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“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.”. 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 dictionaryA 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..
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 or 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.” 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 InteroperabilityInteroperability 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. and InterconnectednessInterconnectedness 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. 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 indicatorsHealth 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). 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 CoordinationCoordinated 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. , 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., 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

Tools & Resources

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Health Management Information Systems
Personal care records
Civil registration and vital statistics
Financial management information systems
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Surveillance systems

What questions should be asked to begin improvements?

Effective information systems use data to provide timely, accurate, and complete information for informed decision-making for health. The questions below may be a useful starting place for assessing the performance of information systems in your context, determining whether information systems is an appropriate area of focus for improvement efforts, and brainstorming how one might begin to plan and enact reforms.

How comprehensive are your health information systems?

Comprehensive information systems report and use a broad spectrum of health-related data from both the public and private sectors, and other relevant non-health sectors. Comprehensive information systems integrate data from the following types of systems across different levels of the health system and different types of facilities: HMIS, surveillance information systems, patient medical records, FMIS, LMIS, and civil registration and vital statistics. To get started, you might consider:

How are the different types of information systems used?
If not all types of information systems are being fully utilized, are there plans in place to develop or enhance these systems?
What types of data sources are used (i.e. facility-based or informal)?
Are these systems interoperable and interconnected?

Do your information systems capture essential PHC indicators and enable tracking of PHC capacity and performance?

In order for information systems to support strong PHC service delivery it is critical that they be designed to capture and report on PHC-specific indicators and PHC performance. To determine whether your system does this effectively, you might consider:

Do your country’s information systems capture key PHC indicators, such as those included in the PHC Vital Signs Profile?
Do your country’s information systems allow users to track PHC capacity and performance specifically? For example, can you track the availability of key inputs--such as facility infrastructure, drugs and supplies, funds, and workforce--at PHC facilities compared to hospitals? Can you specifically track and assess the competence of the PHC workforce and PHC service quality compared to competence and quality in secondary or tertiary care levels?

How interoperable and interconnected is your health information system?

Information systems are considered interoperable when the same information is captured in the same or similar format and channels are established such that information can be exchanged, triangulated across data sources, and used across multiple sectors. To assess the interoperability and interconnectedness of information systems in your country, you might consider:

Is there a platform in place to integrate and manage the different types of information systems in your country? (i.e. DHIS2) Is this cost-effective, secure, and easy to use? Is this platform fully digitized?
Are there data quality standards in place that are appropriately regulated and enforced to ensure standardized quality and use?
Does information follow patients as they move geographically or between different levels of the system?

Is the format of your information system electronic-based, paper-based, or somewhere in between?

While much can be accomplished with paper-based systems, the most effective information systems are fully digitized and interoperable across all levels of care. To get started on the transition from paper-based to fully electronic in your country, you might consider:

What elements of information systems in your country are electronic vs. paper-based?
Is there variation in the format used, for example by geographic region, level-of-care, type of facility, or type of information system?
Are there policies and plans in place to support investments in infrastructure that supports electronic information system use, for example skills training, modernized technologies, and necessary facility infrastructure?

Is the design and functionality of information systems compatible with the needs and skills of users across all levels of the health system?

In order for information systems to be useful and used, they must be designed to ensure that that they are user-friendly and intuitive for all types of health workers and decision makers and that they can be easily and efficiently incorporated into workflows. Additionally, the intended users of information systems need appropriate and ongoing training in how to effectively and efficiently use information systems. To get started in assessing your system’s performance, you might consider:

Do information systems have a user friendly structure and fit efficiently and intuitively into existing workflows with and clearly-defined standards (i.e. standard operating procedures for data collection, analysis, and use) and principles to ensure standardization of data quality and use?
Are information communication technologies suitable to the local context? If not, are systems in place to train and capacitate health workers to appropriately and effectively use new technologies to perform their duties associated with the collection of health data, data analysis, and data use?
Is the information produced by the different types of information systems in your country complete, accurate, and accessible to relevant users at the right place at the right time? Is it in a format that users can easily review and use to support quality, continuous, and coordinated care (i.e. identify and follow trends, address gaps in care, etc.)?

Case studies for Information Systems

Ireland launched its national eHealth Strategy in 2013 to transform its health information system and keep pace with the rapid global proliferation of technology using patient-centered, information-based eHealth solutions. Key eHealth initiatives at the core of Ireland’s reform seek to leverage the potential of innovative digital technologies to empower patients and healthcare workers by way of greater transparency, access to services, and information.

In 2009, Bangladesh introduced DHIS2 as the national health information management system to improve the integration and interoperability of different health information systems and to make the data produced by these systems more accessible and reliable to both data producers and users.

PHCPI is a partnership dedicated to transforming the global state of primary health care, beginning with better measurement. While the content on this website represents the position of the partnership as a whole, it does not necessarily reflect the official policy or position of any partner organization.

References:

Yazdi-Feyzabadi V, Emami M, Mehrolhassani MH. Health Information System in Primary Health Care: The Challenges and Barriers from Local Providers’ Perspective of an Area in Iran. Int J Prev Med. 2015 Jul 6;6:57.
MEASURE Evaluation. Defining Health Information Systems — MEASURE Evaluation [Internet]. [cited 2019 Apr 15]. Available from: https://www.measureevaluation.org/his-strengthening-resource-center/his-definitions/defining-health-information-systems
WHO. Framework and Standards for Country Health Information Systems. World Health Organization; 2012. Available from: https://www.who.int/healthinfo/country_monitoring_evaluation/who-hmn-framework-standards-chi.pdf
WHO. Monitoring the building blocks of health systems: health information systems. World Health Organization; 2010. Available from: https://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf
WHO. SCORE to reach your health goals technical package.[in press].
MEASURE Evaluation. Health Management Information Systems (HMIS) [Internet]. [cited 2019 Aug 29]. Available from: https://www.measureevaluation.org/resources/training/capacity-building-resources/health-management-information-systems-hmis-1
MEASURE Evaluation, USAID. PRISM: Performance of Routine Information System Management Series — MEASURE Evaluation [Internet]. 2019 [cited 2019 Aug 29]. Available from: https://www.measureevaluation.org/resources/tools/health-information-systems/prism
PHCPI. PHCPI Progression Model Assessment Tool. PHCPI; 2019 Apr.
WHO. Patient engagement: Technical Series on Safer Primary Care. WHO; 2016. Available from: https://apps.who.int/iris/bitstream/handle/10665/252269/9789241511629-eng.pdf?sequence=1
WHO. Continuity and coordination of care. WHO; 2018. Available from: https://apps.who.int/iris/bitstream/handle/10665/274628/9789241514033-eng.pdf?ua=1
John Snow, Inc, VillageReach, Clinton Health Access Initiative. Information Systems for Supply Chain Management: The case for connecting separate and interoperable technology applications for Logistics Management Information System and Health Information Management Systems data. John Snow, Inc; 2017 May. Available from:https://www.jsi.com/JSIInternet/Inc/Common/_download_pub.cfm?id=18394&lid=3
John Snow, Inc. The Supply Chain Manager’s Handbook: A Practical Guide to the Management of Commodities. John Snow, Inc; 2017. Available from: http://supplychainhandbook.jsi.com/wp-content/uploads/2017/02/JSI_Supply_Chain_Manager%27s_Handbook_Final-1.pdf
Dener C, Watkins J, Dorotinsky WL. Financial management information systems: 25 years of world bank experience on what works and what doesn’t. The World Bank; 2011. Available from: http://siteresources.worldbank.org/PUBLICSECTORANDGOVERNANCE/Resources/285741-1303321730709/FMIS-and-OBD_eng.pdf
WHO. Communicable disease surveillance and response systems: guide to monitoring and evaluating. World Health Organization; 2006. Available from: https://www.who.int/csr/resources/publications/surveillance/WHO_CDS_EPR_LYO_2006_2.pdf
Bitton A, Veillard JH, Basu L, Ratcliffe HL, Schwarz D, Hirschhorn LR. The 5S-5M-5C schematic: transforming primary care inputs to outcomes in low-income and middle-income countries. BMJ Glob Health. 2018 Oct 2;3(Suppl 3):e001020.
WHO. Primary Health Care Transforming Vision into Action: Operational Framework. World Health Organization; 2018. Available from: https://www.who.int/docs/default-source/primary-health-care-conference/operational-framework.pdf?sfvrsn=6e73ae2a_2
CDC. Disease Surveillance and Monitoring | About | CDC [Internet]. [cited 2019 Jun 3].
Institute of Medicine (US) Forum on Emerging Infections. Managed care systems and emerging infections: challenges and opportunities for strengthening surveillance, research, and prevention: workshop summary. Davis JR, editor. Washington (DC): National Academies Press (US); 2000.
Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: a multidisciplinary review. BMJ. 2003 Nov 22;327(7425):1219–21.
HIMSS. What is Interoperability? | HIMSS [Internet]. [cited 2019 Mar 15]. Available from: https://www.himss.org/library/interoperability-standards/what-is-interoperability
WHO. Global Strategy on Digital Health 2020-2024 (Draft). WHO; 2019 Mar. Available from: https://extranet.who.int/dataform/upload/surveys/183439/files/Draft%20Global%20Strategy%20on%20Digital%20Health.pdf
World Bank, World Health Organization. Global Civil Registration and Vital Statistics: Scaling Up Investment Plan 2015-2024. World Bank | WHO; 2014 May. Available from: https://www.worldbank.org/en/topic/health/publication/global-civil-registration-vital-statistics-scaling-up-investment
MEASURE Evaluation. What are the characteristics of a strong HIS? — MEASURE Evaluation [Internet]. [cited 2019 Jul 8]. Available from: https://www.measureevaluation.org/his-strengthening-resource-center/characteristics-of-strong-his
Akhlaq A, McKinstry B, Muhammad KB, Sheikh A. Barriers and facilitators to health information exchange in low- and middle-income country settings: a systematic review. Health Policy Plan. 2016 Nov;31(9):1310–25.
Africa Programme for Accelerated Improvement of Civil Registration and Vital Statistics. Why improving civil registration and vital statistics systems in Africa is important. Africa Programme for Accelerated Improvement of Civil Registration and Vital Statistics; 2017. Available from: http://apai-crvs.org/sites/default/files/public/Making%20Everyone%20Visible_September%20EN%20_0.pdf
Kruk ME, Ling EJ, Bitton A, Cammett M, Cavanaugh K, Chopra M, et al. Building resilient health systems: a proposal for a resilience index. BMJ. 2017 May 23;357:j2323.
Bitton A, Flier LA, Jha AK. Health information technology in the era of care delivery reform: to what end? JAMA. 2012 Jun 27;307(24):2593–4.
Delbanco T, Walker J, Darer JD, Elmore JG, Feldman HJ, Leveille SG, et al. Open notes: doctors and patients signing on. Ann Intern Med. 2010 Jul 20;153(2):121–5.
Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502.
WHO. Global Reference List of 100 Core Health Indicators (plus health-related SDGs) [Internet]. 2018 [cited 2019 Jul 8]. Available from: https://www.who.int/healthinfo/indicators/2018/en/
WHO Europe. E-health [Internet]. World Health Organization Regional Office for Europe. [cited 2019 Jul 12]. Available from: http://www.euro.who.int/en/health-topics/Health-systems/e-health

Information Systems

Tools & Resources

Health systems strengthening chapter 3: health information systems WHO, 2010

PAHO and WHO IS4H Maturity Model PAHO and WHO, 2018

Management of patient information: trends and challenges in member states WHO, 2012

Health statistics and information systems: civil registration and vital statistics page WHO

Global Civil Registration and Vital Statistics Scaling up Investment Plan 2015 - 2024 WHO and the World Bank, 2014

Strengthening civil registration and vital statistics for births, deaths and causes of death: resource kit WHO, 2012

Improving the quality and use of birth, death and cause-of-death information: guidance for a standards-based review of country practices WHO, 2010

Rapid assessment of national civil registration and vital statistics systems WHO, 2010

Principles and recommendations for a vital statistics system: revision 3 United Nations, 2014

Improving mortality statistics through civil registration and vital statistics system WHO, 2014

ICD-11 Training Tool WHO, 2016

Application of ICD-10 for low-resource settings initial cause of death collection: The Start-up Mortality List (ICD-10-SMoL) WHO, 2014

A system of health accounts (2017 revised edition) OECD, Eurostat, and WHO, 2017

Routine Health Information Systems: A curriculum on basic concepts and practice USAID, Measure Evaluation, and WHO, 2017

Health management information systems (HMIS) webpage MEASURE Evaluation

Health information systems strengthening: standards and best practices USAID and MEASURE Evaluation, 2018

Financial management information systems brief The World Bank, 2019

Financial management information systems and open budget data: do governments report on where the money goes? World Bank, 2013

Joint External Evaluation Tool: International Health Regulations (2005) WHO, 2016

Factors that influence the implementation of e-Health: a systematic review of systematic reviews Ross et al., 2016

Measuring the performance of primary health care: a practical guide for translating data into improvement Joint Learning Network for Universal Health Coverage, 2018

Health information systems strengthening: resource center MEASURE Evaluation

Supply chain manager’s handbook: a practical guide to the management of health commodities John Snow Inc, 2017