Open Source HMIS Enabled Evaluation of Financial Burden of Disease and Patient Coverage in Three University Hospitals in Great Lakes Africa.

Since the eighties, case mix evaluation methods based on diagnosis-related groups (DRG) were gradually introduced in developed countries. These methods of assessing the costs of diseases to measure the productivity of the hospital have been introduced in management softwares that are not accessible to low-income countries. In this study, the authors applied these methods to an open source hospital management information system (HMIS) implemented in three university hospitals in Great Lakes Africa. A comparative study of the financial burden of five major diseases, monitored as part of a universal health coverage (UHC) analysis, was carried out. The level of coverage of patients in the hospitals was evaluated and the impact of UHC policies demonstrated. Although the financial protection of patients treated in the three hospitals had improved, HIV and tuberculosis treatments that ought to be free, remained a considerable financial burden for the patient.

OpenClinic GA Open Source Hospital Information System Enabled Universal Health Coverage Monitoring and Evaluation in Burundian Hospitals.

The Universal Health Coverage (UHC) is at the center of the 2030 Sustainable Development Goals agenda. In this study, the authors made an evaluation of the patient health coverage indicators in eight Burundian hospitals from 2011 to 2016. The relevant UHC indicators were calculated on the basis of patient administrative and health insurance data, collected via OpenClinic GA, an information and communication technology (ICT) supported health management information system (HMIS). The results show that the patient health services coverage rate was 70.8% for inpatients and 46.0% for outpatients. The patient health services payment rate as the proportion of total health service costs was above the 25% threshold recommended by WHO for inpatients (30.2%) and for outpatients (43.1%). The patient out-of-pocket payment was below the threshold of 180USD per patient per year for public hospitals. This study demonstrated the possibility to assess the degree of UHC in developing countries, by using routine data extracted automatically from the electronic HMIS.

The Role of Hospital Information Systems in Universal Health Coverage Monitoring in Rwanda.

In this retrospective study, the authors monitored the patient health coverage in 6 Rwandan hospitals in the period between 2011 and 2014. Among the 6 hospitals, 2 are third level hospitals, 2 district hospitals and 2 private hospitals. Patient insurance and financial data were extracted and analyzed from OpenClinic GA, an open source hospital information system (HIS) used in those 6 hospitals. The percentage of patients who had no health insurer globally decreased from 35% in 2011 to 15% in 2014. The rate of health insurance coverage in hospitals varied between 75% in private hospitals and 84% in public hospitals. The amounts paid by the patients for health services decreased in private hospitals to 25% of the total costs in 2014 (-7.4%) and vary between 14% and 19% in public hospitals. Although the number of insured patients has increased and the patient share decreased over the four years of study, the patients' out-of-pocket payments increased especially for in-patients. This study emphasizes the value of integrated hospital information systems for this kind of health economics research in developing countries.

Human Factors Predicting Failure and Success in Hospital Information System Implementations in Sub-Saharan Africa.

From 2007 through 2014, the authors participated in the implementation of open source hospital information systems (HIS) in 19 hospitals in Rwanda, Burundi, DR Congo, Congo-Brazzaville, Gabon, and Mali. Most of these implementations were successful, but some failed. At the end of a seven-year implementation effort, a number of risk factors, facilitators, and pragmatic approaches related to the deployment of HIS in Sub-Saharan health facilities have been identified. Many of the problems encountered during the HIS implementation process were not related to technical issues but human, cultural, and environmental factors. This study retrospectively evaluates the predictive value of 14 project failure factors and 15 success factors in HIS implementation in the Sub-Saharan region. Nine of the failure factors were strongly correlated with project failure, three were moderately correlated, and one weakly correlated. Regression analysis also confirms that eight factors were strongly correlated with project success, four moderately correlated, and two weakly correlated. The study results may help estimate the expedience of future HIS projects.

Evaluating the impact of ICT-tools on health care delivery in sub-Saharan hospitals.

This research explores to what extent Information and Communication Technology (ICT)-based information management methods can help to improve efficiency and effectiveness of health services in sub-Saharan hospitals and how clinical information can be made available for secondary use enabling non-redundant reporting of health- and care performance indicators. In the course of a 6 years research effort between 2006 and 2012, it was demonstrated that patient identification, financial management and structured reporting improved dramatically after implementation of well adapted ICT-tools in a set of 19 African health facilities. Real-time financial management metrics helped hospitals to quickly identify fraudulent practices and defective invoicing procedures. Out-patient case load significantly increased compared to the national average, average length of stay has been shortened in 15 of 19 health facilities and global hospital mortality decreased. Hospital workforce-evaluated impact of hospital information system implementation on local working conditions and quality of care was very positive. It was demonstrated that local sub-Saharan health professionals strongly believe in the importance of health information systems.