chits july 27__2010
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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
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