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Stella Bivoli

Stella Bivoli – The role of Health Information Systems in Improving Quality of Care in Health Sector

Expert and head of Information and Regulatory Affairs of international consulting company “Global Alliance”, Stella Bivoli talks about Health Sector in Georgia.

Bovoli graduated from the Boston University School of Public Health in epidemiology studies; She has participated in international development and public health programs; Stella bivoli has worked as a consultant for strategic information in Eastern Europe for 15 years. Stella bivoli has working experience with organizations like the World Bank, WHO, UNICEF, as well as other national and international NGOs.

Why Health Information Systems are important

The universal health coverage debate concentrating on access to services, financial protection and quality of care currently ongoing in Georgia provides an opportunity to launch the process of strengthening quality of care systems throughout the entire health sector. As is the case in many countries in the Eastern European and Central Asia region, the quality of health services tends to be inconsistent and disorganized, with some patients receiving excellent care, while others receive substandard care. Drug safety, medical mistakes and malpractice, hospital-acquired conditions, information system constraints, and fragmented delivery systems are just some of the many issues affecting quality and safety of health services.

Addressing these challenges to address quality of care challenges requires governments to capture valid and reliable data that can be transformed into useable information to aid in developing change strategies. Also, achieving high quality, cost-efficient healthcare requires collaboration among all healthcare professionals and stakeholders. Converting data into meaningful information for decision making calls for a thorough review of existing information frameworks. To achieve quality of care and be able to track improvements of it, there is a need for strong partnerships between health information teams with clinical teams to advance the quality and safety of patient care delivery.
In terms of the components of health information systems, there are many components that need to function well together:

  1. Resources: the physical and structural inputs, such as leadership and coordination, the existence of necessary laws and policies; financial resources and people with the necessary skills to do the work; and finally the infrastructure and computer networks.
  2. Processes: indicators, data sources, data management, information products, and dissemination and use of these products.
    An integrated health information system pulls together data from a range of sources, and integrates them into meaningful information products that can be readily accessed and used. Once data has been collected and stored, it needs to be processed and compiled in such a way that the data can easily be compared and collated with information drawn from other sources, so that data is not duplicated, mistakes are identified and corrected, and accuracy and confidence levels can be measured.
    An ideal and quality health Information system is one that provides connections between government statistics offices and every hospital, clinic, laboratory and pharmacy across the country through a web-based, fully computerized system and designed to be used in any type of health facility, from central hospitals to remote health outposts, and can function independently in the event of internet interruptions and provides access to the centralized and analyzed data in a transparent way while protecting confidentiality of data.

Georgian context

In Georgia work on information systems has started more than a decade ago, with support from external donors but also development of clinical information systems by each institution and various private entities. Currently, efforts are undertaken to connect medical service providers, pharmaceutical organizations and regulatory agencies on electronic platforms. The electronic components have been developed or are under development for many of the areas, such as pharmaceutical product registration, electronic systems for certification and accreditation of medical personnel, development of a cancer population register, centralized prescription registration system. Yet, existing health information system still has many shortcomings in terms of data collection and evidence generation. In spite of the fact that the data are collected by means of standard instruments, the country has to develop effective data quality assurance system, and this will be reflected on the reliability of statistical information.

Quality and information systems in an era of towards electronic health records and systems

The expansion of IT and electronic documentation will improve the capture and quality of healthcare data, leading to safer and more reliable care delivery systems. In order to continue advancements in these areas, organizations must facilitate the flow of information among different parties. In addition, leveraging electronic data from numerous sources and integrating it into a centralized repository can help improve the quality and consistency of patient care delivery.5
As is the case of Georgia, health information systems need to evolve in the context of more emphasis on monitoring and measuring health care quality. The framework for health care quality needs to look at two main issues: what dimensions of quality of health care should be measured and how should they be measured.
Data needs to be transparent and overseen in a way it gains everyone’s buy-in and there is a need to facilitate data stewardship by promoting the adoption of guidelines for data access, use, and control, as well as principles and guidelines for the standardization of content and definitions. There is also a need to shift focus from data transactions to quality and outcomes, which will require a new data architecture that enables multiple systems to operate together.

Numerous roles and responsibilities are emerging as data are standardized across organizational systems. Throughout this process there is a need to focus on data content standardization and improved validation, capture, analysis, and output of information for quality and patient safety initiatives. Few functions are needed to be ensured along the way:

  1. Data governance – the foundation of information management rules and is a structure to enforce rules involving technology training and education, auditing, and compliance.
  2. Data standardization as an important element in data stewardship that affects the use of data for quality and patient safety programs that includes developing and a data dictionary that not only standardizes definitions and ensures consistent use and assures the end user that the information used for decision making is consistent and comparable.
  3. Data capture validation and maintenance, with a greater need than ever for integrity and quality of data is ensured
  4. Data capture, analysis, and output, require critical thinking about healthcare performance to draw informed conclusions from measurement data. The ability to measure the quality of patient care accurately and efficiently will be central.
  5. Patient safety and compliance issues represent a major factor in data integration. Through the use of clinical decision support and electronic documentation, healthcare-associated infection and other negative healthcare-associated events can be more quickly identified, tracked, monitored, and eliminated.

In a context of developing incentives to improve and pay-for-quality goals requires improved documentation throughout the healthcare system, so the task will be to monitor the quality of documentation while working collaboratively with other members of the health institutions to maintain the clinical accuracy and completeness of the data.

In conclusion, better health information systems make it possible for government and insurers have better decision making, health care providers to better manage patient care through the secure use and sharing of health information and it can improve the quality of care as it makes health care more cost effective, better coordinated, more convenient to patients, it helps reduce medical errors and provide safer care at lower costs. The Georgian health system together with its external partners has made significant progress in developing the infrastructure and some of the processes for it and is now in an excellent position to take it to integrate quality of the health information systems themselves as well as develop appropriate frameworks to measure the quality of care.