To give you a better idea how a maternal health information system works, the following is a brief story that describes perinatal encounters and events in a normal pregnancy.
Suppose, that a 25 year old fecund woman whom we will call Mary, wishes to start a family. She initially goes to a woman's polyclinic for advice on planning her family. At that time, her name and the date and reason for her visit are entered into the HIS. This is the first time she has had an encounter with a facility with an HIS so she also provides information about her spouse and other family contacts and her health, financial, educational, occupational and living status. This information is stored in the database and is available to providers who she will be seeing; not only during her future pregnancies and deliveries but also whenever she or her infant visit a facility that also uses the HIS.
Mary receives counseling and a risk assessment from one of the nurses at the polyclinic. Once the visit is complete, the nurse enters her observations and the nature of the advice given into Mary's electronic health record. The next time that Mary visits the clinic, her health care provider will review Mary's electronic health record thereby reducing the amount of time taken to reinterview Mary.
A few months later, Mary believes that she is pregnant. She presents herself at the polyclinic and sees a gynecologist. The gynecologist reviews Mary's health record, gives Mary a pelvic examination, performs a pregnancy test, gives Mary a blood test, estimates the date of conception, and counsels Mary on nutrition and perinatal care. The gynecologist enters the test results and observations into Mary's health record and tells Mary to return in one month if no problems arise.
Mary continues to make regular visits to the polyclinic. Each time that she comes not only is her visit recorded but so too are the reasons for her visit, the test results, risk assessments and observations. Each time that Mary comes, the gynecologists or nurses are able to review the history of previous visits and use this information to make more informed decisions. There is no need to search through paper records because the data is easily retrieved using a computer.
When Mary begins her labour, she arrives at the maternity hospital and is admitted. The date and time of her admission is entered into the HIS and a gynecologist reviews Mary's health record. A further blood test and urine test are performed and Mary is given a physical examination. These results and observations are also entered into the system. As labour becomes more painful, the gynecologist administers an epidural and the procedure is entered into the HIS.
A great deal of information is entered during and after the delivery. The types of observations made include, among other data, the time of delivery, medications prescribed, eclampsia, the delivery procedure, the weight and APGAR of the infant, length of the gestation period, congenital anomalies (if any), and state of the umbilicus. Once the mother and child are discharged from the hospital a discharge report is entered.
Mary subsequently visits the children's polyclinic with her infant. At the polyclinic, the infant is examined, weighed and immunized. Although the infant is entered as a new patient, Mary's history is available for review. If, for example, there were birth complications or if Mary were to have had a history of babies born with specific congenital diseases, this information would be available to the pediatrician. The health record of the baby and that of Mary would be combined to present a complete clinical picture.
At the end of each month, quarter and year, the health care facilities are required to submit summaries. The clinical history entered for Mary and her baby is summarized with that of other patients during the reporting period and submitted to the Regional and Public Health Offices which, in turn, submits summarized data to the national health planning and statistical agencies. This data is then used to evaluate the national health strategic plan and to formulate changes to the plan if they are needed.
Working with Existing Data
Reproductive health and obstetric data is already being collected and entered into a computer. This data is used primarily to construct indicators such as the type and frequency of contraceptives used, the rate of abortion, frequency of neonatal deaths, preterm births and deliveries. The new HIS can be used to capture and supplement that same information without entering the data a second time.
The HIS has several major advantages over the existing data collection methods. Here are a few:
In summary, the HIS is a step down a path leading to a more complete understanding of the health status of your country. Planners will be able to make better decisions and to design health care strategies that fit the requirements of the people.