title: Decline in mortality with the Belize Integrated Patient-Centred Country Wide Health Information System (BHIS) with embedded program management.
abstract: BACKGROUND
  Belize deployed a country-wide fully integrated patient centred health information system with eight embedded disease management algorithms and simple analytics in 2007 for $4 (Cad)/citizen.
  
  
  OBJECTIVE
  This study evaluated BHIS uptake by health care workers, and pre and post BHIS deployment mortality in selected areas and public health care expenditures.
  
  
  METHODS
  BHIS encounter data were compared to encounter data from required Ministry of Health reports from licensed health care entities. De-identified vital statistics death data for the eight BHIS protocol disease domains and three non-protocol domains were compared from 2005 to 2011. Belize population data came from the Statistical Institute of Belize (2005-2009) and from Belize census (2010) and estimate (2011). Public health system expenditures were compared by fiscal years (2000-2012).
  
  
  RESULTS
  BHIS captured over 90% healthcare encounters by year one, 95% by year two. Mortality rates decreased in the eight BHIS protocol domains (each 2005 vs. 2011, all p<0.02) vs. an increase or little change in the three domains without protocols. Hypertension related deaths dropped from 1st cause of death in 2003 to 9th by 2010. Public expenditures on healthcare steadily rose until 2009 but then declined slightly for the next 3 years.
  
  
  CONCLUSIONS
  For modest investment, BHIS was well accepted nationwide and following deployment, mortality in the eight BHIS disease management algorithm domains declined significantly and expenditures on public healthcare stabilized.
authors.affiliation: Ministry of Health, Government of Belize, Belmopan, Belize; Department of Peadiatrics, Faculty of Medicine, Dalhousie University, etc, Halifax, Nova Scotia, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Graven
authors.affiliation: Ministry of Health, Government of Belize, Belmopan, Belize.
authors.forename: Peter
authors.initials: P
authors.lastname: Allen
authors.affiliation: Ministry of Health, Government of Belize, Belmopan, Belize.
authors.forename: Ian
authors.initials: I
authors.lastname: Smith
authors.affiliation: Department of Peadiatrics, Faculty of Medicine, Dalhousie University, etc, Halifax, Nova Scotia, Canada. Electronic address: noni.macdonald@dal.ca.
authors.forename: Noni E
authors.initials: NE
authors.lastname: MacDonald
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001531:Belize; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records / Q000191:economics* / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D063005:Health Information Systems / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D018802:Patient-Centered Care / Q000191:economics* / Q000706:statistics & numerical data; D018511:Systems Integration; D014481:United States; D014492:United States Public Health Service / Q000191:economics*; D055815:Young Adult
keywords: BHIS; Belize Health Information System; Developing country; Electronic clinical decision support; Electronic health records; Electronic medical record; Health information system; Health outcomes; eHealth