Design and Implementation of a Multi-Platform Electronic Medical Record System in Geographically Isolated and Disadvantaged Areas (GIDAs) Arturo M. Ongkeko Jr.,RN1 and Portia Fernandez – Marcelo, MD, MPH2 1
University Research Associate, University of the Philippines Manila National Telehealth Center Mailing address: 3/F IT Complex UPMASA Science Hall, PGH Compound Ermita, Manila 1000, Philippines Contact information: +632 509 1003 Email:
[email protected]
2
Associate Professor and Director, University of the Philippines Manila National Telehealth Center Mailing address: 3/F IT Complex UPMASA Science Hall, PGH Compound Ermita, Manila 1000, Philippines Contact information: +632 509 1003 Email:
[email protected]
ABSTRACT Quality health information provides the context necessary for local health leaders to establish equitable and responsive programmes. This is especially important in geographically isolated and disadvantaged areas (GIDAs) in the Philippines where health inequities are most stark. Yet, the Philippine health information system (HIS) is largely manual and paper-based: known to be prone to error, and health workers who generate the data do not use these routinely to inform programme-level decision-making. The University of the Philippines Manila National Telehealth Centre (UPM NTHC), in partnership with United Nations Children’s Fund (UNICEF) implemented rCHITS or ‘Real-Time Monitoring of Maternal, Child Health and Governance Indicators through the Community Health Information Tracking System’. The intervention is aimed at better HIS management and developing ICT-enabled health workers at the front lines, springing from the ethical use of eHealth tools: an electronic medical record (EMR), an android-based mobile health application and a local government unit (LGU) dashboard. The Community Health Information Tracking System (CHITS) is the EMR installed in a Rural Health Unit (RHU) primarily used by Rural Physicians and Public Health Nurses. It captures patient-level clinical data and generates aggregated reports required by the Ministry of Health and by the national health insurance programme. CHITS matured through its 10 years of implementation; the current and second version – a four-year technology, uses the OpenMRS as its back-end, and is implemented in over 200 government RHUs. The mReports, an android-based application, documents clinical data through a smartphone by the rural health midwives based in remote village health stations and transmits these to a central database via Short Messaging Service (SMS) and synchronizes with CHITS. The LGU Dashboard, a web application that visualizes aggregated clinical services rendered by the RHU, is hosted on a central server, accessible anywhere with Internet access and proper authentication. rCHITS is implemented in 13 selected GIDA with high rates of maternal mortality and poverty incidence. A total of 365 health workers were trained to use rCHITS. It unfolded in a multi-year phased implementation from pilot to institutionalisation. The first phase involved three towns to unpack technology, organizational, policy and human resource concerns. Next
was a small-scale implementation in 10 other GIDA communities where the rCHITS tools were enhanced. In this phase, rCHITS successfully demonstrated that systems on two separate platforms can be synchronised through a standards-based messaging exchange format (HL7). An aggregate 126,953 reports were submitted by the users from all sites using rCHITS. In addition, end-users noted efficiencies in data storage, records retrieval and reports generation. One of the lessons from previous experience is the need to support further the development of an information-based culture among local health leaders to sustain and institutionalise supportive organisational mechanisms. This is the subject of rCHITS' third phase of implementation. The NTHC's rCHITS experience contributed to recent significant gains in health information management in the country through its membership in the Philippine National eHealth Steering Committee (NeHSC) Technical Working Group (TWG). The TWG crafted the Philippine eHealth Strategy to support major goals of the government's campaign for universal health care (UHC). Policies on standards and privacy were developed, harnessing existing electronic health information systems geared towards measuring UHC. National level efforts towards better IT governance were supported by the WHO and the Asia eHealth Information Network; the latter is a community of eHealth practitioners engaged in south-to-south peer learning on how eHealth and HIS investments can most deliver impact. The NTHC is a founding organizer of the AeHIN, and is its current Secretariat.
Competency domain/s addressed by the paper: Health Information and Records Management, eHealth Conference Stream and Session Topic: Health Information Management, eHealth – EMRs, Service management – reporting, planning, analytics and data quality
