Health Cards (24)
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[During this brief intermission - while we are awaiting comments from our
colleagues in the field - Bill sent some more food for thought... DN Mod.]
I would like to share with all my Afro-Net friends a brief summary of
the IMPACT methodology.
Bill
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A Comprehensive "AutoManual" MIS
Introduction
The IMPACT methodology approaches the issue of MIS from the standpoint
that a proper MIS in a developing country must utilize both manual and
automated instruments in order to attain its assessment and intervention
goals. Information within the IMPACT methodology must be readily
accessible to:
1) Health Care Workers at the service delivery level providing primary
health care.
2) Upper level and supervisory management who are involved in the
assessment and evaluation of program impact and health worker
performance, and
3) Patients and/or care givers at home or other non clinical setting.
In addressing the issue of health information systems(HIS) in developing
countries there are three main issues that need to be addressed.
First there is the need to have immediate access to a patient's historical
health data regardless of service or geographical location. In other words,
historical health data must be available to every possible care giver at
every possible location. The Hand Carried Comprehensive Health Card(CHC) is
the main document for achieving this objective. It is not dependent on
computers, electricity, facility accessibility or geography.
Secondly, there is a need for "real time" documentation of diagnoses and
treatments , or other health related issues, for additional service
providers at various geographical sites. If the care giver has no need for
historical health data, they may have a need to document a specific
diagnosis, treatment or training.
Thirdly, the first two issues must have the capability of providing the
necessary health indicators for assessment and intervention at the
patient's home, the service delivery level, program management level and
the regional and national levels. These three issues are addressed in the
IMPACT methodology through a combination of manual/paper and computerized/
automated components within the system.
Where resources permit computerized systems should be implemented.
Resources in this area are defined as, but not limited to:
1) adequate electrical supply
2) properly trained data entry personnel
3) security
4) environmental, and
5) budgetary constraints.
Where feasible, computerized systems should be installed and utilized to
the fullest extent possible. Where computerized systems are not applicable
then data from the manual system should be entered into a computerized
system as soon as possible. Computerization should be as close to the
periphery of services as possible. This will ensure availability of health
data for the HCW at the service delivery level, where it is needed most.
This is discussed elsewhere in this document.
Manual Instruments
The primary manual instruments IMPACT utilizes are the CHC, and the
consultation forms, although other manual forms can be utilized to document
service related activities such as services provided at health posts if the
consultation form is not used.
Hand Carried Comprehensive Health Card(CHC)
The hand carried health card is one of the most important components of
the IMPACT methodology. The card is a comprehensive card containing
every health related, as well as some demographic, data pertaining to
the patient. The card is kept by the patient, or if the patient is a
child, by the caregiver. Services in the form of diagnoses and
treatments are documented by the care giver or any other qualified HCW.
If the care giver is illiterate then the care giver can give a verbal
description to a competent individual and/or HCW to make the appropriate
notations in the card. The card is completely versatile regarding the
person documenting the illness and the location of the illness. By this
it is meant that a mother can write in the date a child had a case of
diarrhea and treatment, exp. ORS treatment, a village health care worker
can also document the dx and rx, or a nurse at the local clinic can
document the occurrence.
The concept of a CHC is not new. Several industrialized nations
including France and Germany, utilize a standardized "Life Book" health
card. Its is sometimes referred to as a life book because it contains
health information on the individual from birth until death, including
the patient's biological mother's prenatal visit data. The CHC is
carried by the patient at all times and is presented at each encounter
for physician documentation. In these industrialized nations every
health care provider is required by law to document all diagnoses, vital
signs, treatments(including medications), and any other pertinent health
information regarding the patient. The main purpose of this card is so
that health care professionals irrespective of geographical location,
service or institution can have immediate access to the patient's health
history.
Key Advantages and Comments
1.) A patient's historical as well as current health data is available
to every service and provider regardless of organization or
geographical location.
2.) In small clinics where limited services are provided the CHC is the
patient's "dossier" and there would be no need to keep separate
records on each patient. This would expedite patient services seeing
that a clerk would not have to locate a patient's dossier.
3.) The use of a CHC would initiate some standardization within the
health care system.
4.) If the patient's HCHC is lost or destroyed a new one can be
replicated from the Impact area's central database.
5.) LQA surveys can be performed by supervisory personnel at local
clinics or other health facilities. Data from the central database
can be compared to the data in the HCHC to evaluate VHW's performance.
For example, a VHW should note in the patient's HCHC that a "home
visit" was performed on a specific day. The VHW would also make a
note of the visit in the community roster, which is brought in to the
IS department to update the central database. The two records can be
compared and appropriate action taken if discrepancies are noted.
Supervisors would not necessarily have to visit random houses in order
to do LQA assessments. They would just check HCHC of patients coming
into a clinic or other health facility. These would constitute the
random sample.
6.) KPC or sample surveys would be more accurate due to improved
documentation of critical health issues and immediate access to
related information. Data collection time would decrease because they
would not be solely relying on someone's recollection of a an episode
of fever or other illness.
7.) Migrations would be easier to track across service boundaries.
8.) Mass destruction or loss of records due to a facility fire or other
natural disaster would be minimized.
9.) Patient's emigrating from the impact area with or without
notifying local health officials will take their "medical records"
with them and thus allow other services to provide more appropriate
care.
10.) Less likely to be lost due to increased importance in utilization
as well as size.
11.) Eliminate the need for multiple health cards (immunization,
Vitamin A, Road To Health, Women's Health Card etc.) based on age or
gender. Everyone would have the same type of card regardless of age or
gender.
12.) Mechanism for issuing Health Identification Numbers(HIN). This
would be especially useful when recording births. If all health
services are provided and recorded in the CHC then the populace have
some motivation for registering the births of children.
William Billingsley
Impact Demographic Health Surveillance Information Systems
Application Software Technologies, Inc.
1841 South Ridge Road
Green Bay, WI 54304, USA
Tel.800-992-0533
Tel. +1-414-499-0533
Tel. +1-414-655-3962 (Cell)
Fax +1-414-490-3218
Tel. +1-715-823-6375 (Home)
mailto:wbillingsley@aztechcon.com
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