AFRO-NETS> RFI: Health Information Systems (6)

[Dr Salah H Mandil <mandils@who.ch>]

RFI: Health Information Systems (6)
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Dear colleagues,

The book entitled, "Tam Tam to Internet", which was published at the 
time of Africa Telecom 98, included an Invited Chapter by the under-
signed, Dr Salah H Mandil, entitled, "TeleHealth in Africa: Status 
and Prospects". The second section of this invited chapter, which is 
sub-titled "What Information? And for what purposes?" is almost en-
tirely dedicated to the issue/question raised on AFRO-NETS by some 
colleagues. It is based on the pragmatic view that formal definitions 
are difficult and controversial and that it is more intelligible to 
"define health information systems" in terms of the main functions 
for which the information (not the system) is put to use. 

The section is quoted here below (the restrictions in force does not 
allow us to reproduce the entire 21-pages of the chapter and its 8 
graphics/images):

"The provision of health care requires, and generates, a wide variety 
of data and information, which need to be collected, processed, dis-
tributed and used. One way to view the scope of the uses of informat-
ics and telematics in Health, is through an understanding of the 
principle functions, and the types of data and information, in the 
health sector.

There are basically five main types. The first is Management informa-
tion, which is information for the day-to-day administrative needs 
and for planning, programming, budgeting, monitoring and evaluation 
of, for example, a health care institution (e.g. a hospital, a health 
centre, a laboratory), an immunisation campaign, the health services 
in a geographic area (e.g. a province, a district, a city), a commu-
nity, or the whole nation. The second is Clinical information, which 
is the data and information required to carry out and is generated 
by, clinical functions such as diagnosis and treatment; this includes 
medical images. The third is Epidemiological information, that is 
surveillance information on the patterns and trends of diseases and 
related health care measures and services. The fourth is Literature, 
that is written notes, reports, formal publications and "grey" lit-
erature. The fifth and last is Knowledge, that is the information on 
the actual know-how for carrying out a medical or a technical task, 
such as how to diagnose a specific medical problem, how to conduct a 
related laboratory test and how to treat an ailment.

The sources of these types of data and information are within and 
outside the health care infra-structure and located at varying dis-
tances from the users. In practice, users require and generate a mix 
of these types of information and at differing stages of their re-
spective functions. For example, a physician may consult a "knowl-
edge" base, whilst examining a patient and would enter relevant 
"clinical" data into the patient's record, which may be used by the 
"management" system for billing purposes. Also, the clinical data 
would eventually be stripped of its "personal and private" items and 
passed on to contribute parts of the health "surveillance" informa-
tion. Thus, the collection, flow, processing and distribution of 
health, and health-related, data and information are key to the effi-
cacy, efficiency and economy of the operations and development of the 
health care services.

Thus, the health care encounters and transactions are multi-faceted. 
They occur, for example, between a patient and a physician; between 
two physicians; between a patient or a physician and an expert con-
sultant or a health institution (e.g. a laboratory, a pharmacy or a 
rehabilitation centre). And, such encounters may occur in one's own 
community, in another part of the country or in another country. All 
such encounters require data and information prior to the actual 
start of the encounter, and generate the same during the encounter or 
soon thereafter. Such "data and information" could be in differing 
volumes, at differing times and in differing forms such as voice, 
numbers, text, graphics and static or dynamic images, and are often a 
judicious mix of these.

The uses of technology in the clinical/medical aspects of the health 
care services steadily grew and included sensing and measuring equip-
ment, laboratory services, static and dynamic imaging. With the 
growth of the uses of such technologies and of the variety and so-
phistication of these, it was inevitable that many of such "techno-
logical" services became separated from the mainstream health care 
institutions - separated in distance and more significantly in man-
agement. So, the communications between such technology-based ser-
vices and the mainstream health care services became an important 
consideration in the efficacy and economy of the health sector.

The sources and repositories of such data and information could 
spread over differing locations and would take differing forms, for 
example, complete patients records; hand-written prescriptions; re-
ports by a physician, a consultant or a laboratory; and responses 
from a library, a surveillance system or a drug interaction informa-
tion service."

Best wishes to the AFRO-NETS colleagues.

Salah Mandil
Director-Adviser
Health Informatics & Telematics
WHO Geneva
mailto:mandils@who.ch

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