Learning objectives: You will learn about specification and uses of information systems.
This section uses text written by Neeraj Malhotra and Meic Goodyear. It covers some applications of health information including specification and uses of information systems, common measures of health service provision and usage, and use of information for health service planning and evaluation.
Read the resource text below.
Health Information: specification and uses of information systems
Data are raw numerical items collected.
Information is the result of applying various transformations to data (processing) to derive something perceived as meaningful. Note that this depends to an extent on the perceiver.
Knowledge is a structure wherein information is interpreted and used as a step towards a conclusion of action. It may be expressed in a formal way that computers can use, it may be implicit in organisational behaviour, or it may exist only in the minds of users.
- Data: 95, 171
- Information: process the data into the form 171/95
- Knowledge: The figures represent undesirably high blood pressure, which should be monitored and may be treated.
The health industry is a data-intensive business. Ray Rogers, inaugurating the NHS Information Strategy in the mid 1990s, cited the fact that an average 600-bed acute hospital generated as much data per day as the London Stock Exchange.
Information systems should be specified in the first instance by the outputs that are required of them. That is to say, they should be purpose-driven. From these outputs you can derive the data that need to be input, and the various transformations to the data that are needed to arrive at the desired information.
All too often, though, health information systems have been technology driven, without sufficient thought being given to the business purpose they are intended to fulfil. In general, information systems model the business processes of their organisations, and when these change the specification, and therefore the system functions, also change. This is a prime reason why large-scale health computer systems have been much criticised: systems specified and implemented for one business model are often shoehorned to work in another, incompatible structure, and inevitably fail to some extent.
A classic example in the NHS is the combination of the Resource Management Initiative (RMI) and the internal market [1,2]. The RMI was intended to enable hospital management to understand the contributions made to treatment by various parts of the service, to improve costing and planning. This formed a part of the Information Management and Technology Strategy, and funds for purchasing such systems were made available. However, the internal market required Health Authorities and GP fund holders to commission work from hospitals, and for hospitals to contract and bill for work done. Funds to support this aspect of the business were not made available, and as a result, many RMI systems were adapted to support the market processes and never accomplished their intended function.
Systems are also specified, in a slightly different sense of the word, in terms of access and confidentiality, e.g. what password restrictions or physical separation the system should have.
The process of specifying information systems is multi-layered, involving a range of formulations and methods that are the province of computer scientists rather than public health people. Users such as public health staff need to be able to assure themselves that they understand the outputs they are provided with, and that the systems meet security and confidentiality requirements, but need not concern themselves with the more technical aspects of the process.
For most public health work, the information available is collected for other purposes, e.g. recording acute care, and the data item specifications, together with professional knowledge of how and why the data are collected, are what we mostly have to work from. For the main NHS systems, the NHS data dictionary sets these out in detail.
It should be borne in mind that though information technology (IT) generally refers to the use of computers and telecommunications technology in information systems, manually maintained pencil-and-paper records still constitute information systems.
The Exeter system is a database of all patients registered with an NHS GP in England and Wales. It includes data on:
a. Patient registration
b. Prescription certification
c. Breast screening call/recall
d. Cervical screening call/recall
e. NHS organ donor register
f. GMS quarterly payments
An expert system is where computers are programmed to accept a large number of items of information and, based on rules set in the program, make decisions. One example is automatic pilot systems in aircraft.
The NHS Data Dictionary gives common definitions and guidance to support the sharing, exchange, and comparison of information across the NHS. See http://www.datadictionary.nhs.uk.
HealthSpace is a secure online personal health organiser for NHS patients. Anyone aged 16 or over and living in England can open a HealthSpace account. See www.healthspace.nhs.uk.
 Andrew D. Brown, Managing Change in the NHS: The Resource Management Initiative, Leadership & Organization Development Journal, 1992, 13,6,13 - 17
 Department of Health, Working for patients, 1989, HMSO