Role of Country-Wide Health Information System in Decreasing the Intensity of Service Required to Manage Hypertension Among Belizeans Age GE 65

Belize is the first country in the world to have a country-wide fully integrated health information system, the BHIS. It currently captures >85% of all health care encounters in Belize. Hypertension is a chronic disease that afflicts may Belizeans, particularly over age 64. It was the 7th leading cause of death in 2007 in Belize. Disease management for hypertension is among the major goals of the Belize Ministry of Health. The BHIS supports evidence-based protocols for management of hypertension. Systematic and timely feedback on the status of hypertensive patients to their physician began in January 2008 throughout Belize. To monitor and evaluate the management of Belizeans with essential hypertension, BHIS encounter records containing corresponding ICD-10 diagnoses, either primary or secondary, and patient age GE 65 years were selected. Using the unique patient identifier, all encounter records for Belizeans with any record containing a hypertension diagnosis were included. All analyses were conducted as monitoring and evaluation activities by the Belize Ministry of Health. All required steps were taken to protect the privacy and confidentiality of each and every health record. Hospitalization rates for hypertension, starting at 1.81 per 1,000 per month in January 2008, fell steadily to 0.83 per 1,000 per month in March 2009. For that same period, outpatient clinic visits rose from 1.90 per 1,000 per month to 7.15 per 1,000 per month, and the ratio of outpatient visits to hospitalizations for hypertension rose from 1.04 to 8.42. Annualized, the savings achieved over this 15 month period from inpatient to outpatient care represents over 0.5% of the 2009 Belize healthcare budget. The BHIS has contributed to the management of complex, noninfectious chronic disease in Belize, as this example involving essential hypertension illustrates. A country-wide integrated health information (iHIS) also makes systematic, timely monitoring and evaluation possible.