1. “At its essence, every organization
is a product of how its members
think and interact.”
-- Peter Senge

2. Community Health Information
Tracking System:
Towards an eRHU
Alvin B. Marcelo
National Telehealth Center
University of the Philippines Manila

3. Outline
National Telehealth Center

20th century RHU

CHITS: Integrated Health Services at the

Point-of-Care
BuddyWorks Project

− e-learning
− telemedicine
The eRHU


4. Welcome to San Pablo…..Eto ang
community namin……

5. National Telehealth Center
Vision
created by the UP Board of Regents in 1998

mandated to study how ICT can be used to

improve the health of Filipinos

6. 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

7. 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

8. 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


9. All or None Reporting Scheme
HC
B
Province
HC
B Region
B HC Province DOH
B Region
HC
Province
B
HC

10. All or None Reporting Scheme
HC
B
Province
HC
B Region
B HC Province DOH
B Region
HC
Province
B
HC

11. 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

12. Vertical Programs
Disintegrating at Philhealth
the Health Center Maternal Care
Level
Child Care
Family
Planning
Leprosy
Overworked,
underpaid, Filariasis
demoralized
government Schisto
health worker
Patient
Family
Barangay
What quality of data will we get? Will it be good enough for decision making?

13. Proposed Solution
Technology

Training

Teamwork


14. 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

15. Design Philosophy
Design data structures like Lego® blocks so

we can build health information systems that
interoperate

18. Integrating health
information
through data CORE MODULES
PhilHealth
modeling and
Maternal Care
business process
Immunization
re-engineering
Child Care Maternal and
Child Health
DOTS
CHITS
Immunization
CONSULTS TODAY
DEMOGRAPHICS
Notifiable
Patient
Diseases
Family
Barangay
REPORTS
Immunization
Notifiable Diseases
USER MODULES VERTICAL
INTERFACE PROGRAMS

19. How It Works
Suite of components:

− Technology
− Training
− Teamwork [LCE, SB, MHO, PHN, RHM,
community]

20. How It Works
Technology

− 3 computers
− Standard computer networking (with WiFi)
− Open source (free) software
Total cost:

− 50,000

21. How It Works
Technology

− Broadband Internet
Total cost:

− 15,000 per year
Benefits

− online backup
− online troubleshooting
− province-wide data integration
− automated data submission

29. 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


41. 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

42. 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)

43. Future Directions

44. - Connect cellphones to CHITS using
GPRS (Internet over cellphones)
- Establish partnerships with
SMART/Globe/Nokia/Sony

45. - Establish Bluetooth intranets inside
health centers (ASTI)
- Allows Bluetooth-enabled phones
to be used as input devices (obviates
need for desktops)

46. - Develop Java midlets for field data
collection and home-based
monitoring
- Partnerships with the various
computer science programs of the UP
System

47. - Connect CHITS to Geographic
information systems (link up with
Department of Geography, UPD)
LAGROSA
HEALTH CENTER
MALIBAY
HEALTH CENTER
MANILA INTERNATIONAL
AIRPORT
1 km
N
MAP OF PASAY CITY

48. - 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+)

49. Coming Soon: BuddyWorks!
E-Learning

− RHU/BHW staff training over broadband Internet
with Voice-over-IP
Telemedicine

− Trauma
− Poisoning
− Referral coordination and networking

50. Quality health care for Filipinos,
especially for those who cannot afford it.

51. Salamat po! info@telehealth.ph
Pangkaraniwang Araw sa Lagrosa
Health Center, Pasay City