Community Health Information Tracking System (CHITS) : 21st Century Health Information System for LGUs

Community Health Information Tracking System
21st Century Health Information System for
Local Governance

At its essence, every organization is a product of how its members think and interact.

-- Peter Senge

Welcome to San Pablo..Eto ang community namin

UP College of Medicine
Vision

Towards excellence and leadership in community-oriented medical education directed to the underserved using the primary health care approach

Overview

Introduction to Health Information Systems

Introduction to CHITS

CHITS Free and/or Open Source Software?

Next steps

Health Information Systems

What is the problem?

Why does the problem persist?

How can we solve the problem?

How are we solving the problem?

What remains to be solved

CHITS

Started out as CHild Injury Tracking System or CHITS

A cellphone-based reporting system for child injury in Pasay City

Obtained small grant from IDRC (Canada)

Immersed project team in Pasay local health centers

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

What are the problems?

Problems

Data quality assessment 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

Contained vertical programs that had their own vertical information systemsExpanded Program on Immunization

National TB Program

Family Planning

Maternal Care

and others

PatientFamilyBarangayChild CareMaternal CarePhilhealthFamily PlanningLeprosyFilariasisSchisto

Overworked,underpaid, demoralizedgovernmenthealth worker

What quality of data will we get? Will it be good enough for decision making?Vertical Programs Disintegrating at the Health Center Level

More Problems

Target-based systems or quota-based systems can contribute to data errorsgiven a certain target within a given amount of time, data collectors will attempt to meet targets at the expense of quality

The 3-Legged Stool of HIS

1. collection2. consolidation3. analysis/presentation

Target-based Systems Consequence

Two stories in GMA7 Saksi sometime in October 2006Story 1: vaccines worth P40M expired in QC warehouse

Story 2: ten children die of measles in Caloocan

Let's Do the Math

44, 000 barangays nationwide

assuming 1 midwife per barangay

and each midwife adds one extra dose of BCG/month to her data (to meet targets)

Result: 44,000 extra doses of BCG/month

44,000 X 12 months = 528,000 (half a million of unnecessary extra doses of BCG)

Good Apples, Bad Apples

Chronic persistent mixing of good data with bad causes demoralization and the good data/attitude deteriorates into bad.

Summary of Problems

manual, paper-based system allowed for errors

target-based systems pressured collectors to manipulate data

poor data quality at the collection level resulted in poor data at the higher levels and in erroneous decisions

Proposed Solution

Multi-part solutionSystemic problems requires systemic solutionsstaff training

information systems re-engineering

CHITS Design Philosophy

Create computer program side by side with health workers inside the actual environment (c/o Dr. Herman Tolentino)

Build up the morale of health workers and allow them to participate in the development

Integrate the disintegrated vertical programs (provide a common interface)

Design Philosophy

Design data structures like Lego blocks so we can build health information systems that interoperate

Benefits of CHITS

faster record retrieval

less record loss

more efficient data entry/storage

data analysis/mining

helps with completeness

can streamline workflow

resource management

time management (appointment system)

Integrating health information through data modeling and business process re-engineering

How It Works

Suite of components:Information technology

Capability-building

Policy development

Data for decision making

How It Works

Information technologyOrdinary computers

Standard computer networking

Open source (free) software

Total cost:15,000 per computer (if brand new)

Minimum: one PC

Ideal: three PCs

How It Works

Capability buildingProject team:Developers: knowledge on the health care flow and vocabulary (the language of health)

Doctors: data and process modelling (the language of programming)

Health center staff (BHW, midwives, RN, MD):Basic computer skills

Introduction to Health Information Systems

(Yes! Midwives can use Linux!)

How It Works

Policy DevelopmentProvision of mandate for the 'new way of doing things'

Most difficult/delicate part of the project

How It Works

Data for decision makingQuick access to patient records

Integrated view for frontliners (TB, vaccination, maternal care, etc)

Vertical view for program managersEspecially PhilHealth (important for reimbursement and possible source of funds for sustainability)

Fig. 1: Consults Page

Registration page

SCREENSHOTS

Fig. 2: Patient Record

Individual Treatment Record

SCREENSHOTS

Fig. 3: NTP Module

National Tuberculosis Program

SCREENSHOTS

Fig. 4: Maternal Care Module

Maternal Care

SCREENSHOTS

Fig. 5: Child Care Development Module

Expanded Program on Immunization

SCREENSHOTS

Fig. 6: PhilHealth Module

PhilHealth

SCREENSHOTS

Fig. 7: Appointments Page

Appointments

SCREENSHOTS

Fig. 8: Appointment Per Patient

Appointments

SCREENSHOTS

Fig. 9: Daily Service Report

Standard Daily Reports

SCREENSHOTS

Fig. 10: EPI Weekly Monitoring Report

Special Program Reports (EPI)

SCREENSHOTS

Fig. 11: EPI Target Client List (TCL)

Target Client List

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)

- Mine the database for new knowledge and for evidence-based policy making

- Partnerships with Department of Health, College of Public Health [CPH], National Center for Public Administration and Governance [NCPAG], School for Urban and Regional Planning [SURP], etc

RHU/ CHITS

RHU/ CHITS

RHU/ CHITS

CHO/PHO

LCE

DOH

CHITS Ideal Set-up

Updates

Lagrosa and Malibay now on second year

Total of 60,000 transactions

Marikina now starting with 3 RHUs

Quezon province starting with 2 RHUs

CHD IV-A will assist in training program

For presentation to AMHOP in annual meeting March 2007

Pasay - 2004Marikina - 2005Alabat Island - 2006

CHITS is a Finalist in the 2006
Stockholm Challenge!!!






The only Filipino entry in the health category

www.stockholmchallenge.se

If Interested, Next Steps:

Create a CHITS project team (or assign to existing office/unit -- will coordinate with the UP National Telehealth Center)

LCE provides leadership and vision for the digital strategy

Contact Info

Dr. Alvin B. MarceloCHITS Project ManagerNational Telehealth CenterPGH, Taft Avenue, ManilaTel: 522-9231 Email: alvin.marcelo@miu.phhttp://www.chits.info

Salamat po!Pangkaraniwang Araw sa Lagrosa Health Center, Pasay City