Building Effective Health Information Systems

Module 5: Logic Models and System Classification

Hello, and welcome to the module Logic Models and System Classification. This module focuses on logic models that are the basis of health information systems as well as ways to classify systems to aid in making decisions about which to adopt.

Learning Objectives

This session has two learning objectives. By the end of this module, you will be able to:

  1. Describe the logic supporting health information systems, and
  2. Describe different information system classifications.

Learning Activities

  • Video: Bringing Order to Chaos (3 min)

    Welcome to the module on Logic Models and Systems Classification. We will begin this module with a video that sets the stage for learning about health information systems. This short video provides one scenario where information collected in a patient-provider interaction can lead to improved patient care, long term disease management, and public health benefit.

    Instructions: Click or tap the video to play.

    Video Reflection: This video presented an example of the flow of information in the form of a lab order, a lab test result, and various reports on lab tests from the facility level to the national level. In real life, the way a viral load test is ordered and reported may be more complicated.

  • Reading: What is a health information system? (5 min)

    Information systems are a part of our everyday lives. Let’s break down that term into its component parts to better understand how we begin to bring order from chaos.

    Information is a collection of data points that convey meaning. For example, we collect the data points of height, length, head circumference, and age to determine if a newborn is growing appropriately. Each of these data points combine to inform clinicians whether the newborn is on track or failing to thrive.

    Systems are a set of standardized practices, procedures and principles that ensure uniformity in a given context. Systems are everywhere in our healthcare work. The standard process of collecting blood pressure includes a number of systems: the procedure of where to place the blood pressure cuff and stethoscope, the calibration and regulation of the devices themselves, and the practice of listening are all evidence of systems that allow us to collect blood pressure in a standard and accurate way.

    Health Information Systems are technologies that allow the healthcare workforce to collect multiple data points in a standard way so the care that is provided to patients can be managed, improved, and optimized. Health information systems aim to support provider-patient interactions at the point-of-service, within large facilities and across populations. The information contained and organized within the systems can be used for clinical, program, and policy decision making.

    Popular health information systems include: Electronic Medical Records, Laboratory Information Systems, Logistics Management Information Systems, mobile platforms, and district health information systems. Each of these technologies provide a unique service that can support the delivery of care to an individual within the population.

  • Reading: Social Determinants of Health and Intro to the Logic Model (5 min)

    This graphic shows a number of social determinants of health. The center of the target is the individual. Our health is impacted by our family, community, access to clean water, education and many other factors. It’s clear that we can’t be healthy without the systems, services and communities that surround us.

    Health information systems are built with outcomes in mind. It is important that any health information system go beyond simply recording data to organizing and managing data to ensure that it becomes part of useful, actionable information for clinicians and policy-makers.

    Logic models are one way to systematically organise, plan, manage and assess one or many systems. Later in this module, we will examine different ways of classifying health information systems to aid in determining their fit with the logic model.

    As we examine these methods of organizing data and systems in a logical manner, it’s important to remember that a health information system supports the larger health system to achieve its goal: improving the health of patients and the population.

    health-systems
  • Reading: Logic Models (5 min)

    A health information system is a combination of elements connected together in an organized way to produce outputs. This means that a health information system has inputs that work together to produce outputs that will lead to the health information system’s goal: improved health.

    • What are a health information system’s inputs?
    • What activities or processes occur in a health information system that produce outputs?
    • What is the difference between outputs and outcomes?

    Instructions: Let’s find the answers to these questions. Click or tap the buttons below to reveal answers to these questions. You are encouraged to move from left to right in this activity.

    Inputs

    The resources need to support the programme’s activities/process.

    Activities/Processes

    What the health care programme and staff actually do.

    Outputs

    The tangible, countable products produced by the activities/processes.

    Outcomes

    The changes resulting from what is done.

  • Reading: Logic Models Example (5 min)

    Let’s look at an example. We’ll first begin by looking at the outcomes we want.

    • What are a health information system’s inputs?
    • What activities or processes occur in a health information system that produce outputs?
    • What is the difference between outputs and outcomes?

    Instructions: Let’s find the answers to these questions. Click or tap the buttons below to reveal answers to these questions. You are encouraged to move from left to right in this activity.

    Inputs

    Finally, what resources need to be available in order to perform these activities? These will also be your inputs, such as:

    Legislative, regulatory, and planning frameworks that govern how the health information system works

    Resources, including personnel, financing, logistics support, information and communication technology, and coordinating mechanisms

    Activities/Processes

    Now, what health information system activities produce these outputs?

    Activities include collecting data, storing data, and retrieving data. For example, collecting a patient's laboratory test results, storing patients' laboratory test results in a database, and retrieving patients' laboratory results from a database to be included in a laboratory report.

    Outputs

    What outputs of a health information system will contribute to these two outcomes?

    Information products that highlight the value of the data, such as data visualizations (dashboards, alerts, graphs, etc.), daily and monthly reports, which will help guide decisions.

    Dissemination, sharing, and use of information by those making decisions when delivering care and treatment, planning and managing health programs, and developing health policies and strategies.

    Outcomes

    Two health information system outcomes that we are interested in are improvements in HIV patient care and treatment and decreased long-term effects of HIV.

  • Reading: Logic Model (5 min)

    Let’s look at logic models underlying two systems commonly found in many facilities: Electronic Medical Record Systems (EMR) and Laboratory Information Systems (LIS). For both, the outcomes are the same: use information to improve care and treatment for patients.

    The outputs are also the same: information products and sharing & use. The inputs are regulatory and legislative frameworks-EMR data collection procedures for EMR systems and laboratory information system procedures for the LIS system.

    The activities and processes for each system are also slightly different. Taking the viral load example from earlier in the module. Sending test orders to the lab would fall under activities in the EMR system. In the LIS system, the activity would be entering the viral load test that was ordered by the clinician.

    logic-model
  • Video: Putting It All Together: Logic Models (2 min)

    You’re doing a great job so far! Let’s put it all together by watching a short summary video about logic models.

    Instructions: Click or tap the video to play.

  • Video: System Classification – Simple or Complex? (5 min)

    Next, watch a short video that will introduce you to system classification and identifying the complexity of data.

    Instructions: Click or tap the video to play. After you watch the short video, assess your knowledge with the question listed below.

    Question: Does this diagram show a simple or complex system?

    complex
  • Video: System Classification – Open or Closed? (5 min)

    Let’s continue the conversation about system classification by watching a second video where you will learn about open and closed systems.

    Instructions: Click or tap the video to play. After you watch the short video, assess your knowledge with the question listed below.

    Question: Does this diagram show an open or closed system?

    closed-exercise
  • Video: System Classification – Stable or Dynamic? (5 min)

    What about a system that is stable or dynamic? Please watch a third video where we discuss additional system classifications.

    Instructions: Click or tap the video to play. After you watch the short video, assess your knowledge with the question listed below.

    Question: In 2008, a new loan repayment system was introduced in multiple countries. This service allowed users to receive and repay loans using SMS messages. Within the first year, users began using the SMS system to deposit and withdraw funds from an account stored on their cell phones, transfer funds, pay bills, among other transactions. These core services are now routinely used by millions of customers. Is this system stable or dynamic?

  • Video: System Classification – Permanent or Temporary? (5 min)

    Next, we will watch another video and think about system classification being permanent or temporary. After you watch the short video, you will have an opportunity to test your knowledge with a question listed below the video.

    Instructions: Click or tap the video to play. After you watch the short video, assess your knowledge with the question listed below.

    Question: Is this Zika tracking health map permanent or temporary?

    zika
  • Video: System Classification – Proprietary or Public? (5 min)

    Now, watch a short video that discusses proprietary and public system classification. After you watch the short video, you will have an opportunity to test your knowledge with a question listed below the video.

    Instructions: Click or tap the video to play. After you watch the short video, assess your knowledge with the question listed below.

    Question: In January 2002, Capital Software Ltd developed an in-house electronic medical record system, Integra, for use at two sites in Kenya. These sites do not have the source code, relying instead on an agreement with Capital Software Ltd for updates and support. This is an example of a public system.

  • Reading: Types of Software (15 min)

    Another way to classify systems considers how the software is developed and reviewed.

    Instructions: Click or tap the buttons below to reveal additional information about these different types of software.

    Open Source

    Open source refers to a process for developing any kind of software. Through this process, software code and modules are contributed to a software project from many developers, frequently shared through an open source community. The OpenMRS community is one example of a group using this process.

    Open source is also a way to describe software that undergoes peer review through a transparent process. For instance, OpenMRS is an electronic medical record system software produces by the OpenMRS community.

    open_mrs

    Open source software doesn’t just mean access to the source code. It must comply with specific criteria:

    • Free redistribution
    • Includes access to source code
    • Allows modifications
    • May restrict distribution of modified code
    • Cannot discriminate against persons or groups
    • Cannot discriminate against fields or endeavor
    • Rights to distribute a programme applies to all
    • License is not specific to a product
    • License cannot restrict other software
    • License is technology neutral
    Freeware

    Another kind of public software is freeware. Freeware can be public software, open source software developed through an open source community, or by one developer who wants to freely share the software developed. The key part of the word is “free.” While the software itself is free to download, there may be other costs associated with running the software, such as paying IT support to install it on computers or developers to adapt the software to your system and needs.

    Firefox is one example of freeware. You can download and use it at no cost.

    Take a moment to think: do you know of a health information system software programme that can be used at no cost?

    Web-Based Systems

    Another way to describe your system is to look at how it or its information is made available. In a web-based system users access data through software that uses web technologies (HTTP). Web-based applications often run inside a web browser and can run locally on one machine, over a local network that isn’t connected to the Internet, or over the Internet.

    web-based-system
    Free and Open Source Software (FOSS)

    As you have seen, it is possible to classify a system using different criteria: open or closed, proprietary or public, permanent or temporary. A single system can have multiple classifications.

    For example, a Free and Open Source Software, or FOSS, has no license or user fees and the code can be changed by a programmer, depending on the license model. A FOSS is most likely supported by public funds, although some are supported by private entities like Oracle. It’s developed in a community of interested information system designers and programmers.

  • Quiz: Classifying System (5 min)

    We covered a lot of different way in which we can classify a system. Let’s put the information we learned into action with a short quiz. Read the case scenario and respond to the question.

    Malatka is an information system software for managing equipment inventory information. Facility staff enter and view data via a web browser. When staff at the regional and national level want to view or run reports, they use Firefox to launch Malatka. It was developed by a group with a special interest in equipment inventory, and the group reviews any additions to the software contributed by other developers in order to make sure it works well. Malatka can be freely downloaded by anyone interested in using the software.

    Question: How would you classify this system?

  • Video: Putting it All Together – System Classification (2 min)

    You’re doing a great job! Let’s put it all together by watching a short summary video about the various types of system classifications we discussed.

    Instructions: Click or tap the video to play.

  • Activity: HIS Case Scenario 1 (15 min)

    Think about the information that was shared with you on System Classification and complete a short case study. Read the case scenario below, then respond to the question about the scenario. If you need to revisit the terms used in this module, click or tap the Terminology button.

    Case Scenario 1: At the national level, Dr. Obuso is leading a health information system technical working group in a review of several different electronic medical record systems for use by all facilities in Ayo County. This group is aware that Meramita clinic, along with many other facilities, is located in a hard to reach, rural area. Electricity and Internet are not available all of the time. The Ministry of Health has told Dr. Obuso that there isn’t much funding for the health information system.

    Imagine you are in Dr. Obuso’s shoes. What classification of systems might you recommend to the group? Move the circle right or left in the slider to select which option you think would work best for Dr. Obuso’s health information system. For example, if you think they should have an open system, slide the red circle to the left.

    Instructions: Use your mouse or finger to slide the red circles left and right on the slider.

    Question: What classification of systems might you recommend to the group?

  • Activity: HIS Case Scenario 2 (15 min)

    Let’s complete a second case study on System Classification. Read the case scenario below, then respond to the question about the scenario. If you need to revisit the terms used in this module, click or tap the Terminology button.

    Case Scenario 2: Now imagine that Dr. Obuso and the health information system technical working group are making recommendations for the Capital City Administrative Region. In this region, the clinics serve a mobile urban population and there are also many large hospitals. Would you make the same recommendation as you did for Ayo County?

    As before, move the circle right or left in the slider to select which option you think would work best for Dr. Obuso’s health information system. For example, if you think they should have an open system, slide the red circle to the left.

    Instructions: Use your mouse or finger to slide the red circles left and right on the slider.

    Question: What classification of systems might you recommend to the group?

  • Reading: Summary (5 min)

    Congratulations! You just completed this module. You’ve just learned about logic models, which are the basis for health information systems. Logic models have inputs, activities or processes, outputs, and outcomes. You also learned about different ways to classify systems: simple or complex, open or closed, stable or dynamic, permanent or temporary, and proprietary or public. Other classifications include open source, freeware, and web-based. One system can have multiple classifications as in the case of the Malatka software scenario. For related content, you will also want to view the module “System Architecture”. Now go on to the final quiz.

  • Quiz: Module Post-Test Questions

    After you take the module, please be sure to take the post-test. Read each question and select the correct answer. Please note that the post-test will open in a new website page. You will need access to the Internet to complete the post-test.

    Click to go to the post-test Post-test Module 5