Information Systems

The following six types of information systems are essential for the delivery of high-quality primary health care. As described below, each type of system plays a critical role in ensuring that the right type of data is available to the right stakeholders at the right time to make informed decisions about PHC planning and service delivery. 

1. Civil registration and vital statistics systems: Civil Registration and Vital Statistics (CRVS) systems are a type of information system that registers all births and deaths, issues birth and death certificates, and compiles and disseminates vital statistics, including cause-of-death information.  CRVS systems may also record other events such as marriage, divorce, adoption and legitimation. CRVS systems generate administrative data that are used across multiple sectors and which can be compiled to serve as the basis for databases such as population registers that play a vital role in PHC service delivery. CRVS systems provide routine, up-to-date fertility and mortality data for a population which can be used to establish the foundation for many health policies and provides a meaningful denominator for monitoring and evaluation of the burden of disease data. CRVS systems are particularly critical for ensuring that PHC systems can Adjust to Population Health Needs and for effective Population Health Management.⁵
2. Routine Health Management Information Systems: Health Management Information Systems (HMIS) are facility reporting systems used to collect routine data from public, private, and community-level health facilities and institutions. Well-designed HMIS provide data on health status, health services, and health resources at the health facility level that can be used to support evidence-informed planning, management, and decision making and the facility and administrative levels.⁴⁶⁷ This goes beyond simple monitoring and evaluation to facilitate the active collection and assessment of service data. HMIS systems should be integrated into a national/sub-national monitoring framework built on a standardized list of service delivery indicators and definitions, called a data dictionary. 
3. Personal care records: Personal care records are information systems that are used to provide a longitudinal health history of patients to facilitate the provision of High-Quality Primary Health Care services. Comprehensive personal care records include unique patient identification (ID), problem lists, care history and notes, medication lists and allergies, referrals and results of referrals, and laboratory, radiology and other test results.⁸⁹¹⁰ Well-designed personal care record systems continuously collect and coordinate information that is reliable, timely, up-to-date, and comprehensive. Personal care records can be paper-based or electronic, however, the use of electronic health records helps to improve management of patient care.⁹ Regardless of the format used, to empower patients and health care providers to ensure the delivery of high-quality person-centered care, personal care records must be sufficiently accessible to both patients and providers.⁹
4. Logistics Management Information Systems: Logistic Management Information Systems (LMIS) are records systems that supply chain workers and managers use to collect, organize, present, and use logistics data about the supply and demand for commodities. Logistics data includes information about the quantification, procurement, inventory management, and storage and transportation of essential drugs and commodities. Effective LMIS gather data across all levels of the health system to support informed decision making and supply chain management. ¹¹¹²
5. Financial management information system: Financial Management Information Systems (FMIS) are a system used to manage and track the flow of funds at the facility level, including expenditure, staff, line-item budgets, internally generated funds, and reimbursed pooled payments.¹³ They are a facility-level tool managers use to improve the strategic allocation of resources, minimize waste and align spending for operational efficiency, establish credibility of the budgets, and improve service delivery.¹³
6. Health surveillance information systems: Health surveillance information systems generate the information needed for effective Surveillance, including  detecting, reporting, and responding to specific notifiable conditions and events.¹⁴  Surveillance systems are multimodal networks that bring together information from facilities and communities with a focus on defining emerging and existing population health needs and providing a basis for timely and appropriate response across the health system. ⁴⁸¹⁵¹⁶

The most effective information systems are entirely interoperable and interconnected: ^17181920

• Interoperability is the ability of different information systems, processes, devices, or applications to connect, in a coordinated manner, within and across organizational or geographic boundaries to access, exchange and cooperatively use data amongst stakeholders, with the goal of optimizing the health of individuals and populations. ²⁰
• Interconnectedness refers to the facilitated linkage or connection of all constituent parts of the information system. This refers to the connection of information system components—data systems, detection, reporting, and investigative activities, and feedback loops—within a sub-national health system network, and the linkage between different sub-national health system networks. 

Information systems can be either paper-based or electronic. While much can be accomplished with paper-based systems, it is difficult to achieve interoperability and interconnectedness with exclusively paper-based systems. ²¹ To promote the development of information systems that are comprehensive, reliable, scaleable, accessible, interoperable, and interconnected, countries should work to move from paper-based to electronic systems. ²¹²² (Users can find more information about digital and e-Health strategies in the National eHealth Strategy Toolkit and the WHO’s Global Strategy on Digital Health.) 

The transition from paper-based to electronic information systems represents an ambitious goal for many countries. In the interim there are many important improvements that can be made even to paper-based systems. In particular, there are five general characteristics common to strong information systems that support the delivery of high-quality PHC that can be achieved regardless of whether the systems are electronic: ²³ 

1. Well-defined: To ensure that information systems capture data that is timely, reliable, comprehensive, and relevant to the needs of the population, information systems should be implemented with standard operating procedures for data collection and analysis. This includes using standard data sources and data dictionaries that define a standardized list of health indicators that are built into national or subnational monitoring frameworks to ensure that all users of the information system are defining and measuring indicators in the same way. ⁸
2. Comprehensive: To support the core principles of coordination, continuity, comprehensiveness, and patient-centeredness, information systems should comprehensively capture and monitor all health services and functions across all levels of the health system.
3. Functional: To ensure that information systems are consistently used to support effective decision-making for health, their design and functionality should:
   1. Be accessible and user-friendly for all levels of the health workforce
   2. Fit efficiently and intuitively into existing workflows
   3. Use technology appropriate for the context.
   4. Have plans and systems in place to ensure data quality, appropriate data communication and use, and appropriate training for health workers. 
4. Resilient: To support the capacity of the health system to adapt and respond to population health needs, information systems should be able to withstand social, political, and biological crises. Mechanisms such as data backup systems and systems for operationalizing learnings from past crises, coordination with other health system functions, and regular performance assessments help to build resilient information systems. ³ 
5. Adaptable and scalable:  A strong information system is adaptable and scalable, or able to be redesigned, reformed, expanded, and rolled out at all levels of the health system. Information systems that are readily adaptable and scalable embody the above four characteristics and are interoperable and integrate with existing in-country platforms. Additionally, adaptability and scalability depend on having clear standards and decision-making structures regarding health information systems and a well-defined sustainability plan for ensuring necessary financing for, training in, and monitoring and evaluation of the system. You can read more about building in-country capacity in the adaptable and scalable section of MEASURE Evaluation’s what are the characteristics of a strong health information system? 

Strengthening information systems requires leadership and good management, governance of policies and procedures, public trust, financial support, and a skilled workforce. ²³ For this reason, it is important that information systems are aligned with national priorities and local needs with a clear policy direction, financial support, and skills training to ensure their successful implementation and ongoing functionality. ²⁴²⁵ More information on developing strong information systems can be found in the tools and resources section of this module.

Information systems are important for effective, high-quality PHC at the policy, management, and service delivery levels:

• At the policy level, the information generated from well-functioning information systems supports the capacity of the health system to sense and adapt to emerging and existing population health needs, create effective health policies, monitor health equity, and build health system resilience. ³ Information systems are essential for collecting indicators and evaluating progress in evidence-based priority setting and surveillance systems. In addition to supporting adjustment to population health needs, data captured and transferred in information systems play a role in assessing health financing needs and strategies.
• At the facility and sub-national management levels, routine use of HMIS, LMIS, and FMIS to establish targets, monitor progress, and implement ongoing improvement initiatives supports effective facility organization and management, including the availability, control, and appropriate management of drugs and supplies, facility infrastructure, workforce, and funds.
• At the service delivery level, information systems such as personal care records and civil registration and vital statistics systems collect critical information on local population health that supports evidence-informed decision making and the provision of high-quality PHC services. ²⁶ In particular, well-functioning information systems empower and engage patients, improve communication among team members, and improve continuity and coordination of care. ¹⁹²⁷²⁸

Effective health information systems are comprehensive and capture data about health services at all levels of the health system. However, often health information systems are lacking data about PHC or do not enable data to be disaggregated by type or level of service. In order for health information systems to support PHC as described above, it is critical that they not only embody the characteristics of strong information systems but that they also include PHC-specific indicators--such as those included in the PHC Vital Signs Profile--and be designed in a way that enables disaggregation of data to track the capacity and performance of PHC specifically. The Joint Learning Network and PHCPI’s guide on measuring the performance of PHC provides practical guidance and tools for countries on how to do so.

Service data: “Service data are data generated at the facility level and include key outputs from routine reporting on the services and care offered and the treatments administered.” ⁴ 

Interoperability: Interoperability is the ability of different information systems, processes, devices, or applications to connect in a coordinated manner, within and across organizational or geographic boundaries to access, exchange and cooperatively use data amongst stakeholders to respond to disease instances, with the goal of optimizing the health of individuals and populations. ²⁰

Interconnectedness: Interconnectedness refers to the facilitated linkage or connection of all constituent parts of the information system. This refers to the connection of information system components—data systems, detection, reporting, and investigative activities, and feedback loops—within a sub-national health system network, and the linkage between different sub-national health system networks. ⁸

Data dictionary: A data dictionary is made up of a standardized list of indicators and definitions that are built into a national or sub-national monitoring framework to ensure that all users of an HMIS are defining and measuring indicators in the same way. ⁸

Continuity: “Continuity is the degree to which a series of discrete healthcare events are experienced as coherent and connected and consistent with the patient’s medical needs and personal context.” Three types of continuity are considered to be important for primary care: relational continuity, informational continuity, and management continuity. ¹⁹ 

Coordination: Coordinated care includes organizing the different elements of patient care throughout the course of treatment and across various sites of care to ensure appropriate follow-up treatment, minimize the risk of error, and prevent complications. Coordination of care happens across levels of care as well as across time, and often requires proactive outreach on the part of health care teams as well as informational continuity. ²⁹

Health indicators: Health indicators are quantifiable characteristics of a population that provide information on the population health situation, such as information related to health status, risk factors, service coverage, and health systems (i.e. quality and safety of care or utilization and access). ³⁰

Electronic health (eHealth): “eHealth involves a broad group of activities that use electronic means to deliver health-related information, resources and services: it is the use of information and communication technologies (ICT) for health.” ³¹