The article is incomplete. I hope to build on it when I have more to say.
Disambiguation of Terms
First of all we need to disambiguate the terms. A distinction must be made between “health management” as a governmental or societal responsibility and “healthcare” as a service provided by various facilities. Factors contributing to people’s health include good nutrition, food safety, clean water, and clean environment not just the control of diseases. Hence, health management is a broader activity. On the other hand, healthcare is concerned with services for people affected by disease, early detection of diseases, disease prevention and promotion of health of an individual.
Information systems to facilitate the delivery of healthcare services are developed for the type of facilities distinguished by the level of services it provides. Hence, we have Hospital Information Systems (HIS), Clinic information systems, Day care Information Systems and Hospice Information systems etc.. These are called Healthcare Information Systems, where care is defined as a business of service provision. This is the main subject matter of my website.
Health Management Information System (HMIS) of the Ministry of Health (MOH)
The ministry of health being an arm of the government is responsible for managing all aspects the health of its citizens through of efforts at promoting health and the prevention, detection, control of diseases.
MOH is a huge organization that oversees the county’s health issues (public health), Health Management is its core function. The information system that facilitates the function of Health management would be called Health Management Information System (HMIS). This is the subject discussed in this post.
This can be by manual or computerized means. We would imagine that there would be a vast amount of data involved and a computerized system consisting of applications that would facilitate this function would be named the Health Information Management System. It facilitates preventive activities plus early detection of disease (screening services). It also monitors disease incidence & prevalence and control (epidemiology) through Health offices at national, state level. You can get the information about this central function and how it is organized at .
However, in Malaysia like in many countries, the ministry’s facilities provides promotion of health, early detection and primary healthcare services through health clinics. To do this it uses the Wellness Information System (which has not been well developed as yet).
Healthcare is a business endeavor (not necessarily for profit) provided by various and provision of healthcare for people affected by disease. On the other hand, healthcare services are provided by both the private and public sector. The role of MOH as a ministry within the government would be to regulate and oversee the services provided.
However, if the MOH also runs its own healthcare services (care of the sick) through hospitals and clinics, information management for these would be part of the Healthcare Information Systems but would contribute to HMIS.
To carry out its strategic management function (forecasting, planning, budgeting, funding), the health ministry requires information regarding the status, trends, and future needs of health and healthcare. The information is obtained from those peripheral services. It is then gathered, stored, analyzed, and interpreted at a central office. In Malaysia, it is called the Information Documentation System (IDS) unit in the MOH head office.
The website on IDS of MOH mentions how it obtains data from the various health care facilities and health administration offices i.e., through a web application which enables those facilities and offices to submit their reports (called returns) using electronic forms via the internet.
Sources of Data
The website of Malaysian IDS mentions certain applications like THIS, CDCIS, SMRP, FOSIM etc which purportedly collects data electronically. These usually provided secondary data i.e. those that have been collated and analyzed.
However, the website glossed over how raw data was obtained. It was not mentioned how data was actually obtained. and does not even mention how they work. THIS is Total Hospital Information System. MOH implies that for hospitals and clinics that has computerized systems, reports are generated by the system. This is not quite so because those systems may not be developed to create specific reports directly. SMRP (Sistem Mengurus Rekod Pesakit) is the computerized patient registration system used in certain hospitals and clinics. CDCIS (Communicable Disease Control Information System) is a system for the management of data for the detection and prevention of communicable diseases. It has a reporting system for the notification of infectious disease known as e-Notifikasi. FOSIM is the Food Safety Information System.
Primary Sources of Data
Data is collected at the primary source of raw data and converted into ‘returns’ to MOH. This is a very tedious and laborious process which needs further explanation.
For managing the operations of healthcare delivery at its own facilities managers at MOH needs to know, among other items, the workload, case types, staffing needs, requirements for acquiring and facility maintenance. Data for workload concerns number of inpatient admissions / discharges, clinic attendances, number of deliveries, surgical operations and quantity of service items such as laboratory tests and so on radiology images. This requires each department and unit to keep registration books. These are large books maintained by middle managers or supervisors like Nursing Sisters and supervisors. Registers are kept for clinic attendances, hospital admissions, births, deaths and bed occupancy
In Malaysia, the practice is inherited from the times before independence and still used to this day. Data from them are gathered and converted into reports by Medical record officers.
Besides giving data concerning workload, data regarding disease burden (incidence, prevalence, epidemiology) can also be taken from the registration books mainly because there are columns on the pages of the books for reason for visit and diagnosis on discharge. However, the data regarding diagnosis must be copied from what the doctor writes in the medical record which is not easy. Data concerning number and cause of death is taken from death certificates. Registers are kept for some specific causes of deaths such as Maternal mortality and neonatal mortality. Labor rooms keeps a register of births and stillbirths. Operation theatres keeps a registry of all surgical operations performed.
Notification of Infectious Diseases
Data concerning epidemiology relies very much on the system for notification of disease. It is mandatory (by law) to report the occurrence or detection of a communicable disease. This has been made easier and quicker by the electronic notification system introduced in recent years. The system requires the awareness to report by doctors but often are known only when the discharge diagnosis is looked at by medical record officers.
Data From Research
For non-communicable disease, National Health Morbidity Survey by Institute for Public Health, National Institutes of Health (NIH) conducts a survey in 4-yearly cycles since the year 2011.
There are also disease registries or databases which are run by MOH, professional bodies or NGOs as an ongoing, systematic collection, analysis and interpretation of disease specific data, and timely dissemination of these consolidated and processed information essential to the planning, implementation and evaluation of clinical and public health practice, to contributors to the surveillance and other interested persons. Existing ones are listed at https://acrm.org.my/AffiliatedDB.php .
National Cardiovascular Database (NCVD) http://www.acrm.org.my/ncvd/faq.htm