title: Assessing the ability of health information systems in hospitals to support evidence-informed decisions in Kenya.
abstract: BACKGROUND
  Hospital management information systems (HMIS) is a key component of national health information systems (HIS), and actions required of hospital management to support information generation in Kenya are articulated in specific policy documents. We conducted an evaluation of core functions of data generation and reporting within hospitals in Kenya to facilitate interpretation of national reports and to provide guidance on key areas requiring improvement to support data use in decision making.
  
  
  METHODS
  The survey was a cross-sectional, cluster sample study conducted in 22 hospitals in Kenya. The statistical analysis was descriptive with adjustment for clustering.
  
  
  RESULTS
  Most of the HMIS departments complied with formal guidance to develop departmental plans. However, only a few (3/22) had carried out a data quality audit in the 12 months prior to the survey. On average 3% (range 1-8%) of the total hospital income was allocated to the HMIS departments. About half of the records officer positions were filled and about half (13/22) of hospitals had implemented some form of electronic health record largely focused on improving patient billing and not linked to the district HIS. Completeness of manual patient registers varied, being 90% (95% CI 80.1-99.3%), 75.8% (95% CI 68.7-82.8%), and 58% (95% CI 50.4-65.1%) in maternal child health clinic, maternity, and pediatric wards, respectively. Vital events notification rates were low with 25.7, 42.6, and 71.3% of neonatal deaths, infant deaths, and live births recorded, respectively. Routine hospital reports suggested slight over-reporting of live births and under-reporting of fresh stillbirths and neonatal deaths.
  
  
  CONCLUSIONS
  Study findings indicate that the HMIS does not deliver quality data. Significant constraints exist in data quality assurance, supervisory support, data infrastructure in respect to information and communications technology application, human resources, financial resources, and integration.
authors.affiliation: Ministry of Health, Government of Kenya, Nairobi, Kenya; The Health Services, Implementation Research and Clinical Excellence (SIRCLE) Collaboration, Nairobi, Kenya; Ekihuba@kemri-wellcome.org.
authors.forename: Elesban
authors.initials: E
authors.lastname: Kihuba
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: David
authors.initials: D
authors.lastname: Gathara
authors.affiliation: Ministry of Health, Government of Kenya, Nairobi, Kenya; The Health Services, Implementation Research and Clinical Excellence (SIRCLE) Collaboration, Nairobi, Kenya.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mwinga
authors.affiliation: The Health Services, Implementation Research and Clinical Excellence (SIRCLE) Collaboration, Nairobi, Kenya; Department of Pharmacy and Phamacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya.
authors.forename: Mercy
authors.initials: M
authors.lastname: Mulaku
authors.affiliation: The Health Services, Implementation Research and Clinical Excellence (SIRCLE) Collaboration, Nairobi, Kenya; Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya.
authors.forename: Rose
authors.initials: R
authors.lastname: Kosgei
authors.affiliation: Ministry of Health, Government of Kenya, Nairobi, Kenya.
authors.forename: Wycliffe
authors.initials: W
authors.lastname: Mogoa
authors.affiliation: Ministry of Health, Government of Kenya, Nairobi, Kenya.
authors.forename: Rachel
authors.initials: R
authors.lastname: Nyamai
authors.affiliation: The Health Services, Implementation Research and Clinical Excellence (SIRCLE) Collaboration, Nairobi, Kenya; KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Department of Paediatrics, University of Oxford, Oxford, United Kingdom.
authors.forename: Mike
authors.initials: M
authors.lastname: English
mesh_terms: D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000592:standards / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000379:methods*; D006739:Hospital Administration; D006751:Hospital Information Systems / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D012107:Research Design
keywords: data quality; health information system; hospital management information system
references.citation: Glob Health Action. 2013 Aug 29;6:21424
references.pmid: 23993022
references.citation: Adv Health Care Manag. 2012;12:25-58
references.pmid: 22894044
references.citation: BMC Int Health Hum Rights. 2008 Mar 28;8:4
references.pmid: 18373839
references.citation: Arch Dis Child. 2014 May;99(5):452-6
references.pmid: 24482351
references.citation: AMIA Annu Symp Proc. 2005;:942
references.pmid: 16779229
references.citation: PLoS Med. 2010 Jan 26;7(1):e1000223
references.pmid: 20126260
references.citation: BMC Health Serv Res. 2011 Nov 11;11:307
references.pmid: 22078071
references.citation: Int J Med Inform. 2008 Jun;77(6):377-85
references.pmid: 17904898
references.citation: Lancet. 2007 Mar 24;369(9566):1039-46
references.pmid: 17382830
references.citation: Lancet. 2007 Mar 3;369(9563):779-786
references.pmid: 17336655
references.citation: Int J Epidemiol. 1996 Aug;25(4):807-13
references.pmid: 8921460
references.citation: J Acquir Immune Defic Syndr. 2009 Nov;52 Suppl 1:S58-62
references.pmid: 19858942
references.citation: J Pak Med Assoc. 2010 Aug;60(8):649-53
references.pmid: 20726196
references.citation: J Am Med Inform Assoc. 2013 Jul-Aug;20(4):792-801
references.pmid: 23416247
references.citation: BMC Health Serv Res. 2013 Jun 12;13:212
references.pmid: 23758921
references.citation: Int J Med Inform. 2004 Jun 30;73(6):479-91
references.pmid: 15171977
references.citation: Med Care. 2004 Nov;42(11):1066-72
references.pmid: 15586833
references.citation: Health Policy Plan. 2009 May;24(3):217-28
references.pmid: 19304786
references.citation: Bull World Health Organ. 2012 May 1;90(5):379-84
references.pmid: 22589572
references.citation: Int J Med Inform. 2005 Jan;74(1):31-8
references.pmid: 15626634
references.citation: Am J Public Health. 1992 Feb;82(2):243-8
references.pmid: 1739155
references.citation: PLoS One. 2009;4(5):e5483
references.pmid: 19434234