Reply To: Topic 1 Significance of health informatics

[Phyo]

Health informatics project in my organization
I was involved in a health informatics system (HIS) for refugee health in Thailand until 2021. The HIS for refugee health was created and organized by UNHCR to generate, analyze, and disseminate health data and information of nine refugee camps along the Thai-Myanmar border. The purpose of the system also intends to organize and collaborate all health program activities to achieve better outcomes. The reporting system is made as a simple, standardized, and flexible tool.
It was a Microsoft Access-based database reporting system and data from the program were updated weekly/monthly depending on the program. The internet was not accessible in many camps, the data were first imported in an Excel-based reporting format and merged into an Access database in the central computer in a camp office. The finalized data was then shared with the focal HIS coordinator of Thailand by several agencies.
Health informatics project helps to improve the current practices
The most interesting part of the reporting system was that different health sessions were integrated into a single reporting system. It included 10 sessions and those are population, mortality, morbidity, In-patient department (IPD) & referral, disease control (TB, Leprosy), laboratory, EPI, nutrition, reproductive health, VCT & HIV.
It rendered reliable consolidated data and information which is an essential part of decision-making across all health system. It was a necessary tool for monitoring and evaluation (M&E) from which standard indicators can be compared between the current period and certain periods in the past. Moreover, health indicators can be analyzed comparatively across the refugee camps in the border area and even with the global figures.
The unusual disease pattern can be captured in the system and those could be alerted to local health authorities to respond to disease intervention timely. Thus, disease surveillance and outbreak control can be carried out effectively due to the accessibility of data in real time. Trends in health status can be overviewed in the system so that healthcare priorities are addressed by planning and implementing the project to fill the gap. The effectiveness of health interventions can be interpreted by regular assessment of the target achievement and trends of health problems.
It ensured that health resources were contributed to the targeted audience and the most needed group in the community. In some circumstances, health managers had the opportunity to supervise that humanitarian assistance was distributed to meet the demands of the community.
Challenges in implementing the project
There are several drawbacks encountered in the implementation and utilization of the HIS project.
*Paper-based registration: The system was only designed to collect weekly/monthly reports in Excel-based reporting format from different programs. There was no electronic registration system imported directly to the HIS system. Thus, frontline health workers faced the burden of recording registration in paper-based format and then preparing weekly/monthly reports by using a tally sheet.
*Limitation of resources: Some organizations have created an electronic registration system in some health sessions, designed to produce the report which in turn combined into a central HIS report. However, limited resources such as IT equipment and human resources (high turnover rate) are the barriers to the implementation of the comprehensive system.
*Internet access: Online data reporting from camp-based to the office has been hindered by no internet coverage in some camps. Office-based staff collect the report and submit it to the central database in this situation.
*Standardization of indicator definition: Organizations have been implementing projects depending on the context and by using preferential guidelines and protocols. The definition of cases or program activities was slightly different among agencies. For example, some organizations count all urethral discharges as STIs in OPD records, but others count only for suspected cases.
*Analysis of health information: Once data from all health programs were imported into the UNHCR database, the summary report can be generated automatically. Due to the design of the database, it was not possible to customize it to extract the data that the user wanted to analyze.
*Old-fashion reporting system: The report became quite outdated in some parts for example, the introduction of new vaccines such as the Rota vaccine and Hib vaccines was not included in the report. The reporting format and contents were required to be updated to include newly implemented and essential health data in the report.