Interoperability and the Impacts of Health Information Systems

Dykki Settle, Director of Information Systems and Technology for IntraHealth International, recently attended two conferences devoted to the topic of health information systems. He spoke with the HRH Global Resource Center about these meetings and shared his insights about this rapidly evolving and increasingly important field.

What was the first meeting you attended?

The first was the World Health Organization’s (WHO) June conference, "Framework for Interoperability for Public Health Tools Meeting," which was attended by many of the leaders in national health information systems.

What were the key points of this meeting?

Software is part of the answer as long as it is used in context and addresses underlying health information needs. One of the primary issues under discussion was the ability of tools to communicate and exchange information, as well as the need to consider how sustainability, training and infrastructure affect the interoperability of health information tools. There was confusion about the boundaries of these tools. The focus was on data use and reuse, how to exchange information to avoid duplication, reduce the burden of information collection and strengthen the abilities of countries to sustainably use data delivery for strengthening their health systems.

The attendees included WHO teams such as the Health Metrics Network and representatives from the University of Oslo, the Centers for Disease Control and several leading initiatives for information system development. These groups came together to discuss how to build a comprehensive health information system from the ground up. There were good conversations showing agreement about what is needed and how to maximize the opportunities of such a system while minimizing the negatives.

Can you tell us about the other conference you attended on your trip?

The second meeting was the Innovation and Challenges in Health Informatics conference in Durban, South Africa, held in conjunction with OpenMRS. While the group at the first meeting was mainly concerned with national health information systems, this meeting was for those working on facility-based clinical health information systems. The emphasis was on patient care and records management, but there were also discussions of interoperability at this level, particularly between systems that track patient records, pharmacy and laboratory systems.

What were the primary differences between the two conferences?

There was very little overlap between the two meetings, which highlights the gap between the need for interoperability between national and facility-level information systems. The two teams have different issues and methods, and the language they use to discuss their systems is dissimilar. The groups don’t recognize the value of the other. It is clear to me that there is a lot of information national health systems could use from the facility level to better support the health infrastructure and that facilities don’t understand the kind of valuable information they could get from a national system. For example, if facilities could get data from the national level about health workers, they could better manage patient load and also feed information on health worker needs to the national level to enable better health worker training plans.

Why do you think these meetings are happening now?

All of the health information teams are working in silos-health management information systems (HMIS), facility-level health systems, national health systems, etc. We have begun to realize the need to be able to share information and to get information from each other. We want to avoid all the duplicated effort. There are many approaches to the problem such as data warehouses, knowledge portals and dashboards. Some are working on transferring data between systems using web services or aggregating information, and others are talking about web exchange formats that convert the information from various sources into one programming language.

What's next?

From these conversations, I see a number of things to watch. One of these is the Health Metrics Network, which is moving to build enterprise architecture that can be adopted and used to create interoperability between all country systems. We should explore ways to share information with other systems as we work on country solutions and identify ways to generalize how these solutions could work in other places.

We should also contemplate how health informatics connects to health workers. There are lots of different systems that have implications for health workers. Currently, nobody recognizes the impact of these systems on health workers in terms of health worker performance and building the capacity of health workers to manage these systems in ways that enhance performance. I have heard anecdotal examples of how a well-functioning facility-level system can create a threefold increase in health worker productivity, and the tremendous negative impacts a poorly planned health information system can have as well.

We need to build the capacity of health workers to use health information systems and utilize data effectively, recognize the positive impact of a strong facility-level system on health worker performance and ask what a human resources information system might look like at the facility level.

The HRH Global Resource Center has additional resources on this topic in the Information Systems subject category. IntraHealth International also has an Informatics Blog that discusses these types of issues.