(System.GetDate()); this.issueDate = new Date(-1); // Date will be set when approved }

private Date fileDate; Date FileDate { get { return this.fileDate; } }

/// <summary> /// LoadFinancials - set financial information on requisition after authorization /// </summary> /// <returns>Returns true if values are set</returns> public bool LoadFinancials(int departmentCode, int authorizationCode){ bool flag = true; if (CheckUserAuthorization(this.submitter, authorizationCode, departmentCode) == false) { this.financials = new FinancialInfo(); flag = false; // Failure to authorize } else { FinancialInfo fi = CompanyFinancials.Lookup(deparmentCode); this.financials = fi; } return flag; } }

How are these requirements being used? 1. Used to develop RFPs to evaluate software in the

market2. Used by developers to develop technical

specifications and write software3. Used to evaluate what is already installed to

compare how well it meets requirements and develop plans to enhance existing applications

4. Used by commercial off-the-shelf product companies to build products more in line with user needs

04/19/23 26

Topics for This Session1. The Challenges Countries Face in Strengthening Their

Health Information Systems2. Towards a Systematic Architected and Rational

Approach to HIS Strengthening3. Results of a Demonstration of this Approach Applied

in LMIS4. Discussion, Feedback, Next Steps

04/19/23 27

Thank youขอบคุ�ณMerciلك شكرا

謝謝您Cảm ơn bạnThank You

AsanteShukranDankeGrazieDank jeGracias