UNIVERSITY OF DAR ES SALAAM

COLLEGE OF ICT

CS336
Trends and Social-Cultural
Implications of Information
Technology
 Content
 Introduction to Course
 Computer Information and Communication
Technologies
 ICT and Agriculture
 ICT and Health
 ICT and Water Supply
 General Impact of computers
 Trends in development of ICT
 Future of Computer Technology with AI
Shortage of Health Care Providers
Health Information Systems (HIS)
 The shortage necessitate Health Information
System to boost satisfaction.

 A health information system denotes processes of

input, throughput, output, and feedback around
health related information

 The goal of an HIS is to produce relevant

information that health system stakeholders can
use for making transparent and evidence-based
decisions for health interventions.
HIS Multiple Meanings
 For the health managers, it means aggregate data;
Health Management Information System (HMIS)

 For the nurses and doctors, it means data related to

patients; (electronic) medical records (EMR)

 For lab technicians, it means data related to blood

samples and test results, laboratory information system
(LIS)

 Thus, HIS is a much broader term which encompasses

these various information systems
HIS Multiple Layers
HMIS-Health Management Information System
 Focus on the needs for health management
o Processes of PODC - (Planning, Organizing,
Directing & Controlling).

 The collection and use of information in order to

make decisions regarding the effective and efficient
allocation of resources.

 Emphasis is on routine (service) aggregate data

and its analysis over time and across geographical
space
 HMIS-Health Management Information System

Decision making
(about effective &
Gathering
efficient
Ungathered Information Gathered allocation of
Information Information resources)

Decision Decision
Achievement
implementing
Unallocated Effectively &
of desired
/resource
efficiently aim
allocation
Resources allocated resources
EMR-Electronic Medical Records
 Are related to patient care, and focus on patient
data (name, age, symptoms, medical history,
test results etc), and is collected longitudinally
over time.

 Functionality is around patient care, registration

symptoms, test results, medicine prescription,
referrals, billing, etc.
EMR: Supports patient workflow
HRIS-Human Resource Information System
 For the management of human resources,
with data related to staff (name, profession,
diplomas, salary, etc)

 Functionality of the system is geared towards

managing hiring, distribution, payment,
education, training, and certification of staff,
over time
Logistics Management Information Systems (LMIS)
 Related to the logistical tasks around
distributing health related commodities, such as
vaccines, medicines, instruments, etc

 Functionality for inventory management,

ordering and procurement, tracking
commodities, certifying suppliers, forecasting
etc
Integrated Health Information Architectures
(IHIAs)

 An overall framework for how these various

information systems work together and speak
to each other (HMIS, EMR, HRIS, etc)

 Integrated:
o Working together, sharing definitions and data

o Integrated has different meanings to different people:

here it means they can speak to each other and share
data across the subsystems
IHIAs : Roles and Relationships
 Architecture
o Collection of sub-systems; organized to form a
whole, but have different roles

o An architecture describes their roles and

IHIA
relationships

HMIS Laboratory
LMIS IS

HRIS EMR
Why IHIAs is important?
 To share data
o Build powerful analysis by combining data sources
and study cross-cutting indicators
o Improve quality by reducing duplication and
manual transmission of data

 Resource optimization
o Reduce duplication of data collection
o Reduce development and maintenance of
overlapping systems
 Examples benefit from IHIA: Connecting
HR and clinical data

Service delivery data comes from many sources
o
HMIS
o
Patient records

Health worker deployment also data comes from many
sources
o
Payroll at Ministry of Finance,
o
HR System at Ministry of Health
o
Licensure and Registration from councils
o
Training information systems

Connecting these two data sets among multiple systems
allows new questions to be asked and answered
o
What facility is most in need of nurse midwives?
o
Which districts should we target training for chronic diseases?
o
Where should we prioritize financial incentives to retain health
workers?
Examples benefit from IHIA: Connecting
HR and clinical data

Data
warehouse
Number of deliveries Statistical Number of midwives
aggregated and shared aggregated and shared
data

Medical records Human resource

system

Data and functionaity Data and functionality

for each delivery on each staff
Tools for enabling an IHIA
 Data warehouse

 Standards and interoperability

Data warehouse
 A database compiled from differerent sources,
designed to process and present data for a
multiplicity of users, based on their needs

 For an IHIA, a data warehouse should contain data

from all the subsystems related to health, including
service data, census, surveys, environmental data
etc.

 Also called an integrated data repository

The benefits of a data warehouse
 Availability of different data sources in one
place: for creation of indicators for analysis
o Can combine different data sources

 Enables business analysis intelligence

 Enables data mining

 Customized outputs for different users

 Enables the possibility of new systems and data

sources being plugged in (and out)
Standards and Interoperability
 Standards allows the various subsystems of an
IHIA to share data
o Standard data definitions
o Data exchange standards

 When subssystems can share data and work

together as an IHIA, they are interoperable

 Controversial area: a «standard» is not just

created and accepted by all.
Data, Information, Knowledge:
founding blocks of an (H)IS

Increasing
usefulness
Data, Information, Knowledge: founding
blocks of an (H)IS
 Data- is raw material in form of numbers,
characters, images. This is the basis of creating
information after analysis
 Information: is a meaningful collection of data
organized with reference to a context (time, other
facilities, denominators)
 Knowledge: when information is analysed,
communicated and acted upon, it becomes
knowledge

Data Information
Knowledge
Example of value chain from Data to
Knowledge
 Data: 23 children with Malaria in a district

 Context makes Information: There are 1425 children

in this district. This gives a incidence rate of 1.6%

 Analysis and action creates Knowledge: This is not so

high, but higher than last month and the neighbouring
district. Why is this? We must check if they have
enough bednets to distribute at the facilities.
A social systems perspective
 An IHIA does not exist in a vacuum:
o It is not only about technology and software

 An IHIA is not built from scratch

o There are existing structures in all countries,
the IHIA grows out of this

 A social systems perspective helps us to

understand the complexity of the IHIA
A social systems perspective
 People, routines, organizations, institutions,
tools (such as a data warehouse, and paper
forms), legislature, instructions etc

 These exist in a context, shaped by history,

social, institutional and political conditions
 It can be seen as a social web of ministry
officials, vendors, other government entities,
international organizations, NGOs, involvement
of evolving technology and infrastructure
A social system is a complex system
 The HIS consists of thousands of staff, who collect,
process, analyse and use health data in a variety of
ways, with the help of various tools, enforced by
legislation and shaped by the larger social system
they are part of.

 HIS are thus complex systems

 It is not the technology that is the HIS, but the social

system as a whole. Socio-technical systems
HIS development from a social system
perspective
 An HIS is never built from scratch, but exists as a
social system. There is always a history associated,
which has to be engaged with

 The introduction of new routines, new technology

etc. thus takes place in a highly complex and
embedded setting, and will thus not be simply
overruled

 Unintended consequences are the order of the day –

things dont happen to as we plan .
 eHealth & mHealth
 Explain key eHealth and mHealth concepts
• Define commonly used eHealth and mHealth terms
• Illustrate eHealth and mHealth applications
• Describe limitations and considerations for eHealth and
mHealth

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eHealth
 eHealth (or e-health) is a relatively recent term for
healthcare practice supported by electronic processes
and communication, dating back to at least 1999.

 World Health Organization definition: eHealth is the

cost-effective and secure use of information and
communications technologies in support of health and
health-related fields, including healthcare services,
health surveillance, health literature, and health
education, knowledge and research.
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eHealth

42
Common Terms in eHealth
 Electronic health record (EHR) or electronic
medical record (EMR): systematized collection
of patient and population health data in a digital
format that is electronically-stored.

 Clinical decision support system (CDSS): ICT

solution designed to provide health professionals
with clinical decision support (CDS) such as
assistance with clinical decision-making tasks
43
Common Terms in eHealth
 Telemedicine: physical and psychological
diagnosis and treatments at a distance,
including telemonitoring of patient functions.
eHealth Interventions
 Delivering health information to health professionals and
health consumers through the Internet and
telecommunication.

 Using ICT to improve public health services―for

example, through the education and training of health
workers.

 Applying e-commerce and e-business practices in health

systems management (planning, budgeting, accounting,
etc.)
Why eHealth?
 In many low- and middle-income countries (LMICs),
health system challenges relating to weak
governance, health workforce shortages, and
geographic and economic barriers to care impede
effective delivery of health services to those in need.

 Information and communication technology (ICT)

offers the potential for addressing some of these
challenges with innovative solutions, especially if
offered at scale.
Why eHealth?
 Low- and middle-income countries (LMICs)
account for three-quarters of the rapidly
expanding Internet and mobile cellular
subscriptions globally, thus creating
opportunities for innovative and cost-effective
health services through the use of ICT.
Application of eHealth in HIS
 Data collection
o Use of hand-held devices

o Automated information messaging

o Use of different data management

applications such as DHIS 2, iHRIS, and eLMIS
to collect, aggregate, and report routine
data.
Application of eHealth in HIS
 Data management and storage
o To address requirements of interoperability
and integrated sets of data

o More sophisticated data storage to address

complexity and variability of health data
across the health enterprise

o Relational databases are increasingly the

norm, as opposed to the older, flat database
formats that limited functionality and
scalability, such as Microsoft Excel
workbooks
Application of eHealth in HMIS
 Data analysis, presentation, and use
o Extraction and triangulation of health data

o Data analysis and synthesis tools to produce

routine or ad hoc reports, identify trends and
issues of concerns, and track progress

o Data dashboards and other data visualization

tools can be customized to include maps
(geographic information systems, or GIS)
Application of eHealth in HMIS
 Data quality
o Tools for improving data quality include:
 Data standardization
 Geocoding
 Data matching
 Data monitoring
 Profiling
Common Terms in mHealth
 mHealth or m-Health: includes the use of
mobile devices in:
o Collecting aggregate and patient-level health
data

o Providing healthcare information to

practitioners, researchers, and patients via
Short Message Services (SMS) platforms such
as mHero

o Real-time monitoring of patient vital signs

and direct provision of care
mHealth Applications
o Rapid collection/sharing of current data via
mobile phones

o Public health and lifestyle messages over

mobile phones

o Medication alerts using mobile phones

o E-prescribing for repeat prescriptions via

mobile phones

o Telemonitoring to transmit patient results to

clinicians
mHealth Applications
o Transmission of test results to patients via
SMS messages

o Online electronic health records via computer

or phone

o Clinical emergency care for accidents, natural

disasters

o Patient appointment booking and alerts via

wireless e-mail (continuity of care)

o Efficient workflow via wireless communication

Limitations and Considerations
 Lack of knowledge by health professionals
concerning the possible applications of eHealth

 Unknown cost-effectiveness of mHealth/eHealth

initiatives

 Cost of implementing eHealth solutions is

perceived to be high
Limitations and Considerations
 ICT infrastructure and particularly Internet access
limited by low connectivity and bandwidth (urban
areas are better covered than rural areas)

 Absence of legal guidelines on privacy and

confidentiality in the eHealth and mHealth
domains

 Change management to consider to deal with the

new ICT cultural environment