Questions as an Organizing Framework for Health Information Systems

Author(s): James C. Thomas, Manish Kumar

Year: 2019

Abstract:

A country’s health services are guided by an information system that reveals which health services are most needed and where. Among its many uses, a health information system (HIS) can show which programs are effective, and it can help a country coordinate with neighboring countries in combatting an epidemic that crosses their borders. The flow of data used for these purposes resembles a vast watershed that gives rise to a river—unconnected rivulets that coalesce together to form increasingly large flows. Individual data elements originate in a wide variety of institutions and settings. The data collectors add counts of individual patients or vials of medicine into aggregate numbers and send them to district, provincial, and national offices. The reach of an HIS is broad, ideally extending into any place where people are living. It is composed of subsystems designed to focus on components as disparate as patient diagnoses and the availability of hospital beds. Each subsystem has its own paper forms for data collection or, increasingly, its own digital system for data collection, storage, and analysis.

It is difficult to see an HIS as a whole or to understand it due to its complexity. This obscures which components most need strengthening and compromises the coordination and collaboration essential to establishing a strong HIS. A framework that shows how the parts fit together and function toward a larger purpose can lessen the confusion. A variety of frameworks has been proposed in the last 10 years or so to serve this purpose. In this paper we describe those frameworks, identify their limitations, and propose a new framework that is more informative and helpful. The frameworks previously proposed were based on a set of systems, a means of informing programs, and levels of health system governance. The system we propose is based on questions that an HIS needs to address.