forging a (ehealth) health information system - a multi-axial enterprise approach
TRANSCRIPT
6th HELINA Conference, Abidjan, 2009
Forging a Health Information Systems Framework:
A Multi-Axial Enterprise Approach
Dr Ime AsangansiHealth Information Systems Programme, Nigeria
& University of Oslo, [email protected]@matnat.uio.no
6th HELINA Conference, Abidjan, 2009
Presentation
• Introduce terms and concepts• Offer a practical tool• Stimulate inquiry
6th HELINA Conference, Abidjan, 2009
Questions• What is a (health information)
system/infrastructure?• What are the existing systems/components?• How do these inter-relate/integrate?• What framework could unite all these?
6th HELINA Conference, Abidjan, 2009
A system• Actors• Behaviour• Heterogeneity• Interdependency• Scaling /hierarchy• Non-predictability
6th HELINA Conference, Abidjan, 2009J. Yasha Kresh Integrative Systems View of Life: Perspectives from General Systems Thinking p8 in Complex Systems Science in Biomedicine Ed. Deisboeck TS and Kresh JY Springer NY 2006 ISBN 0-387-30241-7
6th HELINA Conference, Abidjan, 2009
Problems• Fragmentation• Issues with communication/collaboration• Silo thinking – lack of awareness of other
possibilities
6th HELINA Conference, Abidjan, 2009
What is the need for a big picture/framework?
Results
Our Goals
Actors & actions
"Side Effects"
Actions ofothers
Their Goals
6th HELINA Conference, Abidjan, 2009
Managing Complexity
Arnie Levin, New Yorker, December 27, 1976
Michael L. Deaton – Univ of Pitt Environmental/Health Summit, 2007
6th HELINA Conference, Abidjan, 2009
Managing Complexity – “silo” thinking
Arnie Levin, New Yorker, December 27, 1976
Michael L. Deaton – Univ of Pitt Environmental/Health Summit, 2007
6th HELINA Conference, Abidjan, 2009
Complexity – systems/framework thinking(Consequences)
Arnie Levin, New Yorker, December 27, 1976
Michael L. Deaton – Univ of Pitt Environmental/Health Summit, 2007
6th HELINA Conference, Abidjan, 2009
So, what are the existing health information systems? - Architectures, Frameworks, Applications
What are their components?• Actors• Processes• Domains• Hierarchy
6th HELINA Conference, Abidjan, 2009
Multi-axial (modular) Framework• Should take into considerations all the
components separately – actors, processes, domains, hierarchy
• Decomposable high-level framework into lower-level matrices and practical artefacts
• Continuously developed based on action research methodology – loops of observation, reflection and use (action)
• DHIS as national system
6th HELINA Conference, Abidjan, 2009
Actors (Types)
Hierarchy
ProcessesModulesDomains
National
People - Paper-based, electonic tools Hardware & communication arch.Data elements/Indicators
Public Health/StatisticalEMRs/EHR modules
Administrative systemsSupply (drugs, etc)
management systemFinancial systems
ICT support systemSocial welfare/faith-based
systems
PlanningRequirements specification
Information cyclesM&E (input, processes, output,
outcome)Deployment
Verification/TestingOptimization
Maintenance/Support
Household
Community
Facility
LGA (district)
State
6th HELINA Conference, Abidjan, 2009
Household Community
Facility LGA State
People Family membersIndividualsTBAs
Village Health workersCHEWsTBAs
Clinicians,PharmacistAnd other workers
M&E officersDistrict workers
Public health physiciansEpid.Statistician
Tools Household forms – child health cards
Community health forms
Facility registersEMRs
LGA formsDHIS + Statistics
State summaryDHIS
Hardware Mobiles, TV,Internet
Mobiles Mobiles e.g DHIS MIDP
Computers ComputersInternet
Data elements/indicators
Person unique identifiers,Household data elements
IdentifiersHealth profileCommunity tally sheets
Health facility data set
District minimum dataset
State minimum dataset/indicator
Matrices from the Framework
6th HELINA Conference, Abidjan, 2009
Example – Actors vs. HierarchyHousehold Community Facility LGA State
People Family membersIndividualsTBAs
Village Health workersCHEWsTBAs
Clinicians,PharmacistAnd other workers
M&E officersDistrict workers
Public health physiciansEpid.Statistician
Tools Household forms – child health cards
Community health formsJavaRosa
Facility registersEMRs – OpenMRS
LGA formsDHIS + Statistics
State summaryDHIS
Hardware Mobiles, TV,Internet, Computers
Mobiles Mobiles e.g DHIS MIDP
Computers ComputersInternet
Data elements/indicators
Person unique identifiers,Household data elements
IdentifiersHealth profileCommunity tally sheets
Health facility data set
District minimum dataset
State minimum dataset/indicator
6th HELINA Conference, Abidjan, 2009
• Reusability – design with sharing in mind• Software factories – shared IT artefacts• Taxonomic – shared terms• Ontological – shared meaning
6th HELINA Conference, Abidjan, 2009
Implications – Leaning on Game theory1. Gains in time and money across projects
2. Improved collaboration and connection between people, domains, processes and hierarchies.
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6th HELINA Conference, Abidjan, 2009
Open ‘Lego Bricks’
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Multi-axial enterpriseFramework
Matrices65431 2
12111097 8
National HIS Architecture
1 1172
National HIS Solutions
B BAA
HIS SolutionsAAAAA A
BBBBB B
Modified from Lubinski
6th HELINA Conference, Abidjan, 2009
• Collaboration based on HMN tools viz-a-viz multi-axial enterprise framework
• Further development & testing- AR• WHO Bulletin (IJPH) paper on HMN -upcoming• MEDINFO 2010 Panel• Further work on “generativity and innovation in
the health information system framework/infrastructure”