DHIS2 has been expanding its reach into many health systems. Starting from its familiar grounds of aggregate data sets for routine data it has included patient related data and then data in the areas of HR, finance, logistics and laboratory management, moving towards operational or transactional data.
We can differentiate between transactional and aggregate data. A transactional system (or operational system from a data warehouse perspective) is a system that collects, stores and modifies detailed level data. This system is typically used on a day-to-day basis for data entry and validation. The design is optimized for fast insert and update performance. DHIS2 can incorporate aggregate data from external data sources, typically aggregated in the space dimension (the organisation unit hierarchy), time dimension (over multiple periods) and for indicator formulas (mathematical expressions including data elements).
When we look at a transactional system, such as a logistics software for the entire supply chain or parts of it, there is one fundamental decision to take: Do you need to track all detailed transactions at all levels, including such operations as returns, transfer between facilities, barcode reading, batch and expiry management? Or can you get most of your needed decision insight results using aggregate data?
Supply chains may often be well monitored and to some degree, managed, as long as data are reliably available where and when they are needed for operational decisions and for monitoring purposes.. The main indicators intake, consumption and stock level at the end of period can be managed without electronic transactions and often suffice to give the big picture of system performance, and may reduce the needs for system investment.
Being realistic about what data need to be collected, how often, and who will be using them is important so you don’t create systems that fail due to lack of use or unrealistic expectations about how the data will be used. Digital logistics management systems can work well when they are fully integrated into routine workflows and designed to make the users’ jobs easier or more efficient.
The expectation, that more detailed data leads to better logistics management is not always fulfilled. Sometimes the ambitious attempt to regularly collect logistics transaction data results in less data quality, for example because the data recording, which may have to happen on a daily basis instead of a monthly or quarterly basis, is not carried out reliably. On the other hand, if the transactional system is well maintained and monitored, more detailed data can help identify inaccuracies and data quality challenges, reduce wastage (due to expiry or CCE failure), support a recall, manage performance and lead to improvements in supply chain decision making. Analysing detailed data may help to discover root causes of some problems and improve the data quality in the long run.
DHIS2 can assume different roles in interoperability scenarios. A common interoperability scenario is for DHIS2 to receive aggregate data from an operational system, in which case the operational system adds up the transactions before passing it on to DHIS2. However, DHIS2 may to a certain extent also be configured to store detailed transactional data, receiving it from external systems or through direct data entry in DHIS2.
On this basis we try making a comparative overview, comparing aggregate DHIS2 data management with data management of external specialized system. This can serve as a rough orientation, but is not static since both the capabilities of DHIS2 and its interpretation by implementers are broadening with almost each release.
|Area||Aggregate DHIS2||External specialized systems|
|Logistics||Aggregate data, e.g. end-of-month facility stock levels can be send through DHIS2. DHIS2 can produce simple stock level and consumption reports.||Supply chain management support logistics system operations and can track detailed stock movements (Issuing, resupplying, allocating, wastage) and record details such as production batch numbers. SCM systems create forecasting, replenishment and elaborate control reports, allowing for real time monitoring of stock levels, notifications (low stock, workflow management, CCE failure, etc.), supported estimations, and emergency orders.|
|Finance||Aggregate data, e.g. on total expenditure or cash level can be send through DHIS2. DHIS2 can produce simple finance overview reports, e.g. on remaining budgets.||Finance management systems allow fully traceable recording of financial transactions according to legal requirements, including budgeting, transfers, cancellations, reimbursements etc. Multi-dimensional tagging of transactions allows for analytical reports.|
|Patient tracking||Disease or program related data are collected by DHIS2, DHIS2 Tracker also allows a simplified longitudinal view on medical records, including patient history and multi-stage clinical pathways.||Specialized hospital management systems can cover and optimize complex workflows between different departments (e.g. reception, payment counter, wards, OPD, IPD, laboratory, imaging, storeroom, finance and HR administration, medical device maintenance, etc.).|
|Human Resources||DHIS2 collects human resource related indicators, for example planned positions and vacancies per facility.||A specialized HR management system can track detailed status information and changes for a Health Worker (accreditation, promotion, sabbatical, change of position, change of location, additional training, etc.). It comes with pre-designed reports for both operational oversight and planning.|