Annual Report of the Department of Health 2010 - Unrwa

THE HEALTH INFORMATION SYSTEM
The current system in UNRWA for gathering and processing these statistics is mainly paper-based in the clinics and computer spread
sheet-based in the UNRWA field offices and headquarters. The main problems of which are that:
- Gathering, consolidating and reporting on this data is time-consuming, costly, heavily manual and cumbersome with data re-written,
re-calculated, re-entered, couriered, emailed and copied and pasted many times;
- Less time can be allocated to direct patient care (doctors spend an average of 3 minutes per patient due high doctor / patient ratios);
- Data is not adequately validated at point of entry resulting in inaccuracies;
- Data is consolidated into electronic format at the field offices, but :
o Inefficiently stored into spread sheet formats with related data held in hundreds of distinct and unlinked files making data use beyond
the original purpose difficult;
o Aggregated during consolidations causing loss of detail;
o Not readily accessible; and
o Unsecured - changes can be made without adequate controls.
In response to this need, UNRWA responded with a multiphase project (e-Health),financed by the Danish government, aimed at creating
an automated and integrated health ICT system, automating to the most practical extent, patient medical records, clinical orders and
dispensation of medicines. With effective computerisation, the flow of statistical information from the clinics to the regional field offices in
Lebanon, Syria, Jordan, West Bank and Gaza and further processing in UNRWA headquarters in Amman, will also be streamlined making
data more rapidly available and accurate.
The e-Health vision is long-term and applies to the whole Agency. The first phase of the vision, and the objectives of this project, was
focused solely within Lebanon. Systems and processes developed in Lebanon would be later applied in subsequent phases throughout
UNRWA. The key objectives of this project, in ‘phase 1’, were:wq
1. Piloting a Clinic Information System (CIS) in three clinics to automate all clinical and administrative processes and establish a life-long
updatable electronic health record for every refugee patient. The extension to all UNRWA clinics and Palestine refugees would be
separate phases following evaluation and successful completion of the pilot.
2. Establishment of a Field Health Information System (HIS) to streamline and automate statistical gathering processes and consolidate all
statistical heath data, including historical data, into a single repository. This system would be designed so that it could be deployed in
‘phase 2’ to all UNRWA fields.
In the long-term, the HIS would automatically 'mine' the data from each clinic’s CIS. As the CIS was beyond UNRWA financial means, it was
decided to develop a semi clinical information system that consists of several data screens and a workflow within the system to be used by
health clinics staff for automating most of their daily operations which will result into the health care data that would be utilised for the HIS.
To achieve their full potential for streamlining of processes, the HIS and the semi CIS data would be held in a central repository, achieved
through automated data replication technologies and ICT infrastructure.
PROJECT IMPLEMENTATION IN 2010
The project management was moved to the UNRWA Information System’s Division at HQA, Information Systems Division which allocated
three internal staff for this project. Accordingly, the e-Health team in coordination with HQA Health Department and Lebanon Field health
management have discussed and agreed on an approach that will add more value to e-Health by establishing a semi clinical information
system that serves the health staff at the health clinic, the field office and HQA level.Moreover, it was decided to establish a pilot clinic in
Jordan for testing and delivering mature system software packages in order to be gradually implemented in Lebanon clinics with minimum
travel missions from HQA to Lebanon Field.
The Non Communicable Diseases package (NCD) was developed and piloted at Nuzha Health Clinic in Jordan first. Accordingly, the refined
NCD package was deployed at 3 Health clinics in Lebanon and rolled out to all 29 Health clinics in Lebanon by end of April 2010. The
implementation of this system package has faced many challenges mainly:
1. Frequent Power cuts; due to the instability of the electricity in Lebanon and the inadequate /insufficient power replacements.
2. Lack of computer literacy among health clinics staff.
3. Clinics overloaded staff, which caused delays in entering the patient’s files records which are the base of the system deployment.
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