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  1. 1. Presenters: Jupitar Sanasam & Avantika Gupta Moderator: Prof. Brogen Singh Akoijam Management Information System
  2. 2. OUTLINE 1. What is MIS 2. Evolution of MIS 3. Why is MIS important 4. How to organize MIS 5. Current trends in MIS 6. Advantages & Limitations 7. Conclusion
  3. 3. “It can be defined as a system, which provides the required information to each level of management at the right time, in the right form, covering the desired quantity and quality, so that it may form the basis of decision-making” MANAGEMENT INFORMATION SYSTEM (Davis G.B. and Oslon M.H. Management Information system Conceptual foundation, structure and Development)
  4. 4. Basic terms Management: Process of planning, decision making, organising, leading motivation and controlling the human resources, financial, physical, and information resources of an organisation to reach its goals efficiently and effectively Information: The processed data that helps the management in planning, controlling and operations Data: Data means unstructured raw facts, observations or unevaluated messages in isolation System: A collection of components that work together to achieve a common objective
  5. 5. Important concepts in healthcare management Effectiveness: How well the objective is met Efficiency: How well the health sector is using its resources to achieve that goal Equity: • Access to healthcare is the basic right of all people • The absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically
  6. 6. Scope of Management (Health)
  7. 7. Management cycle Planning Organization Implementation Evaluation
  8. 8. Health information sources Information from other sectors System organized on a national scale Information as a result of purposeful effort or as an outcome of activities at local level Findings of special surveys
  9. 9. Health information sources Information from other sectors System organized on a national scale Information as a result of purposeful effort or as an outcome of activities at local level Findings of special surveys • Population censuses, Civil registration system • Periodic reports by health ministry, or other ministries on political economic and social situation • Five year development plans
  10. 10. Health information sources Information from other sectors System organized on a national scale Information as a result of purposeful effort or as an outcome of activities at local level Findings of special surveys • Routine service records and registers maintained by health personals at different levels • Periodic work done and activities undertaken by health personal
  11. 11. Health information sources Information from other sectors System organized on a national scale Information as a result of purposeful effort or as an outcome of activities at local level Findings of special surveys • Undertaken for objectives such as case detection for TB, leprosy, blindness and malaria etc. • Ongoing surveillance for communicable disease, cancer registry etc
  12. 12. Health information sources Information from other sectors System organized on a national scale Information as a result of purposeful effort or as an outcome of activities at local level Findings of special surveys • Social, demographic and economic status, developmental activities, village water supply system • Educational system and extension of education in various fields such as agriculture, animal husbandry
  13. 13. Decision Support system Management Information system Office support system Transaction support system Executive support system Tacit Knowledge Explicit Knowledge Information Basic Data Operation Support system Management support system Types of information system
  14. 14. Decision Support system Management Information system Office support system Transaction support system Executive support system Types of information system •Ensures that all of the contractual, transactional, and customer relationship data is stored •Includes daily accounting, sales registry etc. Routine work like daily data entry, process documents and daily report •Creates reports/information for managers •Corrective decision and action •Helps to take decision on a small scale, e.g. management of human resources •Takes inputs from MIS, DSS, and other side information for future planning and decision
  15. 15. Uses of health information • Measurement of community health & Community diagnosis • Finding solution to health problems • Prioritization & Planning of interventions • Directing and controlling health programmes
  16. 16. • Development of procedures, definitions, classification and methods of collection, analysis, storage and retrieval of data • Establishing administrative standards • Determination of met and unmet health needs
  17. 17. • Monitoring & evaluation of health programmes • Carry out Information-Education-Communication activities for community and decision-makers • Demand social support for health activities • Support health legislation
  18. 18. Characteristics of health information (WHO) • Population based • Problem oriented • Avoid unnecessary agglomeration of data • Employ functional and operational terms (e.g. episodes of illness, treatment regimens, Lab test)
  19. 19. • Express information briefly and imaginatively (e.g. Tables, charts, percentages • Facility for data feed back must be present
  20. 20. “A mechanism for collection, processing, analysis, and transmission of information required for organising and operating health services and also for research and training” (Conference on HIS, WHO/EURO, 1973) Health Information System (HIS)
  21. 21. HIS and MIS • MIS has a more specific and limited objective and scope • It provides information support necessary for decision making for effective management of health organization • MIS also involves evaluation and monitoring • MIS implies immediate action on information
  22. 22. Resources Indicators Data sources Data management Information products Disseminati on and use Components of HIS Legislative, regulatory, and planning framework, ICT, manpower and finance Indicators which determine health system inputs, outputs, and outcomes, and health status Population based (Census, surveys, and civil registration) Institute based data, occasional health surveys, research Collection, storage, quality- assurance, flow, processing, compilation, and analysis Data transformed into information basis for evidence and decision making Value enhanced by making it readily accessible to decision makers
  23. 23. Health Management Information System (HMIS) It is a Government to Government (G2G) web-based Monitoring Information System that has been put in place by Ministry of Health & Family Welfare (MoHFW), Government of India to monitor the National Health Mission and other Health programmes and provide key inputs for policy formulation and appropriate programme interventions
  24. 24. Objective of HMIS • To provide reliable, latest and useful health information to all levels of health officers and administrators • To amend health policies and working system on the basis of feedback, received from health information system • To provide information about periodically and time bound programmes and for mid term evaluation • To contribute towards achievement of objectives of health policies and programmes. • To increase efficiency and quality in health management.
  25. 25. Year and event Content 1982 MIES- Management information and Evaluation system was tried to be introduced but has not taken roots 1983 national health policy Envisaged a nationwide organizational setup to procure essential health information 1983-85 Development of HMIS with WHO collaboration and National Informatics Center (NIC) Evolution of HMIS
  26. 26. Year and event Content 1986-88 HMIS version 1.0 in four participating state of Gujarat, Haryana, Maharashtra and Rajastan 1989 Field testing of the HMIS in one district of Gujarat, Haryana, Maharashtra and Rajasthan 1990-95 Implementation efforts in 13 states and Union Territories in phased manner Evolution of HMIS Contd.
  27. 27. Year and event Content 1996 March review meeting To take note of the changes suggested by the implementing states and revise the HMIS 2.0 1997 CBHI organised a workshop To take note of the changes suggested by the implementing states and revise the HMIS 2.0 21st Oct, 2008 HMIS web portal started under NRHM 4th April, 2021 Virtual launch of IHIP Evolution of HMIS Contd.
  28. 28. IMPORTANCE of HMIS • It transforms data inputs into information output for use by decision makers • Produces information needed by Patients, communities, service providers, program managers, policymakers, providers of funds, global agencies and organizations • Identification and allocation of manpower and other resources
  29. 29. • Effective and efficient uses of resources • Performance evaluation of program • Detect and control emerging and endemic health problems • Monitor progress towards health goals; and promote equity
  30. 30. OUTLINE 1. What is MIS 2. Evolution of MIS 3. Why is MIS important 4. How to organize MIS 5. Current trends in MIS 6. Advantages & Limitations 7. Conclusion
  31. 31. Steps of Organizing HMIS
  32. 32. 1. Definition of Information requirements Relevant Valid Accurate Ease of handling Useful Adequate Reliable Timely Complete Action- oriented Economics Levels of decision- making Review the existing system Format of information
  33. 33. 2. Define data needs of relevant units within health system Determine the data elements needed Identify the indicators needed by each level to perform its functions Differentiating data (routine data collection system vs special studies)
  34. 34. Major data elements • ANC care • Intra-natal care • Post natal care • Child immunization • Family planning • Mortality • Patient services • Adolescent health • Laboratory testing • Other programs under NHM Key performance indicators (KPIs) • % of 1st trimester registration • % PW received 4 ANC • % PW fully immunized • % institutional deliveries • % C-Section • Sex ratio at birth • % children fully immunized • OPD/IPD per lakh population • % male/ female sterilization
  35. 35. 3. Determine the most appropriate & effective data flow Flow of data in most of the states follows the bottom up approach SC SC SC PHC PHC PHC CHC CHC District Hospital
  36. 36. 4. Conversion of data into information 5. Time bound collection, processing and transmission of data / information • Frequency and exact point of time at which these steps are to be achieved is to be laid down and strictly adhered to • Processing at different levels in the upward flow would tend to convert bits of data into useful information. 6. Develop training programs according to needs and levels of target groups
  37. 37. District Hospital CHC Sub- Centre PHC Monthly report NRHM/DH/3/M 5th of following month District HQ State HQ Monthly report NRHM/CHC/3/M 5th of following month Monthly report NRHM/HSC/3/M 5th of following month Monthly report NRHM/PHC/3/M 5th of following month Data capturing unit Report submitted electronically Quarterly report NRHM/DHQ/2/Q 10th of month of quarter Monthly report NRHM/DHQ/3/M 10th of following month Annual report NRHM/DHQ/1/A 5th April Quarterly report NRHM/SG/2/Q 10th of month of quarter Annual report NRHM/SG/1/A 15th April Response for state collected All states submitting their reports to centre National HQ Report generation at different levels
  38. 38. 7. Analysis, regrouping and presentation of information • In order to make the system flexible enough for all the states without much complexity, the concept of data aggregation unit (DAU) was devised • DAU is the place where the data is collected and consolidated • Certain basic requirements: Availability of Computers, Internet Trained Personnel – Nodal M & E Officers HSC HSC HSC PHC PHC Block HQ CHC District Hospital SDH District HQ DAU State HQ
  39. 39. 8. Interpretation, comparison, evaluation HMIS Reports Standard reports Analytical reports Live reports
  40. 40. Key Objectives Comparative assessment Highlights inequities Facilitates use of exiting HMIS data Visual presentation
  41. 41. 9. Feedback, identification of problem HMIS Checking When? Monthly checking of entered data at district and facility level
  42. 42. Validation is performed by comparing values of ≥ 2 data elements that are comparable Common validation rules
  43. 43. 10. Decision-making and activity planning 11. Monitoring and evaluation of system 12. Periodic review of MIS
  44. 44. Performance of HMIS at a glance Currently around 2.06 Lakh health facilities are reporting data every month Performance at glance: 6th Jan, 2020
  45. 45. 5th April, 2021
  46. 46. Integrated Health Information Platform (IHIP) is a web- enabled near-real-time electronic information system that is embedded with all applicable Government of India's e- Governance standards, Information Technology (IT), data & meta data standards to provide state-of-the-art single operating picture with geospatial information for managing disease outbreaks and related resources
  47. 47. IDSP Functional Needs IDSP Data and Information Products IDSP Portal Users Envision integrated near real-time eSurveillance Empower public health surveillance workforce Ensure sustained financing & continued leadership Embed innovation for data quality, accessibility IDSP ICT Master Plan 4 pillars 3 components
  48. 48. Key features of IHIP Near real- time information Single operating picture Integration of data Geospatial epidemiology Public health surveillance attributes One health approach Person Place Time Geocode
  49. 49. Cross sectional view of IDSP information system Single operating picture
  50. 50. One health approach One Health: Interconnectedness of human health, animal health and the ecosystem IHIP Ministry of Health & Family Welfare Ministry of Agriculture & Farmers Welfare Ministry of Home Affairs Ministry of Environment, Forest and Climate Change(MoEFCC) Ministry of Earth Sciences Ministry of Electronics & Information Technology
  51. 51. Geospatial epidemiology Can describe & analyse geographic variations among diseases NIC portal: • Maintains data of public health assets such as schools, airport locations, road networks, geographic & political boundaries • Hosts vast amount of high resolution satellite imageries that are of use to emergency preparedness & response activities
  52. 52. Near real- time information High-level architecture (based on health surveillance informatics principles and best practices) Application Module Approach and Capabilities Data Integration Data collection IDSPApp on handheld devices IDSP web portal /store-forward Line listings and aggregate Automated geo-tagging of all appropriate fields Data Management Near real-time Lossless data storage Integration of IDSP data with relevant datasets from GoI/CRS, and other entities. Data Analytics and Forecasting Location based alerting algorithm for analysis and projection Automated alert generation Automated Geospatial trend analysis and visualization Data visualization Results displayed on navigation maps, satellite imagery and other modes Dynamic dashboard (mapped to time, place, person and custom rules) Business Intelligence and reports Automated outputs Custom Summary, PDF, on-screen display Custom reports made available at all levels on relevant reports to ANM; DSU, SSU and CSU Documentation and Support Cloud server (NIC BSNL) Standalone server Scalability to all states and within each state; API based data exchange Use of innovation Provide opportunities for private sector engagement
  53. 53. A vision to monitor public health for action in near real-time
  54. 54. Integration Proposed integration of data sets through IDSP Data Linked Record System
  55. 55. India’s integrated health information architecture
  56. 56. IDSP’s current data collection effort at state level
  57. 57. IDSP’s access to ICT infrastructure Mobile computing platform Store-and- forward
  58. 58. What are the essential differences between previous and new IDSP portal? Capture aggregate data only Paper-based data collection Not to link data from S, P & L forms Weekly surveillance Monitor only 13 health conditions IDSP Capture disaggregate data at all levels Analysis provided on mobile phones Link data from S, P, L, EWS 1 & 2 forms Integrate with ongoing surveillance programs Monitor >33 health conditions Capture real-time data IHIP
  59. 59. Sr. No. State (Total no. of Districts) No of Districts implementing IHIP No of Districts (ever) Reported S Form P Form L Form Issues in implementation 1 Andhra Pradesh (13) 13 13 13 13 Training completed 2 Himachal Pradesh (12) 12 12 12 12 Training completed 3 Karnataka (30) 30 29 30 30 Tablets distributed in all Districts. Training of HWs to be completed in District Ramnagaram by next week and data entry will be started. 4 Kerala (14) 14 10 14 12 Integration between E health & IHIP 5 Odisha (30) 17 6 12 8 Computer & internet connectivity issues. Training completed in 11 Districts out of 17. Tablets distributed in all Districts. 6 Uttar Pradesh (75) 10 2 10 10 Training completed in all 75 Districts. Tablets distributed only in 10 implementing Districts. Proposal for computers to be sent with gap analysis and justification. 7 Telangana (33) 33 32 33 33 Hyderabad has no S form reporting unit, Hence not reporting. Total (207) 129 104 124 118 1st Phase IHIP Reporting Status (26.11.18 - 16.09.2019)
  60. 60. Sl. No. State Districts covered in ToT training Plan for District. Training (Initiated or not) 1. Arunachal Pradesh 19/25 Planned in Sep-Oct 2019 2. Uttarakhand 14/14 October 2019 3. Assam 27/27 To be initiated 4. Meghalaya (along-with Assam) State level officials only To be initiated 5. Nagaland (along-with Assam) 1/10 To be initiated 6. Sikkim (along with Assam) -- To be initiated 7. Madhya Pradesh 51/51 Ongoing, Completed in 24/51 8. Gujarat 33/33 On-going 9. Dadar & Nagar Haveli (along-with Gujarat) 1/1 To be initiated 10. Daman & Diu (along-with Gujarat) 2/2 To be initiated 11. Haryana 5/22 Planned in September. 12. Goa 02/02 Completed 13. Maharashtra 36/36 To be initiated 14. Manipur 16/16 Planned in November 15. Bihar 38/38 On-going 2nd Phase IHIP implementation status
  61. 61. WHO personnel facilitating training of participants from DSU on IHIP-IDSP at Manipur Health officials trained on IHIP in Mokokchung, Nagaland • WHO has supported refresher ‘trainings of trainers’ for all state-level officers, and trainings of > 2500 have been completed • At the district-level, trainings and refresher sessions have been completed in >600 districts, in which >64,000 participants were trained
  62. 62. Information on IHIP Disease summary Dashboard Real-time Lab confirmed cases of health conditions Summary downloadable real-time charts Real-time view of lab-confirmed cases of And progression and daily/weekly monitoring of activity Real-time end-to-end management of outbreaks Manage health facilities along with the list of health workforce, essential and emergency medicines and supplies within them. View heatmaps and distribution of lab-confirmed cases. Time place and person (patient case summaries)
  63. 63. 13th Dec, 2019: Manipur becomes the first in North East to implement IHIP IHIP in Manipur Less reporting
  64. 64. NMIS (Nursing management information system) KAMIS (Kala-Azar Management Information System) NCCMIS (National Cold Chain Management Information System) eVIN MERA ASPATAAL (MA) Web based Malaria Management Information Systm NIKSHAY / NIKSHAY AUSHADHI TMIS (Training Management Information System)
  65. 65. ANMOL Launched on World Health Day, 2016
  66. 66. 12 Dec, 2019: Health & Family Welfare Minister L Jayantakumar Singh distributed 20 ANMOL (ANM On Line) tablet to the nurses serving in Tengnoupal District
  67. 67. COVID-19 & MIS •Data analytics and forecasting underpin decision making •Provides information on effectiveness of policies and decisions •Facilitates MIS
  68. 68. Objective: To avail real-time health data of patients in home isolation for prompt response
  69. 69. Manipur: NHP for COVID-19
  70. 70. Advantages of MIS in Healthcare Informed decision making Planning Monitoring Evaluation Inter- operability at various levels Increased patient satisfaction Research Easy data handling Integrated warehouse of information Increased EWAR Data standardi- zation Cost- effective Patient engage- ment Data security Account- ability
  71. 71. BUILDING BLOCKS FOR VISION 2035: Public Health Surveillance in India Architecture Proposed flow of information
  72. 72. Limitations of MIS in Healthcare Private sector involvement Systemic errors Unclear expectations Training needs assessment at all levels Non-quantifiable indicators (quality of care) Feedback mechanism Lack of motivation
  73. 73. Conclusion HMIS is a tool which helps in gathering, aggregating, analyzing and then using the information generated for taking actions to improve performance of health systems Vision of IHIP is an essential part of India’s National Digital Health Plan and NHP 2017 goal towards greater accountability Critical step in any MIS is effective utilization of the information generated, which requires strengthening of management
  74. 74. Conclusion To enable IHIP implementation: Hands on trainings to be conducted for all manpower Identification of data entry point within existing manpower Procurement and Distribution of Tablets at the earliest Proposal for unavailable logistics to be made in PIP after gap analysis and justification.
  75. 75. References • WHO. Developing Health Management Information Systems: A PRACTICAL GUIDE FOR DEVELOPING COUNTRIES. Regional Office for Western Pacific:WHO;2004 [cited 2021 June 23]. Available from: https://apps.who.int/iris/bitstream/handle/10665/207050/9290611650_eng.pdf?sequence=1&isAllowe d=y. • Ka M, Periyasamy AG, Venkatesh U, Kishore J. A situation model of integrated health information platform in India: an anticipated review. IJCPH. 2020 Mar;7(3):1197. https://www.ijcmph.com/index.php/ijcmph/article/view/5929. • MoHFW (Statistics Division). Score Card User Manual Using HMIS Indicators. New Delhi:MoHFW;2008 [cited 2021 June 23]. Available from: https://nrhm- mis.nic.in/GuideLine/Guidelines%20for%20developing%20Score%20Card.pdf.
  76. 76. References • HMIS. HMIS MANAGERS’ MANUAL User Manual for Web Portal & DHIS2. New Delhi:MoHFW;2011 [cited 2021 June 22]. Available from: https://www.nrhm- mis.nic.in/Part%20A%20HMIS/Understanding%20Health%20Management%20Info rmation%20Systems/Manager's%20Manual.pdf. • IHIP. Mission. New Delhi:MoHfw;2021 [cited 2021 June 26]. Available from: https://ihip.nhp.gov.in/idsp/#!/mission. • HMIS. State Fact Sheet: FY 2018-2019 (April -March). New Delhi:MoHFW;2018- 19 [cited 2021 June 24]. Available from: https://nrhm- mis.nic.in/hmisreports/analyticalreports.aspx.
  77. 77. THANK YOU

Hinweis der Redaktion

  • Web based MIES form flow
  • Validation checks are a part of all HMIS softwares and can be used by data entry operators to check for sources of error.
  • Mobile based or tablet based data collection facility (real time or offline data collection abilities)
  • Data standardization- help in easy comparison and cross analysis
  • Data standardization- help in easy comparison and cross analysis