Health Information Systems
A Health Director cannot manage what the health program cannot see.
Good health care depends on good information. The Health Director needs to know who the program serves, what services are being provided, whether patients can obtain care, what resources are being used, and where problems are developing.
Health information is therefore not simply a technical matter. It is a management resource.
The system belongs to the health program
Tribal health programs may use different information systems.
Many Tribal health programs have selected their own electronic health record systems, while others continue to interact with systems operated or supported by the Indian Health Service.
The particular software matters less to the Health Director than whether the information needed to manage the program is available, accurate, timely, and understandable.
The objective is not to have the most sophisticated information system.
It is to have information that helps the organization make good decisions.
What does the Health Director need to know?
The specific measures will vary by program, but management generally requires information about:
- Patients and access to care.
- Appointments and utilization.
- Staffing and vacancies.
- Clinical services.
- Referrals and Purchased/Referred Care.
- Third-party revenue and collections.
- Costs and financial performance.
- Quality and patient safety.
- Public health conditions and trends.
- Community health needs.
The Health Director does not need to personally generate every report.
But the Health Director needs to understand what the reports are saying.
Information must be trusted
A report is only useful if people trust the information.
If patient counts change because definitions changed, if services are recorded inconsistently, or if financial and clinical systems do not agree, management can make poor decisions based on apparently precise numbers.
The Health Director should therefore ask basic questions:
What is being counted?
How is it being counted?
Who is responsible for the information?
How often is it updated?
What does the measure actually tell us?
These questions are often more important than the software used to produce the report.
Information and decision-making
Information should lead to action.
If appointment data show that patients are waiting too long, management should investigate why.
If PRC referrals for a particular specialty are increasing, the program should ask whether the problem is workforce, facilities, access, or some other factor.
If third-party collections are falling, the program should determine whether the problem is eligibility, staffing, documentation, billing, or another issue.
If employee turnover is increasing, staffing information may help identify a management problem before it becomes a crisis.
The purpose of collecting information is not to create more reports.
It is to make better decisions.
Protecting patient information
Health information is also sensitive information.
The health program must protect patient confidentiality and establish appropriate controls over who can see, use, and share information.
The Health Director has to balance two responsibilities:
Make information available to the people who need it to manage the program, while protecting information that should remain confidential.
That requires clear policies, appropriate staff training, and effective oversight.
Information belongs to the larger health system
Clinical information is only one part of what a Health Director needs.
A good management system connects information about clinical services with information about finance, staffing, PRC, eligibility, public health, and quality.
The goal is to see the health program as a whole.
For example, a shortage of primary care providers may appear first as a scheduling problem. But it may also affect referrals, PRC expenditures, patient satisfaction, employee workload, and health outcomes.
Looking at only one report can hide the larger problem.
Questions for Tribal leadership
- Does the health program have reliable information for making decisions?
- Do leaders understand what the major measures actually mean?
- Can the program identify changes in access, utilization, staffing, and costs?
- Can clinical, financial, and operational information be considered together?
- Are patient information and confidentiality adequately protected?
- Does the Health Director receive the information needed to manage the program?
- Are information systems helping management—or simply generating reports?
A practical management principle
Technology is a tool.
The important question is not whether a Tribal health program has an advanced electronic health record or another sophisticated information system.
The important question is whether the right people have reliable information at the right time to make good decisions.
A Health Director who understands the information behind the program can see problems earlier, explain them more clearly, and make better decisions about the future of the health program.