The document introduces the Community Health Information Tracking System (CHITS), an open-source health information system developed to address problems with the Philippines' existing paper-based system. CHITS aims to improve data quality, integrate vertical health programs, and provide faster access to patient records. It was developed through collaboration between health workers and developers to build morale and allow for participation. The system utilizes basic computer hardware and free software to create an affordable solution. It has been piloted in multiple localities and shows benefits like more efficient data management and analysis to help decision making. Future directions may include connecting the system to cellphones and developing additional analytic tools.

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 Introduction to Health Information Systems

6. Introduction to CHITS

7. CHITS Free and/or Open Source Software?

8. Next steps

9. Health Information Systems 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

14. CHITS 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

18. FHSIS 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

22. What are the problems?

23. Problems Data quality assessment Incomplete

24. Inaccurate (errors in addition, 'guessing')‏

25. Illegibile

26. Not useful nor relevant for data collectors

27. Delayed Employed an “all-or-none” reporting scheme

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 Contained vertical programs that had their own vertical information systems Expanded Program on Immunization

31. National TB Program

32. Family Planning

33. Maternal Care

34. and others

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

37. The 3-Legged Stool of HIS 1. collection 2. consolidation 3. analysis/presentation

38. Target-based Systems Consequence Two stories in GMA7 Saksi sometime in October 2006 Story 1: vaccines worth P40M expired in QC warehouse

39. Story 2: ten children die of measles in Caloocan

40. Let's Do the Math 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)‏

45. Good Apples, Bad Apples Chronic persistent mixing of good data with bad causes demoralization and the good data/attitude deteriorates into bad.

46. Summary of Problems 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

49. Proposed Solution Multi-part solution Systemic problems requires systemic solutions staff training

50. information systems re-engineering

51. CHITS Design Philosophy 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)‏

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

55. Benefits of CHITS 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)‏

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

64. How It Works Suite of components: Information technology

65. Capability-building

66. Policy development

67. Data for decision making

68. How It Works Information technology Ordinary computers

69. Standard computer networking

70. Open source (free) software Total cost: 15,000 per computer (if brand new)‏

71. Minimum: one PC

72. Ideal: three PCs

73. How It Works Capability building Project team: Developers: knowledge on the health care flow and vocabulary (the language of health)‏

74. Doctors: data and process modelling (the language of programming)‏ Health center staff (BHW, midwives, RN, MD): Basic computer skills

75. Introduction to Health Information Systems

76. (Yes! Midwives can use Linux!)‏