MINPHIS: Nigeria's experience using VistA, MUSTI, and other technologies in building their own national health information system

Ife-Ife 30 August 2005The important role of Information Technology (IT) in Africa's development has recently been recognized by several international agencies, including the United Nations, World Bank, USAID, and International Development Research Centre. Health care is one of the highest-priority areas where IT should be applied for public health benefits (Mandil et al., 1993). However, appropriate software packages for African hospitals and health centres off-the-shelf cannot generally be found - they must be developed locally. However, there is one significant exception, the "Made-In-Nigeria Primary Healthcare and Hospital Information System (MINPHIS)".

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MINPHIS was developed as part of a joint R&D project by Nigeria and Finland on health informatics. The MINPHIS hospital information system has now been deployed in approximately 8 teaching hospitals in Nigeria and is used to keep electronic patient records and generates various reports for health management and research purposes. The system easily scales up or down in size to meet the needs of different types of health care facilities. It is very affordable and has been found to be a productive and efficient tool that opens up the path to more effective and higher quality of care over time. The system is based on free or "open source" software developed and used by the governments of Finland and the United States. Variations of these systems are being used by public and private health care institutions around the world. MINPHIS may prove to be of great interest to other countries across Africa that wish to acquire and implement a health care information system for their own use.

Background

Established in 1962, Obafemi Awolowo University (OAU) in Ife-Ife is one of the biggest universities in Nigeria with approximately 20,000 students and 5000 faculty and staff. OAU Teaching Hospital Complex consists of two hospitals (342 and 212 beds), two urban and one rural health centre, a dental hospital, and schools of nursing, laboratory technology, etc.

In 1987, initial contact between the OAU Teaching Hospital Complex in Nigeria and the University of Kuopio in Finland led to the creation of a on a joint R&D project on health informatics in Nigeria called the "Ife Project". It was formally launched in 1989. The project partners jointly produced a rudimentary Hospital Information System in late 1989, using the public domain Admission-Discharge-Transfer (ADT) software module of the U.S. Department of Veterans Affairs (VA) VistA system (Veterans Health Information Systems & Technology Architecture). It also makes use of the VistA Kernel, FileMan, and Mailman software modules which are all written in the M programming language. The software technology is the same as that deployed in the MUSTI systems deployed in most hospitals in Finland.

This computerized system for storing and reporting patient record data has been under operation and refinement in the Obafemi Awolowo University Teaching Hospital since 1991. Its use was expanded to the second OAU hospital in 1995.

Another proposal for continued Finnish-Nigerian collaboration on the system was approved by the Academy of Finland and funded for two more years in 1997. This new research project started January 1998.

Basic infrastructural improvements were made followed by new systems development work on the "Made-in-Nigeria Primary Healthcare and Hospital Information System" - MINPHIS. In May 1999, an application to extend the project into 2000-2001 was submitted to the Academy of Finland.

The system was originally installed on a PC server with 3 dumb terminals back in 1991. The 2nd generation of the system implemented in 1998 was based on more powerful servers running Microsoft NT, Intersystems Caché, the VA Kernel and FileMan, and the FixIT software developed in Finland for the MUSTI system. It was upgraded and enhanced for potential national use.

Current System

The MINPHIS application keeps patient records and generates various reports for health management and research purposes. The reports include the patient status, medical history and admissions plus indicators like length of stay per patient, discharge summaries, mortality and morbidity data, and operations. The application can answer ad hoc queries from medical researchers (e.g. cases of cholera for a period per geographical location for specific age group or sex or both). It can also provide performance information relevant to particular health care professionals, such as the mortality rates for patients treated by a particular staff member. Such information can be used for self-appraisal by medical staff, or for formal appraisal by hospital managers. As of July 2005, there are 8 teaching hospitals using MINPHIS in Nigeria.

Benefits

The system has helped to improve the quality of patient data which, in turn, has been used through reporting to improve the quality of decision-making. This should have helped in planning, for example to understand which disease categories to priorities for attention, or to understand the availability and requirements for particular drugs. It should help in research, for example to identify trends in patient health and care. And it has been used in resource management decisions, by improving the understanding of indicators such as the number of consultations per day handled by medical professionals, the number of patients per ward, the number of professionals who fail to write discharge summaries for their patients, etc. The availability of such performance information should also help focus the minds of health professionals on their clinical performance.

Conclusions

MINPHIS v.2.0 is now available. The system easily scales up or down in size to meet the needs of different types of health care facilities. It is very affordable and has been found to be a productive and efficient tool that opens up the path to more effective and higher quality of care over time.

The intention is to continue to extend the system to become a more comprehensive electronic health record (EHR) solution that can be deployed across the three tiers of the Nigerian health care system.

A multidisciplinary Health Informatics Group has gradually emerged in Ife-Ife, and it is currently the strongest Research and Development centre in Health Informatics in Sub-Saharan Africa excluding South Africa.

Key Web Sites

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Peter Groen, Abimbola Soriyan, Caroline Nyamai-Kisia

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