THE CHITS MANIFESTO

The Health Information Ecosystem

The health information environment is like a big lake. The condition of the lake depends on the condition of the water coming from its tributaries. If the water coming from the sources is polluted, the lake becomes polluted. The most sustainable way to clean up the polluted lake is to teach the people living near the sources (the tributaries) why we need to keep the water clean, what it takes to keep it clean and what happens when we pollute the lake. Cleaning up the lake without addressing the source of the problem will still keep the lake polluted. Not only will the polluted water kill all the animal and plant life in the lake, it will also render the water useless for human consumption.

Likewise, the health information environment can be polluted with poor quality information coming from its various sources. Poor data quality can come from several sources: lack of quality controls, lack of encoding and data standards, lack of training on data users about the value of data quality, and huge amount of information work from time-consuming non-integrated information management activities. Poor quality information, when used for decision-making can lead to misinformed decisions. Misinformed decisions can lead to poor health outcomes. At the population level, misinformed decisions can lead to misinformation-enabled disasters.

The work of keeping the health information ecosystem alive and functioning is lifelong work and needs to be sustained. It does not end with the installation of an information system but has to lead to deeper realizations about the value of health information.

Simplicity

Complex health information systems can lead to large amounts of information work. Complexity can arise from lack of integration of health information systems, poor automation of repetitive tasks, inconsistent data representation and poor information retrieval capabilities. For example, why do we need to enter the patient name, age and gender ten times when this can be done just once? Symptomatic of this condition is the amount of time needed to generate a daily report out of the system. This condition contributes to information famine as we store large amounts of information on paper where they become largely inaccessible for later aggregation and analysis. As a result of complexity, information management activities potentially make health center activities more inefficient, leading to poor health service delivery from inadequate temporal resource allocation to critical services.

We need to liberate health workers from the yoke of inefficient information processing by simplifying our complex health information systems through thoughtful integration and automation of repetitive tasks. When we liberate them from this yoke, they will have more time to liberate our people from the yoke of disease.

Capacity Building

Give a man a fish and he will live for a day, teach a man to fish and he will live for a lifetime. Health information systems are agents of change. They are a means to gain deeper understanding of the human condition through efficient collection, integration and presentation of health information. We use the information to gain knowledge and understanding of determinants of disease and how best we can manage them to ensure that the community will have better health outcomes.

This understanding comes at a price. That we go the extra mile in the implementation of health information systems. Not only should we teach end users how to use the information system, but we should allow them to gain insight into their condition (at the community level) so that they can decide to take action and be proactive in empowering others to do the same for as long as it is needed.