This was our project work for the Management of Information Systems unit in my MBA at the University of the South Pacific.

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AN ABSTRACT
The Patient Information System (PATIS) was initially set up in Fiji by the Fiji Health Reform
Project which was jointly funded by the Government of Australia and Fiji. PATIS is based on a
Health Information System developed in Samoa under a project initiated by the Australian
Agency for International Development (AusAid).
PATIS is overseen by the Health Information Unit (HIU), and its principle role is to support the
Ministry of Health in the areas of planning, evaluation, research and monitoring to improve the
quality, efficiency and effectiveness of health services delivery. The Unit also supports the
hospital‟s Medical Records Departments at the national level with policy guidelines for medical
records and information system management. At present, PATIS used the IP – VPN, better
known as the Virtual Private Network.
This project paper focus on the role of the Health Information Unit at the Ministry of Health in
Fiji and will only focus on the Patient Information System (PATIS) to see how it has increased
the efficiency of the service delivery in the respective areas.
The group was not allowed access to many relevant documents for more profound research and
further explanation of this topic. The group managed to extract most information from the
internet and other relevant bodies like the Pacific Health Network, AusAid, Healthlink, World
Health Organization, Online Journals, employees of Ministry of Health, and the background
knowledge on the topic from one of the group members. Documents like the Strategic Plan and
Health Information Policy for the Ministry of Health have been accessed from the web.
ACKNOWLEDGEMENT
The group acknowledges the assistance provided by the Acting Director IT at Ministry of Health,
Mr. Shivnay Naidu who assisted us in providing us the direction for this project.
OBJECTIVE
To determine how the Health Information Systems at Ministry of Health are adding value to the
client and the organization, as a whole.

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TABLE OF CONTENTS
Abstract……………………………………………………………………………2
Introduction………………………………………………………………………..4
Literature Review………………………………………………………………….6
Findings to our Research…………………………………………………………..15
A Discussion of the Findings………………………………………………………26
Conclusion…………………………………………………………………………34
References……………………………………………………………………….....41
Annexure 1…………………………………………………………………………45
Annexure 2…………………………………………………………………………46
Annexure 3…………………………………………………………………………48
INTRODUCTION

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This project paper focus on the role of the Health Information Unit at the Ministry of Health in
Fiji and will only focus on the Patient Information System (PATIS) to see how it has increased
the efficiency of the service delivery in the respective areas.
The group was not allowed access to many relevant documents for more profound research and
further explanation of this topic. The group managed to extract much information from the
internet and other relevant bodies like the Pacific Health Network, AusAid, Healthlink, World
Health Organization, Online Journals, employees of Ministry of Health, and the background
knowledge on the topic from one of the group members.
The Ministry of Health, in its Strategic Plan for 2011 – 2015 (Page 9), states that there is a “need
to strengthen health systems through improving investment in technical infrastructure”.
Furthermore it states that “an assessment of Fiji‟s progress towards achieving its health outcomes
depends on a well functioning health information system with access to age, sex and
geographical, time-series disaggregated data, some of which were not available. Efforts are being
made to address the data gaps to enable planning for prevention and response to emerging health
issues”.
The Ministry of Health, in 2011, has also developed and implemented a Health Information
Policy. The essence of the Policy is “For the Government of Fiji, timely and reliable health
information is necessary for improving the healthcare of individuals and is essential in enabling
evidence-based decision making and tracking performance towards attainment of its human
development aims ascribed to the Millennium Development Goals (MDGs), as well as the
Ministry of Health Strategic Plan (2011-2015) and other related strategic plans. A functional
Health Information System (HIS) is critical for effective service delivery and overall governance
and stewardship of the health sector. Use of reliable and good quality data from a robust HIS
leads to improving health systems performance, quality of health care, achieving universal
access, increasing service delivery, reducing burden, increasing efficiency, and improving cost-
effectiveness” (Page 7).
PATIS is overseen by the Health Information Unit (HIU), and its principle role is to support the
Ministry of Health in the areas of planning, evaluation, research and monitoring to improve the
quality, efficiency and effectiveness of health services delivery.
The Unit also supports the hospital‟s Medical Records Departments at the national level with
policy guidelines for medical records and information system management.
Figure designed from information provided by Ministry of Health Fiji
MINISTRY OF HEALTH HQ
(National Level)

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Divisional Level
Information for Information for
Knowledge Sub divisional Level Action
(Feedback) (Reporting)
Health Center/ Nursing Station
Community Level
The Patient Information System (PATIS) was initially set up in Fiji by the Fiji Health Reform
Project which was jointly funded by the Government of Australia and Fiji. PATIS is based on a
Health Information System developed in Samoa under a project initiated by the Australian
Agency for International Development (AusAid).
PATIS principally supports the inpatient process, pharmacy, radiology, dental, laboratory, and
the outpatient department. Monitoring public health staff utilization and surveillance in remote
areas is catered for by a paper-based system with timely entry into the nearest computer system.
(Kerrison 2003)
The Ministry of Health has the following information systems in use:
Patient Information System (PATIS)
Logistics Management Information System (LMIS)
Asset Management System (AMS)
Human Resource Information System (HRIS)
Financial Management Information System (FMIS)
Public Health Information System (PHIS)
LITERATURE REVIEW

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A Health Information System should be an integrated effort to collect, process, report and use
health information and knowledge to influence policy and decision-making, programme action
and research. Sound decision-making at all levels of a health system requires reliable health
statistics that are disaggregated by sex, age and socioeconomic characteristics. At a policy level,
decisions informed by evidence contribute to more efficient resource allocation and, at the
delivery level, information about the quality and effectiveness of services can contribute to better
outcomes.
Information systems, particularly at the lower levels of the health system, need to be simple and
sustainable and not overburden health delivery staff or be too costly to run. Peripheral staff needs
feedback on how the routine data they collect can be used and to understand the importance of
good quality data for improving health. Capacity building is also required to ensure policymakers
at all levels have the ability to use and interpret health data, whether it originates from routine
systems, health surveys or special operational research. It is also important that staff working at
the periphery of the health system understand the significance of local data for local program
management, and that their needs for strengthened capacity for critical health statistical analysis
are met. Local use of data collected at lower levels of the health system is a key step for
improving overall data quality.
Essential Modules for an Ideal Health Information System
http://www.uq.edu.au/hishub/definition-of-health-information-systems-104912

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A comprehensive hospital information system to meet the specific needs of a hospital contains
modules for in-patient /out-patient registration, patient care, pharmacy, diet planning,
accounting, etc. Sophisticated equipment used in the practice of modern medicine generates huge
amount of data. Evaluation of stored clinical data by using various mining techniques may lead
to the discovery of trends and patterns hidden within the data that could significantly enhance
our understanding of disease progression and management
(http://www.informaticsreview.com/wiki/index/php).
Understanding the Role of Technology in Health Information Systems
(Lewis, Hodge, Gamage, Whittaker, 2011) Adapted from Health Information Systems
Knowledge Hub, School of Population Health, University of Queensland.
Innovations in, and the use of emerging information and communications technology (ICT) has
rapidly increased in all development contexts, including healthcare. It is believed that the use of
appropriate technologies can increase the quality and reach of both information and
communication. However, decisions on what ICT to adopt have often been made without
evidence of their effectiveness; or information on implications; or extensive knowledge on how
to maximize benefits from their use. While it has been stated that „healthcare ICT innovation can
only succeed if design is deeply informed by practice‟ (Sanderson 2007: 4), the large number of
„failed‟ ICT projects within health indicates the limited application of such an approach.
There is a large and growing body of work exploring health ICT issues in the developed world,
and some specifically focusing on the developing country context emerging from Africa and
India; but not for the Pacific Region. Health systems in the Pacific, while diverse in many ways,
are also faced with many common problems including competing demands in the face of limited
resources, staff numbers, staff capacity and infrastructure. Senior health managers in the region
are commonly asked to commit money, effort and scarce manpower to supporting new
technologies on proposals from donor agencies or commercial companies, as well as from senior
staff within their system. The first decision they must make is if the investment is both plausible
and reasonable; they must also secondly decide how the investment should be made. The
objective of this paper is four-fold: firstly, to provide a common „language‟ for categorizing and
discussing health information systems, particularly those in developing countries; secondly, to
summarize the potential benefits and opportunities offered by the use of ICT in health; thirdly, to
discuss the critical factors resulting in ICT success or failure, with an emphasis on the
differences between developed and developing countries; and fourthly, to introduce evaluation
frameworks and models used in developed countries to assess the plausibility of ICT projects in
health.
While infrastructure may be the cornerstone of development (increasing access to knowledge and
linking isolated rural communities); as discussed by Keke (2007), most Pacific Island Countries
and Territories have weak institutional frameworks with limited coordination and management
of staff and infrastructure. Overall, what can be said about the Region is that it is characterized
by remoteness, dispersed and small total populations and vast ocean distances (apart from Papua
New Guinea) and limited human resource and institutional capacity – especially in relation to
ICT (PIFS 2002a; PIFS 2002b; Network Strategies 2010). It is these characteristics that have led

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to the growing agreement that „ICTs offer huge potential for social and economic development in
the Pacific‟ (Network Strategies 2010: ii). However it is these very same characteristics that
make ICT exceptionally difficult to implement and sustain among PICTs.
Health Information Systems
The aim of this section is to provide a common language for talking about Health information
Systems. The first question is what we do mean by a Health Information System (HIS); as the
term is used with two very distinct meanings. The restricted meaning refers to systems that
capture and report aggregated health statistical information. This is the meaning that, for
example, the Health Metrics Network (HMN) and World Health Organization (WHO)
traditionally use. WHO (cited Abouzhar & Commar 2008: 1) define HIS as integrated efforts to,
„collect, process, report and use health information and knowledge to influence policy making,
program action and research‟ and further states that they are essential to the effective functioning
of Health Systems worldwide. For the purposes of this project such systems will be referred to as
Routine Health Information Systems (RHIS). RHIS, such as those operated through health
information departments or national statistics offices, provide information on risk factors
associated with disease, mortality and morbidity, health service coverage, and health system
resources.
The broader meaning of HIS refers to any system that captures, stores, manages or transmits
information related to the health of individuals or the activities of organizations that work within
the health sector. It is this broader meaning of Health Information Systems that is used in this
paper. This extended definition incorporates such things as district level routine information
disease systems, disease surveillance systems but also includes laboratory information systems,
hospital Patient Administration Systems (PAS) and human resource management information
systems (HRMIS) for health workers.
The typical components of a “traditional” Health Information System for a “developing country
includes:
• A routine health information system capturing aggregate activity data from paper forms via
„district‟ level reporting to be eventually recorded in an electronic system at the „provincial‟
and/or national level
• Notifiable disease reporting system (possibly using both routine reporting and sentinel sites)
• Disease registries.
There is significant academic literature regarding the implementation of such systems,
particularly in Africa, but few robust quantitative evaluations of their benefits. Over recent years
there has also been significant research published on the impact of new technologies such as the
use of mobile phones to improve the operation of these „traditional‟ systems.
Of course many HIS environments will not include all such components and where they do exist,
they will have been implemented over an extended period of time building on earlier
developments and dependencies. A number of key elements of the differences between the HIS
environments are:

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• Investment in departmental (auxiliary) systems to support acute care, such as radiology and
Laboratory Information Systems, initially the prime purpose of these is to manage work flow
efficiently
• A focus on systems that store, transfer and use information on individual patients for
prospective clinical decision making rather than on aggregated information used for policy
and monitoring
• A focus on sharing information between health care providers to enable continuity of care,
reducing duplication and improving patient safety
• Richer integration of information available from multiple sources to inform policy and
management decisions.
It can be expected that countries in the Pacific will be looking to adopt and implement such
systems over time. The rate of adoption will vary from country to country but will be driven by
factors such as:
• Changes in disease patterns, the shift from communicable to non-communicable and chronic
diseases, requiring changes in patterns of care and supporting systems
• Increased expectation of stakeholders, this includes both increasing expectations from
patients and possibly more significantly increasing demands from clinicians.
This extended Health Information System is composed of a large number of individual systems.
In the past many of these have been isolated, „stand alone‟ systems but intersystem
communication for data sharing and integration is increasingly the norm. Such communication of
clinical data progresses through a number of distinct stages. Initially data is communicated in a
form understandable by humans but not by the machines (a facsimile is a simple example of this)
and later moves to full semantic interoperability where transmitted data can be used by the
receiving system for things such as computerized decision support. Individual systems include:
• Patient Administration System (PAS): Basic component of a hospital computer system
which records patient details, all admission, discharge, ward allocation and transfer, treating
clinicians and outpatient attendance. Coding of diagnoses and treatment options allows for
the analysis of hospital and national disease burden. Usually one of the first systems to be
installed in starting to „computerize‟ a hospital.
• Laboratory Information System (LIMS): Primary purpose is to manage the flow of
samples through a pathology laboratory. This requires the electronic registration of samples
as they flow through the laboratory and the interaction with all laboratory machines to
electronically capture the results. The secondary purpose is to provide the results to
clinicians in a timely and convenient manner.
• Electronic Medical Records (EMR): Facility or organization-based records of all patient
interactions. Includes details of patient problems, diagnoses, investigations, test results,
treatments and prescribed medicines. Usually requires input from auxiliary systems such
laboratory information systems.
• Electronic Health Record (EHR): Sometimes termed a Shared Electronic Health Record
(SEHR). Includes details from multiple organizations and care settings to provide a complete
longitudinal patient medical history. Information is usually a summary from the contributing
EMRs. Available to all healthcare providers delivering care to a patient.
• Management Information System (MIS): The intention of such a system is to bring
together and present in an integrated manner all the information needed to manage and plan

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the health system. Ideally this includes health system activity data, human resource,
financial, supply, disease incidence and demographic information. Few health systems in the
world would have such an ideal MIS.
The video available at this link from 3M Industries on youtube.com shows in a summary how
data can be linked with outcomes:
http://www.youtube.com/watch?feature=player_detailpage&v=m21qZuu24_o
Opportunities and Benefits
In the developed world there have been two key drivers for investment in health ICT. The first is
the ever increasing burden from chronic disease, often with complex co-morbidities, on the
health care system with costs increasing significantly faster than population or GDP growth. In
Australia, for example 80% of the burden of disease is now from chronic diseases (including
cancers) (AIHW 2003). The treatment and management of such chronic disease continues over
an extended period of time and is performed by multiple health care providers in multiple
settings. The second key driver is the recognition of the need for greatly improved quality and
safety in the delivery of health care. This recognition has been driven by such things as the
National Institutes of Medicine report To Err Is Human (Kohn et al 2000) which estimated that
in hospitals alone, between 44,000 and 98,000 Americans died each from medical error.
Both of the these factors have led to very significant investments in the development of systems
to enable the sharing of structured data to provide more complete and timely information for
clinical decision making. These have included such things as the development of local electronic
medical records, secure messaging to interface systems and shared longitudinal electronic health
records. There has been the expectation that these developments would lead to major savings in
cost and increases in patient safety. In the United States, for example, a RAND Corporation
Study (Hillestad et al 2005) estimated that it would take 10 to 15 years to establish a full e-
Health system but such a system would then deliver savings of $81 billion dollars per year as
well as delivering greatly improved quality of care. In Australia, the projected cost of
implementation of the national broadband network is $42 billion, but in its submission to the
NBN Senate Select Committee, iSoft (2009), an Australian medical software company, estimated
the cost savings for integrated health records to be of the order of $8-$10 billion annually, and
emphasized the importance of broadband in realizing the full e-health system.
The U.S. based Centre for Information Technology Leadership (CITL) reviewed a sample of
studies from academic, industry, and provider sources, aiming to answer the question: What are
the demonstrated benefits of a given system or application? They found few concrete answers,
noting that:
“There is very little hard evidence demonstrating the value of specific HIT investments”;
“A good deal of the current literature is conceptual. Rather than discuss demonstrable benefits of
HIT, about one-quarter of sources did not address specific benefits at all. Instead, these largely
theoretical works discussed value assessment frameworks or barriers to value realization.

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Benefits like cost containment or outcomes improvement were mentioned with little if any
supporting primary data”;
And
“Existing evidence is not sufficient to clearly define “who pays for” and who benefits from HIT
implementation in any organization – except those …that are responsible for paying for and
delivering all the care for the defined population” (Walker 2006).
While there has been limited rigorous quantitative analysis of the benefits from specific ICT
investments in the developed world there has been even less for the developing world. There has
been a significant level of published literature over recent years around such things as:
• Use of mobile phone technology for disease surveillance
• Low cost technologies for clinical video case conferencing
• Open source technology for the development of routine health information systems and the
use of technologies such as hand held PDAs to improve the efficiency and timeliness of
systems.
It is likely over the next decade that the major ICT investments in health in the developing world
will be in:
• Hospital patient administration systems (PAS) to optimize the use of scarce resources,
hospital bed-days and clinicians
• Logistics system to help manage the distribution, storage and distribution of drugs and
medical supplies, and to reduce loss through retention of out-of-date drugs and pilfering
• Simple information transfer systems (referrals and discharge) to support continuity of care as
patients move between primary care settings and acute care
• Extension of access to routine health information systems to lower geographic levels so data
can be entered closer to source and a wider range of users can access information directly
• Pathology, radiology and pharmacy information systems to manage the work flow in these
areas and subsequently provide information to clinicians and support continuity of care.
ICT Project Failure
While the potential health and financial benefits from the use of technological innovation in
health are large, the risks are also substantial. A World Bank Study conducted in 2005 found, for
example, that the majority of public sector ICT applications in developed countries were either
partial or total failures (cited UNAPCICT 2010). Furthermore, in his report on e-Government
projects for development, Heeks (2008) states that 35% of such projects are total failures, 50%
partial failures, and only 15% are considered successful.
A study by Gheorghiu (2006) found that 70-80% of all information technology and information
systems fail. Similarly, Kaplan and Harris-Salamone (2009) reported international failure rates
of major health IT projects of between 30% and 70%. Such figures are found repeatedly
throughout the academic and industry literature. There is a far smaller literature base on the
developing world, but intuitively one would expect the failure rates to be at least as high as in the
developed world. The International Development Research Centre (IRDC) (www.idrc.ca) noted

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a significant failure rate (up to 50%) in the small scale telemedicine projects it had sponsored and
in general, an inability to demonstrate improved patient outcomes from the projects.
Framework for Analysis
The Real Access – Real Impact Criteria designed by BRIDGES (2010) offers a framework for
the analysis of all issues around ICT access and use, including anticipating or detecting why
certain e-Health projects have failed, and highlighting how and why other projects can succeed,
as outlined below:
• Physical access to technology
• Appropriateness of technology
• Affordability of technology and technology use
• Human capacity and training
• Locally relevant content, applications and services
• Integration into daily routines
• Socio-cultural factors
• Trust in technology
• Local economic environment
• Macro-economic environment
• Legal and regulatory framework
• Political will and public support.
Maturity Model
The concepts of „maturity‟ and „adaption‟ in Information Systems (IS) and Information
Technology (IT) are well-known in the business literature, with early „maturity models‟ dating
back to the 1970s (Wetering & Batenburg 2009). Maturity in this sense refers to the state of an
organization‟s effectiveness in performing tasks and how well organizational behaviors,
practices and processes can impact on outcomes (Crawford 2006). Overall, maturity models
reflect the characteristics of an organization as they move through different stages in a change
cycle, providing conceptual guidelines on essential requirements and components at each stage,
including key success drivers and indicators (Duffy 2001; Kim & Grant 2010). In defining the
different stages of development and growth, maturity models are able to analyze organizations;
recognize when and why they should move forward; provide insight into the actions needed; and
establish goals for achieving and measuring progress (Wetering & Batenburg 2009; Duffy 2001;
Sharma 2008).
Due to their holistic nature maturity models are an important managerial tool, and while they
have been used extensively in information system development, especially software
development, they offer important insight into health information systems (Kim & Grant 2010;
Wetering & Batenburg 2009; Crawford 2006). Sharma (2008) describes an „electronically
immature healthcare organization‟ as one that is reactive, with personnel focusing on solving
immediate crises; with no objective basis for judging product quality or solving process
problems; and has unpredictable healthcare product quality. Further, Haux (2006) has proposed
seven different stages in the development of HIS:

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• Shift from paper-based systems to computer-based processing and storage and increased
data processing
• Shift from local to global information system architectures
• HIS used by professionals and patients/consumers
• Data used for patient care and administration, and also increasingly used for healthcare
planning and clinical research
• Shift of focus from technical HIS problems to change management and strategic information
management
• Shift from alpha-numerical data to clinical images and data on a molecular level
• Steady increase in new technologies for continuous monitoring of health status.
Each stage of a maturity model represents greater expectations and complexity of environments,
as well as tracking improvement and transformation over time and the capabilities at each stage
(Wetering & Batenburg 2009; Sharma 2008). While critiques of maturity models have
highlighted the limitations of using a strictly linear assumption in regards to system development
(Kim & Grant 2010; Moon 2002), a key strength in such models is their ability to highlight the
multiple stages in a change cycle, as well as the multiple factors involved (including human,
technological, process and organizational) (Duffy 2001).
Summary
Overall, information and communication technologies have a potentially major role to play in
health information systems. Technology in healthcare can improve access for geographically
isolated communities; provide support for healthcare workers; aid in data sharing; provide visual
tools linking population and environmental information with disease outbreaks; and is an
electronic means for data capture, storage, interpretation and management. Such possibilities are
especially important in the Pacific; a region that is characterized by remoteness, dispersed and
small total populations and limited human resource capacity.
However, key issues have emerged in the implementation of ICT in the region:
telecommunications infrastructure remains a major limiting factor in the success of many ICT
initiatives in the Pacific (and developing countries in general). It is vital that aspects such as
electricity systems, phone lines and internet connectivity are taken into consideration before
implementing any new technology. Furthermore, human capacity and training are fundamental
aspects of any ICT initiative. The affordability of the technology (and use of it) must also be
assessed in terms of initial and ongoing costs such as license fees, maintenance and support
costs. Any ICT initiative that is heavily reliant on external funding is unlikely to be sustainable
over the long term. Additionally, the exceptionally high cost of many telecommunications
services in the Pacific remains a significant limiting factor to their use. There are also important
hidden costs associated with technology, including maintenance, upgrades and replacing broken
equipment, which need to be assessed.
Judgments must be made on the appropriateness of the technology itself. Moreover, the tropical
climate of the Pacific region is damaging to equipment, such as computer hard-drives that

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require climate-controlled and dust-free environments. Appropriateness also refers to the
anticipated benefits of the technology in comparison to its costs.
While ICT initiatives have the potential to support health information systems, any project or
new policy must have an appreciation of the context and challenges of the implementation
environment. These factors are highlighted in the numerous evaluation tools, methodologies and
frameworks available on the appropriate and effective use of ICT in health.
Overall, maturity models are a potentially effective tool that senior managers in health could use
to assist them in making decisions on whether to invest in information and communications
technology. Maturity models offer a means to classify different systems in terms of their current
level of sophistication (in terms of human and technical capacity) and provide a pathway of
development for health information systems in the region.
The following video shows what a customer focused hospital covers in an ideal Health
Information System: http://www.youtube.com/watch?v=cvvVFPz6TBI&feature=related
The following video from youtube.com explains some of the major benefits of a patient
information system: http://www.youtube.com/watch?v=6GMCiWl2Arg
The diagram below shows how an ideal Health Information System looks like:
www.himss.org

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FINDINGS TO OUR RESEARCH
The population of Fiji is estimated to be 883, 125 as of July 2011
(www.indexmundi.com/fiji/demographics_profile.html). Medically, Fiji is split into three
divisions (Central/ Eastern, Western, and Northern).
The Health Service Structure is as follows:
3 Divisional Hospitals (200 beds – Labasa, 300 Beds – Lautoka and 450 Beds – Suva)
22 Sub Divisional Hospital‟s (20 – 80 beds)
78 Health Centres
104 National Stations
2 Specialist Hospitals
3 Old People‟s Homes
The PATIS Sites Fiji wide is shown in Annexure 1.
Manual Data Collection
Processes
Patient Information Logistics Management
Consolidated Monthly Report System Information System
Hospital Return
Asset Management
HEALTH INFORMATION UNIT System
Cancer Registry
Support Informed Decision Making
Notifiable Diseases
Periodic or Ad Hoc Surveys Financial Management Human Resource
Information System Information System
Individual Unit Collections
Public Health
Information System
Figure designed from information provided by Ministry of Health Fiji

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The Ministry of Health has the following information systems in use:
Patient Information System (PATIS)
Logistics Management Information System (LMIS)
Asset Management System (AMS)
Human Resource Information System (HRIS)
Financial Management Information System (FMIS), and
Public Health Information System (PHIS)
Health Information Unit (HIU)
Information has been kindly provided by Ministry of Health.
The HIU has undergone various reforms with different names and functions. The Unit was
initially known as the Medical Registry with the major responsibility of tracer contact for leprosy
and tuberculosis apart from the registering of Notifiable diseases, then to Medical Statistics Unit
where its role as the tracer contact decreased as incidences of leprosy and Tb declined. The focus
is now more on the collection and compilation of health statistical data. It further analyzes and
interprets this data into useful information.
Its main aim is to develop an integrated health information system to cater for the data and
information in an efficient and effective way so that information could be analyzed, reported and
disseminated in a timely fashion to facilitate management of programs and the monitoring of
health care services. The Unit plays a pivotal role in the areas of planning, evaluation, research
and monitoring in order to improve the quality, efficiency and effectiveness of health service
delivery. It also supports the hospital‟s Medical Records Department at the National Level with
policy guidelines for medical records and information management system.
The Health Information Unit‟s principle objectives are:
To provide a timely, reliable and comprehensive information to the Ministry of Health for
decision making, allocation of resources and monitoring of health services.
To provide reliable and timely epidemiological information to the Ministry of Health for
planning, monitoring and evaluation of the effectiveness of health programs.
To provide information for policy guidelines and management support at all levels,
including hospital medical records department to establish national standards for
provision of effective services to patients while maintaining strict patient confidentiality
and assuring the security of medical records.
Provision of regular feedback to Managers and Supervisors of services for their regular
assessment.

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The core functions of the Health Information Unit are to:
Collect and collate data reported from Hospitals and Community Health settings and
provide feedback for any discrepancies in reporting.
Follow-up of the outstanding returns/ reports
Computerization of health information
Data analysis
Generate reports
Presentation of vital and health statistics/ indicators
Provide statistical table and graphs for the Ministry of Health Annual Report
Provide statistical information at all levels of the Ministry of Health, other Government
Departments and NGO‟s for any relevant information needed.
In their „Health Metrics Network Report, prepared by the Health Information Unit in 2009, the
Unit has acknowledged that there is an absence of both a legislation and also a National Health
Information Systems strategy which is supported by policies to address the need for information
sharing amongst the Stakeholders. It further added that the current human resources and
infrastructure for the Health Information Systems was not adequate. This finding was further
supported by the Acting Director IT for the Ministry of Health, Mr. Shivnay Naidu, when the
group interviewed him on Thursday, 8th December 2011.
Feedback for information is necessary for actions to take place within the system, however, this
is lacking in Fiji‟s Health Information System and needs to be strengthened if meaningful and
evidence based information is to be utilized for action based planning within the health sector.
Fiji‟s current health information reporting system is more information for knowledge based
rather than action based due to the weak analysis and feedback mechanisms in the system. There
is a need to standardize and streamline data flow at each level to ensure the timely and effective
feedback and to preserve and promote data integrity, consistency and quality was highlighted by
the “Health Metrics Network Report”.
The Ministry of Health Strategic and Corporate Plan for 2012 will use information submitted
based on the data collected from PATIS which is a pioneering achievement for the Ministry of
Health.
Patient Information System (PATIS)
The Objectives of PATIS are:
Improve patient services and outcomes
Assist health service administration
Collect information for timely Public Health surveillance and health programme
monitoring

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The functionality areas of PATIS are:
Software developed on Access database
Registers all persons who have been serviced at hospital, health centre and nursing
stations
Person registered within their locality
Local area networks linking into wide area networks
An initial key objective of PATIS was to develop a National Health Number (NHN) for all
clients serviced through hospitals and clinics throughout Fiji. The NHM was supposedly to be
unique to each client. This was as a client‟s captured medical history is unique to him/ her.
PATIS was to eradicate the tedious process of waiting for medical record or other relevant
information before clients could be treated. The Ministry of Health has successfully implemented
this process.
There have been instances where clients have been found with two or more NHN‟s. Now the
PATIS support systems are equipped with an option to merger data when a client with two or
more NHN is found.
IT Architecture
A Local Area Network (LAN) is installed at each facility where PATIS is running. The
minimum requirement for each network is a server, personal computers, printers, label printers
(National Health Card production and pharmacy) and a modem. The transmission media for the
networks is principally twisted pair cabling but fibre-optic and wireless communication is
installed where required. A wide area network is also established between the major centers
which assists in communications and maintenance (Kerrison 2003)
Desktop PC‟s run MS Windows or XP Operating Systems. The number of PC‟s installed varies
from 8 in the smaller hospitals (25 beds) to 50+ in larger hospitals. Computers are placed in most
wards, radiology, pharmacy, dental, laboratory, clinics, outpatients, dietician, and management.
Printers are located at strategic points. Servers are all multi-disc running Redundant Array of
Inexpensive Disks (RAID) for faster access and reliability with redundant power supplies and
automated tape backup (Health Information Unit, 2011).
MS SQL Server is used as the data base management system. Communication with the database
is via Open Database Connectivity (ODBC). The SQL Server database structure has been kept
relatively simple principally to alleviate the need for a specialist Database Administrator. Use is
made of database views, functions and triggers. Complex data integrity checks are programmed
into the PATIS application but now need to be upgraded due to the increased workload as from
the 15 server sites, the number has increased to 32 this year. PATIS has also upgraded to an IP-
VPN from 2011 (Naidu, 2011).

19. 19
SQL Server Agent is used to automatically backup (dump) the data to a file on a daily basis that
is subsequently backed up to tape. Virtually all data in each database is synchronized (replicated)
on a nightly basis.
Issues with the National Health Number (NHN)
Inadequate supervision of staff
Attentiveness of staff
Inadequate initial training of staff
Lack of adequate and appropriate training of new staff members
Programmatic inefficiencies (e.g. Too many people returned when search criteria
entered), and
Misunderstanding by patients of the meaning and use of the NHN and/ or embarrassment
to admit they have lost their card or left their card at home.
Training
A series of “PATIS Train the Trainer” courses are run to build a group of experienced PATIS
trainers. Participants are selected from around the country and from all disciplines, including
nursing. Component trainers within the Fiji Ministry of Health now facilitate the courses.
User training has been structured to emphasize not only the “how” but also the importance of the
data, data accuracy, the effect it has at all levels and how the data is to be used. For users who
attend to public/ clients, the training also includes a session on public relations and “interview”
techniques specific to patient registration and/ or their particular task. Use of the registration
equipment (label printers and laminators) is an integral part of the training. Refresher training
courses are run in facilities as and when the need is identified.
For users who have little or no previous experience with computers, an “Introduction to
Computers” course is run immediately prior to the PATIS training. The course is one or two days
depending on the level of experience of the users and covers the basics of computers (hardware,
turning on and off, keyboards, windows, excel, etc). The courses have been very successful in
making users comfortable with computers and have increased the productivity of the PATIS
training.
Search Parameters
Before registering a patient on PATIS a search must be carried out on the database to ascertain if
the individual has been previously registered. It is not possible to usually bypass the search
routine if the NHN of the person is unknown. During training courses, it is stresses vigorously
that staffs must perform the search rigorously every time because of various reasons (lack of
understanding, embarrassment); many patients do not inform staffs that they already possess a
NHN.

20. 20
Replication Overview
In PATIS, replication is the process whereby data in each installation of PATIS is synchronized
with data from all other installations of PATIS. Additions, modifications and deletions of data at
any given installation are applied to the other PATIS installations using an automated nightly
replication process.
The process is controlled from the Ministry of Health Central Office server. All additions,
changes and deletions to all data in the Patient Master Index, with the exception of some system
and installation specific tables, at each hospital, health center and divisional office, are replicated
to the Central Office. This process is known as “One-Way” replication All the data from these
places are the consolidated on the Central Office database, extracted and subsequently
dispatched to all installations that are online. This process is known as “Two Way” replication.
At the completion of the nightly replication process, all installations are synchronized.
Issues
The most common problem encountered has been the telecommunication infrastructure and
related equipment. The reliability and the quality of the telephone lines has been an issue over
time. The modems originally installed also appeared to be problematic with sporadic failures
and/ or degradation in performance.
Another problem has been with intermittent power supply to some of the more remote locations.
On occasions, the timing of the replication processes are adjusted for a particular hospital to
ensure data is extracted and loaded when the power supply is most likely to be available or the
process is initiated manually.
National PATIS Administrator
A National PATIS Administrator has been appointed who is championing the effective and
efficiency of PATIS, dealing with administrative & operational issues and setting up training
courses for the relevant personnel. He is based at the Ministry of Health Head Quarters and
reports to the Director IT.

21. 21
Example of a Service Delivery Process before PATIS was Introduced
Patient comes
to Outpaitents
Department
Patient details
Gets
filled manually
number, Waits
by Outpatients
to see doctor
Staff.
Attendant goes to
Medical Record
Patient seen
Department to
by doctor
collect patients
Medical Folder
When the
Medical Record
Outpatient
attendant goes
Attendant is free
to Storage
then he/ she
Room
collects this folder
Looks physically
Retrieves folder
for
and comes to
folder, sometim
Medical Records
es missing

22. 22
Example of the Same Service Delivery Process after PATIS was Introduced
Patient comes to Outpaitents
Department
Patient details filled
Gets number, Waits to see
manually by Outpatients
doctor
Staff.
Patient Seen by doctor

23. 23
Health Information Systems Assessment - Fiji
An assessment workshop was conducted by the Ministry of Health to:
Raise awareness on the importance of Health Information System at inter-governmental
level between the Ministry of Health, Ministry of Finance & National Planning, Registrar
General of Births, Deaths & Marriages, Bureau of Statistics Unit and the Donor
Community,
Introduce the Health Metrics Network framework and tool to improve Health Information
sharing, analysis and use,
Explore the views of the stakeholders, of the status of Health Information Systems in Fiji
and capture recommendations, and
Facilitate a systematic reflection and sharing of views between the different Stakeholders
on Fiji‟s Health Information Systems strengths and limitations.
The following is a summarized version of the SWOT analysis carried out by this team on the
Health Information Systems (HIS) in Fiji, operated by the Ministry of Health.
SWOT Analysis – Fiji’s Health Information System (HIS)
HIS Strengths
Established administrative and organizational framework already exists; both electronic
and manual systems exist and are being strengthened,
Availability of data, indicators and data collection methods,
Staff capacity has improved over the years,
Availability of support and assistance from other sources, name Fiji Health Sector
Improvement Project,
Presence of the Health Metrics Network Steering Committee at the national level.
HIS Weaknesses
Weak linkages and coordination with other stakeholders,
Absence of specific HIS legislation at a national level, strategic plan and policies to
facilitate information sharing,
Lack of skilled and trained human resources especially in data analysis, validation,
reporting and use,
Inadequate HIS Infrastructure and limited technology to facilitate data compatibility
between the existing databases which limits data integration,
Lack of systematic training, development & provision of other resources at national level
to support existing structures,
Limitation in the national infrastructure development to allow continuous roll-out of HIS
and absence of an upgrade plan of IT Infrastructure,

24. 24
Delay in technology innovation in Fiji to explore better ways of improving HIS for
sustainability,
Low capacity on the sustainability of the existing systems/ databases.
Inactive National HIS Committee
Lack of operational budget to facilitate HIS needs
Lack of data use culture
Under-utilization of available data
Irregular and incomplete reports leading to inconsistency in reporting system,
Weak supervisory capability and absence of efficient feedback mechanism,
Overlapping of project and donor supports,
Information occasionally used for planning, rather than management and decision –
making,
Weak integration and use of census data.
HIS Opportunities
Integration of HIS data amongst the major stakeholders to facilitate information sharing,
Integration of the existing Ministry of Health standalone databases to ensure a more
efficient, effective internal health information system,
Strengthening of system will lead to improved performance and higher productivity,
Stronger and attractive system in the eyes of donors,
Widespread dissemination of information,
Developing a culture of evidence based decision making.
HIS Threats
Unstable political environment which could affect donor interests and initiatives,
High staff turnover,
Frequent interdepartmental re-shuffles,
Conflicting information from other Health Information Users, producers with regards to
population distribution and administrative divisions at a national level.
In summary, the assessment results revealed that most items under the six Health Information
Systems components assessed (resources, indicators, data sources, data management,
information products, dissemination and use) are weak requiring further development and
strengthening for overall improvement of the National Health Information System in Fiji.
The group recommended the following for further improvement of the current systems in place:
Strengthen linkages and coordination among the stakeholders so that mandatory reporting
is facilitated through an automated system feeding from the main HIS system,

25. 25
Develop a National HIS Strategic Plan in line with the Health Metrics Network
framework,
Develop a national HIS Policy that will form the basis of a legal framework to develop
relevant legislation (Developed in 2011),
Upgrade and integrate the current databases existing with the different stakeholders,
especially Ministry of Health, into a data warehousing at a national level,
Improve HIS reporting system,
Have a separate server to be kept for the Health Information Unit at the Ministry of
Health so that the downtime of the main server does not interfere with data entry and
validation at the National Level of the Ministry,
Develop a web – based application and web – based reporting system to accommodate
information sharing amongst all stakeholders,
Assess and strengthen computerization of all HIS functions at peripheral levels through
the identification of the most appropriate technology to facilitate data consolidation,
Strengthen capacity of the HIS staff, health managers and decision makers at all levels to
improve routine data accessibility, analysis, reporting and information sharing,
Strengthen data management at all levels,
Strengthen and improve data collection methods and reporting systems,
Strengthen data coverage, processing and reporting of vital statistics, for national health
planning and reporting of mandatory data,
Improve the disease surveillance system records, health services records reporting
systems and documentation of patient records.
Develop a GIS or GPS mapping system at the national level that incorporates all public
health facilities, populations, infrastructure, health risks and population that is at risk, for
health planning and decision making purposes.

26. 26
A DISCUSSION OF YOUR FINDINGS
Review of Health Information Systems in the Pacific Islands
Health information is essential for proper management and deployment of limited resources in
the health services of the Pacific Islands. There have been numerous efforts to establish and
strengthen sustainable information systems but the common feature of these attempts has been
the very limited achievement. Subsequently, the use of information as a management tool has
been abandoned in favour of 'gut feeling', hearsay and adhocry. In the last decade health planning
and primary health care activities have necessitated the re-emphasis of monitoring and
surveillance of health and health service indicators. Therefore a revival of interest in health
information systems is taking place.
A review of national health information systems in the Pacific showed that routinely collected
data remained largely untouched by human thought. The contributing factors to the current
inertia are examined with suggestions on how to elevate health information from its current
lowly status to its rightful place as an essential tool for management. The special problems of
small island states, like limited resources, geographical isolation, natural barriers to technology,
and diverse cultural milieu, will be examined in relation to an appropriate health information
system for Pacific Island countries in the twenty-first century.
(http://heapol.oxfordjournals.org/content/9/2/161.abstract)
Management of Information Systems
Good work has been done in the area of management information systems, including the current
roll out of the Public Health Information System (PHIS) in Fiji. The roll–out is completed but is
paper based. A database at HQ level is being finalized, as is additional work with PATIS. While
PATIS is used at the hospital level for patient care and internal management purposes, there is
only limited evidence of the widespread use of these systems as a research tool and dynamic
management tools. There are exceptions and in those locations where there are PATIS
“champions”, there is evidence of its potential. The review team was told that the system is being
transferred to one that is web based and this will help encourage wider use of the very valuable
data being generated by the system. In this regard there would likely be benefit from close
liaison with the FSM. Unfortunately PATIS still does not include a module to capture data in
health centers and nursing stations. (Freeman, Sutton, 2010)
E-Health (Adopted from General Practitioner Volume 8, Number 3)
Although the cost of setting up an e-Health platform that relies on internet, may be initially high
due to the need to provide internet services in especially rural areas, progressing towards a tele-
health strategy for countries like Fiji using tele-health technologies, may be more realistic in the
short term. A key step though is to have a formalized strategy for developing telemedicine and to
work towards having the capability to have IT systems in place that will enable the transition
from tele-health to e-health when such systems are in place and fully integrated. A government-

27. 27
sponsored workshop on e-Governance highlighted the need to formalize a tele-health program to
not only provide for improved doctor-patient consultations in rural areas, but also to provide a
more accessible database on patients‟ records. The Fiji School of Medicine is taking a leading
role in developing a regional tele-health facility, whilst the Fiji Ministry of Health‟s development
of its PATIS database system is well advanced.
The internet based provision of health services and products has further been subdivided into two
major areas by health care professionals (HCP): that of information management and in the area
of clinical research and health education. The former has mainly concentrated on providing on-
line records and inventory systems to store information such as patient records; video-
conferencing and presentation of audio-visual information; and the dissemination of related
digital information. The latter though has been focused more in the areas of health and marketing
campaigns; evaluation of the effectiveness of drugs research and the like; health education in
especially cancer and AIDS; mental health research and the specialized areas of robotic surgery.
The establishment of a patient information system (PATIS) in Fiji‟s Ministry of Health is an
example of the development of a part of an information management system; signifying a key
step in the development of a tele-health and e-health platform. This system of information
management comprises a series of independent Local Area Networks (LAN) in the various
divisions and/or subdivisions that are linked to a central database system in the various regional
hospitals. The central database system is then automatically updated using a phone link/downlink
interface. The PATIS database though works on a patient identification system where each
person registered on the PATIS database is given a unique National Health Number (NHN).
Using a paper input, the NHN then provides key patient details comprising medical history and
other personal details required for assisting the delivery of health care services. Benefits such as
a holistic patient record, accuracy of information, and efficient retrieval of patient records are
envisaged when the system is fully implemented, besides the long-term benefits of cost-effective
public health care service.
A key force in moving the PATIS system to the higher levels of health information management
will have to come from the Fiji College of General Practitioners and its list of consultative
specialists. Web based and innovative network server technologies can provide a powerful
interface with the PATIS database to make it more accessible and useable in an environment that
is quickly becoming digital and online.
Development of PHIS (Public Health Information System)
Despite recent improvements in health status, Fiji, like other Pacific Island countries is
undergoing an epidemiological transition, and is now faced with a triple burden of disease:
communicable and non-communicable diseases and injuries and accidents (WHO WPRO 2008).
Non-communicable diseases such as diabetes, heart disease, high blood pressure, respiratory
diseases and cancers, have now replaced infectious and parasitic diseases as the principal causes

28. 28
of mortality and morbidity in Fiji. Around 82% of deaths in Fiji in 2007 were due to non-
communicable diseases and 10% due to communicable diseases (WHO WPRO 2009).
As such the Ministry of Health has now started implementing the Public Health Information
System, better known as PHIS. Public Health Information System (PHIS) provides timely,
complete and accurate information that is being used to measure public health outcomes and plan
future activities
Australia - Fiji Health Sector Support Program 2011-2015
Australia - Fiji Health Sector Support Program 2011-2015 has found a decline in the capacity of
some components of the health system to support decentralized service delivery as follows:
Ineffective and inefficient use of data for policy, planning and service delivery: Data
are routinely processed at the MoH Health Information Unit, but information is rarely
disseminated back to health service delivery points, where it is most needed for
situational assessments and planning. The weakness in analysis and feedback of public
health data was repeatedly raised as an issue by MoH headquarters and during site visits
by the design team.
Weak monitoring and evaluation: The design team noted that the MoH does not have a
strong culture of monitoring and evaluation (M&E). Nor does its current Annual Plan
include a detailed performance measurement framework. There is an identified need to
strengthen monitoring and evaluation skills both within the central MoH headquarters in
Suva and also at divisional and sub-divisional levels, and to foster a culture where M&E
becomes a routine component of service delivery.
Critical knowledge gaps: The design team noted that there were some critical
knowledge gaps where information is not available from routine information sources. The
issue of urban and peri-urban migration and the effect this is having on health parameters
was identified as an area that needs further research; other potential research areas
include investigation of new disease trends and a review of the effectiveness of health
interventions.
Weak supervision: Senior officers at each level in the health system are expected to
provide an important role in supporting; supervising, monitoring, and providing in-
service training for their junior colleagues at lower levels in the system. There was
concern, however, that this system was not institutionalized and that it was highly
dependent on the initiative and motivation of the doctor or nurse practitioner. There was
also a concern about whether supervising staff have the appropriate skills for this
supervisory role. JICA has identified this as a key area of constraint and has developed
and piloted a nursing supervision program in the Central Division prior to rolling it out to
other areas. It is believed that strengthening this vital link could significantly improve
health outcomes.

29. 29
Clinical Quality Improvement and Risk Management: A component of the current
FHSIP program is the introduction of risk management and Clinical Quality
Improvement (CQI) at the divisional level. The value of this was highlighted several
times by MoH staff during the design mission, but it was also noted that it needed to be
consolidated and expanded to the sub-divisional level.
Transport constraints: Transport was identified as a major constraint with respect to
timely access to health services for patients and for Ministry staff conducting outreach.
The Design Team noted the need for vehicles, boats and even horses to improve access to
services. However, there was some indication that existing transport facilities could be
better managed and coordinated.
Attrition of human resources in the health sector: As outlined earlier, the combination
of political uncertainty and recent government policies on public sector staffing cuts and
lowering of the civil service compulsory retirement age to 55 years has resulted in the
loss to the MoH of up to 1000 health staff, many of them consultants and nurses with
specialist skills in areas such as pediatrics, obstetrics, intensive care and oncology.
Expected outcomes of this program include:
 Public Health Information System (PHIS) provides timely, complete and accurate
information that is being used to measure public health outcomes and plan future activities at
central and decentralized levels;
 Maternal & Child Health and diabetic health services are regularly monitored, audited and
evaluated, and gaps/weaknesses addressed;
 Improved M&E at central level and across service delivery areas;
 Clinical Service Guidelines and protocols related to MCH and diabetes standardized,
disseminated and used systematically throughout all service delivery areas;
 Improved supervisory system institutionalized across MoH;
 Operational research provides information to support evidence-based policy and planning of
health services in urban/peri-urban areas. Other potential areas for operational research may
be identified by the ongoing Fiji Health Systems in Transition (HiT) profile;
 Improved corporate and strategic planning leading towards a sectoral approach to planning;
and
 Improved transport systems to: a) facilitate patient referrals and access to health services
from remote villages/islands, and b) facilitate outreach and supervisory visits by health staff
to remote locations.
Shift to Web Based Systems
The shifting of the PATIS infrastructure to a web based system from late 2011 (beginning from
the Central Division and the 3 major hospitals) and the increased bandwidth will now lead to
increased efficiency of the system. With more leased lines, the information flow is expecting to
be improved significantly.

30. 30
Bulk SMS System
The Ministry of Health has teamed up with Vodafone Fiji Ltd and a NGO, namely ACATA, to
disseminate productive information collected from the Patient Information System and the Public
Health Information System to Vodafone‟s customers. The data will initially focus on the trends
of non-communicable diseases and what steps can be taken to avoid them.
Licenses
The Ministry of Health is currently negotiating with the Government of Fiji to renew the
Licenses for the Windows software as most of the PATIS infrastructure as now Windows based.
There is some debate that the Government ITC Center should take over this role. At present the
Ministry of Health has 1,300 PC‟s and now has 32 server sites.
Electronic Dashboard
The Ministry of Health has approved the development of an Electronic Dashboard for the Patient
Information System and the Public Health Information System from early 2012. This will be
compared against pre-defined key performance and will be critical to the collection of Business
Intelligence for the improvement of organizational wide health care.
Partnership with Healthlink (http://www.healthlink.net/)
Healthlink is a health-system integrator. Its key purpose is to enable medical practices to
communicate electronically with the rest of the health system. Since 1993, it has been doing this
by integrating or connecting the computer systems of health care practitioners so they can talk
with each other and share information, securely.
Its mission is to eradicate paper from the health care system, saving practitioners vast amounts of
time and money and opening up a world of information to them so they can make better
decisions for their patients. We are already well on the way to making this happen, with over
15,000 practitioners from more than 9,000 healthcare organizations across Australia, New
Zealand and the Pacific using Healthlink daily.
In 2010, Healthlink processed over 65 million clinical messages. Imagine if all these messages
had been processed the old fashioned way, on paper. Stacking them one by one would reach well
over 29,000 feet - that's the height of Mt Everest!
Healthlink doesn‟t see why practitioners should have to put up with slow and unreliable paper-
based practices when there is a better way electronically. One that is faster, more reliable and
totally secure. Its customers agree and they utilize Healthlink to get the following information at
their fingertips:
Pathology and radiology reports
Radiology image viewing
Hospital discharge summaries

31. 31
Patient referrals
Specialist letters
Lab test ordering
Messages between general practice and community based care providers
Emergency Room access to a patient's general practice or pharmacy-held records
Business Intelligence (Adopted from TeleTracking Technologies “Business Intelligence
Report”)
Patient Flow: Data vs. Information
Several patient flow automation systems exist on the market today. While many of these provide
a means to streamline core patient flow processes such as patient placement, bed management,
transport and EVS, few provide the robust data needed to evaluate and monitor performance.
Many of these solutions simply provide basic data – raw figures on where patients are and where
they have been. Most systems do not provide a robust way to organize this data into actionable
information. The standard, built-in reports available in these products are indeed useful; vital
pieces of data can be located and tracked, which are well suited to the needs of operational
managers for analysis. However, advanced analytics allow managers to drill down through the
same data to quickly analyze trends and comparisons with a much smaller overhead of required
work, turning the data into fuel for an engine of change.
A few examples can serve to illustrate how patient flow data can be employed to drive true
change in the enterprise:
Admission and discharge analysis. Efficient patient placement is paramount to good patient
flow. BI allows for users not only to track general patient flow statistics, but to slice those
statistics into user efficiency and system compliance numbers. By breaking down discharges by
time of day as well as overall volume, hospitals can identify bottlenecks in the discharge process
and use the information to drive for earlier discharges.
Patient Safety: Infection and isolation control. At the current infection rate, a 500-bed hospital
will experience 194 unnecessary deaths and $28 million in unnecessary costs per year. As
readmissions due to hospital-acquired infections (HAIs) continue to increase, BI can contribute
to the fight by tracking patients‟ movements and how their infection and isolation attributes
change, then presenting it in a way that allows for targeted improvements in areas that are not
managing HAIs well.
Capacity Management: “Dead bed” time. While patient flow software is excellent at telling
users where patients are, it is often hard to find where patients aren‟t. By turning patient flow
data on its head, BI can satisfy a core requirement of improving patient flow through identifying
underused assets: capturing beds that are not being used and the spans of time in which they lie
empty, therefore enabling hospitals to target patients more efficiently to those areas. Proactively

32. 32
acting on the information provided by a robust BI solution translates directly into better patient
care and increased revenue.
Transport and housekeeping performance: These vital departments have a profound effect on
patient flow; patients can‟t occupy clean beds without efficient transportation and housekeeping,
and flow can grind to a halt with inefficient departments. BI can track job times, but more
importantly, can present long-term information on jobs by date, employee and geographical area,
in an easily digestible format suitable for executives. BI can also power the live display of
transport and housekeeping information, allowing for immediate action on staffing or job time
issues.
Overall scorecard-based reporting: BI can pull information from multiple sources
simultaneously, allowing for easy, executive-level summaries of the most important patient flow
statistics. Popular examples include length of stay analysis; early discharge metrics; discharge
and transfer process compliance; totals for admissions and discharges; and transport and
housekeeping turn times.
BI with TeleTracking Business Analytics
TeleTracking Business Analytics offers best-of-breed BI systems that can turn data from your
TeleTracking XT system and other operational and clinical systems into valuable,
transformational information, and put it directly into the hands of hospital decision-makers.
TeleTracking Business Analytics and Avanti Patient Flow Consulting professionals have deep
experience with technology and patient flow improvement, allowing them to work with both
technical and operational staff at hospitals. This ability allows Business Analytics to synthesize
process and technology to create personalized packages of information while keeping the costs
of hospital staff involvement and IT upkeep to an absolute minimum.
The Patient Flow Dashboard™ application lets the user see a “live” enterprise-wide snapshot,
including a multi-campus roll-up, of your healthcare organization‟s operational performance,
moment by moment. This can help hospital systems avoid bottlenecks and delays as they
develop, without the details of reports, which are often geared toward historical trend analysis.

33. 33
Research Based Unit
The Ministry of Health to develop a Research based Unit with the Health Information Unit with
a genuine view of creating more “resource based value” out of the Health Information Systems.
As the Ministry of Health‟s National Health Information Policy states on page 19, Section 7 that
“ideally Fiji‟s HIS should provide evidence for informed and effective health system decisions.
Policy and decision – makers in Fiji do occasionally use the information in the planning process
but do not often analyze their respective health statistics comparative to the national benchmarks.
It is acknowledged that, if not disseminated and/or shared, health research outputs will not
increase the existing stock of knowledge or contribute towards improved service delivery.
However, a good proportion of the health research work done in Fiji remains unpublished and
inadequately disseminated. Consequently, key stakeholders are not adequately informed about
research processes and outcomes. Poor dissemination and packaging of research outcomes also
results in poor linkages between research, policy and programme development.

34. 34
CONCLUSION
1. The Health Information Systems at the Ministry of Health, in particular the Patient
Information System, has added a lot value and provided return on investment to the
Ministry and its customers such as:
Data being used for development of Corporate and Strategic Plan for 2012 onwards
(Naidu 2011),
Reduced waiting time for patients at the relevant departments (as opposed to
previously where a lot of time was spent on search manually for medical record
folders),
Based on the data collated, most of the outpatients department functions has been
shifted to relevant health centers (as opposed to the previous arrangement where the
capacity of the General Outpatients Department at the major hospitals was exceeded
as people living far away from the hospital, chose to visit them instead of their nearest
health facilities),
Close to real time historical information available for Clinicians and nurses when
assessing patients,
Information used from the data collected from the system enabled the Ministry of
Health to identify the rise of the non communicable diseases (as people are getting
less physically active) and then proposed to the Government to remove duty on health
related sporting equipments. The Government of Fiji, in the 2012 National Budget
announcement, removed all duty on health related sporting equipment, for e.g.
treadmills,
Patient‟s information (medical records) are now in virtual space and will not be lost
(as opposed to the manual system before where patient information was lost
sporadically),
The program has met its key initial objectives of a) Improve patient services and
outcomes and assist health service administration and, b) collect information for
timely public health surveillance and health programme monitoring,
The data collated from PATIS has been used to determine the capital expenditure
budget of hospital infrastructure in the Ministry of Health 2012 budget (Naidu 2011),
and
Development of a tele-health and subsequently an e-health platform (Fiji School of
Medicine developed an e-newsletter for clinicians and now is working on developing
a virtual platform for the training of doctors).
2. The Ministry of Health needs to now shift its focus from collecting data (as is very
evident in their Strategic Plan) and move towards using these data to evaluate and make
more informed decisions. This should be part of the Strategic Plan with clearly set Key
Performance Indicators, a IS and IT Strategy, Measurement Plans with definitive

35. 35
deadlines. These should be done as part of a “Lateral Change Framework for better IT
Governance”, as when PATIS was implemented, it was enforced on the health staff in
2001. Staffs have now got onboard after nearly a decade, after seeing the benefits and
results of the system and its potential to improve even further. This will lead to more
action-based planning.
As discussed in our findings, the Ministry of Health‟s Health Information Unit should
have a Research Based Unit, within it, to carry out this task effectively and efficient
health website.
3. The shifting of the PATIS infrastructure to a web based system, from late 2011
(beginning from the Central Division and the 3 major hospitals) and the increased
bandwidth will now lead to increased efficiency of the system. With more leased lines,
the information flow is expecting to be improved significantly
4. The Bulk SMS System with Vodafone is a very good example of how the information
generated from the Patient Information System and the Public Health Information System
can be used to provide additional value for the customers of Ministry of Health. The
mobile health platform can be further developed as is evident in the article presented as
Annexure 2.
5. The Ministry of Health could use the social networking tools to gather feedback about its
service delivery and administration process from the deep end users – its customers. An
example would be the Ministry of Health‟s blog on its website. This would be a radical
approach, which goes without saying that there would be a lot of comments in the initial
years. Ministry of Health then should work seriously in solving these issues if it
genuinely has the best interests of its customers at its heart.
6. The development of the Electronic Dashboard is a positive step from the Ministry of
Health. This will be compared against pre-defined key performance and will be critical to
the collection of Business Intelligence for the improvement of organizational wide health
care. As per the “2011 TeleTracking Technologies report”, published in July 2011,
“Robust BI solutions from professionals steeped in the patient flow continuum allow
hospitals of all sizes to gain new perspectives on their patient flow data: the ability to see
emerging trends and take action immediately; the ability to present complex, long-term
historical information in easily digestible formats; the ability to project future needs. In
short, proper BI allows hospitals to turn data into information – useful, actionable
intelligence, which is what‟s needed for transformational change”.
A sample performance dashboard from 3M Information Systems looks as follows:

36. 36
www.nationalimagingnetwork.com
The Performance Dashboard is in line with the Ministry of Health‟s National Health
Information Policy Section 3.3, which states “Ensure all HIS sub-systems (including, but
not limited to, PATIS, PHIS, HRIS, FMIS, LIS, Drug Inventory and NIMS) are standards
– based to promote inter-operability and can support a national health observatory or
dashboard.
7. Healthlink is the trusted provider of healthcare information systems and technology in
New Zealand and Australia. The Group feels that Ministry of Health should partner with
Healthlink and allow Healthlink to access the data on PATIS and PHIS. This way the
Ministry will be able to upgrade its systems to the best practices in health care
information systems in Australia and New Zealand. This will also allow the Ministry of
Health to get electronically connected, in a secure way, to the various General

37. 37
Practitioners in Fiji. The potential of this partnership is gigantic! This will also
complement what has been discussed in the Literature Review that “Shift from local to
global information system architectures” is one of the key outcomes of a functional
Health Information System.
The following figure shows how such a system can be integrated together for such an
objective:
www.karoshealth.com
8. The Group believes that Ministry of Health, in partnership with AusAid, is on the right
path in terms of developing its Health Information Systems for more improved patient
care and medical facilities in and around Fiji. This can only be achieved if all staff at the
Ministry works collectively towards this goal. It is stated in the “Australia - Fiji Health
Sector Support Program 2011-2015 Report” that “Ministry of Health staff at operational
level are not supportive of some of the key objectives and approaches used in this
program” (pg. 53). These positive changes need to be embraced as a “culture” and as it is
already part of the best practices in Australia and New Zealand.
9. It‟s now an opportune time for the Ministry of Health to generate feedback from Key
Stakeholders to see where the gaps are in the system and how it could be improved with
the contribution of these stakeholders, who are, but not limited to, customers, doctors/
nurses/ other staff, government members, Board of Visitors, Community Leaders,

38. 38
Donors, potential donors, etc. This will engage “end user involvement” to ensure that the
sustainability of the PATIS beyond the time when AusAid is not around.
10. The group believes that the use and upgrading of the Health Information System should
be part of government legislation so that there is more action and accountability at the
relevant level and specific points. The HIS Policy, IS & IT strategies shall be aligned to
this legislation, and partnerships with Health Care solution providers like Healthlink. The
use and upgrading of the Health Information Systems should also be embedded in the
national curriculum of the relevant courses at places like the Fiji School of Medicine, Fiji
School of Nursing, Sangam School of Nursing, University of the South Pacific,
University of Fiji, etc. Ongoing training for administrative staff at all levels in Ministry of
Health, in this area, should also be an on-going process.
HIS embedded in teaching
curriculum of MoH staff providers'
PRM - Link with Health Care
IT Strategy - Business Level
HIS Strategy
HIS Steering Committee
National
Legislation HIS
This will also ensure the future sustainability of the HIS at the Ministry.

39. 39
11. The Government of Fiji, through the Ministry of Health, in its National Budget should
allocate adequate funds to continue with the various Health Information Systems and
upgrade them to realize its full potential by becoming a front end application where a
patient can get easy access to his/ her medical records online in a secure environment..
The dependency on donor funds must stop as this will further ensure the sustainability of
these information systems.
12. This will present a new set of problems as in the rural and remote areas of Fiji; the
customers are not techno savvy. The Group believes that whilst there will be initial
problems in this area; the Government‟s National Broadband Policy is a long term
solution to this issue. This policy focuses on the 2 key areas of education and health,
especially in the rural and remote areas, and aims to make the future generation techno
savvy at a young age.
13. The National HIS Steering Committee is currently inactive and such legislation will
ensure that it does what is required of the committee promptly in terms of Direction
Setting, structuring, staffing, communicating, evaluating and governing. This will negate
the threat of government change (thus direction change) as identified in the SWOT
analysis in our findings.
14. The use of historical and current data from the Health Information Systems should
continuously be used in a strategic and operational manner to improve the service
delivery process to the clients of Ministry of Health at the relevant service delivery
points. This is use of the “Predictive Analysis” concept, discussed in our course book, in
the real world to improve the service delivery of essential public services.
15. The group believes that more “Product Champions” should be introduced at the various
levels of the whole organization and at the respective service delivery points to ensure the
efficiency and future sustainability of the Health Information Systems.
16. As outlined in the figure below the Ministry of Health could work harder to ensure that
there is a more effective alignment of the 3 key segments which ensure that the IT tools
and software realize their full potential in terms of adding value and providing a return on
investment in providing a more efficient and improved service delivery process. These
are its people, its processes and its IT and IS systems!

40. 40
People
Processes
IT and IS
A MORE EFFICIENT AND IMPROVED
SERVICE DELIVERY PROCESS
17. The Health Information Systems at Ministry of Health have progressed and are making a
difference. There is enormous opportunities for these systems to make further more value
added difference on a more macro and micro level. The Ministry of Health now needs to
make that decision to make more significant use of these systems by further upgrading
the system and infrastructure.
“What we are living with is the result of human choices and it can be changed by making
better, wiser choices”.
Robert Redford

41. 41
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http://www.youtube.com/watch?feature=player_detailpage&v=m21qZuu24_o

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solutions.3m.com › United States › Products & Services › Health Care
www.nationalimagingnetwork.com
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ANNEXURE 1