Analysis of prerequisites to introduce computer-based information systems in health care : a developing country study

Sammanfattning: To attain a state of global health requires integrated efforts of many professionals. The lingua franca for the many professionals involved in health care is data and information. For example, information on the extent of an infectious disease found in a community is required by the health care management, to mobilize appropriate resources. Information on the pattern and spread of a disease is vital for the care providers, to understand how to best control and care for the affected. That action is based on information is well recognized; in response, information systems to support health care delivery are being developed, including computer-based systems. Systems that meet the composite needs of the organization must support the peripheral care providers with appropriate information, and then extract from the database of the primary care provider the appropriate primary data for the health care administration. This data will then be more accurate, since the data providers are also the prime users of data and information.Before designing an information system that supports the health care providers and management, detailed analyses of the developmental state, the human element, the technological potential, and the social implications of such system, are required. This comprehensive analysis serves as a prerequisite to the study and design of the organization's information system. Especially in developing countries, the successful introduction of computers demands a well defined strategy adapted to the local conditions. The design must be preceded by a Stage of Assessment (STAGE I) and a Stage of System Analysis (STAGE II).In Stage I, the Part I of the study required an assessment: of acceptance, of existing skills, the capability to learn, and the capacity to absorb the technology, of the people in the environment. The appraisal (survey) of the human element of the system, an end-user group (physicians), was accomplished through self-enumerating questionnaires. The results highlighted respondents' interest and expectations from computer based information systems. Fears such as for redundancy (i.e., a superfluousness in their jobs) were expressed [1].In Stage I, Part II of the study, the problems concerning the technological potential of computers and the justification to use computers over manual information systems, especially in a dispersed primary health care organization, were addressed. Whether the system design should be either administration-oriented (top down) or health professional-oriented (bottom up), as well as the development of criteria other than those based on cost-benefit for systems evaluation, were the other points of issue. By the application of syntheses methodologies, such-as the Delphi technique, Glaser's state of the art, and including a literature review, the computer's potential to support health care delivery was evaluated. The computer's role was classified and its decision support at each level to the health care professionals described. The conclusions derived were that a computer could today support the decision process by ensuring method and supplying knowledge. However, the application of computers as tools for reasoning is in rather limited areas and is still a field calling for further research [II]. The properties that give information value were identified and a justification for a computer-based information system delineated. To support primary health care delivery, an integrated system design is required. An alternate methodology to evaluate such systems is described [III].In Stage II, the study is conducted within specific co-operating primary health care organizations, and the conclusions from Stage I studies provided the guide-lines for this stage. A descriptive study of district health sites in developing countries was undertaken. As a part of the systems analysis study, questionnaires were mailed to the three principle sets of data providers/users, (i.e., the district health administrator, hospital consultant, and the primary health care physicians). Preliminary assessments extracted from some sites on attitudes towards and acceptance of computers in health care are presented in this thesis.The conclusion derived is that a prelude study to develop guide-lines for computerization is essential before conducting an in-depth methodological systems analysis. Each health care site must therefore be assessed before an appropriate computer-based information system is developed for implementation in that environment.