Sandra McDonald, MHSA, RHIA, Florida International University
Over the past few decades, the Ministry of Health, Bahamas, Government, has consistently strived to develop and implement an information system that would meet the needs of its uniquely designed health system. From human resource training and education to system design and redesign, development, and implementation, the search for excellence in information management continues. Millions have been invested in the infrastructure and human resources development. Yet, the ideal system seems to be quite a ways off.
Despite the unique challenges and opportunities facing the public health system, the desire to optimize and build a 21 st century information system is still being aggressively pursued. The purpose of this paper is to provide an overview and an understanding of the processes used and challenges experienced by the Bahamas government in the development of its health information management system. Consideration will be given to the following factors that have impacted the systems growth and development:
- Development of HIM professionals
- System development through technology
- The systems future
Understanding the System
The Bahamas, an independent nation, located off the tip of Florida, is made up of 700 rocks, islands, and cays, 21 of which are inhabited. The current population of 300,000 relies heavily on the public health system (socialized medicine) to provide basic healthcare services. The government budgets millions of healthcare dollars annually by to maintain the infrastructure in Nassau (the nation's capital) and each of the 20 individual Family Islands.
The Public Hospitals Authority Board is composed of 3 major hospitals, two of which are located in Nassau--Princess Margaret Hospital (PMH), a 436-bed acute care hospital, and the Sandilands Rehabilitation Centre, a 352-bed facility for psychiatric patients with a geriatric campus of approximately 128 beds. The third facility, Rand Memorial Hospital, is an 80-bed facility located on the Island of Grand Bahama. The Ministry of Health is responsible for the public sector healthcare services of the Bahamas and is composed of other healthcare agencies, including the various clinics and treatment centers located throughout the islands of the Bahamas. Each of which maintains an HIM department. Additionally, the Ministry of Health maintains a separate Health Information Unit at its headquarters in Nassau. This unit serves as the central repository for all health information received from the various healthcare facilities throughout the Bahamas. The geographical location of the islands presents major challenges for the health system overall, and more specifically, for the management, reporting, collaboration, and coordination of health information.
Development of HIM Professionals
In the Bahamas, health professionals have crafted a step- by-step, partner-to-partner strategy for bringing the healthcare system to a sustainable level. One key component is the availability of health information managers, administrators, and technicians that are prepared to embrace the opportunities and challenges of the system. The Bahamas Government for many years has used various strategies to educate, train, and prepare people employed in the various healthcare facilities. Such strategies included the provision of in-services, awards, and full scholarships to colleges and universities abroad.
Thousands of healthcare dollars are spent annually on training and developing HIM professionals in order to meet the growing demands of the public health information system. One of the major challenges facing the system is the lack of available educational opportunities on the island for persons employed in the HIM departments of the various government facilities. Hence, all tertiary education and training that has occurred to date has occurred overseas, either in the US or in other Caribbean Islands. This creates a major problem in that only a few individuals can be trained at a time, given the government's limited financial resources for training and education. Additionally, most HIM professionals that were successfully trained in early years have now either moved on to more successful employment opportunities or have retired.
With the rapid growth of the public health system, the impact of illegal immigrants, and globalization, the demands on the public healthcare system has increased dramatically. Despite the rapid growth, the system has not kept up with the training of HIM professionals. Currently, the challenge for the government is to find a strategic way to bridge the gap between the systems growth and the preparation of HIM professionals in order to meet the systems demands.
System Development through Technology
Given the rate at which healthcare is evolving, it has become difficult for health systems, particularly those in developing countries, to stay abreast of change. Hence, the advancement of an enhanced, integrated health information management system continues to pose a challenge to the government of the Bahamas. As noted earlier, one of the most challenging aspects of systems development in the Bahamas is the geographical location of the islands and the barriers of water.
In an attempt to meet this challenge, the government has developed a GWAN (Government Wide Area Network) composed of frame relay, T1 connections, and expanded bandwidth with an Ethernet backbone. This is an attempt to provide a robust solution that will accommodate the technology needs in a complex and diverse archipelago. Internet access is obtained through either cable modem or DSL, and lately the government has been exploring wireless solutions. Security and firewalls are in place to ensure patient privacy and confidentiality of health data.
While trying to develop the newly enhanced health information systems, the Ministry of Health still relies heavily on the submission of in-house reports to its repository (the Health Information Unit), where trained statisticians compile the data for decision making and reporting purposes. The government's current strategic health plan proposes a secure and robust data warehouse that will facilitate the management, reporting, collaboration, and coordination of health information at all levels. It is also intended to meet clinical and administrative data needs.
Another challenge facing the public health system is the scarcity of IT (information technology) professionals in the public sector. Unable to compete with the private sector in terms of benefits and salaries, the government loses its trained personnel to private companies offering more lucrative salaries. Strategically, pooling resources and appropriate funding are two elements required for sustaining this very important aspect of the system development. Along these lines, the government is fostering multi-sectoral collaboration and partnerships throughout the region with organizations, such as PAHO/WHO, CAREC, UNICEF, and financial institutions, such as IDB, to support and ensure their efforts.
The System's Future
It is estimated that by the year 2010, a minimum of 150 HIM professionals will be needed to adequately meet the needs of the public health information system. By the year 2010, at least one qualified HIM professional (RHIA) will be needed in each of the 20 Family Islands in order to coordinate the island-wide health information system and the reporting of health information data to the Ministry of Health's central HIM office in Nassau. The minimum of a Registered Health Information Technician (RHIT) will be needed in each of the government clinics located in Nassau, Grand Bahama, and the Family Islands. Currently, the HIM departments in most of the clinics and treatment centers in the various islands are managed and sustained by clerks with no formal HIM education and/or training. In order to meet the information needs of the country and the government, additional investment in education and training of HIM personnel is required.
Overall, the future of the health information system and the HIM profession in the public health system in the Bahamas appears to be promising. Individuals employed as RHIA/RHITs are strategically positioned to make a significant impact not only to the government, but the country at large. With additional investments in human resource education and training, success is eventual.
Dorsette, G., Senior Manager MIS, Public Hospital Authority Board, Nassau, Bahamas
|Source: 2004 IFHRO Congress & AHIMA Convention Proceedings, October 2004|