Khalid Moidu

Impact on the management and delivery of primary health care by a computer-based information system

Timely and accurate information forms the basis for management to plan and for care providers to take appropriate action. We report from a developing country a research project aimed to strengthen the information infrastructure with a computer at a Primary Health Centre. The software (MCHS) was designed to assist the care providers in the information management for the Maternal and Child Health (MCH) programme activities. In Phase I, a baseline survey was conducted to identify the needs and target groups. In Phase II, the MCHS was integrated into routine delivery of MCH to monitor the target population and help in evaluation. The research projects impact is reflected in enhanced utilization of services and quality in care, as seen by reduction of dropouts from the immunization program. In economic terms, we see that the costs for a fully immunised child are reduced with reduction of dropouts; thus, the computer system contributes to quality assurance and cost effectiveness in delivery of care.

Computer based information systems in primary health care—why?

The delivery of health care is information based. A host of computer-based information systems have been developed and implemented in the health care environment. The mere availability of the computer as a tool for information handling should, in itself, not be the cause for developing computer-based information systems. The earlier assumption of a cost-benefit impact with the development of such systems has not been effectively shown in all cases, and as seen in a report by van Bemmel, the recent trend is to apply other criteria in systems evaluation. Information is essential in health care related decision making. The properties of information are described to present a case for a computer-based information system to support primary health care delivery.

MCHS: An Application Software for Family Welfare Programmes

At the level of first contact, a primary health care centre, information management is an unwieldy task, therefore health information systems are reported to be inadequate and weak. Microcomputers could improve information management at this level, but there is little success due to a lack of specialized application software. In this paper we describe software developed after a multi-centre systems analysis study, on an essential data set, to support the delivery of the public health programmes for family welfare, i.e. maternal health care, family planning and immunization programmes. The modular approach was taken to develop a common application software for information management use at multiple sites. The software is tested in a laboratory mode by retrospective data entry from sites in Sweden and in India. All the information could be entered and site-specific reports that were generated are compared. The software provided a common data collection format, an essential platform for outcomes research.

MULTI CENTRE SYSTEMS ANALYSIS STUDY OF PRIMARY HEALTH CARE: A STUDY OF SOCIO-ORGANIZATIONAL AND HUMAN FACTORS

The information management systems to support health programmes are inadequate. As computers become cheaper and more powerful, their application in the strengthening of the information infrastructure becomes more feasible. However, the high cost of specialized applications software limits their potential, especially in developing countries. A multi-centre systems analysis, (a descriptive study using a questionnaire), was made of District Health Sites in developing countries to analyse whether a common specialized application software design for implementation at a primary health care centre was feasible. Responses to the questionnaires by physicians at the primary health centres were compared between district health sites using contingency tables. Significant inter-site differences in social factors existed, respondents had no prior experience, but with near unanimity (98%) accepted the idea of computer assistance in their work. However, general reservations (31%) and fears (26%) about computer interference in the doctor-patient relationship were expressed. The human factor must be considered in interface design and training before implementation.

Primary health care computing analysis of Swedish maternal health records

In our attempt to develop an “Essential Data Set” for a computer based information system to support Maternal & Child Health Care services an analysis of Swedish maternal care services was undertaken. The present study analyses the information system in the domain of maternal and child health care at the primary health center level with a view to identify areas where a computer-based medical record could effect improvements. The study showed that even in a well organized maternal care service as in Sweden lacunae exist in the information system. The paper forms, called MHV1, MHV2, MHV3 and FV1, though well designed, were incomplete in a large number of the cases. The MHV1 forms were completed in less than 45%, the MHV 2 form in 87.5% and the FV1 form in 70% of the cases. Certain elements of the data set were less likely to be completed than others. Another weak spot was the inaccessibility of the paper records during off-hours. These deficiencies could be eliminated by the use of a computerized medical record based on an essential data set.

Computers in Primary Health Care

The primary health care concept holds the key to make “Health for All by the year 2000 AD” a reality and not remain just a slogan. If an effective health care service is to be provided to the larger population mass living in the rural areas of the developing countries. Then the primary health care delivery must be strengthened. The information infrastructure strengthened through computer implementation would support the care providers, as for example in monitoring the target population to follow-up the drop-outs from the immunisation programme. The administrators would receive accurate reports and have a factual base to study the outcomes of the interventions. In the preparatory phase to implement a computer-based system to support the Mother and Child Health Programme, a base line study was started, and a cohort group for immunisation followed. A dropout rate of 72% was seen in the immunisation programme and not a single pregnant lady had till then received any antenatal care. A computer-based system will make the programme delivery effective through follow-up and monitoring, thus introduce quality assurance in the care.

Computers and physicians - an appraisal study

The use of computers to improve health care delivery in a cost-conscious era is increasingly considered appropriate and is even recommended by the World Health Organization. Provision of adequate and appropriate health care requires a large amount of information. However, the assessment of acceptance, of existing skills and of the ability of people to learn and absorb computer technology is still a neglected aspect in the implementation of computer systems. Therefore, in order to address this problem, a study was performed among end users in a rapidly developing country. The results demonstrated that the physicians are interested, but that an information gap exists. Respondents with some experience and information accepted the potential of the computer as a decision support tool, but those without experience had reservations.

A multicenter study of data collection and communication and communication at primary health care centers

Health care delivery is information intensive. As computer applications make information available to the decision maker with speed and accuracy, informatics applications will strengthen the infrastructure. This paper is the second part of a multicenter systems analysis study to design a common application software to support primary health care focused on information flow. We present the questionnaire analysis and observations from a field study of a district health site. Analyses using contingency tables revealed differences, some statistically significant. The field study confirmed that minor differences exist even within a district health site. Development of a common application software on the basis of information flow studies is feasible. However, to make optimum use of computer implementation, revision of the health information systems was recommended. It was suggested that application software be developed with thecore data set required by the care providers to deliver and administrators to manage a vertical health program.

Application of an essential data set based computer system in support of maternal and child care

A simple functional application software has been developed to support care providers in information management related to perinatal care activities, family planning encounters and the immunization of infants. This was distributed to some sites and was implemented with no organizational change, though the methods differed. An early assessment of the software after a period of implementation is made based on the observations and experiences reported. This is presented in a framework outlined earlier as the OUST model. The systems objective to enhance the value of information was observed to have been partially achieved. The utility to the users is observed in the ability of the end-users at the sites to identify the local community needs and adopt accordingly suitable strategies. The social impact was seen in the assistance provided by the sentinel action of the system in tracking dropouts from the immunization programme at a site, thereby ensuring quality in care and also economic benefits. From a technical standpoint, the application software was small yet functional and in it were incorporated features that ensured data quality. The application software was designed to generate a unique identity code to assist in follow-up of the target population. Based on the data entered it compiled reports to meet administrative requirements, reports that gave the care providers feedback and lists to coordinate in the follow-up of the target population. The application software is a common data collection tool that can assist in building a data registry for health outcomes research.

Medical Practice — Decision Making: A Logical Model

Medical practice is described as shrouded in myths, one of which being the unexplained strategies of decision making in medical practice. After a brief review of the existing theories and models of medical decision making, a definition is made and the components enumerated. The process of diagnostic decision making is modeled, based on the assumption that the inference mechanism is a trained cognitive skill. It develops as the knowledge base is built and the methodology of clinical examination is learnt. The issues in the “informatization” of the model are briefly discussed.