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Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
Chits july 27__2010
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Chits july 27__2010

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  • 1. Community Health Information Tracking System 21st Century Health Information System for Local Governance
  • 2. “ At its essence, every organization is a product of how its members think and interact.” -- Peter Senge
  • 3. Welcome to San Pablo….. Eto ang community namin……
  • 4. UP College of Medicine Vision Towards excellence and leadership in community-oriented medical education directed to the underserved using the primary health care approach
  • 5. Overview <ul><li>Introduction to Health Information Systems
  • 6. Introduction to CHITS
  • 7. CHITS Free and/or Open Source Software?
  • 8. Next steps </li></ul>
  • 9. Health Information Systems <ul><li>What is the problem?
  • 10. Why does the problem persist?
  • 11. How can we solve the problem?
  • 12. How are we solving the problem?
  • 13. What remains to be solved </li></ul>
  • 14. CHITS <ul><li>Started out as “CHild Injury Tracking System or CHITS”
  • 15. A cellphone-based reporting system for child injury in Pasay City
  • 16. Obtained small grant from IDRC (Canada)‏
  • 17. Immersed project team in Pasay local health centers </li></ul>
  • 18. FHSIS <ul><li>Field Health Service Information System
  • 19. Fourth iteration of the DOH Management Information System (since 1980s)‏
  • 20. A manual, paper-based system that required aggregation of data at several levels of the hierarchy
  • 21. Data collection done by midwives; consolidation and analysis by public health nurses and municipal health officers </li></ul>
  • 22. What are the problems?
  • 23. Problems <ul><li>Data quality assessment </li><ul><li>Incomplete
  • 24. Inaccurate (errors in addition, 'guessing')‏
  • 25. Illegibile
  • 26. Not useful nor relevant for data collectors
  • 27. Delayed </li><ul><li>Employed an “all-or-none” reporting scheme </li></ul></ul></ul>
  • 28. All or None Reporting Scheme B B B B B HC Province Region DOH HC HC HC Province Province Region HC
  • 29. All or None Reporting Scheme B B B B B HC Province Region DOH HC HC HC Province Province Region HC
  • 30. Problems <ul><li>Contained vertical programs that had their own vertical information systems </li><ul><li>Expanded Program on Immunization
  • 31. National TB Program
  • 32. Family Planning
  • 33. Maternal Care
  • 34. and others </li></ul></ul>
  • 35. Patient Family Barangay Child Care Maternal Care Philhealth Family Planning Leprosy Filariasis Schisto Overworked, underpaid, demoralized government 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
  • 36. More Problems <ul><li>Target-based systems or quota-based systems can contribute to data errors </li><ul><li>given a certain target within a given amount of time, data collectors will attempt to meet targets at the expense of quality </li></ul></ul>
  • 37. The 3-Legged Stool of HIS 1. collection 2. consolidation 3. analysis/presentation
  • 38. Target-based Systems Consequence <ul><li>Two stories in GMA7 Saksi sometime in October 2006 </li><ul><li>Story 1: vaccines worth P40M expired in QC warehouse
  • 39. Story 2: ten children die of measles in Caloocan </li></ul></ul>
  • 40. Let's Do the Math <ul><li>44, 000 barangays nationwide
  • 41. assuming 1 midwife per barangay
  • 42. and each midwife adds one extra dose of BCG/month to her data (to meet targets)‏
  • 43. Result: 44,000 extra doses of BCG/month
  • 44. 44,000 X 12 months = 528,000 (half a million of unnecessary extra doses of BCG)‏ </li></ul>
  • 45. Good Apples, Bad Apples <ul><li>Chronic persistent mixing of good data with bad causes demoralization and the good data/attitude deteriorates into bad. </li></ul>
  • 46. Summary of Problems <ul><li>manual, paper-based system allowed for errors
  • 47. target-based systems pressured collectors to manipulate data
  • 48. poor data quality at the collection level resulted in poor data at the higher levels and in erroneous decisions </li></ul>
  • 49. Proposed Solution <ul><li>Multi-part solution </li><ul><li>Systemic problems requires systemic solutions </li><ul><li>staff training
  • 50. information systems re-engineering </li></ul></ul></ul>
  • 51. CHITS Design Philosophy <ul><li>Create computer program side by side with health workers inside the actual environment (c/o Dr. Herman Tolentino)‏
  • 52. Build up the morale of health workers and allow them to participate in the development
  • 53. Integrate the disintegrated vertical programs (provide a common interface)‏ </li></ul>
  • 54. Design Philosophy <ul><li>Design data structures like Lego ® blocks so we can build health information systems that interoperate </li></ul>
  • 55. Benefits of CHITS <ul><li>faster record retrieval
  • 56. less record loss
  • 57. more efficient data entry/storage
  • 58. data analysis/mining
  • 59. helps with completeness
  • 60. can streamline workflow
  • 61. resource management
  • 62. time management (appointment system)‏ </li></ul>
  • 63. Integrating health information through data modeling and business process re-engineering
  • 64. How It Works <ul><li>Suite of components: </li><ul><li>Information technology
  • 65. Capability-building
  • 66. Policy development
  • 67. Data for decision making </li></ul></ul>
  • 68. How It Works <ul><li>Information technology </li><ul><li>Ordinary computers
  • 69. Standard computer networking
  • 70. Open source (free) software </li></ul><li>Total cost: </li><ul><li>15,000 per computer (if brand new)‏
  • 71. Minimum: one PC
  • 72. Ideal: three PCs </li></ul></ul>
  • 73. How It Works <ul><li>Capability building </li><ul><li>Project team: </li><ul><li>Developers: knowledge on the health care flow and vocabulary (the language of health)‏
  • 74. Doctors: data and process modelling (the language of programming)‏ </li></ul><li>Health center staff (BHW, midwives, RN, MD): </li><ul><li>Basic computer skills
  • 75. Introduction to Health Information Systems
  • 76. (Yes! Midwives can use Linux!)‏ </li></ul></ul></ul>
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  • 98. How It Works <ul><li>Policy Development </li><ul><li>Provision of mandate for the 'new way of doing things'
  • 99. Most difficult/delicate part of the project </li></ul></ul>
  • 100. How It Works <ul><li>Data for decision making </li><ul><li>Quick access to patient records
  • 101. Integrated view for frontliners (TB, vaccination, maternal care, etc)
  • 102. Vertical view for program managers </li><ul><li>Especially PhilHealth (important for reimbursement and possible source of funds for sustainability)‏ </li></ul></ul></ul>
  • 103. Fig. 1: Consults Page Registration page
  • 104. SCREENSHOTS Fig. 2: Patient Record Individual Treatment Record
  • 105. SCREENSHOTS Fig. 3: NTP Module National Tuberculosis Program
  • 106. SCREENSHOTS Fig. 4: Maternal Care Module Maternal Care
  • 107. SCREENSHOTS Fig. 5: Child Care Development Module Expanded Program on Immunization
  • 108. SCREENSHOTS Fig. 6: PhilHealth Module PhilHealth
  • 109. SCREENSHOTS Fig. 7: Appointments Page Appointments
  • 110. SCREENSHOTS Fig. 8: Appointment Per Patient Appointments
  • 111. SCREENSHOTS Fig. 9: Daily Service Report Standard Daily Reports
  • 112. SCREENSHOTS Fig. 10: EPI Weekly Monitoring Report Special Program Reports (EPI)‏
  • 113. SCREENSHOTS Fig. 11: EPI Target Client List (TCL)‏ Target Client List
  • 114. Future Directions
  • 115. - Connect cellphones to CHITS using GPRS (Internet over cellphones) - Establish partnerships with SMART/Globe/Nokia/Sony
  • 116. - Establish Bluetooth intranets inside health centers (ASTI)‏ - Allows Bluetooth-enabled phones to be used as input devices (obviates need for desktops)‏
  • 117. - Develop Java midlets for field data collection and home-based monitoring - Partnerships with the various computer science programs of the UP System
  • 118. - Connect CHITS to Geographic information systems (link up with Department of Geography, UPD)‏
  • 119. - 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
  • 120. CHITS Ideal Set-up RHU/ CHITS RHU/ CHITS RHU/ CHITS CHO/PHO LCE DOH
  • 121. Updates <ul><li>Lagrosa and Malibay now on second year
  • 122. Total of 60,000 transactions
  • 123. Marikina now starting with 3 RHUs
  • 124. Quezon province starting with 2 RHUs
  • 125. CHD IV-A will assist in training program
  • 126. For presentation to AMHOP in annual meeting March 2007 </li></ul>
  • 127.  
  • 128. Pasay - 2004 Marikina - 2005 Alabat Island - 2006
  • 129. CHITS is a Finalist in the 2006 Stockholm Challenge!!! The only Filipino entry in the health category www.stockholmchallenge.se
  • 130. 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
  • 131. Contact Info Dr. Alvin B. Marcelo CHITS Project Manager National Telehealth Center PGH, Taft Avenue, Manila Tel: 522-9231 Email: alvin.marcelo@miu.ph http://www.chits.info
  • 132. Salamat po! Pangkaraniwang Araw sa Lagrosa Health Center, Pasay City

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