Community Health Information Tracking System

eRecords

eLearning

Telemedicine

Transcending the delivery of healthcarefor Filipinos through Electronic Health Records in Rural Health Units
Capability-building, Deployment and Implementation of the Community Health Information Tracking System (CHITS)
The Need to Deliver Quality Data
At the helm of policy analysis and planning in the public health system hierarchy in the Philippines is the data for the Field Health Service Information System (FHSIS) which originates during a patients encounter at barangay health stations (BHS), city and rural health units (RHU). With the volumes of data being collected in a typical RHU, it has always been a challenge to consolidate data into a cohesive and relevant whole. Reporting health data is still paper based, which is prone to error, destruction, and alteration. Consolidation of data on paper records is also time consuming causing severe delays which make the information stale and irrelevant.

The Plan of Action for CHITS deployment

1. Memorandum of Agreement between UPM-NThC and LGU. 2. Identify local technical support (c/o State Colleges and Universities in the Region to be Accredited CHITS Reference Centers) 3. Establishment of Infrastructure a. Secure hardware and network equipment b. Setup hardware and network c. Install and configure software 4. Computer Literacy Capability-building for Health Workers (c/o LGU or local technical support). 5. CHITS Capability-building for Health Workers

CHITS: The Open Source for Health Development Initiative

In line with its mandate to increase access to health information and services through information and communications technology, the University of the Philippines Manila - National Telehealth Center (UPM-NThC) has developed the Community Health Information Tracking System or CHITS, a low cost computerization initiative for local health centers. CHITS was envisioned to automate the core processes in the health center and contribute to effective and efficient delivery of services. CHITS is made up of several components which work together to form a cohesive whole. At the core of CHITS is its capacity-building program component that gradually introduces important concepts of information systems to health Today, CHITS is installed in 36 health center staff. CHITS employs a free facilities* around the country including and/or open source software which Pasay City, Marikina City, Quezon makes it extremely flexible and Province, Cavite, Laguna, Bataan, compliant to the needs of the local Batanes, Zamboanga, Quezon City, and Tarlac. health center and other partners in -- *as of July 2010 the future such as the DOH. Once CHITS is installed in an RHU, it now serves as a platform for further enhancements such as e-learning for health and telemedicine.
Lagrosa Health Center, Pasay City Dr. Herman D. Tolentino and Pasay City health center workers (doctors, nurses, midwives, and barangay health workers) collaborated on the design of CHITS and was pilot-tested in May 10, 2004.

Benefits of CHITS
Rural Health Units or Health Centers - Faster patient record retrieval - Patient spent waiting for services are minimized - Streamline workflow of health center transactions - More efficient data entry and storage - Appointment and follow-up scheduling system - Monitor the health of the community through data accrual daily - Projection of patient loads - Secure access to health care workers (including audit trail) Municipal and City Health Offices (MHO, CHO) - Easier and timely generation of health report that the Field Health Service Information System (FHSIS) requires - Potential for inter-health center integration, thus makes tracking of patient more convenient - Detect possible outbreaks - Review of the health of the community can be done on a regular basis - Projection of logistical needs to allocate supplies and manpower Department of Health (DOH) - Integrates health programs - Aggregate data to any format required by DOH and PhilHealth - Facilitates epidemiology data analysis - Activities of the RHUs are monitored if compliant with Sentrong Sigla standards - Improves quality of FHSIS reporting - Timeliness of submission of reports Government to Citizen - Makes information available to stakeholders in the community for better decision making - Leads to more efficient use of community resources - Visible services to the community - CHITS is a proactive public health tool. It can alert and inform health professionals on possible program defaulters thus increasing the level of health service delivery.

General Objective
It aims to extend the technology resources and services of the UPM-NThC to the level of the local government units. Using health information systems, CHITS hopes to increase the efficiency of the local health center in caring for its constituents and to aid in health decision making at the local level.

Specific Objectives
1. To computerize / automate the generation of health center reports; 2. To minimize loss and destruction of patient records by the use of electronic patient records; 3. To improve access to health center data.

Community Health Information Tracking System

eRecords

eLearning

Telemedicine

How CHITS Work

The deployment and implementation of the Community Health Information Tracking System is composed of four (4) major components namely: Information Technology Infrastructure, Capability-building, Policy Development, and Data for Decision-making.

I. Information Technology Infrastructure

A. Hardware and Networking Composed of workstations connected over a network that will allow end-users to enter their health center data to CHITS. One workstation will be assigned to each of the three stations (admissions, consultation and treatment) inside the health center. All workstations are connected via the router thus forming a local area network or intranet. In order to access CHITS, all computers must be connected over the Internet. CHITS is hosted in an external industry-grade and secure application server. Health centers will be provided with login accounts and appropriate access level such that only those that have been authorized can access the system. a. Local Workstations 3 units (admissions, consultation, and treatment) b. Hardware Peripherals printer, UPS c. Local Area Network Hardware router, LAN cables or wireless LAN cards d. Internet Connection to be catered by a local Internet Service Provider e. Workstation Support to be provided by the hardware distributor
The linking of the CHITS and the E-FHISIS will be helping the FHSIS coordinator a lot as it would save her time from encoding municipality and RHU data into the system. It would also be easier for the FHSIS coordinator to provide the PHO with summary data usually requested from their office for submission to decision makers of the province. -Pinky Cacdac FHSIS Coordinator Tarlac Provincial Health Office

II. Capability- Building

A. Orientation to CHITS the session is provided for public health practitioners in order to orient them about basic concepts on health information management and CHITS as a public health electronic health record. B. Capability-Building for End-Users intended for health centers who are about to implement CHITS. This module includes basic electronic health record features of CHITS and specialized modules based on Field Health Service Information System (FHSIS). C. Capability Building for CHITS Administrators intended for the physician or public health nurses who will be acting as the local CHITS administrator in the health center. Topics that are included are providing access level to various users, understanding basic system maintenance task, report generation and techniques in maintaining good and quality data. This is given free of charge.

B. Software Services The support services intended to run and configure the application in the initial phase and provide application level support during implementation phase. The application level support has an annual subscription charge and can be renewed upon the agreement of the stakeholders.

Development of additional and more specialized modules is done on a separate occasion upon the request of the CHITS end-users. Work schedule for implementation and cost will be determined based on the number programming man-hours needed and level of the requirements complexity. a. Data Center houses the health center data. Provides security and better management of system maintenance tasks such as back up of data and optimization of server resources. This service includes purchase of two server racks, system administration support, co-location management, data center power supply and internet connection. b. Server Configuration setting up and configuring the CHITS application and its corresponding databases on the data center. c. Annual Subscription for Application Level Support support includes phone, SMS, electronic trouble ticket and on-site troubleshooting. d. Subscription to New Module Releases e. Development of End-User Customized Module

III. Policy Development

Refers to the provision or mandate for the 'new way of doing things' in a particular health facility in a locality. Considered as the most crucial and delicate part of CHITS deployment, a supportive local government unit who is willing to express commitment of support through ordinance or resolution; a pro-active MHO who is ready to lead; and RHU personnel who are aware of the significance of delivering quality health data and willingness to be trained spells a difference in the success or failure of the deployment of CHITS in an area.

IV. Data for Decision-Making

Essential data from health programs are integrated in CHITS and viewed by the frontliners (Physician-incharge, MHO, CHO, PHO), and program managers of the DOH. With the inclusion of the PhilHealth module, PhilHealth will benefit from it as data will be used for reimbursement and possible source of funds for sustainability.

Community Health Information Tracking System

eRecords

eLearning

Telemedicine

We have 120-200 patients seen every day, and thus if record keeping is not good, how can we give efficient service and accommodate all the patients?

With CHITS, waiting time in the RHU was lessened; RHU staff are not stressed out anymore.
- Mayor Miguel Rivilla Paniqui, Tarlac

CHITS: Looking Ahead

- CHITS deployment and training to various rural health units nationwide are underway. - The Department of Health and the Commission on Information and Communications Technology (CICT) are looking into the possibility of deploying CHITS in health facilities across the country. - The UPM-NThCs homegrown electronic health record that is CHITS continues to lead in making public-private partnerships possible with the Wireless Access for Health (WAH) initiative in Tarlac province which was supported by various stakeholders through a multisectoral partnership. - The UPM-NThC proposes the use of an electronic health record featuring CHITS as an application used by student nurses in their Nursing Informatics course. - To build a national network of users that would benefit with the developments on CHITS.

Solution Snapshot
CHITS is an extensible, modular system that leverages existing routine health information systems (vertical programs of the Department of Health) in publichealth care to serve as a starting point for implementing comprehensive information system integration.

Know more about CHITS:

Demo Website
For an online demonstration of CHITS, open your Internet browser and visit: http://demo2010.chits.ph login name: user password: user For online information on CHITS, visit the official website at http://www.chits.ph

eRecords

eLearning

Telemedicine

Contact us
For inquiries on deployment, and capability-building, contact: UPM - NATIONAL TELEHEALTH CENTER University of the Philippines Manila The Health Sciences Center Information Technology Complex 3rd floor, Philippine General Hospital Taft Avenue, Manila PHILIPPINES 1000 Telefax: Email: Website: (+63) 2 525-6501 admin@info.telehealth.ph www.telehealth.ph

About NTHC
The National Telehealth Center (NThC) of the University of the Philippines Manila was established in June 1998 through a University of the Philippines Board of Regents resolution with the mandate to increase access of Filipinos to health information and services through the appropriate use of technology. UP Manila aims to improve the health of Filipinos through the optimal use of information and communications technology.

Content by: Herman D. Tolentino, M.D. Alvin B. Marcelo M.D. Alex I. Gavino, M.D. Noel A. Baez, R.N.
CHITS Primer published on August 2010

Budgetary Requirements for CHITS deployment for Rural Health Units are available upon request.