HIS Module

LET’S BEGIN!
LESSON 1
Intended Learning Outcomes
At the end of the lesson, you are expected to:
 Define educational institutions.
 Distinguish the difference between formal and informal
education.
 State the significance of core values and objectives to
educational institutions.
Introduction
Educational Institution
It is a place where learners of different ages gain education.
Education is based on an age grade system from preschool, primary,
intermediate, and secondary level (junior and senior high school), to
tertiary level (colleges and universities). Educational institutions carry out
educational activities that engage students with various learning
environment and spaces.
However, not all types of educational institutions are structured and
formalized. While established educational institutions follow a well-defined
curriculum, some learning environments are spontaneous and have no
fixed timetables.
There are two types of education: Formal and Informal.
 Formal education deals with the conventional classroom setup
where structured methods of learning are administered in
educational institutions.
 Informal Education, on the other hand, is anything learned
independently outside conventional classroom setup. It is not
restricted to a certain location and is usually integrated with the
surroundings such as home, cultural setting, and even in formal
education institutions.
Unlocking of Difficulties
Definition of Terms
 Conventional – formed by agreement or compact
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 Structured – of, relating to, or being a method of computer
programming in which each step of the solution to a problem is
contained in a separate sub program
 Formalized – to give formal status or approval to
 Spontaneous –developing or occurring without apparent external
influence, force, cause, or treatment.
Lecture Notes
Vision and Mission Statement
Vision Statement
A vision statement conveys the desired end of an academic
institution. It is usually a one sentence statement that describes the distinct
and motivating long –term desired transformation resulting from
institutional programs. The vision statement should be clear, memorable,
and concise with an average length of 14 words.
Mission Statement
A Mission Statement is a one sentence statement relating the
intention of an institutions’ existence. This communicates what you do or
who you do this for. The mission statement must be clear by using simple
language with an average of 5 to 20 words. Examples include “Spreading
Ideas” by TED, “The increase and diffusion of knowledge” by the
Smithsonian, and “Seeking to put God’s love into action, Habitat for
Humanity brings people together to build homes, community and hope” by
Habitat for Humanity.
Below is the detailed comparison between a Vision Statement and a
Mission Statement.
Vision Statement Mission Statement
Function It inspires to give the It defines the key
best and shapes your measure of the
understanding of why institution’s success
you are in the
institution.
Developing Statement When do we want to What do we do
reach success? today?
Where do we want to go For whom do we do
forward? it?
How do we do it? Why do we do what
we do?
Time Talks about the future Talk about the
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present leading to
the future
Question Where do you aim to be What makes you
different?
How will you get
where you want to
be?
Value Statement
A value statement, or the core values, is a list of fundamental
doctrines that guides and directs the educational institution.
For an educational institution to have a useful value statement, its values
must be incorporated in all levels of the institution to give direction to its
engagements, viewpoints, and decision-making processes.
Objectives
Educational objectives, or goals, are short statements that learners
should achieve within or at the end of course or lesson. When setting the
objectives, curriculum developers must think of the SMART criteria; that is,
objective must be Specific, Measurable, Attainable, Realistic, Realistic, and
Time bound.
Focus Question
Name:
Section:
Rating:
Instructions: Write your answer after the question. After answering you
can take a picture of it and send it to my messenger account or have it in
MS word and send at my email account. 10 pts each
1. What is vision statement?
2. State what is mission statement.
3. Define objectives.
Related Readings
Assembling and Governing the Higher Education Institution: Democracy,
Social Justice and Leadership in Global Higher Education (Lynette Shultz,
Melody Viczko Palgrave Macmillan UK, 19 Oct 2016
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Learning Assessment
PART 1 In a long Bond Paper,
Research and Tabulate 5 Vision, Mission, and goals of 5 institutions
related to Food and Beverage, Medicine and Health or Educational
Institutions. 1 point per item with a total of 15 points.
Attach this file to the google classroom with your name and section.
PART 2.
Instructions: Encircle the letter of the correct answer
1. These are short statements that learners should achieve within or at
the end of course or lesson.
a. Value Statement c. Core value
b. goals d. Mission
2. It is a list of fundamental doctrines that guides and directs the
educational institution.
a. Value Statement c. Core value
b. goals d. Mission
3. A one sentence statement relating the intention of an institutions’
existence.
a. Mission Statement c. Core value
b. Goals d. Vision
4. It conveys the desired end of an academic institution.
a. Mission Statement c. Core value
b. Goals d. Vision Statement
5. It is a place where learners of different ages gain education.
a. Goals c. Educational Institution
b. Core Value d. Mission Statement
Reference
Health Information System for Medical Laboratory Science, Lesson 1:
Vision, Mission, Core Values and Objectives of the Institution
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LESSON 2

 Define health system in the international, national, and local
perspectives.
 Identify the goals and functions of a health system;
 Explain the relationship between the system building blocks and
health outcomes; and
 State the structure of the Philippine health system.
Introduction
Health System
Health system is the “combination of resources, organization,

financing, and management that culminate in the delivery of health
services to the population (Roemer, 1991).” This system consist of many
parts such as the community, department or ministries of health, health
care providers, health service organizations, pharmaceutical companies,
health financing bodies, and other organizations related to the health
sector.
Goals and Functions of a Health System
The World Health Organization (WHO) identifies three (3) main goals
of a health system:
1. Improving the health of populations
2. Improving the responsiveness of the health system
3. Providing fair health financing
The four (4) vital health system functions are:

1. Health service provision
2. Health service inputs
3. Stewardship
4. Health financing
 Revenue collection
 Risk pooling
o Bismarck Model (Bismarck’s Law on Health Insurance of
1883
o Beveridge Model (Beveridge Report or The Social
Insurance and Allied Services of 1942
 Strategic Purchasing
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Definition of Terms
 Culminate- reach a climax or point of highest
 Provision- the action of providing or supplying something for use
 Stewardship- the job of supervising or taking care of something, such
as an organization or property
 Revenue- income, especially when of a company or organization and
of substantial nature.
Lecture Notes
Lesson 2: Health System
WHO Health System
In its World Health Report 2000, WHO released a single framework (Figure
2.1) with six clearly defined building blocks and priorities which are
necessary in strengthening health system and improving health outcomes.
BUILDING BLOCKS OUTCOMES
Service delivery Safety Improved efficiency
Leadership and Quality Social and financing risk

governance protection
Financing Improved level and

equity of health
Health products, Coverage

vaccines, and Responsiveness
technologies
Access
Health workforce
Information
Figure 2.1 WHO Health System Framework
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The Philippine Health System
Historical Background
The health reform initiatives carried out over the years in the Philippines
were primarily focused on these areas of concern: health service delivery,
health regulation, and health financing. These health reforms aimed at
addressing issues such as poor accessibility, inequity, and inefficiency of the
Philippine health system.
1. 1979: Adoption of Primary Health Care Strategy (LOI 949)
2. 1982: Reorganization of DOH (EO 851)
3. 1988: The Generics Act (RA 6675)
4. 1991: Local Government Code (RA 7875)
5. 1995: National Health Insurance Act (RA 7875)
6. 1999: Health Sector Reform Agenda
7. 2005:FOURmula One (F1) for Health
8. 2008: Universally Accessible Cheaper and Quality Medicines Act (RA
9502)
9. 2010: Kalusugan Pangkalahatan or Universal Health Care AO 2010-
0036)
Leadership Governance
The Department of Health (DOH) is mandated to provide the appropriate
direction for the nation’s health care industry. Its other tasks include (1) the
development of plans, guidelines and standards for the health sector; (2)
technical assistance; (3) capacity building; (4) advisory services for disease
prevention and (5) control of medical supplies and vaccines.
DOH is duty-bound to:
1. Develop policies and programs for the health care sector,
2. Provide technical assistance to its partners,
3. Encourage performance of the partners in the priority health
programs,
4. Develop and enforce policies and standards,
5. Design programs for large segments of the population, and
6. Provide specialized and tertiary level care.
Directions of the Philippine Health Sector
1. The Health Agenda 2016-2022 (DOH Administrative Order 2016-
0038)
2. The Philippine Development Plan 2017-2022
3. NEDA AmBisyon Natin 2040
4. Sustainable Development Goals 2030
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Focus Questions
Name:
Section:
Rating:
MS word and send at my email account (10 pts each).
1.) What are the 4 vital health system function?
2.) What is Beveridge Model?
3.) Define the following:
 Service delivery
 Information
 Financing
 Health workforce
4.) What is Bismarck Model?
5.) Who is the Current DOH secretary and undersecretary/ries. Include
also the Region XI director.
Related Readings
A Legacy of Public Health: The Department of Health Story (Celeste Flores
Coscolluela, Edgar Ryan Faustino.
The Philippine Health System Preview (Alberto G. Romualdez (Jr.). WHO
Regional Office for the Western Pacific 2011
Learning Assessment
 Answer the following and Include in the Submission of the focus
Questions
Matching type:
Health Reform Initiatives in the YEAR
Philippines
The Generics Act-RA 6675 1982
Reorganization of DOH 1988
Kalusugan Pangkalahatan 2005
FOURmula One for health 2010
Local Government Code 1991
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Reference
Health System
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LESSON 3

 Define primary health care.
 Explain the elements and principles of primarily health care.
 Discuss the processes involved in health care management; and
 Describe the status and processes of the Philippine health care
system.
Introduction
Health Care
According to the Alma-Ata Declaration of 1978, health is a
fundamental human right. It states that the most important global goal is
for humans to reach the optimal level of their health; this requires not only
the action of the health sector but the collaboration among other sectors
such as those in the social and economic sectors.
For better understanding, the following concepts under health care

are defined (as cited in DeDios,n.d.):
1.) Health care system is defined by Miller & Keane (1987) as “an
organized plan of health services.”
2.) Health Care Delivery, as defined by Williams & Tungpalan (1981),
is the rendering of health care services to the people.”
3.) Health care delivery system, also as defined by Williams &
Tungpalan (1981), is “the network of health facilities and
personnel which carries out the task rendering health care to the
people.”
Definition of Terms
 Optimal- best or most favorable; optimum
 Collaboration- the action of working with someone to produce or
create something
 Rendering – the process of an outline image using color and shading
to make it appear solid and three-dimensional
 Task- a piece of work to
 Facilities- a place, amenity, or piece of equipment provided for a
particular purpose
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Lecture Notes
Lesson 3: Primary Health Care and the Philippine Health Care
Delivery System
Primary Health Care

The goal of primary health care is better health for all. WHO has
identified five key elements to achieve this goal? These are:
1.) Universal coverage to reduce exclusion and social disparities in
health,
2.) Service delivery organized around people’s needs and expectations,
3.) Public policy that integrates health into all sectors,
4.) Leadership that enhances collaborative models of policy dialogue,
and
5.) Increased stakeholder participation
Essential Elements of Primary Health Care

Below are the eight (8) elements of Primary Health Care
1.) Education concerning prevailing health problems and the methods of
identifying, preventing and controlling them.
2.) Locally endemic disease prevention and control
3.) Expanded program of immunization against major infectious diseases
4.) Maternal and child health care including family planning
5.) Essential drugs arrangement
6.) Nutritional food supplement, an adequate supply of safe, and basic
nutrition
7.) Treatment of communicable and non-communicable disease and
promotion of mental health
8.) Safe water and sanitation
Principles of Primary Health Care

The basic objectives to launch and sustain primary health care as part
of the comprehensive health system are as follows:
1. Improve the level of health care of the community
2. Promote favorable population growth structure
3. Reduce the morbidity and mortality rates especially among
infants and children
4. Reduce prevalence of preventable, communicable, and other
diseases
5. Improve basic sanitation
6. Extend essential health services especially to the undeserved
sectors
7. Develop the capability of the community to become self-reliant
a. Encourage the contribution of other sectors to the social
and economic development of the community
b. Provide equitable distribution of health care
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c. Ensure community participation and monitor adequacy and
distribution of health workers who ae supported locally and
at the referral levels.
d. Recognize that the formal health sector needs other sectors
in the promotion of health
e. Use the appropriate technology which are accessible,
feasible, affordable, and culturally accept to the
community.
Management of Primary Health Care
Health care managers usually carry out the following functions in

the process of management:
1. Planning
2. Organizing
3. Staffing
4. Controlling
5. Directing
Below are the management principles in relation to organizing:

1. Authority, responsibility, and accountability
2. Types of Authority (Line authority, Functional authority, and staff
authority)
3. Centralization, decentralization, and formalization
4. Staffing
Focus Question
Name:
Section:
Rating:
1. What are the eight (8) elements of Primary Health Care?
2. What is a primary health care?
3-5. Give at least 3 functions that managers carry out in process of
management.
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Related Readings
World Health Organization. (2005). Philippine Environmental Health and
Country Profile. Retrieved from
http://www.who.int/gho/countries/phl/country_profiles/en
Learning Assessment
Instructions: Explain the following.
1. As a Future Medical Technologist, how will you contribute in
giving Primary Health Care Services to your patient?
2. Differentiate Line authority, Functional authority, and staff
authority
3. What is the relation of organized leadership and accountability?
Reference
Primary Health Care and the Philippine Health Care Delivery Systems
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LESSON 4

1. Define health information technology.
2. Identify the advantages and disadvantages of health informatics in
the cloud and;
3. Describe the status of health informatics in the Philippines.
Introduction
Health Information Technology

The dawn of the information age has resulted in the generation of
huge amounts of routine data, particularly in healthcare, which can become
perplexing to process and analyse. This is the challenge foe health
informatics- to make sense of large amounts of data while ensuring that the
processes are valid and secure.
The transition from a manual to a more advanced health information
system is an overarching issue for providers of health care, managers,
policy makers, researchers, and patients alike. While there are benefits,
there are also undeniable disadvantages. One innovation that manages
health information for better service delivery is health information
technology.
Rouse (2016) defines health information technology (HIT) as “the
area of IT involving the design, development, creation, use, and
maintenance of information system for the health care industry.
Automated and interoperable health care information systems are
expected to improve medical care, lower cost, increase efficiency, reduce
error, and improve patient satisfaction while also optimizing
reimbursement for ambulatory and inpatient health care providers.”
Health information technology vows to provide innovation to health
care delivery and connection among users and stakeholders in the e-health
market. Systems such as electronic health records, decision support
systems, and personal health records are promising and are becoming
widely deployed worldwide. (Kushniruk & Borycki, 2017).
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Definition of Terms
 Dawn- become evident to the mind; be perceived or understood.
 Perplexing- completely baffling; very puzzling
 Overarching- forming an arch over something.
 Innovation- a new method, idea or product.
 Interoperable- able to exchange and make use of information.
 Optimizing- rearrange or rewrite to improve efficiency of retrieval or
processing
 Reimbursement- the action of repaying a person who has spent or
lost money.
 Deployed- bring into effective action; utilize.
Lecture Notes
Lesson 4: Overview of Health Informatics
Health Care Software Systems
Rouse (2016) enumerates the following types of health information
technology.
An electronic health record (HER) is also called an electronic medical
record (EMR). It is one of the fundamental components of health
information technology infrastructure. HER is the patient’s official health
record in digital form and this information is shared across multiple health
care providers and agencies. The other key elements are the personal
health record (PHR) and the health information exchange (HIE). A PHR is a
person’s self-maintained health record while HIE is the health data
clearinghouse which is comprised of health care organization with
interoperability pact to share data among their health information
technology systems.
There are two widely used types of health information technology,
the picture archiving and communication system (PACS) and vendor
neutral archive(VNA). These two help manage and store the patients’
medical images.
PACS and VNAs integrate radiology into the main hospital workflow.
Radiology used to be the primary repository for medical images. Presently ,
other specialties such as cardiology and neurology are also among the
large-scale producers of clinical images. VNAs can also be installed for the
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purpose of merging stored imaging data from various department into a
multi-facility health care system.
Health Information Ecosystem

The Healthcare Information and Management Systems Society (2017)
define a health interoperability ecosystem as a composition of individuals,
systems, and process that share, exchange, and use of health information
and/or data.
An efficient health interoperability ecosystem provides an
information infrastructure that uses technical standards, policies, and
protocols to enable seamless and secure capture, discovery, exchange, and
utilization of health information.
Health Informatics Cloud

The role of cloud technology is undeniably significant in our everyday
lives. Currently, 83 percent of health care organization are making use of
cloud-based applications, and it is changing the landscapes of the health
care system and health informatics. However, both benefits and threats
exist (University of Illinois, 2014)
Advantages of Cloud Technology

1. Integrated and Efficient Patient Care
Cloud technology offers a single access point for patient
information which allows multiple doctors to review
laboratory results or notes on patients. Physicians can spend
more time deciding and performing patient treatment instead
of waiting for information from different departments.
2. Better Management of Data

The accumulation of electronic health record will allow more
meaningful data mining that can better assess the health of
the general public; More data can mean more opportunities to
identify trends in diseases and crises.
Disadvantages of Cloud Technology
1. Potential Risks to Personal Information
a. The strength of cloud technology is also the very same
characteristic that makes it vulnerable to data breaches. The
information contained within medical records may be
subjected to theft or other violations of privacy and
confidentiality. Fortunately, safeguards may be put in place to
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minimize such threats such as encryption, proper data
disposal, and other security features.
2. Cloud Setup seems cumbersome
The transition to an automated system might be difficult for
some members of health care organizations that may not be
familiar with cloud technology. This technology, however, will
be adopted by more institutions in the future. With proper
education and illustration of its function, hesitant practitioners
may be able to see its advantages.
Health Informatics in the Philippines
Health informatics is the application of both technology and systems
in a health care setting. It has been loosely practiced in the Philippines since
the 1980s. Practitioners who had access to IBM (International Business
Machines Corporation) compatible machines used word processors to store
patient information.
Focus Question
Name:
Section:
Rating:
1. Define Health Information Technology.
2. Differentiate health care software systems and health information
ecosystem.
3. What are the advantages and disadvantages of health informatics in
cloud?
Related Readings
Innovation in Health Informatics: A Smart Healthcare Primer (Miltadis
Lytras and Akila Sarirete
Global Health Informatics: Principle of EHealth and MHealth to improve
Quality of Care (Celi, Fraser, Nikore, Osorio, Paik)
Learning Assessment
Instructions: Answer the following. IDENTIFICATION.
1. It is the application of both technology and systems in a health care
setting. It has been loosely practiced in the Philippines since the
1980s.
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2-3. What are the two widely used types of health information
technology?
4. It is the patient’s official health record in digital form and this
information is shared across multiple health care providers and
agencies.
5. It is a person’s self-maintained health record.
Reference

Overview of Health Informatics
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Lesson 5
1. Define health management information system;
2. Identify the different functions of HMIS; and
3. Describe the roles of HMIS.
Introduction
Traditionally, health care administrations have been managed
manually starting from patient registration to consultation. The creation of
documents proved to be time-consuming and posed the risk of having
duplicate records. Improper storage of these documents was also a concern
because of difficulty in retrieval and the high cost of maintaining proper
storage. Getting an overview of the number of patients visiting the hospital,
or consolidating the nature of problems that need Immediate action and
providing pertinent reports were very difficult to achieve. Tools such as
snapshots and dashboard which are necessary in the analysis of the
performance of hospitals were unavailable.
Hospital using the traditional manual process do not have real-time
data and delays in the receipt of data pose a challenge to evidence-based
program management. Accurate and real time records of equipment and
drugs could not be obtained in a timely manner resulting in problems in
accountability, monitoring of expiry dates, stock and auto indenting.
Inventory of medicine and equipment was a tedious task due to lack of
standards filling names and codes in the institution.
The need to enhance the management of health services and to have a
real-time data to monitor the hospital performance thus calls for a health
information management system that will address these concerns.
Definition of Terms
 Consultation- the action or process of formally consulting or
discussing.
 Overview- a general review or summary of a subject.
 Pertinent- relevant or applicable to a particular matter
 Tedious- too long, slow, or dull; tiresome or monotonous
 Snapshots- a record of the contents of a storage location or data file
at a given time.
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 Dashboard- a home page on a website giving access to different
elements of the site’s functionality.
Lecture Notes
Lesson 5: Health Management Information System
As defined by the World Health Organization (2004), health
management information system (HMIS) is “specially designed to assist in
the management and planning of health programs, as opposed to delivery
care”. The health component of HMIS refers to clinical studies to
understand medical terminologies, clinical procedures, and database
processes; management refers to the principles that help administers the
health care enterprise; and information system refers to the ability to
analyze and implement applications for efficient and effective transfer of
patient information. An HMIS is one of the six building blocks essential for
health system strengthening. It is a data collection system specifically
designed to support planning, management, and decision-making in health
facilities and organizations.
HMIS was developed within framework of the following concepts
(Republic of Uganda Ministry of Health Resource Center, 2010)
 The information collected is relevant to the policies and goals of the
health care institution, and to the responsibilities of the health
professional at the level collection.
 The information collected is functional as it is to be used immediately
for management and should not wait for feedback from higher levels.
 Information collection is integrated for there is one set of forms and
no duplications of reporting
 The information is collected on a routine basis from every health unit.
Roles of HMIS
The major role of HMIS is to provide quality information to support
decision- making at all levels of the health care system in any medical
institution. In addition to encouraging the use of health information in
hospitals, it also aims to aid in setting of performance target at all levels of
health service delivery and to assist in assessing performance at all levels of
the health care sector. (Republic of Uganda Ministry of Health Resource
Center, 2010)
An HMIS needs to be complete, consistent, clear, simple and cost-effective,
accessible, and confidential (Janneh, 2002) It should complete with all the
information but avoiding duplication and consistent in assigning definitions
to similar information from various sources. It should also be simple to use
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and clear as to what is measures by the elements. The eligible users must
have access and should be able to use the system with ease. The
confidentiality of patient information and data privacy should always be a
top priority. While providing all these benefits, the system must prove its
cost-effectiveness through its operations.
Function of HMIS
The information from an HMIS can be used in planning, epidemic prediction
and detection, designing interventions, monitoring, and resource
allocation. (Republic of Uganda Ministry of Health Resource Center, 2010)
1. Data input includes data acquisition and data verification
a. Data acquisition refers to the generation and collection of data
through the input of standard coded formats (e.g bar codes) to
assist in the faster mechanical reading and capturing of data.
b. Data verification involves data authentication and validation. The
authority, validity, and reliability of the data sources help ensure
quality of gathered data.
2. Data Management, also called processing phase, includes data
storage, data classification, data update, and data computation.
a. Data Storage includes preservation and archiving of data. It is
advisable that data which are no longer actively used should be
archived. At times, it is mandatory and part of legislation.
b. Data classification is also called data organization which sets the
efficiency of the system. Key parameters should be used for data
classification schemes for easier data search.
c. Data computation requires various forms of data manipulation and
data transformation. This function allows data analysis, synthesis,
and evaluation so that data can be used not only for decision-making
but also for other tactical and operational use.
d. Data update facilitates new and changing information and requires
constant monitoring. For HMIS, the mechanism for data maintenance
must be in place for updating changes for manual or automated
transactions.
3. Data output includes data retrieval and data presentation.
a. Data retrieval pertains to the processes of data transfer and data
distribution. The transfer process considers the duration of
transmittal of required data from the source to the appropriate
end-user. The economics of producing the needed information is
a significant criterion.
b. Data presentation is the reporting of the interpretation of the
information produced by the system. Summary tables and
statistical reports are expected but the use of visuals is
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encouraged especially for high level managerial decision-making
because they provide a better intuitive perspective of data trend.
List of Functions of HMIS

Listed below are the possible functions in an HMIS with the corresponding
type of information that can be captured and tracked in the system.
(Behavioral Health Collaboration Solutions, 2006)
1. Client Data
2. Scheduling
3. Authorization Tracking
4. Billing
5. Accounts Receivable (A/R) management
6. Reporting
7. Medical Record
8. Compliance
9. Financial data
Determinants of HMIS Performance Area

The determinants affecting the performance of an HMIS may be behavioral,
organizational, and technical.
Behavioral Determinants
The data collector and users of the HMIS need to have confidence,
motivation, and competence to perform HMIS tasks in order to improve
routine health information system (RHIS) process.
Organizational Determinants
The important factors that affect the development of the RHIS
process are the structure of the health institution, resources, procedures,
support services, and the culture within the organization. (Aqil, Lippeveld,
& Hozumi, 2009). However, other factors which include lack of funds,
human resources, and management support to contribute to the
determinant of the RHIS process.
Technical Determinants
Technical factors involve the overall design used in the collection of
information. It comprises the complexity of the reporting forms, the
procedure set forward in the collection of data, and overall design of the
computer software used in the collection of information.
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Focus Question
Name:
Section:
Rating:
1. State the definition of Health Management Information System
2. Enumerate the different functions of HMIS.
3. List the roles of HMIS.
Related Readings
Developing a Health Management Information System: Training &
Reference Manual –Ministry of Health and Population, Planning
Department, Health Management Information Unit.
Learning Assessment
Instructions: Answer the following. IDENTIFICATION
1. It involves the overall design used in the collection of information.
2. It is the reporting of the interpretation of the information produced
by the system.
3. It refers to the generation and collection of data through the input of
standard coded formats (e.g bar codes) to assist in the faster
mechanical reading and capturing of data.
4. This requires various forms of data manipulation and data
transformation.
5. It involves data authentication and validation. The authority, validity,
and reliability of the data sources help ensure quality of gathered
data.
Reference
Health Management Information Systems
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LESSON 6
1. discuss the roles of health information systems;
2. enumerate the components of a health information systems; and
3. identify the different data sources for a health information system.
Introduction
Health informatics is the application of both technology and systems
in a healthcare setting. While health information technology focuses on
tools, health information systems cover the records, coding,
documentation, and administration of patients and ancillary services.
Concerns about the cost and quality of healthcare among the
motivating factors why health information systems are increasingly
implemented across health industries all over the world. The combination
of elements in a health information system enables the provision of more
efficient and effective health care services. The component of a health
information system is correlated and translated into harmonious
operations.
The health information system (HIS) covers different systems that
capture, store, manage and transmit health-related information that can be
sourced from individuals or activities of a health institution. These include
disease surveillance system, district level routine information systems,
hospital patient administration system (PAS), human resource management
information system (HRMIS), and laboratory information system (LIS).
The information collected from a well-functioning HIS is very useful in
policymaking and decision making of health institutions and becomes the
basis in creating a program action. This translates to efficient resource
allocation at the policy level, and improvement of the quality and
effectiveness of health at the delivery level.
HIS should be sustainable, user friendly, and economical. Health care
personnel should be educated on the use of the routine data collected from
the system and the significance of good quality data in improving health
(Pacific Health Information Network, 2016).
24
Definition of Terms
 Correlated- establish a mutual relationship or connection between
 Allocation- the action or process of allocating or distributing
something
 Receptionist- a person employed in an office or other establishment
to answer the telephone, deal with clients, and greet visitors
 Census- a typical count or survey of a population, typically recording
various details of individuals.
Lecture Notes
Lesson 6: Health Information Systems
Role and Function of Health Information System
Sheahan (2017) defines health information system (HIS) as a
mechanism which keeps track of all data related to the patient such as
patient’s medical history, contact information, medication logs,
appointment schedule, insurance information, and financial account
including billing and payment. The roles that a well-implemented HIS can
perform in improving health services are as follows:
1. Easier access to files
The system has revolutionized the collection and management of
patient information. The need for a hard copy of the patient’s
medical records becomes optional as the systems are electronic.
2. Better control
Only authorized personnel can have access information on the
patient’s health. Doctors may be given permission to update patient
information while a receptionist may only have the authority to
update a patient’s appointments.
3. Easier update
After creation of the record, patient information can be accessed and
reviewed any time and copies can be printed or released to the
patient upon request.
4. Improved communications
HIS assists communication among doctors and hospitals. However,
medical professionals, must adhere to regulations on patient privacy
25
and security to ensure that information is kept confidential and safe
from unauthorized access.
A good health information system delivers accurate information in a timely
manner, enabling decision-makers to make informed choices about the
different aspects of the health institution, from patient care to annual
budgets. It also upholds transparency and accountability due to easier
access to information.
Components of Health Information System
The health Metrics Network (HMN), in its Framework and Standards for
Country Health Information Systems (2008), defines health information
systems as consisting of six components.
 Health information system resources
 Indicators
 Data sources
 Data management
 Information products
 Dissemination and use
1. Health information systems and resources

This includes the framework on legislation, regulation, planning, and
the resources required for the system to be fully functional (e.g
personnel, logistics support, financing, ICT, and the component’s
coordinating mechanism).
2. Indicators
The basis of the HIS plan and strategy includes indicators and related
targets such as the determinants of health, health system inputs,
outputs and outcomes; and the health status.
3. Data sources
Data sources are divided into two main categories: (1) population-
based approaches such as civil registration, census and population
surveys and (2) institution-based data such as individual records,
resource records, and service records. Occasional health survey,
research and information produced by community-based
organization may not be directly classified under main categories, but
they may provide useful information.
4. Data management
Data management refers to the handling of data, starting from
collection and storage to data flow and quality assurance, processing,
compilation, and data analysis.
26
5. Information products
Data is transformed into useful information that serves as evidence
and provides insight crucial to shaping a health action.
6. Dissemination and use
HIS enhances the value of health information by making it readily
available at policymakers and data users.
These six components of health information systems can be categorized

into inputs, processes, and outputs.
Input refers to the health information system resources. These resources
include health, institutional coordination and leadership, health
information policies, financial and human resources, and infrastructure.
The indicators, data sources, and data management forms the process in
HIS. Core indicators are needed as bases for program planning, monitoring,
and evaluation. Population-and institution- based sources are also essential
for decision-making as they provide guide to health service delivery.
Importantly, these data must be accessible and understandable by users
and policymakers.
Outputs refers to the transformation of data into information that can be
used for decision-making and to the dissemination and use of such
information.
Different Data Sources for Health Information Systems
Demographic data Administrative data Health Risk Information
Health status Patient Medical History Current Medical

Management
Outcomes Data
Source: Donaldson and Lhor (1994)

Donaldson and Lhor (1994) explain that a comprehensive database for
health information systems include the following:
1. Demographic data refers to the facts about the patient which include
age and birthdate, gender, marital status, address of residence, race
and ethnic origin. Information on educational background and
employment is also recorded along with information on immediate
family members to be contacted during emergency.
27
2. Administrative data includes information on services such as
diagnostic tests or out-patient procedures, kind of practitioner,
physician’s specialty, nature of institution, and charges and
payments.
3. Health risk information records the lifestyle and behavior (e.g., use
of tobacco products or engagement in strenuous activities.) of a
patient and facts about his or her family’s medical history and other
genetic factors. This information is used to evaluate the patient’s
propensity for different disease.
4. Health status refers to the quality of life that a patient leads which is
crucial to his/her health. This shows the domains of health which
include physical functioning, mental and emotional well-being,
cognitive functioning, and social functioning. It also shows one’s
perception of his/her health in comparison with that of his or her
peers.
5. Patient medical history gives information on past medical
encounters like hospital admissions, pregnancies and live births,
surgical procedures, and the like. It also includes previous illnesses
and family history (e.g., alcoholism or parental divorce).
6. Current medical management reflects the patient’s health screening
sessions, diagnoses, allergies (especially on medications), current
health problems, medications, diagnostic or therapeutic procedures,
laboratory test, and counselling on health problems.
7. Outcome data presents the measures of aftereffects of health care
and of various health problems. These data usually show the health
care events (e.g., readmission to hospital, unexpected complications,
or side effects) and measures of satisfaction with care. Outcomes
directly reported by the patient after treatment will be most useful.
Focus Question
Name:
Section:
Rating:
1. Define what is Health Information System.
2. What is Health Informatics?
3. Enumerate the four (4) roles of Health Information System.
4. Identify the six elements of Health Information System
28
Related Readings
Health Management Information Systems: Methods and Practical
Application (Joseph K. H. Tan, PhD)
Health Management Information Systems: A Handbook for decision
markers (Jack Smith)
LEARNING ASSESSMENTS
1. It refers to the quality of life that a patient leads which is crucial to
his/her health.
2. It refers to the facts about the patient which include age and
birthdate, gender, marital status, address of residence, race and
ethnic origin.
3. It presents the measures of aftereffects of health care and of various
health problems.
4. It gives information on past medical encounters like hospital
admissions, pregnancies and live births, surgical procedures, and the
like.
5. It records the lifestyle and behavior (e.g., use of tobacco products or
engagement in strenuous activities.)
Reference
Health Information System
29
LESSON 7
1. Define the purpose, framework, and plan of an HMIS monitoring and
evaluation system.
2. Describe the relationship of monitoring and evaluation with HMIS
indicators; and
3. Identify the relationship of HMIS indicators with health programs.
Introduction
A health management information system aims primarily at assisting
in the planning and management of a national health strategy plans; thus,
continuous monitoring and evaluation is necessary for it to be effective.
And function, monitoring and evaluation are complimentary.
Monitoring refers to the collection, analysis, and use of information
gathered from programs for the purpose of learning from the acquired
experiences, accounting the resources used both internal and external, and
obtaining result and making decisions. These purposes correspond to three
functions: learning, monitoring, and steering. Meanwhile, evaluation is the
systematic assessment of completed programs or policies. The objective is
to gauge the effectiveness of the program so that adjustments can be made
in areas that need improvement. An evaluation has both learning function
in which the lessons learned need to be incorporated into future proposals,
and monitoring function in which means that the concerned parties review
the implementation of policy based on the objectives and resources.
Definition of Terms
 Gauge – thickness, size or capacity of something
 Complimentary- given or supplied free of charge
 Antenatal – before birth
 Immunization - the action of making a person or animal immune to
infection.
30
Lecture Notes
Lesson 7: HMIS Monitoring and Evaluation
Purpose of M&E
A robust monitoring and evaluation (M&E) system is required to
assess the effect of an integrated service delivery. Appropriate indicators,
data collection systems, and data analysis to support decision-making help
guide the successful implementation of integrated services and measure
the effect on both service delivery and use of services. (FP/Immunization
Integration Working Group, n.d.).
M&E Framework
A general framework of M&E of health system strengthening (HSS)
was developed by various global partners and countries. Derived from the
Paris Declaration on aid harmonization and effectiveness and the
International Health Partnership (IHP+), this framework places health
strategy and related M&E processes of each country at the center. The
strengthening of a common country platform for the M&E of HSS is the
core of the framework. There is better alignment and the monitoring of
funding for health system is easy.
There are four components of the framework of M&E as provided by
WHO, namely, the indicator domains, data collection, analysis and
synthesis, and communication use, intended for achieving greater health
impact. For monitoring medical services, indicators should be tracked to
assess processes and results associated with the various indicator domains.
In this way, the strength and weaknesses of implementation are provided
and can be used for troubleshooting in the system. In terms of outcomes
and impact indicators, the changes may not be directly caused by service
delivery efforts for there are other factors to consider. However, these data
are still useful in understanding the current health status and context
within the country. (FP/ Immunization Integration Working Group, n.d.).
MSE Plan
An M&E Plan addresses the components of the framework and
establishes the foundation for regular reviews during the implementation
of the plan for the national level. Local M&E systems generate information
for global based on the health sector review process which are considered
key factors in monitoring the progress and performance of the entire
system. Medical institutions are monitored and evaluated through the
assessment of reports, surveys, HMIS, and other evaluation studies.
31
Specifically, the National Health Mission of India identifies strategy
which help in the successful implementations of the framework. The
framework should (1) be localized, (2) address the needs for multiple users
and purpose, (3) facilitate the identification of indicators and data sources
and (4) be able to use the M&E in disease-specific programs.
M&E and HMIS Indicators
An indicator is a variable which measures the value of the change in
units that can be compared to past and future units. The focus is on single
aspect of a program such as input, output, among others. HMIS uses
various indicators to monitor key aspects of health system performance.
The United States Agency for International Development (USAID) classifies
these indicators (Table 1) into five broad categories, namely, reproductive
health, immunization, disease prevention and control, resource utilization,
and data quality:
Key Performance Area Key Indicator
Reproductive Health 1. Family planning acceptance rate
2. Antenatal care coverage
3. Proportion of deliveries attended by
skilled health personnel
4. Proportion of deliveries attended by
HEWs
Immunization 5. DPT-3(Pentavalent-3) coverage
(>1child)
6. Measles Immunization coverage
(>1child)
Disease Prevention and 7. Malaria case fatality rate among
Control patients under 5 yrs of age
8. New Malaria cases per 1000 population
9. New Pneumonia cases among children
under 5 per 1000 population of <5yrs)
10. TB case detection rate
11. TB cure rate
12. Clients receiving VCT services
13. PMCT treatment completion rate
14. PLWHA currenty on ART
Resource Utilization 15. Trace drug availability (in stock)
16. OPD attendance per capita
17. In-patient admission rate
18. Average length of stay (in-patient)
Data quality 19. Bed occupancy rate
20. Reporting completeness rate
21. Reporting timeliness rate
Source: HMIS Information Use Training Manual (USAID, 2013)
32
HMIS Indicators and Health Programs
HMIS is a source of routine data necessary for monitoring different
aspects of various health programs implemented in a country. The HMIS
indicators should be carefully selected to meet the essential information
necessary for monitoring the performance of various health programs and
services and to present an overview of available health resources.
This section explains the relationship of HMIS indicators and some of
the health programs on the communicable and non-communicable
diseases. These disease data provide an in-depth understanding of how
HMIS can be used for monitoring program performance and how it
encourages similar in-depth analysis for health programs and services such
as maternal survival intervention, child mortality and child survival
intervention, and Stop TB Program.
Maternal Survival Interventions
The fifth millennium development goal targets to reduce the
maternal mortality ratio by 75 percent and to achieve universal access to
reproductive health. Despite this set goal, none of the maternal survival
intervention alone can reduce the maternal mortality rate. As Campbell and
Graham (2006) explained, the complexity of the country contexts and
maternal health determinants makes it complicated to choose the best
strategies in achieving this goal. However, they found that packaging of
health facility-oriented interventions is highly effective and has high
coverage of the intended target group.
To routinely monitor the progress towards implementation of a
highly effective package of maternal survival interventions, HMIS is
designed to provide some of the core input, process, and output indicators.
The HMIS indicators are related to the following:
1. Pregnancy care interventions
 Ist antenatal care attendances
 4th antenatal care attendances
 Cases of abnormal pregnancies attended at out-patient
department (OPD) of health facilities
 Institutional cases of maternal morbidity and mortality due to
antepartum hemorrhage (APH), hypertension and edema
reported by in-patient departments (IPD) of Health Facilities.
 Cases of abortion attended at health facilities
 Cases of medical (safe) abortions conducted at health facilities.
33
2. Intrapartum Care
 Deliveries by skilled attendants (at health facilities)
 Deliveries by health extension workers (HEW) (at home of
health posts)
obstructed labor
3. Postpartum care
 1st postnatal care attendance
postpartum hemorrhage (PPH) and puerperal sepsis.
These indicators, although not complete to monitor all aspects of
maternal survival strategies, capture data related to pregnancy, such as
intrapartum and postpartum care, and are sufficient to give a broad
indication of the performance of the package of maternal survival
interventions. More so, using these indicators help prompt further
investigations when problems on issues arise.
Child Mortality and Child Survival Interventions
The leading cause of under-5 child mortality rate in the Philippines in
2012, as reported by the Department of Health (DOH) in its top 10 leading
causes of child mortality report was pneumonia.
1 Pneumonia
2 Diarrhea and Gastroenteritis
3 Congenital Anomalies
4 Other diseases of the nervous system
5 Septicemia
6 Accidental drowning and submersion
7 Chronic lower respiratory diseases
8 Dengue Fever and Dengue Hemorrhagic fever
9 Meningitis
10 Pulmonary and Heart Disease
Source: the 2012 Philippine Health Statistics, 2012)
The Philippine government through DOH launched various strategies
to help ensure good health of Filipino children by 2025.
1.) Child 21- Child 21 or the Philippine National Strategic Framework for
Plan Development for Children 2000 to 2025 serves as a framework
for policymaking and program planning and as a roadmap for
interventions aimed at safeguarding the welfare of Filipino children.
This is part of the Philippines’ commitment to the United Nations
Convention on the Rights of the Child (UN CRC)
34
2.) Children’s Health 2025- This is subdocument of Child 21 which
focuses on the development of Filipino children and the protection of
their rights by utilizing the life cycle approach.
3.) Integrated Management of Childhood Illness (IMCI)- IMCI is a
strategy that aims to lower child mortality caused by common
illnesses.
4.) Enhanced Child Growth- This is an intervention aimed to improve the
health and nutrition of Filipino children by operating community-
based health and nutrition posts all throughout the country.
Stop TB Program
Envisioning a tuberculosis-free world, the goal of the Stop TB
Program (STP) is to dramatically reduce the global burden of tuberculosis
(TB) by 2015. This is in line with the WHO’s millennium development goals
and the Stop TB Partnership which aims to push TB up the world political
agenda. One of the main objectives of the program is to achieve universal
access to high-quality care (i.e., universal access to high quality diagnosis
and patient-centered treatment) for all people with TB (including those co-
infected with HIV and those with drug-resistant TB.
TB case detection and successful completion of the treatment/cure of
TB remain at the core of the Stop TB Strategy. Thus, by 2050, one of the
targets of the strategy is to reduce the prevalence of and deaths due to TB
by 50% compared with the 1990 baseline.
The HMIS indicators to monitor Stop TB Program are
 TB Patients on DOTS (Number of new smear-positive pulmonary TB
cases enrolled in the cohort.)
 TB case detection (Number of new smear-positive pulmonary TB
cases detected, number of new smear-negative pulmonary TB cases
detected, number of new extra-pulmonary TB cases detected)
 HIV-TB co-infection (Proportions of newly diagnosed TB cases tested
for HIV)
 HIV + new TB patients enrolled in DOTS
 TB Treatment outcome (Treatment completed PTB+, Cured PTB+,
Defaulted PTB, Deaths PTB+)
Focus Question
Name:
Section:
Rating:
35
MS word and send at my email account.
5pts each
1. What is the purpose of M&E?
2. Describe the framework of M&E.
3. Define what is indicator.
4. Enumerate the ten-leading cause of less than 5 child mortality in the
Philippines in 2012.
Related Readings
Advances in Health Management (Ubaldo Comite)
Design and Implementation of Health Information Systems (Theo Lippeveld,
Rainer Sauerborn, Claude Bodart-2000)
LEARNING ASSESSMENT
Instructions: Answer the following. IDENTIFICATION
1. This serves as a framework for policymaking and program planning
and as a roadmap for interventions aimed at safeguarding the
welfare of Filipino children.
2. This is an intervention aimed to improve the health and nutrition of
Filipino children by operating community-based health and nutrition
posts all throughout the country.
3. This is subdocument of Child 21 which focuses on the development
of Filipino children and the protection of their rights by utilizing the
life cycle approach.
4. It is a strategy that aims to lower child mortality caused by common
illnesses.
5. This is subdocument of Child 21 which focuses on the development
of Filipino children and the protection of their rights by utilizing the
life cycle approach.
Reference
Health Information System for Medical Laboratory Science, Lesson 7: HMIS
Monitoring and Evaluation
36
LESSON 8
1. Define data quality, quality assessment, and development
implementation plan.
2. Describe the importance of data quality tools and;
3. Differentiate the different techniques used in root cause analysis.
Introduction
Data Quality
Over the years, data quality has become a major concern for large
companies especially in the areas of customer relationship management
(CRM), data integration, and regulation requirements. Aside from the fact
that poor data quality generates cost, it also affects customer satisfaction,
company reputation, and even the strategic decisions of the management.
Data quality is the overall utility of a dataset(s) as a function of its
ability to be processed easily and analyze for a database, data warehouse,
or data analytics system.
Aspects of Data Quality
 Accuracy
 Completeness
 Relevance
 Consistency
 Reliability
 Presentability
 Accessibility
Data quality signifies the data’s appropriateness to serve its purpose

in each context. Having quality data means that the data is useful and
consistent. Data cleansing can be done to raise the quality of available data
(Rouse, 2005)
Definition of Terms
 Signifies- be an indication of
 Biannually- occurring twice each year
 Sensitized- cause someone or something to respond to certain
stimuli
37
 Encompassing- surround and have or hold within
Lecture Notes
Lesson 8: HMIS Data Quality
Lot Quality Assurance Sampling (LQAS)
Lot Quality Assurance Sampling (LQAS) is a tool that allows the use of
small random samples to distinguish between different groups of data
elements (or lots) with high and low data quality. For health managers and
supervisors, using small samples makes the conduct of surveys more
efficient. This tool has been widely applied in the health care industry for
decades and has been primarily used for quality assurance of products.
The concept and applications of LQAS have been adopted in the
context of District Health Information System (DHIS) data quality assurance.
The adoption was comprised of designating health facilities, monthly
reports, sections of monthly reports, and group of data elements as “lots”
to provide representative samples for data quality assurance of DHIS.
Steps in applying LQAS

1. Define the service to be assessed (e.g,. DQA of DHIS).
2. Identify the unit of interest (e.g,. a supervisory area,
facility, hospital, a district)
3. Define the higher and lower thresholds of performance
based on prior information about the expected
performance of the region of interest.
4. Determine the level of acceptable error.
5. Determine the sample size and decision rule for
acceptable errors to declare an area as performing “below
expectations”.
6. Identify the number of errors observed (mismatched data
elements will be reliably determined if the facility is
performing above or below expectations.)
Routine Data Quality Assessment (RDQA)

The Routine Data Quality Assessment (RDQA) tool is a simplified
version of the Data Quality Audit (DQA) tool which allows programs and
projects to verify and assess the quality of their reported data. It also aims
to strengthen data management and reporting system.
38
The objectives of RDQA are as follows (RDQA User Manila, 2015):
1. Rapidly verify the quality of reported data for key indicators at
selected sites.
2. Implement corrective measures with action plans for strengthening
data management and reporting system and improving data quality.
3. Monitor capacity improvements and performance of data
management and reporting system to produce quality data.
The RDQA is a multipurpose tool that is most effective when
routinely used. Following are the uses for the RDQA tool (RDQA User
Manila, 2015)
RDQA Use Case Example
Routine data quality checks as part Routine data quality checks can be
of on-going supervision included in already planned
supervision visits at the service
delivery sites
Initial and follow-up assessments of Repeated assessments (e.g.,
data management and reporting biannually, or annually) of a
systems system’s ability to collect and
report quality data at all levels can
be used to identify gaps and
monitor necessary improvements
Strengthening of the program Monitoring and evaluation (M&E)
staff’s capacity in data staff can be trained on the RDQA
management and reporting and sensitized to the need to
strengthen the key functional areas
linked to data management and
reporting to produce quality data.
Preparation for a formal data The RDQA tool can help identify
quality audit data quality issues and areas of
weakness in the data management
and reporting system that would
need to be strengthened to
increase readiness for a formal data
quality audit
External assessment by partners of Such use of the RDQA for external
the quality of data assessment could be more
frequent, more streamlined, and
less resource intensive than
comprehensive data quality audits
that use the DQA version for
auditing.
39
Development Implementation Plan
An implementation plan is a project management tool that illustrates how a
project is expected to progress at a high level. It helps ensure that a
development team is working to deliver and complete tasks on time (Visual
Paradigm, 2009). It is also important in ensuring the efficient flow of
communication between those who are involved in the project so as to
minimize issues that would delay delivery of the project. It validates the
estimation and schedule of the project plan.
An implementation plan is developed through the following key steps
(Smartsheet, 2017):
 Define goals/objectives. Address the question, “What do you want
to accomplish?”
 Schedule milestones. Outline the deadline and timelines in the
implementation phase.
 Allocate resources. Determine whether you have sufficient resources
and decide how you will picture those missing.
 Designate team member responsibilities. Create a general team plan
with overall roles that each team member will play.
 Define metrics for success. How will you determine if you have
achieved your goals?
Data Quality Tools
A data quality tool analyzes information and identifies incomplete or
incorrect data. Data cleansing follows after the complete profiling of data
concerns, which could range anywhere from removing abnormalities to
merging repeated information.
By maintaining data integrity, the process enhances the reliability of the
information being used by an organization. Usually, these data quality
software products can share features with master data management, data
integration, or big data solutions.
Gartner (2017) explains how these data quality tools are used to address
problems in data quality:
40
 Parsing and standardization refers to the decomposition of
fields into component parts and formatting the values into
consistent layout based on industry standards and patterns
and user-defined business rules.
 Generalized “cleansing” is the modification of data values
to meet domain restrictions, constraints on integrity, or
other rules that define data quality as sufficient for the
organization.
 Matching is the identification and merging of related
entries within or across data sets.
 Profiling refers to the analysis of data to capture statistics
or metadata to determine the quality of the data and
identify data quality issues.
 Monitoring refers to the deployment of controls to ensure
conformity of data to business rules set by organization.
 Enrichment is the enhancement of the value of the data by
using related attributes from external sources such as
consumer demographic attributes or geographic
descriptors.
As data quality continues to become increasingly all-encompassing,

data integration tools are further developed to include data quality
management functionality.
Application/ Scope of Data Quality Tools
The first generation of data quality tools was characterized by
dedicated data cleansing tools designed to address normalization and
reduplication. However, in the last 10 years, it was observed that there is a
generalization of Extract, Transform, Load (ETL) tools which allow the
optimization of the alimentation process. Recently, these tools started to
focus on Data Quality (DQM), which generally integrates profiling, parsing,
standardization, cleansing, and matching processes (Goasdue, Nugier,
Duquennoy, and Laboisse, 2007).
Root Cause Analysis
A root cause analysis is a problem-solving method that identifies the
root causes of problems or events instead of simply addressing the obvious
symptoms. The aim is to improve the quality of products and services by
using systematic ways to address problems to be effective. (Bowen, 2011).
41
Techniques in Root Cause Analysis
Root cause analysis is among the core building blocks in the
continuous improvement efforts of an organization in terms of its
operation dynamics, especially in the way it handles information. However,
root cause analysis alone will not produce any valuable results. The
organization should seek to improve at every level and in every department
for this to work. The analysis will help develop protocols and strategies to
address underlying issues and reduce future errors. Bowen (2011) suggests
that “to address the root cause of a problem, one must identify the
problem and ask “why” five times to determine the proper strategies to
address its root cause”.
1. Failure Mode and Effects Analysis
The failure mode and effects analysis (FMEA) aim to find various modes
of failure within a system and addresses the following question for
execution.”
a. What is the mode in which an observed failure occurs?
b. How many times does a cause of failure occur?
c. What actions are implemented to prevent this cause from occurring
again?
d. Are these actions effective and efficient?
FMEA is used when there is a new product or process or when t problem
is reported through customer feedback.
2. Pareto Analysis
The Pareto Analysis uses the Pareto principle which states that 20
percent of the work creates 80 percent of the results. It is used when
there are multiple potential causes to a problem. The Pareto chart was
created using the Excel Software. It lays down the potential causes in a
bar graph and tracks the collective percentage in a line graph to the top
of the table. The reflected causes from the table should account for at
least eighty percent of those involved in the analysis.
3. Fault Tree Analysis
The fault tree analysis (FTA) is used in risk and safety analysis. It uses
Boolean logic to determine the root causes of an undesirable event. The
undesirable result listed at the top of the tree then all the potential
causes are listed down to form the shape of an upside-down tree.
4. Current Reality Tree
The current reality tree (CRT) is used when the root causes of multiple
problems need to be analyzed all at once. The problems are listed down
42
followed by the potential cause for a problem. By doing so, a cause
common to all problems will appear.
5. Fishbone Diagram
The fishbone diagram is also called the Ishikawa or cause-and-effect
diagram. The diagram looks like a fishbone as it shows the categorized
causes and sub-causes of problem. This diagramming technique is useful
in in grouping causes. (e.g., people, measurements, methods, materials,
environment, machines) into categories. Categories could be the 4 Ms
(manufacturing), the 4 Ss (service), or the 8 Ps (also service) depending
on the industry.
6. Kepner-Trego Technique
The Kepner-Tregoe technique breaks a problem down to its root cause
by assessing a situation using priorities and orders of concern for specific
issues. The various decision that should be made to address the problem
are then outlined. Then, a potential problem analysis is made to ensure
that the actions recommended are sustainable.
7. Rapid Problem Solution (RPR Problem Diagnosis)
Another technique for root cause analysis is the rapid problem solution
(RPR problem diagnosis) which diagnoses the causes of recurrent
problems by following the three phases below:
 Discover- data gathering and analysis of the findings
 Investigate- creation of a diagnostic plan and identification of the
root cause through careful analysis of the diagnostic data
 Fix- fixing the problem and monitoring to confirm and validate that
the correct root cause was identified.
Sustaining a Culture of Information Use
Choo, Bergeron, Detlor and Heaton (2008) state that information
culture affects outcomes of information use. The information culture is
determined by the following variables: mission, history, leadership,
employee traits, industry, and national by the way of tasks are performed
and decision are made.
The result suggests that to have sense of information attitudes and
values, managers should consider talking the pulse of information of their
own organizations. The sets of identified behaviors and values could
account for significant proportions of the variance in information use. Thus,
management plays an important role in sustaining a culture of information
and should continuously work on maintaining and improving the quality of
data and information used in daily operations.
43
Focus Question
Name:
Section:
Rating:
MS word and send at my email account (5pts each).
1. Define LQAS.
2. What are the objectives of RDQA?
3. Enumerate the aspects of data quality.
4. What are the key steps to develop an implementation plan?
5. Describe what is root cause analysis.
Related Readings
Health Data in the Information Age: Use, Disclosure and Privacy (Moila S,
Donaldson & Kathlyn Lohr)
Data and Information Quality Dimensions, Principles and Techniques (Carlo
Batini, Monica Scannapieco)
LEARNING ASSESSEMENTS
Instruction: Answer the following. IDENTIFICATION
1. It is a problem-solving method that identifies the root causes of
problems or events instead of simply addressing the obvious
symptoms.
2. It is used in risk and safety analysis. It uses Boolean logic to
determine the root causes of an undesirable event.
3. It diagnoses the causes of recurrent problems.
4. This technique breaks a problem down to its root cause by assessing
a situation using priorities and orders of concern for specific issues.
5. It is used when there are multiple potential causes to a problem.
Reference
Health Information System for Medical Laboratory Science, Lesson 8: HMIS
Data Quality
44
LESSON 9
1. Define Hospital Information System, its use in the different
departments of the hospital, and the criteria for selection.
2. Identify the functions of a hospital information system from patient
registration to billing.
3. Describe the different reports and summary in the hospital
information system; and
4. Discuss the use of materials management system and in-built tally
interface.
Introduction
Hospital Information System

Health care plays a vital role in a society and people expect efficiency
from health care providers and health institutions which face the challenge
of handing the numerous patients that seek their services. Proper
management of clinical and operational record is therefore necessary.
Presently, most hospitals have shifted from tedious manual recording to
the use of a hospital information system (HIS) to assist them in maintaining
the different records of the institution.
Definition of Terms
 Shifted- change in emphasis, direction or focus
 Seek-search for and find someone or something
 Inadequate- lacking the quality or quantity required.
 Stakeholders – a person with an interest or concern in something,
especially a business.
Lecture Notes
Lesson 9: Hospital Information System
Hospital Information System (HIS) is a computer system structured to
manage all the records of health care providers to make available
information and reports useful to health care personnel in doing their job
more efficiently. HIS was introduced in the 1960s and has evolved since
then to cope with the changes and demands of the modern times. Back
then, the features of HIS were used mainly for billing and inventory.
45
However, all of these have changed though time. Today’s system is also
integrated with other financial, scientific, and administrative programs.
The modern HIS has applications built to address the needs of the
various departments of health facilities such as nursing, pharmacy, finance,
radiology, and pathology. There are hospitals with as many as 200 disparate
systems integrated into their HIS. Hospitals using the HIS experience
efficiency in accessing reliable patient information with just few clicks,
however, advancements and new developments will be rendered useless if
the system is not user-friendly and training is inadequate.
While HIS delivers high quality patient care and better management
of financial records, it needs to be affordable, scalable, and centered on the
needs of patients and medical personnel. It should be adaptable to rapid
technological changes. An effective HIS also provides enhanced integrity of
facts and, minimization, transcription error and duplication of records, and
shorter turnaround times of report.
His available today links computers that are capable of quickly
optimizing operations and delivering quality service. The system gathers,
process, retrieve patient information, and provide hospital stakeholders
with relevant information through reports for better decision making.
The system also guarantees delivery of information required by the
healthcare personnel because of the optimized core library. It can also be
customized to consider the needs of the department and centralize them
into the system. However, a hospital should provide the requirements in
detail to the HIS provider during the initial stages of scoping so that its need
will be met and accurately provided. For example, the institution could ask
that the solution based on RDBMS (relational database management
example, the institution could ask that the solution be based on RDBMS
(relational database management system) or ask for a multilingual interface
for better handling of information (EMR Education Center, 2013)
HIS for Different Departments
1.) Nursing Information System
Nursing information system (NIS) are developed to enhance patient care
by providing nurses with accurate information to assist them in
performing their duties more efficiently. An NIS carries out numerous
functions including the handling of personnel schedules, accurate
patient charting, and better clinical integration.
2.) Physician Information System
Physician information system (PIS) are designed to improve the practice
of Physicians. Electronic medical records (EMRs) and electronic health
46
records (EHRs) are some programs where PIS is deployed and
extensively used. Most systems offer support 24/7 to facilitate easier
usage of the system by health care professionals.
3.) Radiology Information System
Radiology Information System (RIS) can provide billing services and
appointment scheduling aside from reporting and database storage.
Technological advances have made the practice of radiology more
complicated such that more and more hospitals turn to RIS to address
the commercial concerns of their radiology departments.
4.) Pharmacy Information Systems
Pharmacy Information Systems (PIS) help monitor the utilization of
medicines in health institutions. The system also handles information
on medication-related complications and drug allergies of patients. It
provides information to identify drug interactions which helps in
administering the appropriate drugs by considering the physiological
conditions of the patient (EMR Education Center 2013).
Selecting a Hospital Information System
The following are the aspects needed to be considered in selecting an
HIS (EMR Education Center, 2013)
1. Total cost package
2. Web-based system
3. Implementation and support
HIS Providers in the Philippines
 BizBox
 KCCi Medsys
 Comlogik
HIS Functions
 Help Desk
 Scheduling
 Patient registration
 Admission
 Discharge
 Transfer procedures
 Billing
 Contract management
 Package Deal Designer
47
Focus Question
Name:
Section:
Rating:
MS word and send at my email account (5pts each).
1. Define Hospital Information System.
2. What are the 4 HIS in a hospital?
3. Enumerate the aspect needed to consider in selecting HIS.
4. Identify three (3) HIS providers in the Philippines.
5. Enumerate all the HIS functions.
Related Readings
HELP: A Dynamic Hospital Information System (Gilad J. Kuperman, Red M.
Gardner, T. Allan Pryor-2013)
Hospital Information Systems: A Concise Study (Kelkar S. A. – 2010)
LEARNING ASSESSMENT
Instruction: Answer the following. IDENTIFICATION
1. It is developed to enhance patient care by providing nurses with
accurate information to assist them in performing their duties more
efficiently.
2. It helps monitor the utilization of medicines in health institutions.
3. These are designed to improve the practice of Physicians
4. It is a computer system structured to manage all the records of
health care providers to make available information and reports
useful to health care personnel in doing their job more efficiently.
5. It can provide billing services and appointment scheduling aside from
reporting and database storage.
Reference
Hospital Information System
48
49
LESSON 10
1. discuss the purpose, functional requirements, features, and core
components of laboratory information management systems;
2. describe the laboratory standards in hospitals;
3. explain the application of laboratory information system in patient
registration, billing, contract management, and monitoring Accounts
receivable; and
4. discuss worklist, workflow, and quality control.
Introduction
Laboratory Information Management System

The laboratory information management system (LIMS) is designed to help
process information in medical research to improve the efficiency of the
department services and laboratory operations by reducing manual tasks
and procedures. For example, a LIMS records information automatically
which saves time and reduces typographical error. This is commonly used in
conjunction with laboratory information systems (LIS) in the medical and
pharmaceutical industries.
According to Gartner’s 2016 Hype Cycle for Life Sciences, most of the top
pharmaceutical laboratories use LIMS. The system is also useful for bio
banks and genomic testing canters and laboratories that study drugs and
develop formulations. However, the health care institution must consider
the data capture, process, storage, and retrieval in selecting the solutions
provider because some are more suitable than others (Reisenwitz, 2017)
Definition of Terms
 Typographical- relating to the style, appearance, or production of
printed matter.
 Biobanks- a large collection of biological or medical data and tissue
samples.
 Genomic - relating to the haploid set of chromosomes in a gamete
 Retrieval- the process of getting something back from somewhere
50
 Conjunction- the action or an instance of two or more events or
things occurring at the same point in time or space.
Lecture Notes
Lesson 10: Laboratory Information Management System
Functional Requirements and Features of LIMS
According to Reisenwitz (2017), the functionality of LIMS includes
sample management, workflow management, reporting, electronic health
records (EHR), mobile, and enterprise resource planning (ERP).
Sample Management
Accurate and detailed records are necessary to make sure that
samples are not lost or mixed up. A record should show whether the
sample meets the acceptable values.
LIMS records and stores the following information about the sample:
 Who was the sample taken from?
 What is the sample taken?
 Who is working with it (researcher or provider)?
 Who handled the sample?
 Where does it go next?
 How do you store these samples?
 When does it need to move?
LIMS automates most of these by using radio-frequency
identification (RFID) or barcodes in recording and updating logs and track
the chain of custody of the sample.
Workflow Management
LIMS can be used to automate records and workflows which save
time. Existing coding methods, and procedures enable the system to take
part in the decision process. Using preset rules, it can suggest instruments
needed for the procedure and assign the medical laboratory technician or
specialist to complete the set.
Reporting
Using LIMS, reports can be run and exported to make them standard
and customized. Reports on the most frequently used instrument, the
average handling time of sample, and list of backlogs are useful in data
analysis and formulation of recommendation for future policymaking.
51
EHR
Some LIMS have a built-in electronic health records (EHR)
functionality which is capable of handling patient records and billing
information. A health institution should consider this acquisition because
this feature will greatly help in managing clinical laboratory procedures.
Mobile
Gartner’s (2016) reports that mobile LIMS offerings are limited. But
with the accepted use of smartphones in the laboratory, it is better for
LIMS to be mobile-friendly.
ERP
A LIMS that can handle inventory functions is recommended. The
enterprise resource planning (ERP) solution is especially useful in viewing
current supplies, calculating storage capacity, and managing location.
Core Components of LIMS
LIMS software suites usually involve multiple components to provide
a variety of functions for different levels of the laboratory. IEEE GlobalSpec
(2015) specifies the components of a LIMS software but are not limited to
the following:
 Electronic laboratory notebooks
 Sample management programs
 Process execution software
 Records management software
 Applications to interface with analytical instruments or data systems
 Workflow tools
 Client tracking applications
 Best practice and compliance databases
 ErP software
(View the complete components of a laboratory information
management system in McDowall’s Risk Based Validation of Laboratory
Information Management Systems.)
Laboratory Standards
To help promote laboratory safety, the Occupational Exposure to
Hazardous Chemicals in Laboratories Standard (29 CFR 1910.1450) was
released in the United States by the Occupational Safety and Health
Administration (OSHA) in 2011.
Some important provisions from the standard are cited below:
52
Laboratory is a workplace where hazardous chemicals are used. It is
also a facility that stores small quantities of hazardous chemicals which
are not intended for production use. On the other hand, the laboratory
use of hazardous chemicals should meet the conditions listed below:
 The manipulations of chemicals should be on “laboratory scale”
only and can be handled by one person.
 There is the use of multiple chemicals and procedures.
 The procedures should not stimulate any production process.
 Protective laboratory tools are available and proper practices are
followed to minimize other standards. Examples are:
 Chemicals used in the maintenance of the laboratory
building,
 Production for commercial sale, and
 Testing of a product for quality control.
A Chemical Hygiene Plan (CHP) which discusses all aspects of the
laboratory standards should be formulated if the standards apply. The
employer must implement the provisions which address the proper
purchase, storage, handling, and disposal of the chemicals used in the
facility.
The primary elements of a CHP include the following:
1. Establishment of standard operating procedures (SOP) to minimize
exposure to chemicals and dissemination of information on the
requirements for personal protective equipment, waste disposal
procedures, and engineering controls;
2. Monitoring of the work environment to provide the action and
medical attention required for some chemicals;
3. Statement of plan on how to obtain free medical care for work-
related activities such as handling data sheets, organizing trainings,
monitoring adaption, and revising CHP if deemed necessary.
LMIS Application
Patient Registration
When a patient arrives at the hospital, the admission clerk will take
some basic information and will take some basic information and will guide
him or her to a registration window.
Billing
The process of generating SOAs (statement of accounts) or billing
statements of in-patient, outpatients, and emergencies are the same. In the
following example, and in-patients’ billing statement is used.
53
Contract Management
Most LIMS allow the laboratory professionals to manage the billing
and payment aspects of these activities and to create statistical and billing
reports on a par with the laboratory and management needs. They provide
the parameters for a flexible price schedule and enable heightened
attention on customer needs. They automate billing processing, hasten
collections, and offer marketing tools which reduce the time spent on
standard flow and allow billing and accounting personnel to focus on
improving collection of problematic accounts. (Infomed, 2017)
In addition, the common features of LIMS for invoicing and contract
management include:
 Customer customizable invoices including history analysis of balance
and charges, history balance, detailed services, and participation
when in insurance coverage, discounts, among others;
 Different electronic formats for invoices to allow interfacing with
customer electronic systems;
 Customizable information completion reports for customer;
 Managerial reports which display laboratory billing status for payer
groups including projected return values for each payer group;
 Ability to change the insurance organization of a patient per visit;
 Ability to select which tests are covered by insurance organization of
a patient per visits;
 Immediate access to the billing card of each patient; and
 Consistency with international laws.
Accounts Receivable
Through the integration of the LIMS, the personnel in charge of
managing accounts receivable can easily extract information, which was
already available from the invoicing, and contract management procedures.
Additionally, the LIMS can
 Generate specific or complete accounts receivable reports.
 Monitor balances for reconciliation and audit purposes.
 Export data to other accounting systems, and
 Customize reports according to specifications.
Worklist and Workflow
LIMS assists laboratories in setting priorities of current workloads
based on analyst and instrument availability. This function allows the user
to track a sample, or numerous batches through their lifecycle. Queuing can
also be done by sample or by workflow which is a block of repetitive
procedures in a certain process. The queuing and work list features provide
54
insights about when an event occurred, how long it was, and who was
involved.
In addition, other features also enable personnel and workload
management, thereby, allowing users to plan workload schedules and
assignments, and employee information and training. Ultimately, the
worklist and workflow functions operate to facilitate more efficient
laboratory process.
Quality Control
Diagnostic tests executed inside the clinical laboratory may yield two
kinds of results, a patient result, or a quality control (QC) result. The result
can be quantitative (in numbers), or qualitative (positive or negative) or
semi-quantitative (limited to a few different values). QC results are used to
verify whether the instrument is working within prescribed parameters.
Based on the said results, reliability of a patient’s test results will be
determined (Bio-Rad Laboratories, 2008).
LIMS’ functions enable users to set standards about the relevant range of
patient test results or to extract test result information for the purpose of
quality assurance. Outliers and deviations can be flagged, and appropriate
warning signals can notify users about issues which might involve the
quality of the samples or the equipment currently in use.
Barcode-generation, Printing, and Reading
LIMS modules are commonly linked to a barcoding label generator
which enables a fast and easy method to identify tubes, samples,
documents, and many others. The code can simply be printed on a label
sticker to be placed on any item which needs identification. A barcode
editor also allows multiple labels to be printed at a label printer. The
barcode series can usually be customized to suit the organizations or
classification needs. With this kind of technology, information about a tube,
a specimen, or equipment within the laboratory can be found and retrieved
effortlessly using a barcode scanner.
In-built Bi-directional interfaces with Equipment
A two-way communication between the information system and the
clinical instrument is required. LIMS downloads the test orders and
specimen ID for each test. On the other hand, the clinical instruments
upload the same information for analysis. The same method is also used by
the instruments for microbiology, hematology, and other areas.
When a health institution uses this type of application, productivity is
enhanced because it minimizes the time spent in programming the order
into the analyzer and ensures accuracy due to the eliminations of errors
55
usually committed in the manual process. Nowadays, these machines also
have the random-access testing feature and barcode label scanning for
specimen (Selmyer & Cloutier, 1996).
Focus Question
Name:
Section:
Rating:
1. In your own words, discuss LIMS.
2. In your own words, discuss the laboratory standards.
3. Discuss the different LMIS Application.
Related Readings
Laboratory Information Management Systems (Christine Paszko & Elizabeth
Turner
LMIS-Laboratory Information Management: High Impact Strategies-What
You need to Know: Definitions, Adoptions, Impact, Benefits, Maturity,
Vendors (Kevin Roebuck)
LEARNING ASSESSMENT
Instructions: Answer the following.
1-3. What are the three primary elements of a CHP?
4. A two-way communication between the information system and the
clinical instrument is required
5. Most LIMS allow the laboratory professionals to manage the billing
and payment aspects of these activities and to create statistical and
billing reports on a par with the laboratory and management needs.
Reference
Laboratory Information Management System
56
Lesson 11
1.) Discuss the features, benefits, and functionalities of a cardiology
information system; and
2.) Define radiology information system and describe its functions.
Introduction
Cardiology Information System

The cardiology information system (CIS) is mainly focused on the
storage and retrieval of cardiology-centric images. This system usually
receives an order with patient demographic from other information
management systems. Once the images are acquired from imaging
modalities, they are profile based on the order and stored for further
distribution, viewing, and long-term archiving (Katipula & Ireland, 2013)
The information used by cardiologist for the diagnosis and treatment
of illness varies from personal notes (history, physical examination) to
signals (electro diagrams), images (echocardiograms, angiograms, CT, MRI),
and reports from investigation and procedures. All these types of
information can currently be provided in digital format, and the system
serves as repository of these forms of images. Unfortunately, most system
are limited by their storage capabilities and do not include post-processing
functions.
Evolution of CIS
Decades ago, the requirements for an electronic medical information
system were restricted by the availability of equipment. A good database
schema combined with a functional user interface was deemed adequate.
In the 1970s, available cardiology information systems originated from
mainframe environments, whose technical specifics would be considered
ridiculous in today’s context.
Definition of Terms
 Schema- a structured framework or plan
 Repository- a receptacle, or place where things are deposited.
57
 Modalities- a particular mode in which something exist or is
experienced or expressed
 Deemed- regard or consider in specified way.
Lecture Notes
Lesson 11: Other Hospital Information System
In the 1980s, modular systems that emphasized the use of real-time
applications and minicomputer became the trend (Turney & Khols, 1997).
Over the years, the trend for smaller computers remained, but the
introduction of the internet became a turning point that shifted the focus
of most system towards creating networks and facilitating integration.
Cardiology information systems nowadays have unique features that
enable remote access and easy retrieval. Some systems have also
attempted to integrate radiology information system (RIS) to involve more
administrative processes and go beyond storage purposes.
Benefits of CIS
Different CIS, coming from different sellers, vary in their available
features. However, the following are the most common benefits:
1. Ease of Access while maintaining Data Security
CIS consolidates multiple types of patient cardiology
information, thus eliminating the need for doctors to request
different imaging results from different departments.
2. Flexibility in the Workflow
Availability of mobile technology allows cardiologist to assess a
wide array of information without having to leave the patient’s
bedside. Having cardiological data in a single platform offers
mobility to physicians and nurses, thereby improving the
efficiency of providing service.
3. Enhanced Comparability
CIS is an essential repository of cardiology imagery results;
thereby, retrieval of past data is convenient. This comparability
enables health care professionals to make more informed
decisions on their patient’s treatment.
Functionality of CIS
1. Editing, Viewing, and Storing Multi-Modal Cardiology Data
 With the help of CIS, different types of data, including those of
computed tomography (CT), cardiac ultrasound (echocardiography),
58
magnetic resonance imaging (MRI), nuclear imaging (PET and SPECT),
and angiography may be managed on a single platform.
2. Remote access - the use of networks and integrated information
systems, coupled with the availability of the internet and tablets and
smart phones, offers flexibility to CIS
3. Visualization and Reporting Capabilities- two of the main benefits of
CIS are the ease and the consistency of reporting. As a result, virtual
real-time information retrieval is possible anytime and anywhere
with just a couple of clicks.
4. EHR Integration- CIS may be integrated with existing electronic
health record systems; this results in the enhancement of the quality
of services of the health professionals by offering a more
comprehensive view of the patient care spectrum.
Radiology Information System
A Radiology information system refers to a network system used in
managing imagery and associated data in the radiology department. The
system tracks the orders and billing information of the requesting
department. It uses picture archiving and communication system (PACS) for
the storage and management of medical images and vendor neutral
archival (VNA) to manage image archives and for record-keeping and billing
within a hospital information system (HIS) (Rouse, 2017)
The use of RIS in health care institutions has many advantages in the
context of improving overall operations of the institutions. The system
enables easier access to patient information because it can be integrated in
referring to the doctor’s electronic health record (HER) system, resulting in
better patient experience. It also allows faster processing of payments
because the insurance plans of patients may be verified prior to their visit
and electronic payment is an available option. It also permits reports to be
easily generated and sent to the requesting department which dramatically
improves the efficiency of the workflow of the institution.
Function of RIS
Rouse (2017) describes the following functions of RIS:
 Patient Management- the system tracks the patient’s entire
workflow within the radiology department. It can add images and
generate reports to EHRs for easy retrieval and viewing by the
authorized radiology staff.
 Scheduling- the system allows staff to schedule appointments for in-
patients and out-patients.
 Patient Tracking- Patient tracking means tracing the patient’s
radiology history starting from admission to discharge and
59
coordinating it with his or her past, present, and future
appointments.
 Result Reporting- Result reporting is possible through the statistical
reports generated by RIS. The reports may be done for a single
patient or a group of patients, as well as for specific procedures,
depending on the needs.
 Image tracking- RIS was traditionally used to track individual films
and associated data. Nowadays, RIS-PACS system managed by
radiology departments cover the entire clinical workflow of the
medical enterprise.
 Billing- Billing is made convenient through the system’s financial
record keeping and processing of electronic payments and
automated claims.
Focus Question
Name:
Section:
Rating:
1. In your own words, discuss CIS.
2. List down the different functions of RIS.
Related Readings
Healthcare Information Systems (Kevin Beaver)
The Computer-Based Patient Records: An Essential Technology for
Healthcare, Revised Edition (Richard S. Dick, Elaine B. Sleen &Don E.
Detmer)
Learning Assessment
Instructions: Answer the following.
1. It means tracing the patient’s radiology history starting from
admission to discharge and coordinating it with his or her past,
present, and future appointments.
2. It tracks the patient’s entire workflow within the radiology
department.
3. This mainly focused on the storage and retrieval of cardiology-centric
images
60
4. This allows staff to schedule appointments for in-patients and out-
patients.
5. Refers to a network system used in managing imagery and associated
data in the radiology department.
Reference
Other Hospital Information System
61
LESSON 12
1. Discuss the concept in materials management system;
2. Describe the procurement process from enquiries, quotations,
purchase request, order, and approval, receiving and returns.
3. Compare different issue methods and;
4. Define the generic tax formula configurations.
Introduction
Materials Management System

The management function of hospital materials- that is, to ensure
that services are rendered successfully from one source to an end user-
covers several areas of hospital and could drastically affect the expenses of
the medical institution. Executing this function in a manner that lessens
expenses and ensures adequate cash flow requires effective management
of a large amount of information from several sources.
To successfully manage such information, many hospitals implement
a form of materials management information system (MMIS). The system
can be used to manage functions like purchasing, accounting, inventory
management, and patient supply charges (“Materials management
information systems,” 1996).
Purchasing
In HIS by BizBox, a purchase request marks the beginning of the
procurement process. Using this form, the user notifies the purchasing
department regarding the needed items and services. It contains the
quantity, as well as a timeframe for the items requested. It has the
authorization information needed to proceed with the purchase. The
requested item is then confirmed using the purchase order and a supplier is
nominated. Once completed, the order is sent to the supplier for
processing.
Finally, the items are checked during receipt of the delivery. The
receiver, which is usually the Central Supplies Department, uses the
purchase order as basis for accepting the delivered items that should be
checked for indents and damages. Afterwards, the said items are then
released to the requesting department.
62
Definition of Terms
 Indents- form deep recesses or notches in
 Stipulates-demand or specify (a requirement)
 Replenish- restore to a former lever or condition
 Perishable- likely to decay or go bad quickly
Lecture Notes
Lesson 12: Material Management System
Inventory Control
Inventory is one of the biggest expenses for most medical institution
(Johnston, 2014). Inventory control plays an important part in refining the
quality of health care services since lives of people are on the line and
medical costs are increasing.
Strategies in improving inventory control in the health care facility.
1. Ensuring Shipment Accuracy
Checking shipments for accuracy means ensuring that the received
items are the ones ordered and the supplies are free from possible
damage during transit.
2. Aligning with Sales Projections
Coming up with an inventory tracking report in comparison with
actual sales proves to be challenge in the field of medicine. However,
it is necessary to prevent wastage, identify trends, and ensure that
there is no excess inventory.
3. Complying with regulations
The health institution should be responsive to the current trends and
needs of the highly regulated health care industry. The regulators
monitor health institutions and determine the success or failure of
companies to serve the best interest of the patients.
4. Establishing Buying Cycles
Buying cycles should be determined and understood by inventory
personnel based on the previous cycles, so that inventory ordering
becomes manageable through the elimination of shortages and
overages. The said cycles determine the trends and adjustments that
can be made accordingly.
63
Item Master Maintenance
Since the importance of inventory control has been recognized, the
usage of a materials management system brings an advantage. In this
system, the Inventory Item Maintenance screen has many sections. The
upper portion contains master information. Additional options appear after
the selection of an existing item. “Item Tab” is used for maintenance screen
has many sections. The upper portion contains master information.
Additional options appear after the selection of an existing class, item type,
and others. If the balance and order activity is zero (O), items can be
deleted using this options. Users may set the product type to group similar
items for sales analysis and inventory reporting. Most of the inventory
reports are based on a certain product type. The “Item Availability” form
specifies inventory levels across all warehouses.
Item Indents and Issues
There are some instances when items are damaged either upon
receipt from the supplier or during the move from the source to another
location. Some suppliers allow return of goods that have indents or the like,
with a guarantee of replacement without any additional payments. This
applies to distribution and retail industries where the goods for sale are fast
moving. Normally, damaged items are moved to another warehouse for
them to be monitored.
Reorder Level and Minimum and Maximum Inventory Ordering
In a typical materials management system, reorder level is the
minimum quantity of an item that a company has in stock, so when the
stock reaches the stated minimum quantity, the item must then be ordered
(purchase order/production order)
A basic reordering method implemented in many ERPs and other
inventory management software’s is the Mini/Max inventory ordering
method. The “Min” value is representative of a stock level that prompts a
reorder, and the “Max” value is representative of a new targeted stock
level that follows the reorder. The main difference of these two-Max and
Min- is often interpreted as the economic order quantity (EOQ). Although
the Min/Max method is an unpolished method for inventory ordering, its
settings could be adjusted to provide better inventory performance
(Vermorel, 2014)
Enquiries and Quotations for Drugs, Consumable, Assets, and General
Items
According to Webrino (2018), the following documents are required
in the materials management process:
64
1. Enquiries- the enquiries mark the beginning of the purchasing
process. These establish the relationship between the entity and
the right supplier. The supplier provides the information on the
availability and price of the required items.
2. Quotations- Quotations contain viral information regarding the
requirements which include price, delivery details, payment
terms, and etc. Companies usually review two to three quotations
before selecting the supplier.
3. Orders- The buyer shows the intention to purchase the required
item by issuing a purchase order. A purchase order is placed to
signify intention to engage in commercial operations for a specific
product or service. Upon agreement, the order becomes a
contract between the health care institution and the supplier.
4. Invoices- An invoice is also called a bill. It is a commercial
document that indicates the product, the ordered quantity, and
the agreed price. The supplier issues this to the buyer to show the
products and services that were sold or provided to the buyer.
5. Documents- Documents are statutory requirements used during
purchase and sales transactions. These ensure smooth transition
and completion of the process.
Comparison of Quotations and Preferred Vendors

Purchase Quotations
A purchase quotation is a document for requesting prices and
delivery information from a vendor before the purchase order. It can be
created then sent to a vendor. When a response from a vendor is received,
with a list of prices and delivery dates, the information can be entered in
the purchase quotation. In this way, the complete history of the sourcing
process can already be stored in the system. From the quotation, the right
vendor for the purchase can be chosen based on the tracked information. It
helps in lessening expenses, improving the quality of the product or service,
and increasing on-time delivery. A purchase quotation report allows the
comparison of offers in order to pick the appropriate vendor for the
purchase scenario. Afterwards, the purchase order can already be created
from the selected quotation.
Preferred Vendors
Companies typically maintain a list of preferred vendors from whom
inventory items are usually purchased. They look for a vendor who has on-
time performance, offers reasonable costs, provides high quality products
and services, offers fully licensed, bonded, and insured products and
services, and has good business practices.
65
Purchase Requests, Orders, and Approval
Purchase Request
A purchase request or purchase requisition is a document that
notifies the purchasing department that certain items or services need to
be replenished. The document stipulates a timeframe and required
quantities for the requested items. In certain instances, it also contains
authorizations to acquire assets. For enhanced accountability and for
documentation purposes, some companies require a purchase requisition
for all purchases, but others only require them for specific kinds of
purchases, such as those that would require greater capital outlay. (SAP.
2012)
Purchase Order
A purchase order is a legally binding contract which shows that the
seller has already accepted the order issued by the buyer (SAP, 2012). It
should contain: information about the buyer and seller (name, address,
contact details, and etc); order number and order date; item description
(quantity, unit and total price); shipping information (shipping date and
address); billing address; and the authorized signature.
Approval Process
The person who creates the document, either a purchase request or
order, is the originator. When the said originator adds document/s to the
materials management system, the system checks for any approval
requirements. If the document fails to meet the approval requisites, the
originator is notified that the documents needs approval. The documents is
temporarily saved as draft.
When the approval process is launched, an internal request is
immediately sent to the first approval stage. This request is received in the
Messages/Alerts Overview window, and the approver can access the
document. Approval can be done through a mobile phone if the devices are
integrated. An internal notification goes back to the originator with a link to
the rejected document when the approver reject the document. The
originator can amend the document, and the approval procedure will
continue until the conditions are adequately satisfied (SAP, 2012)
Receiving and Tracking Items
The following policies should be followed for the proper receipt and
inspection of goods. (The York College, 2017):
1. Signing for Deliveries- the person who receives the delivery should
inspect the delivered items before signing the receiving document
66
and the packing list. Then the document should be submitted to the
appropriate department for reconciliation.
2. Refusing Delivery- The receiving department should refuse to accept
any shipment if the packaging appears to be damaged or if there is
any item that does not have a corresponding purchase order.
3. Record Retention- the packing list should be provided to the
receiving department during delivery to ensure that there is proper
documentation since it is are taking possession and legal ownership
of the delivered items. If no list was provided, the department should
request the copy from the supplier. All files should be kept according
to the guidelines of the entity. This helps track partial and staggered
deliveries.
4. Inspecting a Shipment- the personnel receiving the items should
inspect the goods to ensure that the following minimum conditions
are met:
a. The received items match the requirements stated in the
purchase order (type, description, color, and etc.)
b. The quantity is correct.
c. The item has no damage, discoloration, and issues.
d. The quantity per unit of measurement is accurate (e.g., one
dozen=12 pieces)
e. Packing list, certifications, and other delivery documentation are
completely provided.
f. Perishable items should be in good condition and have not
reached the expiration dates.
g. The items are functioning properly.
5. Partial deliveries- when items are delivered partially without proper
notifications from the supplier. The receiving personnel should advise
the Purchasing department for approval and further instructions.
This should also be typically noted in the packing list or the receiving
document.
6. Tracking of Goods- Goods can be easily tracked/trace when they are
managed by serial number of batch. Through that, aging of products
can be monitored based on how long they have been in the
warehouse.
Purchasing Returns along with Returnable/Non-Returnable Gate Pass
Defective or substandard quality goods, incorrect order delivery, and
deteriorated purchased and sold items are usually common in business.
These lead to purchase or sales returns. When purchased goods are
returned, the materials management system updates inventory levels to
reflect the decrease in quantity.
67
Movement of inventory is not limited to purchase returns. Supplies
and equipment are also sometimes required to be taken out of department
for repairs or consignment. For temporary movement, a returnable ate
pass is issued, whereas for permanent movement, a non-returnable gate
pass is given. The system can be configured to track returnable and non-
returnable items or equipment. It can also be set to monitor due dates for
returnable items and to provide detailed reports about the status of
different inventory items.
Consignment Stock Receipt, consumption, and Regularization
In the process of consignment, the vendor or consignor issues
materials to the receiver or consignee, and these materials are stored in the
consignee’s premises. The vendor maintains legal ownership until such
materials are removed from the consignment stores. The invoice is due at
predetermined intervals. In addition, customers can also arranged to take
over ownership of the remaining consignment material after a certain
period (SAP, 2011).
Expired Stock and Quarantine

Expired Stock/ Inventory
Upon reaching their expiration dates, some goods, such as food and
medicine, can no longer be utilized. In rare instances, they may be sold to
other parties at lower cost. Expiration dates and decrease in values of items
must be reflected in the financial records so discrepancies in financial
statements will be prevented. The amount that reduces inventory in the
records is recognized as a loss which equates to a reduction in profit
(Keythman, 2017)
Quarantine Stock/ Inventory
When undecided about how to handle defective goods, whether to
be sold as scrap, reworked, returned, or used as it is, a quarantine location
or warehouse can be used to temporarily house them until a final decision
is reached.
Inventory is put into quarantine if it is initially rejected during (Infor
LN Warehousing, 2018):
 Production upon completion of an operation when specified as
“Move Rejected End Item to Quarantine”
 Inbound inspection upon receipt of:
 Manufactured end items
 Purchased items
 Sold items on sales return orders
68
 Enterprise planning distribution orders
 Outbound inspection upon issue of materials to production.
Drugs and Consumable Issues and Returns to Patients

Nagarajan (2017) affirms that 30 to 50 percent of hospital charges
are actually attributable to diagnostics, drugs and consumables; and
doctors get only between 10 to 20 percent. For both hospitals and patients,
drugs and consumables take up the bulk of expenditure. This is why
materials management is critical for hospitals to optimize the investment in
these kind of consumable assets.
While some hospitals have functional inventory database, the lack of
integration does not give them holistic information, and this affects
decision-making, both on managerial level and during day to day
operations. For instance, some drugs are misplaced or misappropriated, or
shortages and surpluses may occur as a result of improper inventory
controls in a traditional system (Infor LN Warehousing, 2018) . This is where
materials management system becomes advantageous. It provides an
overview of the entire institution’s purchasing and inventory control
processes. As a result, decision-makers can have more reliable information
and can monitor the bigger picture.
Issue Methods
Inventory management is a crucial function for any product-oriented
business. Common inventory handling methods include:
a. First In, First Out (FIFO)- Inventory items are sold based on the order
they are purchased. This is the most common technique.
b. Last In, First Out (LIFO)- Last items to enter the system are sold first.
This is common among non-perishable items like petroleum,
minerals, and metals.
c. First Expired, First Out (FEFO)- Materials are sold based on the dates
they should be consumed, regardless of when they were purchased.
Generic Tax Formula Configurations
Materials management system usually allow tax rates to be defined
internally via tax codes, or imported from an external source. Tax
configurations are usually accounted on a per country basis. The following
taxes that can usually be processed while posting documents are
 Tax on sales and purchases
 Additional taxes like VAT,
 Sales and use tax in USA, and
 Withholding tax like income tax in India
69
The automatic calculation of the tax dues during the purchasing process
makes the process less susceptible to clerical errors.
Periodic Physical Stock Taking and Adjustments with Tracking
An inventory count is a process where a business physically counts its
entire inventory. A physical inventory may be mandated by financial
accounting rules or tax regulations to place an accurate value on the
inventory, or the business may need to count inventory so component
parts or raw materials can be restocked. Business may use the following
tactics to minimize the disruption caused by the physical inventory (CTI
Reviews, 2016):
 Inventory service provides labor and automation to quickly count
inventory and minimize shutdown time.
 Inventory control system software can speed up the physical
inventory process.
 A perpetual inventory system software tracks the receipt and use of
inventory, and calculates the quantity on hand.
 Cycle counting, an alternative to physical inventory, may be less
disruptive.
The materials management systems offer all of these in addition to
the barcode and RFID capability which are supplementary technologies
placed to give the institution more accurate and less burdensome inventory
counts.
Focus Question
Name:
Section:
Rating:
1. In your own words, discuss the concept in materials management
system.
2. Compare the different issue methods.
3. Define the generic tax formula configurations.
70
Related Readings
Materials Management: A System Approach (G.K. Beckman-Love L. Niger)
Materials Management: An Integrated Systems Approach (Prem Vrat-2009)
Learning Assessment
1. Inventory items are sold based on the order they are purchased. This
is the most common technique.
2. Materials are sold based on the dates they should be consumed,
regardless of when they were purchased.
3. Last items to enter the system are sold first.
4. It is an alternative to physical inventory and less disruptive.
5. It is a legally binding contract which shows that the seller has already
accepted the order issued by the buyer
Reference
Material Management System
Study Guide:
TIME FRAME TASKS
Prelim Grading
Period
Week 1 Orientation with Course Facilitator
Unit 1 – Educational Institution
 Vision and Mission Statement
 Value Statement
 Objectives
Unit 2 – Health System
 Goals and Functions of a Health System

 WHO Health System
Week 1-4
 The Philippine Health System
 Leadership Governance
Unit 3- Primary Health Care and the Philippine Health
Care Delivery System
 Primary Health Care
 Essential Elements of Primary Health Care
 Principles of Primary Health Care
 Management of Primary Health Care
Week 5 Prelim Exam
71
Midterm
Grading Period
Unit 4- Lesson 4: Overview of Health Informatics
 Health Care Software Systems
 Health Information Ecosystem
 Health Informatics Cloud
 Advantages of Cloud Technology
 Disadvantages of Cloud Technology
 Health Informatics in the Philippines
Unit 5- Health Management Information System

 Roles of HMIS
 Function of HMIS
Week 5-9
 List of Functions of HMIS
 Determinants of HMIS Performance Area
 Organizational Determinants
 Technical Determinants
Unit 6 – Health Information Systems
 Role and Function of Health Information System
 Components of Health Information System
 Different Data Sources for Health Information
Systems
Week 10 Midterm Exam

Pre-Final
Grading Period
Unit 7- HMIS Monitoring and Evaluation
 Purpose of M&E
 M&E Framework
 MSE Plan
 M&E and HMIS Indicators
 HMIS Indicators and Health Programs
 Maternal Survival Interventions
 Child Mortality and Child Survival Interventions
Week 11-14  Stop TB Program
Unit 8- HMIS Data Quality
 Lot Quality Assurance Sampling (LQAS)
 Routine Data Quality Assessment (RDQA)
 Development Implementation Plan
 Data Quality Tools
 Application/ Scope of Data Quality Tools
 Root Cause Analysis
 Techniques in Root Cause Analysis
72
 Sustaining a Culture of Information Use
Unit 9- Hospital Information System
 HIS for Different Departments
 Selecting a Hospital Information System
 HIS Providers in the Philippines
 HIS Functions
Unit 10- Laboratory Information Management System

 Functional Requirements and Features of LIMS
 Sample Management
 Workflow Management
 Reporting
 Core Components of LIMS
 Laboratory Standards
Week 15  LMIS Application
 Contract Management
 Accounts Receivable
 Worklist and Workflow
 Quality Control
 Barcode-generation, Printing, and Reading
 In-built Bi-directional interfaces with Equipment
Final Grading
Period
Unit 11- Other Hospital Information System
 Benefits of CIS
 Functionality of CIS
 Radiology Information System
 Function of RIS
Unit 12- Material Management System
 Inventory Control
 Item Master Maintenance
 Item Indents and Issues
 Reorder Level and Minimum and Maximum
Week 16-18
Inventory Ordering
 Enquiries and Quotations for Drugs, Consumable,
Assets, and General Items
 Comparison of Quotations and Preferred Vendors
 Purchase Requests, Orders, and Approval
 Expired Stock and Quarantine
 Drugs and Consumable Issues and Returns to
Patients
 Periodic Physical Stock Taking and Adjustments
with Tracking
73
Final Exam
74

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LET’S BEGIN!

Intended Learning Outcomes

Health system is the “combination of resources, organization,

Goals and Functions of a Health System

The four (4) vital health system functions are:

WHO Health System

BUILDING BLOCKS OUTCOMES

Service delivery Safety Improved efficiency

Leadership and Quality Social and financing risk

Financing Improved level and

Health products, Coverage

Figure 2.1 WHO Health System Framework

Intended Learning Outcomes

For better understanding, the following concepts under health care

Primary Health Care

Essential Elements of Primary Health Care

Principles of Primary Health Care

Management of Primary Health Care

Health care managers usually carry out the following functions in

Below are the management principles in relation to organizing:

3. What is the relation of organized leadership and accountability?

Intended Learning Outcomes

Health Information Technology

Health Information Ecosystem

Health Informatics Cloud

Advantages of Cloud Technology

2. Better Management of Data

Health Information System for Medical Laboratory Science, Lesson 4:

List of Functions of HMIS

Determinants of HMIS Performance Area

1. Health information systems and resources

These six components of health information systems can be categorized

Different Data Sources for Health Information Systems

Demographic data Administrative data Health Risk Information

Health status Patient Medical History Current Medical

Source: Donaldson and Lhor (1994)

Data quality signifies the data’s appropriateness to serve its purpose

Steps in applying LQAS

Routine Data Quality Assessment (RDQA)

As data quality continues to become increasingly all-encompassing,

Hospital Information System

Laboratory Information Management System

Cardiology Information System

Materials Management System

Comparison of Quotations and Preferred Vendors

Expired Stock and Quarantine

Drugs and Consumable Issues and Returns to Patients

2. Compare the different issue methods.

3. Define the generic tax formula configurations.

 Goals and Functions of a Health System

Unit 5- Health Management Information System

Week 10 Midterm Exam

Unit 10- Laboratory Information Management System

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