Informacao sobre Saude

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Informacao sobre Saude
Informacao sobre Saude
MSP course
March 2002
Information sobre Saude
• Information system as social system
informacao – information
organizational, social, political, ambiental
Information as social resource
use, purpose, communication, interaction
Information as ‘artifact’
tools, media – meias, documents, systems
Informacao sobre saude
• Information mapping
– Mapping reporting systems
– Registry books, forms
– Reports, documents
•
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•
Information flows
Information audit
Quality and use of data
Information systems for health management
Field research--always
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Who
What
Where
When
Why
How
Field research
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Who
What
Where
When
Why
How
•
•
•
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•
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Quem?
Qual?
Onde? A --? De --?
Quando?
Porque?
Como?
TOOLS
(eg, info systems, computers,
Schedule+ etc)
individuals & teams in
social practices, tools—
artifacts, purposes,
community, rules, division
of labor
OBJECT-OUTCOME
To act as a mediator
between computer
industry and clients
SUBJECT
CommArc
RULES
(inc. values, ethics)
e.g. of a “system”:
Activity system –
COMMUNITY OF
PRACTICE
(other CommArc staff
members, suppliers,
customers etc)
DIVISION OF
LABOUR
Mediating Artifacts, Tools
• Quaternary (where to?): goals RN telephone triage & messaging initiative, desires to transform service to patients & to use RN skills. New tools for
telephone triage & message handling (local tracking systems, EHR design, interactive templates for on-line protocols), “virtual encounters” & telemedicine
• Tertiary (why?): “First I need to get a picture of the patient” (imagination of patient’s clinical context & lifeworld). Models of care (medical/”MD”,
nursing, patient-centered, consumer), ideals about patient-care provider interactions & how patients should be treated; ideals about RN skills, values, service
• Secondary (how?): clinical protocols for assessment & medical advice, clinical documentation, RN professional skills & qualifications, knowledge of
systems, situated knowledge of community, knowledge of communication norms & patterns (to MD, to patient, to appts, to chartroom, to CRD nursing staff)
• Primary (what?): message, medical records forms, telephone, legacy systems data (appt history, outpatient encounters Including.ER but not inpatient,
communication media, information sources, written protocols
Object of
Activity
Subject(s)
• Determine next
step for patient to
get help
• Registered nurse
• Appointment with
whom (specialty,
clinical service)
and when
(urgency) based on
acuity
• Patient
Rules
• Clinical protocols for assessment & medical advice
(implicit/trained. Explicit/written)
• Organizational rules: Fill appt schedules for customer
service & MD productivity
Community,
Community of Practitioners
• Medical Center patient population (250,000)
• Appt system & chart request rules & procedures
• Internal medicine patients with high acuity illnesses
(multiple, chronic)
• RNs given authority to expedite appts & schedule
directly re acuity & to add patients to MD schedules
• Cardiology and Internal Medicine clinical staffs (MDs,
RNs, nursing staff, CRDX
• Scopes of practice: among nursing staff, only RNs
can assess and advise. Between RNs & MDs
• Primary-Secondary-ER: Norms and rules governing
who is responsible for problem(s) presented in
clinical context
• Medical Center staff: non-clinical (appointments
center, chartroom) and clinical (pharmacy, laboratory,
diagnostic imaging) and clinical services (emergency,
hospital, primary care)
Outcome
• Co-constructed
assessment and
medical advice
(RN scope of
practice)
• Improving
message handling
and
responsiveness to
patients
Division of Labor
• RNs scope of practice, roles,
responsibilities
• MDs: diagnosis and treatment, roles of
primary care and specialties. Roles of
multiple MDs caring for a patient
• Appointments Center: receive & route
messages
• Nursing staff (nurses, clinic assistants)
• Patients and significant others
Figure 1: Elements of the Activity System of Telephone Triage -- Preliminary mapping
A chronology of important events in the HISP case.
KEY EVENTS IN THE HISP-CASE
HISP established Last provinces
implement HISP
in Mozambique
Prototyping in
Mozambique
National level
New funding from
endorse HISP for
SW adapted
USAID/NUFU
national rollout
in Malawi
in South Africa
HISP Open
Essential dataset
Day in Cape
implemented in
Town
Eastern Cape Province
First democratic
elections
First essential
dataset implemented
in Western Cape
1994
1995
HISP proposed
by Western Cape
Province
1996
1997
HISP established
in three districts
in Western Cape
1999
1998
First prototype
of DHIS
in Western cape
‘Competing’
Systems are
Recognized as failures
National survey of
standards shows poor
state of affairs
2000
DHIS-software
implemented in
all districts in
Eastern Cape
Survey and DHIS
presented at
NHISSA and subsequently
adopted by Eastern Cape
National Standards
for health data agreed,
processes in all provinces
All provinces part of the
standardisation process
Cyclic development of a hierarchy of essential datasets
TWO TWIN-PROCESSES:
Cyclic prototyping of DHIS software
2001
Prototyping
in India
Figure 3: Hierarchy of standards where each level has freedom to define their own
standards as long as they align with the standards at the level above.
International IS
National IS
Standard
Indicators,
procedures
& datasets:
Community
District
Provincial Information Systems
Province
National
District Information Systems
International
Community & Health Facility Information Systems
Feedback
Feedback
Central level
Admn health program
Statistic and planing dep
•Reports
Provincial level
•Reports
statistic and planing dep.
•Meetings
•Meetings
•Supervision
•Supervision
District level
•District information officer
Health services
HC
Other community sources
HP D. Hospital.
Standard forms
Books
Standard forms
District level
District information officer + 2 representative ( Nur or admin)
Forms + Reports
Reports
Other community sources
Health services
Schools NGO Local Gov
Standard forms
District Hospital/HC/ Priv sector
HP
Nurse chief
Basic health worker
Unions Special
intergroups
Books
Nurse, Doc, Lab men, or farmac
Basic health worker
01-Adilabad
02-Karimnagar
03-Warangal
04-Khammam
05-East Godavari
06-Visakhapatnam
07-Vizianagram
08-Srikakulam
09-West Godavari
10-Krishna
11-Guntur
12-Prakasam
13-Nellore
14-Chittoor
15-Cuddapah
16-Anantpur
17-Kurnool
18-Mahbubnagar
19-Nalgonda
20-Rangareddi
21-Medak
22-Nizamabad
DNHDP
Western Cape
City Health
New /emerging
flow of information
Groote Schuur
Hospital
PAWC
MOU
(Midwife&
obstetric unit)
PAWC
Dental unit 1
PAWC
Dental unit 2
PAWC
Dental unit 3
PAWC
Youth
Health
Services
City Health
Clinic 3
City Health
Clinic 1
School
Health
City Health
Clinic 2
Geriatric
Services
Day Hospital
DNHPD
Psyciatric
hospital
PAWC
Births
Deaths
Notifiable
diseases
Outside
hospitals
City Health
Clinic 4
City Health
Clinic 5
Private hospital:
31 medical specialists
DNHDP
Pretoria
Environmental
office
54 private medical pract.
RSC
23 private dental pract.
12 private pharmacies
MITCHELL’S PLAIN
UWC Oral
Health Centre
12-15 NGOs
Mandalay
Mobile clinic
RSC
Outpatients
Emergency unit and external consultation
Inpatients
Headquarter health centre
Patient + paper form
request
Collection of samples
Nurse or servant +
sample + paper form
request
Registration
Testing done (analysis)
Lack of regularity
Lab Results
Flow of data
Malaria
Parasitologic faeces + urine
Syphilis
Gonorrhea
Leucocytes, Hgb
Tuberculosis and AIDS
patients
Lab report with the
patient or health
worker to the clinician
in RH or HC
Patients sent to
Carmelo Health Centre
(function as TB inpatients health
facility)
Health Centres labs statistics
Statistics
Provincial lab responsible
(aggregation and basic analysis)
District Health Office for
aggregation of data
Feedback report + supervision
Fig. 4. Flows of lab information in Chókwe district
Community level
Health Centre 1 lab
Health Centre 2 lab
District lab data compiled in a Rural
Hospital lab
Health Centre 3 lab
Other relevant data from the community
and health facilities
District level
Nucleus for Planning and Statistics
(Aggregation of health district data)
Provincial level
Department for Planning
and Statistics
National level
Health Information
Department
Provincial lab data compiled
and analysed by the lab
manager
National Section for clinical
labs
Reporting system usually delayed
Feedback reports and supervision less frequent
Figure 1 – The vertical top-down approach of lab information system coupled to the complex health information system in
the National Health System
Interplay of institutions
Technology
Development
& Related Policies
Central
Government
(Ministries/Departments)
Funds
Policy Issues
Scientific Institutions
State Government
Feedback
Funds
Prog. Priorities & Monitoring
District Administration
--------------------------------------------------------------------------------Line Departments
Beneficiaries, Local People, NGOs
GIS S/W and
data
Figure 2: Comparison of the new tally sheet in the injection room on the left with the old reporting form on the right, reporting 66 and 59 ‘events’
respectively. Note the columns marked ‘E’, ‘C’, ‘B’ and ‘A’ in the old form, for European, Coloured, Black and Asian. These columns are not in
use anymore, and the space is used for marking the categories of the events reported.

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