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“At its essence, every organization is a product of how its members
think and interact.”
-- Peter Senge
Community Health Information Tracking System:Towards an eRHU
Alvin B. MarceloNational Telehealth Center
University of the Philippines Manila
Outline
National Telehealth Center 20th century RHU CHITS: Integrated Health Services at the
Point-of-Care BuddyWorks Project
− e-learning− telemedicine
The eRHU
Welcome to San Pablo…..Eto ang community namin……
National Telehealth CenterVision
created by the UP Board of Regents in 1998 mandated to study how ICT can be used to improve the health of Filipinos
CHITS
Partnership with the UP College of Medicine Originally “Child Injury Tracking System” Obtained small grant from IDRC/Panasia
(Canada) Intended to create a cellphone-based
reporting system for child injury in Pasay City Immersed project team in local health
centers (the frontline of the country's health system
FHSIS
Field Health Service Information System Fourth iteration of the DOH Management
Information System (since 1980s) A manual, paper-based system that required
aggregation of data at several levels of the hierarchy
Data collection done by midwives; consolidation and analysis by public health nurses and municipal health officers
Problems
Data quality (based on WHO criteria)− Incomplete− Inaccurate (errors in addition, 'guessing')− Illegibile− Not useful nor relevant for data collectors− Delayed
Employed an “all-or-none” reporting scheme
All or None Reporting Scheme
B
B
B
B
B
HC Province
Region
DOH
HC
HC
HC
Province
Province
Region
HC
All or None Reporting Scheme
B
B
B
B
B
HC Province
Region
DOH
HC
HC
HC
Province
Province
Region
HC
Problems with FHSIS
Also contained vertical programs that had their own vertical information systems
− Expanded Program on Immunization− National TB Program− Family Planning− Maternal Care− and others
Patient
Family
Barangay
Child Care
Maternal Care
Philhealth
Family Planning
Leprosy
Filariasis
Schisto
Overworked,underpaid, demoralizedgovernment
health worker
What quality of data will we get? Will it be good enough for decision making?
Vertical Programs Disintegrating at the Health Center Level
Proposed Solution
Technology Training Teamwork
Design Philosophy Create computer program side by side with
health workers inside the actual environment (c/o Dr. Herman Tolentino, system architect and lead developer)
Build up the morale of health workers and allow them to participate in the development
Integrate the disintegrated vertical programs [provide a unified interface]
Empower the RHU staff to make evidence-based decisions
Design Philosophy
Design data structures like Lego® blocks so we can build health information systems that interoperate
Family
Barangay
Patient
DEMOGRAPHICSCONSULTS TODAY
CHITSCONSULTS TODAY
CHITS
Notifiable Diseases
Immunization
Maternal Care
Immunization
Child Care
DOTS
PhilHealth
Maternal Care
Immunization
Child Care
DOTS
PhilHealth
MODULESUSERINTERFACE
VERTICALPROGRAMS
Maternal and Child Health
Immunization
Notifiable Diseases
REPORTS
CORE MODULES
Integrating health information through data modeling and business process re-engineering
How It Works
Suite of components:− Technology− Training− Teamwork [LCE, SB, MHO, PHN, RHM,
community]
How It Works
Technology− 3 computers− Standard computer networking (with WiFi) − Open source (free) software
Total cost:− 50,000
How It Works
Technology− Broadband Internet
Total cost:− 15,000 per year
Benefits− online backup− online troubleshooting− province-wide data integration− automated data submission
How It Works
Training− Policy makers
LCE and SB− Health center staff
MHO, PHN, RHMs, RSI− Content
Level 0: Orientation Level 1: Introduction to Health Information Systems Level 2: Data for Decision Making
How It Works
Teamwork− Policy Development
Provision of mandate for the 'new way of doing things' Most difficult/delicate part of the project
− Resource generation− Human resource development
How It Works
Data for decision making− Quick access to patient records− Integrated view for frontliners (TB, vaccination,
maternal care, etc) − Vertical view for program managers
Especially PhilHealth (important for reimbursement and possible source of funds for sustainability)
Future Directions
- Connect cellphones to CHITS using GPRS (Internet over cellphones)
- Establish partnerships with SMART/Globe/Nokia/Sony
- Establish Bluetooth intranets inside health centers (ASTI)
- Allows Bluetooth-enabled phones to be used as input devices (obviates need for desktops)
- Develop Java midlets for field data collection and home-based monitoring
- Partnerships with the various computer science programs of the UP System
- Connect CHITS to Geographic information systems (link up with Department of Geography, UPD)
LAGROSA HEALTH CENTER
MALIBAY HEALTH CENTER
MANILA INTERNATIONALAIRPORT
1 kmN
MAP OF PASAY CITY
- Involve the community in data entry
- Build capacity for evidence-based resource allocation and local health systems governance
- Provide a model for other LGUs to emulate
- Establish partnerships with other LGUs (n=1700+)
Coming Soon: BuddyWorks!
E-Learning− RHU/BHW staff training over broadband Internet
with Voice-over-IP Telemedicine
− Trauma− Poisoning− Referral coordination and networking
Quality health care for Filipinos, especially for those who cannot afford it.
