Health Management Information System (HMIS) – SIK

Health Management Information System (HMIS) – SIK
It is systematic approaches for the healthcare system to collect, manage, and share data and information between various levels. Most of it uses software; however, some still remain with paper forms such as TBIS. For some diseases, such as Tuberculosis, pilot programs like MyTB has been developed by health officer from Kelantan state and is currently being used and assessed in some district offices only, MyTB is not being used at SIK DHO at the moment. There is no separate unit which govern HMIS in the DHO, each subsystem is used and maintained by their respective departments.

E-NOTIS

It is formerly known as CDCIS. It is not a software that is installed on your computer, but a website. In contrast to other softwares like VEKPRO, it can be accessed by anyone with the registered username and password, anywhere, on any computer. The link is http://enotis.moh.gov.my. For SIK DHO, the unit that uses E-notis is mainly Communicable Disease Control (CDC). For the user account of PPKP of CDC, SIK, only information of patients from SIK is available; similarly, user account of State Health Officer will be able to access patients information from that particular state only.

It serves as a two-way communication tool, i.e. data flow from peripheral to center as well as from center to peripheral. For instance, if a dengue is newly diagnosed and confirmed by Sik Hospital, it will be notified to the State Health Officer, and he will then key in the data of that new case into the system. Then, the information will be available to SIK DHO and appropriate actions will be carried out. Conversely, if a disease is diagnosed at a DHO, the data entry is to be done by the DHO and available to the state as well as central level. However, this is rare because only confirmed cases will be entered into the system and confirmation normally done by laboratories in larger centers. Diseases covered by E-notis include Dengue/DHF, TB, HIV/AIDS etc.

The officers in charge are expected to keep themselves updated daily by logging in everyday. E-notis enables real time information sharing and make the notification process faster and easier. However, this system is vulnerable to technical problem such as system corruption, lack of IT support etc.

VEKPRO

This is software which is installed on selected computers in the DHO. Unlike E-notis, whatever data being entered into the software is available only to that particular computer user. It covers various vector-borne disease such as Dengue, Malaria, Filariasis, Japanese Encephalitis etc. However, only Dengue, Malaria, Filariasis are being used in SIK. It enables the Vektor Unit to record all the activities and findings into the system, e.g. new cases, its associated data, Aedes survey findings and appropriate actions.

However, the software is not capable of analyzing data and the PPKP has to count the number of cases as well as plot graphs manually. As mentioned earlier, it does not support communication of data online like E-notis, hence, the data file has to be saved and emailed to higher level as reporting at regular intervals.

Water Quality System (WQS)
This is a software used by Kawalan Mutu Air Minuman (KMAM). It functions like VEKPRO, enables the officer to record all the readings obtained from every trip for water sampling. Each data sheet belongs to a sampling station, in that sheet are various columns for the readings, such as turbidity, conductivity, chlorine level etc. Again, the report has to be saved and emailed to higher level for reporting. The WQS is only installed on one computer per DHO, and the officer in charge has to bring the computer to the State Health Office for the installation process. Previously, the software installed on the computer was found to be problematic after returning from the State Health Office and therefore the software was not used for a few years. Until 2008, a newer version of WQS was launched and it is this second version of WQS that is in used at SIK DHO at the moment. Even the SIK District Health Officer and PPKPK are not able to view reports from WQS simply because they do not have the software installed on their computer and WQS does not support report printing function. The officer in charge felt personally that the software is not very helpful at this stage, and the use of this software is still at an infancy stage.

Tuberculosis Information System (TBIS)
In contrast to all the previous subsystem, this is neither a software nor a website. It is merely a system which uses paper forms to record information about Tuberculosis. Various forms are available for different purposes.
Form 10A1 – details of the patient
Form 10A2 – details of the treatment
Form 10C – for contact tracing
Form 10D – to inform defaulter
Form 10K – for transfer of patients to other district
Form 10J – for patients who die while receiving treatment, or those who die within 6 months after cessation of treatment

E-measles
This is a website which functions like E-Notis and it is not cuurently used by SIK DHO. The link is http://emeasles.moh.gov.my.

Family Health Management Information System (FHMIS)
Objectives:
- To assist in planning for future needs and evaluation of performance
- To control the quality and effectiveness in Family Healthcare Delivery System
- To help in development of standardization in Maternal and Child Health Delivery
- To standardize the reporting system in Maternal and Child Health

It functions at various levels, including National level, State level, District level and Rural Health Unit Level.

Functions:
1. Production of data required to assess the performance at various levels.
2. Generation of routine reports.
3. To be integrated with other subsystems of HMIS for various purposes.

4. To give rooms for improvements in the future.

Prepared by Ng Kim Lai (0600484)

Health Management Information System - Kota Star

HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS).

HMIS is responsible for collecting information to be used in the effective planning, development, coordination and evaluation of the individual programme. It also allows the monitoring of existing programmes. It is also a decision support system for health management. This system links information to managerial concern. At the same time, accurate, timely & accessible health care data play a vital role in the planning

Vision.

· To Achieve Excellence in Health Information Management to Support Evidence Based Decision Making to Improve Health Outcomes and strengthen Health Governance.

Objective.

· To provide the policy and strategic framework for better health information management in the country
· To provide directions on the legislative and regulatory changes necessary to support the action plan
· To determine the organization and action plan to enable the translation of policy to practice
· To clarify the responsibilities of the stakeholders and coordination activities required to support the action plan
· To identify building blocks necessary to support the change
· To determine the skill match and training required to support the change

Advantages.

HMIS e-Reporting system reduces the time in preparing returns and reports because it decreases the time used in calculating totals & aggregating data (PKD, JKN, IDS). It also improves the quality of data through the validation at source. At the same time, there is a standardisation & consistency of data through the usage and application of facility Codes and National Health Data Dictionary (NHDD) elements.

HMIS e-Reporting System.

HMIS e-Reporting system is an electronic reporting system for the collection, collation and analysis of Health information in MOH facilities. A web-based reporting system has been developed through which all health and health related data from MOH facilities, non MOH facilities and the private sector are transacted to ensure timely and quality health information.

The HMIS e-Reporting system uses Microsoft Excel as a formatted spreadsheet application for the collection of source data at the Facility level and is aggregated at the Submitting Location for online submission to the Information Documentation System Unit (IDS) of the Ministry of Health. The set of Excel files used in the collection of data locally at the Facility level is known as departmental ‘Workbooks’ while the files used at the Submitting Location for submission of aggregate data are known as the ‘Returns’.

Examples of
Facilities are : Klinik Kesihatan, Hospital Departments, Dental Clinics and their respective
Submitting locations are : District Health Office (DHO), Medical Records Office, District Dental Office

System Components.

· E-forms in Excel formatted-worksheets at DHO
· E-Forms System in application software at DHO
· E-Reporting Portal which is accessible to authorized users via the internet.

Roles.

KK
Prepare data / returns & sends to PKD

PKD
Receive data from KK and compile District Returns
Submit completed Returns electronically to IDS

JKN/PKB/PKK
View and verify submissions in Portal and State Reports
Follow-up with District Health Office to correct Returns
Monitor submission status of Returns from Districts

IDS
Monitor submission status of Returns from State
Quality-check aggregate Reports produced by system
Produce Annual Reports
Produce ad-hoc reports from database
Provide support to users

Program Managers
Provide support to users preparing the Returns
View reports in Portal

Data Collection, Reporting & Processing.

Data is collected through e-forms application from all hospitals, health office and clinics in electronic format. Data collection is done through standardized data interface format for collection of relevant data for the returns from the existing electronic systems e.g. THIS (Total Hospital Information System), CDCIS (Communicable Disease Case Information System), SMRP (Sistem Maklumat Rawatan Perubatan – Medical Treatment Information System), FOSIM (Food Safety Information System of Malaysia) and so on.

At district level, data is sent monthly to the District Health Office from the Klinik Kesihatan and Klinik Desa. One such example is the data on Maternal Child Health. The data under Maternal Child Health includes a number components which can be seen in the diagram below :

The work process begins with the District Health Office (DHO) compiling returns from different units. After the compilation process, DHO will then submit the returns electronically via the e-Forms system to the Central Database at the IDS Unit. The Returns and State Reports will also be verified by the State Health Office through the e-Reporting Portal. IDS Unit of Ministry of Health will be responsible for the processing and dissemination of information generated. The information will then be published by IDS in the form of monthly and annual reports. The Web-based portals also allow access to all reports and publications, distribution of updated versions of e forms application as well as interface with other relevant agencies like Statistics Department. JKN and Programs Manager are also able to track status of submissions and view the National and State Aggregate Reports.

HMIS Subsystems.

Family Health Information System.

The Family Health Information System is a system where all the components of Family Health are incorporated inside and sent to the central database for verification and processing. Under this system, there are many subdivisions which are as listed below :

KIB – Kesihatan Ibu (Maternal Health) - 6
KKK – Kesihatan Kanak-kanak (Child Health) - 8
PKW – Kesihatan Wanita (Women Health) - 1
KSK – Kesihatan Sekolah (School Health) - 3
PKR – Kesihatan Remaja (Adolescent Health) - 4
PKWE – Perkhidmatan Kesihatan Warga Emas (Elderly Health Service) - 2
KZM – Pemakanan (Diet) - 1

Total Returns - 25

Each of these units from every Klinik Kesihatan will be sending their data to the District Health Office where it will be compiled collectively by the Medical Record Assistant (Qualification – SPM). The keying in of data is also done by the same person and all the Returns will be sent to IDS in the Ministry of Health on a monthly basis (before the 10th of each month) according to the work process mentioned above.

Periodical Reports of Family Health Information are as follows :

Maternal Health (KIB).
· Monthly/Annual Report of antenatal care – KIB 201A Pind. 2/2007
· Annual coverage of antenatal mothers, average visit to clinics and Immunisation of Anti-tetanus Toxoid – KIB 201B Pind. 2/2007
· Monthly/Annual Report on number of births and postnatal care – KIB 202A Pind. 2/2007
· Percentage of home delivery by different personnel and trained staffs (Ministry of Health/Private) - KIB 202B Pind. 2/2007
· Monthly/Annual Reports on maternal mortality rate, stillbirths and death of children less than 7 years old - KIB 203A Pind. 2/2007
· Annual Reports on maternal mortality rate, stillbirths and death of children less than 7 years old - KIB 203B Pind. 2/2007
· Monthly/Annual Report on neonatal jaundice and G6PD deficiency according to health clinic, district health office and state - KIB 205 Pind. 2/2007
· Monthly/Annual Report of home visit - KIB 206A Pind. 2/2007

Child Health (KKK).
· Monthly Report of child health with regards to clinic session and visit to clinic – KKK 201A Pind. 2/2007
· Annual coverage baby, children (1-4 years), pre-school children (5-6 years) and average visit to clinic for children according to age group - KKK 201B Pind. 2/2007
· Monthly/Annual Report for Immunisation DTP, HIB, DT and Japanese Encephalitis - KKK 202A Pind. 2/2007
· Annual Report for Immunisation DTP, HIB, DT and Japanese Encephalitis - KKK 202B Pind. 2/2007
· Monthly/Annual Report for Immunisation Polio, Measles, MMR & Hepatitis B - KKK 203A Pind. 2/2007
· Annual Report for Immunisation Polio, Measles, MMR & Hepatitis B - KKK 203B Pind. 2/2007
· Monthly/Annual Report for Immunisation Rubella - KKK 204A Pind. 2/2007
· Monthly/Annual Report in usage and control of vaccine stock - KKK 205A Pind. 2/2007
· Monthly/Annual Report for health staffs, blood donors and drug addicts who are tested for Hepatitis B and given the immunization as well as babies who are given Hepatitis B immunization in government hospitals - KKK 209 Pind. 2/2007
· Monthly/Annual Report of children in need of special care 0-18 years - KKK 206 Pind. 2/2007

Women Health (PKW).
· Monthly/Annual Report for family planning – PKW 201 Pind. 2/2007
· Monthly/Annual Report of pap smear taken and positive results according to lab reports - PKW 202 Pind. 2/2007
· Monthly/Annual Reports on pap smear results based on agency - PKW 203 Pind. 2/2007
· Annual Report for family planning for new users according to methods, ethnic, age group and parity at district, state and national level - PKW 204 Pind. 2/2007
· Monthly/Annual Report on control of usage and stock for family planning - PKW 205 Pind. 2/2007

School Health (KSK).
· Monthly/Quarter-yearly Report on Pre-school health service/School health about diseases among pre-school and school children – KSK 201A Pind. 2/2007
· Monthly/Annual Report on immunization for pre-school/school children - KSK 202A Pind. 2/2007
· Coverage Report in school health immunization service - KSK 202B Pind. 2/2007
· Annual Report on pre-school/school health - KSK 203 Pind. 2/2007

Adolescent Health (PKR).
· Monthly/Annual Report on Adolescent health service – PKR 201A
· Annual Report on Adolescent health service – PKR 201B
· Monthly Report on Adolescent health service – dietary habit status/adolescent morbidity - on Adolescent health service – PKR 202A

Elderly Health Service (PKWE).
· Monthly/Annual Report on elderly health – PKWE 201A
· Monthly/Annual Report on elderly health – PKWE 201B

Diet (KZM).
· Monthly/Annual Report on full cream milk powder – KIB 210 Pind. 2/2007
· Monthly/Annual Report on dietary habit standard for children below 5years – KKK 210A, B and C Pind. 2/2007
· Monthly/Annual Report on KZM children who receive and never receive help – KZM 201 Pind. 2/2007


HMIS-TB and TBIS.

HMIS-TB is a system of collection of data based on clinic or treatment centre. At the same time, notification of communicable diseases including tuberculosis is sent and registered at the district health office. This leads to a lot of contradiction in terms of data between the treatment centres and district health office. It also indirectly causes the failure of the Epidemiology Unit and State Health Office to obtain accurate information about tuberculosis cases in their own district although they are supposed to be responsible in the coordination of control and preventive measures.

As such, a new system which is known as the Tuberculosis Information System (TBIS) has been developed to overcome these problems. The characteristics of TBIS include :

1. District Health Office becomes the centre of data collection, monitoring and reporting of all tuberculosis-related activities in the district.
2. Main reports begin from District Health Office except for simple reports regarding the location of patients who are receiving treatment and laboratory services which begins from treatment centre.
3. State report will only be sent to the ministry every 3 months and annually.
4. All cases of tuberculosis including those which are notified by private healthcare facilities will be registered under the District Tibi Registry according to their residence when diagnosis was done. That registration number will be permanent and the registration at other districts is strictly prohibited although they can change their treatment centres for their own convenience.
5. Patients’ information are given more importance to evaluate the effectiveness and achievement of DOTS. This allows a comparison to be done between Malaysia and other countries in line with requirement of World Health Organisation.

This new system allows the coordination of data collection and notification for tuberculosis in the whole country. With this information, the District Health Office is able to carry out the control and preventive measures in a more effective manner.

The TBIS format is prepared for 3 major activities which are the handling of patient and contacts, laboratory services and BCG immunization. Each of these components has 3 formats according to usage which are accessory (daily handling), registration and reporting. The serial numbers(for forms) below 100, 100 and 200 are for accessory, registration and reporting respectively. The summary of the numbering is as shown in the table below :

In Kota Star, the health inspector-in-charged of TBIS will receive all TBIS 10A-1 forms from all the government clinics in the district, but not from the hospitals. The information from the forms will be transferred to the e-notis online database, which is a registry for all diseases. The information from here is automatically transferred to the myTB database, which is updated with more information and gives more detailed information, including treatment progress, defaulters and results.

For cases reported in hospitals, all the TBIS 10A-1 forms will be recorded in e-notis by the Recording Department of the hospital. Like the previous ones, this info will also be automatically transferred to myTB database. However, the myTB database can only be updated by the health inspector of the district health office who will be receiving the TBIS 10A-1 forms from the hospitals.

Communicable Disease Case Information System (CDCIS).

CDCIS is an online programme to register the new cases of many communicable diseases such as Dengue fever, cholera and hand, foot mouth disease. The cases can be reviewed by the higher levels of organisation once the cases are registered. This enables the tracing of the number of new cases reported for a certain disease and as such, precautions can be taken before the communicable diseases spread. The cases will be notified by the doctors either in the general or private hospitals who come across any of the diseases which are in the notification list. Doctors will call up the Health Office to notify them and provide them with necessary information.

Previously, all the information will be sent from the district to the state and finally to IDS in Ministry of Health with the use of diskettes. However, this information can now be sent directly via the online system known as e-notis. E-notis encompasses most of the communicable diseases which includes HIV. Once the information is entered into the system, only certain fields can be edited such as the status of the laboratory results. However, the status and information for HIV patients cannot be edited as this disease is recognized to be not reversible by the system.


VEKPRO.

VEKPRO is a stand alone system for the recording of vector- borne diseases such as dengue fever, malaria and filariasis. This system is another recording system for the vector unit apart of e-notis to monitor the status of certain diseases. The data is compiled and sent to the State Health Office ideally on a daily basis. The difference between VEKPRO and e-notis is that the keying in of data into VEKPRO requires the fulfillment of a few criterias whereas for e-notis, such conditions are not necessary. For example, a dengue case can only be recorded into VEKPRO if the patient is having certain criterias such as fever more than 38oC, joint pain and so on. As for e-notis, the case has to be keyed in even though the patient is suspected for dengue but is not having the symptoms as stated in the VEKPRO system.