Assessing the ability of health information systems in hospitals to support evidence-informed decisions in Kenya

Figures & data

Fig. 1 Hospital management information system (HMIS) production framework.

 Appendix 1: HMIS dimensions and calculation of selected indicators

System level	Dimensions	Indicator	Data collection and indicator calculations
Outputs	Quality of data	Accuracy of the admissions and mortality rates reported by hospitals as core components of monitoring maternal and child health	In each inpatient department (maternity, pediatric, or neonatal), patient episode entries in the registers were reviewed and the number of admissions and corresponding outcomes at discharge tallied for the month of May 2012 to arrive at survey-derived rates for live births, fresh stillbirths (FSB), neonatal and infants deaths for each hospital. These were considered to be the gold standard and contrasted with routinely reported hospital data for the same month.
Birth and death registration	Proportion of vital events registered	Using the registration forms as source documents, a tally was done for live births and deaths (fresh stillbirths, neonatal, under 1 [infants], and under 5 years) within the facility notified in the month of June 2012 across all hospitals. The tally was compared with corresponding survey-derived rates.
Processes	Data collection and analysis	Integrity of register data collection and analysis in maternity, pediatric, and maternal child health clinic	50 patient episode entries for each of the maternity wards (n = 31 fields), pediatric wards (n = 14 fields), and maternal child health clinics (n = 11 fields) were randomly selected from 1 April 2012 to 30 June 2012 and reviewed for each hospital. Valid data elements tallied to allow calculation of a proportion representing completeness of data for maternity, pediatric, or MCH registers (calculated as tally of total valid entries/50*31, 14 or 11 for maternity, pediatric, and MCH locations, respectively).
Institutional arrangements	Existence of institutional interventions that allow optimal performance of the HMIS	Interventions such as data quality meetings, supervision visits, annual operation planning, and budgeting put in place were examined by reviewing facility administration records (committee meeting minutes, visitors book, and reports)
Supplies	Availability of stationery in the HMIS office and inpatient departments	Data on availability of supplies such as printing papers, files, pens, formal registers, and summary forms were collected during a facility walk through
Inputs	Financial resources	Percentage of hospital total annual financial resources allocated to HMIS department	Financial allocation to HMIS and total annual budget appropriated at the hospital was determined by reviewing hospital annual financial statements and reports for 2011–2012 financial year.
Human resources	Percentage fill rate of the recommended records officers positions	Data on number of records officers posted in each hospital were extracted from the personnel records and reports and compared with recommended records officer positions
Infrastructure	Existence of a robust data infrastructure	Data on availability of information and communication technology equipment were collected using a facility walk through and through direct observations.

 Appendix 2: Summary of results tables

System level	Dimensions	Indicator	Survey score (95% CI where applicable)
Outputs	Consistency of hospital reported rate with	Live birth	104.3 (98.4–110.2%)
survey-derived estimate	Fresh stillbirths (FSB)	68.9 (63.4–74.4%)
Neonatal death	71.8 (65.1–78.6%)
Birth and death registration	Proportion of live births registered	71.3 (69.1–73.5%)
Proportion of registered FSB	21%
Proportion of registered neonatal death	25.7 (22.5–28.9%)
Proportion of registered infant death	42.6 (24.8–60.4%)
Processes	Integrity of inpatient maternity register maternity	75.8 (68.7–82.8%)
Data collection and analysis	Integrity of inpatient pediatric register	58 (50.4–65.1%)
Integrity of MCH register	90 (80.6–99.3%)
Inputs	Institutional arrangements	HMIS departments AOP	21/22, 95%
HMIS participation in budgeting	18/22, 82%
Data quality audit	3/22, 14%
Financial resources	Percentage of hospital total annual financial resources allocated to HMIS department	3%
Human resources	Percentage fill rate of the recommended records officers positions	47%
Infrastructure	Availability of a functional LAN	17/22, 77%
Internet connectivity	22/22, 100%
Automation of HMIS activities	13/22, 59%

Fig. 2 The percentage difference between hospital reported and survey rates for live births for the month May 2012.