Grant amount: $39,337 (Small Grants Program)
Brief overview of country status: HMN "Wave One" country, HIS assessment, strategic planning, stakeholder convening.
HISTORY OF HIS IN BELIZE
In 1999, the Government of Belize embarked on a Health Sector Reform Project with support from the Inter American Development Bank (IDB). Six administrative districts were grouped into four regions and the creation of Regional Health Management Teams (RMTs) was aimed at decentralising planning and decision-making. Together with management consultant Accesstec Inc., the need for a national health information system in support of the reform project was identified. The Ministry of Health invested in the development of electronic health records – the Belize Health Information System (BHIS) – a home grown health IT solution that was installed in 2004. Belize, a HMN "Wave One" country, inaugurated its innovative health information system in September 2008.
The Belize National Health Information System - BHIS
The BHIS is a fully integrated, comprehensive health information system designed to improve individual health outcomes and public health performance, and optimize resource utilization. It allows for patient-based data to be made available to authorized users anywhere in the country almost as soon as they are entered in the system.
The BHIS enterprise architecture presents the high functionality, interoperability and security that makes the BHIS user friendly, scalable and secure. At the core of the system are several interconnected modules which include admissions, transfer and discharge; clinical order entry; laboratory; billing; and supply chain management. Recently, an HIV/AIDS module was added and plans are underway to add public health and human resource modules. Electronic health records (EHRs) are portable and can be accessed (with due authorisation) from a computer portal located anywhere in the country. BHIS runs on PostgreSQL, a powerful open source object relational database system available on all major operating systems (Linux, Unix and Windows).
The combination of PostgreSQL, Java-based web technologies and Extensible Markup Language (XML) allows the BHIS to easily overcome barriers to information exchange arising from the use multiple ICT infrastructures by NHIS stakeholders. Hardware and software configurations present multiple layers of security to protect health information. They include use of firewalls, hypertext transfer protocols, usernames and passwords, audit trails and other features. Access codes provided to users are monitored continuously for abuse and additional security features continue to be added to ensure the integrity of the system.
For the interface with other data bases, the BHIS uses social security numbers to generate unique patient identifiers. The government intends to link all major sources of health information such as the Social Security, Vital Statistics and the National Health Insurance to achieve bi-directional data feed on near real time basis. Among other things, this will produce efficiency gains in the use of human resources.
HIGHLIGHTS AND MILESTONES
In 2006, a grant was received from HMN that first brought the Belize system to the attention of the wider Network. In May 2008, Belize became the first country in the Americas to be granted priority technical support from HMN as a “Wave One” country. The country has completed an assessment of its health information system (HIS) and is currently in the process of finalizing its HIS Strategic Plan, with continued HMN and PAHO/WHO technical cooperation.
Rural expansion of the BHIS is envisaged as part of the MOH agenda. In late 2008, the BHIS added the San Antonio Poly Clinic II, located in a rural municipality in the southernmost part of the country, to the network. The facility records approximately 14,000 encounters per year. The intent is to cover 8 health centres and polyclinics in 3 regions by 2010.
Over time the BHIS has expanded functionality and coverage. Today (2009), the BHIS captures around 80% of encounters in public health facilities and to a lesser extent, the private sector. The Government intends to have every Belizean covered through its electronic health records. The small size of the population and rapid diffusion of technology makes this attainable in the medium term. The BHIS is a web-based open source environment.
HIS PROFILES: REFORM IN ACTION
Savings of up to 250.000 USD are attributed to the BHIS drug procurement during 2008 alone, as wastage of drugs, efficient use of available stock, and procurement of generic drugs increased. Documented improved disease management of HIV mother to child transmission resulted in lowering the transmission rate form 20 per year down to 1 case per year (< 5% vertical transmission rate). A documented 90% reduction of hospital cases of adverse reaction is reported. Better patient data on hypertension allowed the hospital discharge cases to go down and increased the outpatient care of these cases to 90%. Overall, an estimated reduction of 8.4% of medical expenses during the first 12 months of BHIS operability is reported. More savings are expected once BHIS covers all public health services. Information retrieved from the BHIS helped to detect H1N1 cases immediately. Patients can easily be followed-up on their compliance with ante natal care visits and vaccination schedule.
HMN'S CURRENT ACTIVITIES IN BELIZE
Belize received HMN technical support for the Global Fund round 9 HIS proposal, and financial support of the inter-Caribbean country meeting to harmonize HIS in the region. The workshop “Belize Health Information System: Lessons Learned to Strengthen National Health Information Systems in Barbados, Eastern Caribbean Countries, Jamaica, and Trinidad and Tobago” was held in Belize from August 17-19, 2009. The workshop was organized by the Belize and Eastern Caribbean Countries offices of PAHO/WHO in collaboration with the Ministry of Health of Belize, the Health Metrics Network (HMN), and the Organization of Eastern Caribbean States.