Chits july 27__2010

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Chits july 27__2010

  1. 1. Community Health Information Tracking System 21st Century Health Information System for Local Governance
  2. 2. “ At its essence, every organization is a product of how its members think and interact.” -- Peter Senge
  3. 3. Welcome to San Pablo….. Eto ang community namin……
  4. 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. 5. Overview <ul><li>Introduction to Health Information Systems
  6. 6. Introduction to CHITS
  7. 7. CHITS Free and/or Open Source Software?
  8. 8. Next steps </li></ul>
  9. 9. Health Information Systems <ul><li>What is the problem?
  10. 10. Why does the problem persist?
  11. 11. How can we solve the problem?
  12. 12. How are we solving the problem?
  13. 13. What remains to be solved </li></ul>
  14. 14. CHITS <ul><li>Started out as “CHild Injury Tracking System or CHITS”
  15. 15. A cellphone-based reporting system for child injury in Pasay City
  16. 16. Obtained small grant from IDRC (Canada)‏
  17. 17. Immersed project team in Pasay local health centers </li></ul>
  18. 18. FHSIS <ul><li>Field Health Service Information System
  19. 19. Fourth iteration of the DOH Management Information System (since 1980s)‏
  20. 20. A manual, paper-based system that required aggregation of data at several levels of the hierarchy
  21. 21. Data collection done by midwives; consolidation and analysis by public health nurses and municipal health officers </li></ul>
  22. 22. What are the problems?
  23. 23. Problems <ul><li>Data quality assessment </li><ul><li>Incomplete
  24. 24. Inaccurate (errors in addition, 'guessing')‏
  25. 25. Illegibile
  26. 26. Not useful nor relevant for data collectors
  27. 27. Delayed </li><ul><li>Employed an “all-or-none” reporting scheme </li></ul></ul></ul>
  28. 28. All or None Reporting Scheme B B B B B HC Province Region DOH HC HC HC Province Province Region HC
  29. 29. All or None Reporting Scheme B B B B B HC Province Region DOH HC HC HC Province Province Region HC
  30. 30. Problems <ul><li>Contained vertical programs that had their own vertical information systems </li><ul><li>Expanded Program on Immunization
  31. 31. National TB Program
  32. 32. Family Planning
  33. 33. Maternal Care
  34. 34. and others </li></ul></ul>
  35. 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. 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. 37. The 3-Legged Stool of HIS 1. collection 2. consolidation 3. analysis/presentation
  38. 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. 39. Story 2: ten children die of measles in Caloocan </li></ul></ul>
  40. 40. Let's Do the Math <ul><li>44, 000 barangays nationwide
  41. 41. assuming 1 midwife per barangay
  42. 42. and each midwife adds one extra dose of BCG/month to her data (to meet targets)‏
  43. 43. Result: 44,000 extra doses of BCG/month
  44. 44. 44,000 X 12 months = 528,000 (half a million of unnecessary extra doses of BCG)‏ </li></ul>
  45. 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. 46. Summary of Problems <ul><li>manual, paper-based system allowed for errors
  47. 47. target-based systems pressured collectors to manipulate data
  48. 48. poor data quality at the collection level resulted in poor data at the higher levels and in erroneous decisions </li></ul>
  49. 49. Proposed Solution <ul><li>Multi-part solution </li><ul><li>Systemic problems requires systemic solutions </li><ul><li>staff training
  50. 50. information systems re-engineering </li></ul></ul></ul>
  51. 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. 52. Build up the morale of health workers and allow them to participate in the development
  53. 53. Integrate the disintegrated vertical programs (provide a common interface)‏ </li></ul>
  54. 54. Design Philosophy <ul><li>Design data structures like Lego ® blocks so we can build health information systems that interoperate </li></ul>
  55. 55. Benefits of CHITS <ul><li>faster record retrieval
  56. 56. less record loss
  57. 57. more efficient data entry/storage
  58. 58. data analysis/mining
  59. 59. helps with completeness
  60. 60. can streamline workflow
  61. 61. resource management
  62. 62. time management (appointment system)‏ </li></ul>
  63. 63. Integrating health information through data modeling and business process re-engineering
  64. 64. How It Works <ul><li>Suite of components: </li><ul><li>Information technology
  65. 65. Capability-building
  66. 66. Policy development
  67. 67. Data for decision making </li></ul></ul>
  68. 68. How It Works <ul><li>Information technology </li><ul><li>Ordinary computers
  69. 69. Standard computer networking
  70. 70. Open source (free) software </li></ul><li>Total cost: </li><ul><li>15,000 per computer (if brand new)‏
  71. 71. Minimum: one PC
  72. 72. Ideal: three PCs </li></ul></ul>
  73. 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. 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. 75. Introduction to Health Information Systems
  76. 76. (Yes! Midwives can use Linux!)‏ </li></ul></ul></ul>
  77. 98. How It Works <ul><li>Policy Development </li><ul><li>Provision of mandate for the 'new way of doing things'
  78. 99. Most difficult/delicate part of the project </li></ul></ul>
  79. 100. How It Works <ul><li>Data for decision making </li><ul><li>Quick access to patient records
  80. 101. Integrated view for frontliners (TB, vaccination, maternal care, etc)
  81. 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>
  82. 103. Fig. 1: Consults Page Registration page
  83. 104. SCREENSHOTS Fig. 2: Patient Record Individual Treatment Record
  84. 105. SCREENSHOTS Fig. 3: NTP Module National Tuberculosis Program
  85. 106. SCREENSHOTS Fig. 4: Maternal Care Module Maternal Care
  86. 107. SCREENSHOTS Fig. 5: Child Care Development Module Expanded Program on Immunization
  87. 108. SCREENSHOTS Fig. 6: PhilHealth Module PhilHealth
  88. 109. SCREENSHOTS Fig. 7: Appointments Page Appointments
  89. 110. SCREENSHOTS Fig. 8: Appointment Per Patient Appointments
  90. 111. SCREENSHOTS Fig. 9: Daily Service Report Standard Daily Reports
  91. 112. SCREENSHOTS Fig. 10: EPI Weekly Monitoring Report Special Program Reports (EPI)‏
  92. 113. SCREENSHOTS Fig. 11: EPI Target Client List (TCL)‏ Target Client List
  93. 114. Future Directions
  94. 115. - Connect cellphones to CHITS using GPRS (Internet over cellphones) - Establish partnerships with SMART/Globe/Nokia/Sony
  95. 116. - Establish Bluetooth intranets inside health centers (ASTI)‏ - Allows Bluetooth-enabled phones to be used as input devices (obviates need for desktops)‏
  96. 117. - Develop Java midlets for field data collection and home-based monitoring - Partnerships with the various computer science programs of the UP System
  97. 118. - Connect CHITS to Geographic information systems (link up with Department of Geography, UPD)‏
  98. 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
  99. 120. CHITS Ideal Set-up RHU/ CHITS RHU/ CHITS RHU/ CHITS CHO/PHO LCE DOH
  100. 121. Updates <ul><li>Lagrosa and Malibay now on second year
  101. 122. Total of 60,000 transactions
  102. 123. Marikina now starting with 3 RHUs
  103. 124. Quezon province starting with 2 RHUs
  104. 125. CHD IV-A will assist in training program
  105. 126. For presentation to AMHOP in annual meeting March 2007 </li></ul>
  106. 128. Pasay - 2004 Marikina - 2005 Alabat Island - 2006
  107. 129. CHITS is a Finalist in the 2006 Stockholm Challenge!!! The only Filipino entry in the health category www.stockholmchallenge.se
  108. 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
  109. 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
  110. 132. Salamat po! Pangkaraniwang Araw sa Lagrosa Health Center, Pasay City

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