CHITS

The nice thing about free and open source software is its inclusiveness. We received an email from one of our OJTs who was assigned to understand how CHITS works in Pasay City. There are several interesting things in his report. First, the healthcare domain is a specialist one. Even after being deployed to the CHITS sites for two weeks, it is difficult for non-health personnel (eg, developers) to grasp the whole health careflow. Second, using frameworks (CHITS uses GAME) makes it easy for developers to join the careflow using something that they can comprehend — source code. This is only possible because CHITS is open source. Third, collaboration between health and IT is crucial to the success of any eHealth application. There should be enough attention placed on teamwork and communications to increase chances of success.

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Sir Noel and I attended the CHITS training sessions being conducted by the instructors, Sir Rosendo Pantino and Ma’am Josie Tresvalles. On the fhe first day, upon arrival, we observed the terminals where the software was installed and found out that only 1 terminal, the server, was being used due to a network problem. This allowed me to do some network troubleshooting which was finally identified as a faulty wifi-adapter.

The demo-training topic for that day were: the basic steps of patient registration, family folders, Philhealth modules. Most of these were already familiar since I read the CUTE Manual already (CHITS User Training Experience). This is my 2^nd time to see CHITS in action, this time with detailed explanation per modules. I am finally being able to grasp the importance of having a need for computerized systems in health centers, and the convenience that CHITS can provide the health sector. As we went through step by step with the modules, I’ve noticed both major and minor design and logical issues which I took note of, including some of the wish-lists of the participants/end users. Some of them were asking me to debug on the spot which I tried to do so, even if it was my first time to touch the code. In the end,  I decided to ask for Sir Randy’s help. The CHITS/GAME framework was well written and very easy to understand, but I will need some time before I can finally get around the code. After the discussions, the instructors asked the participants to input data based on the process/steps that have been discussed. This allowed them to put to practice what they have learned immediately.

The next day all the terminals were already repaired by their tech nurse and was now fully functional. The day’s topic was all about the maternal care modules. Again for this day I took notes of the problems we encountered in the system. Sir Randy taught me how to connect to a remote computer through SSH so I can edit files through my terminal. He(Randy) mentioned to me about some ethical issues in which I have little idea about and I might need to ask you doc sometime.

The third day, we again went on with the discussion, this time the Family Planning, Hypertensive and TB Therapy Modules. For the day, I learned different ways of how to install CHITS through Sir Rotchie Paneda(Pasay Nurse) and Sir Randy. I have also succesfully installed it on my laptop.

To sum up my report, I would say everyone was doing their jobs well, the instructors and the healthcare workers. I enjoyed the three days of training. Aside from the good food(pasay nurses cook very well ) , seeing the enthusiasm of the health workers to learn something new is priceless. I am also learning a lot of new things, and the joy of meeting new people feels good. I’ve had a desire to contribute in the development of CHITS, specifically in the remodeling of the systems overall look base on the different feedbacks I have gathered.

Earl Justin Garcia

(posted with permission)

What is the use of collecting data with computers if these will not have an impact on individual, community or population health? Thankfully, information from CHITS can be used for decision making. Before CHITS, we could only say motherhood statements about information for decision making. Now we can actually demonstrate it. Here are examples of how data can be used to improve health.

1) Tracking individual data over time. This is an important feature at the RHU level because it provides them with a longitudinal perspective of the care received by a patient in their facility. It also helps them relate this with the other members of the family, and to the barangay. This is most helpful especially in cases of outbreaks.

2) Impact to community health is best manifested if there are outbreaks. If a patient comes in with suspected cholera, a quick scan of CHITS will show if there have been previous consultations or which barangay health workers (BHWs) to warn.

3) For population health, CHITS can aggregate data to any format that will be required by DOH and PhilHealth and send it off securely for epidemiology analysis. This is important for national level decision making.

Over the years, some of the lessons we’ve learned with CHITS:
1) Scaling up will be a challenge. And this will not be because of the technology but rather the lack of capacity to absorb it. Rural health units rarely have access to technical staff that can help them with hardware, software, and networking requirements. Solution: tap the local state universities to provide the needed tech support.

2) Contrary to conventional thinking, a typical midwife can use a computer as long as it is related to her work. In the past, some of them have received training on word processing, slide presentation, and spreadsheets (WPSS). All of these are fine but I still have to see a midwife in an RHU actually do these on a daily basis as part of their job description. We must teach midwives how to use electronic health records because that is what they do well: document patient care.

The reason many techies teach RHUs WPSS is because these techies don’t know how to use EHRs! Solution: we should also start teaching these techies how to use EHRs so they can train more midwives.

3) Make the data flow. Once CHITS is installed, health center staff experience a myriad of emotions. They are happy because they learned a new skill. But they also feel sad because their numbers are much lower than before. The most important thing to do is to stick to the truth, and continue making the data flow. Use CHITS daily and commit to quality data collection.

Solution: monitor data accrual daily with CHITS to monitor the health of the system and the health of the community.

4) Make the data live. Once data of good quality accumulate inside your CHITS system, then these must be used for decision making (see blog titled: Information for Decision Making). The data should impact the care of individuals and/or the population. If the data cannot do that, there is no use collecting it.

Solution: weekly data review among the RHU staff.

5) Review, enhance, upgrade. There is no perfect software system, only good software review protocols. We must continuously review the performance of the data to see if they have an effect on the effectiveness and efficiency of the local health system. If not, the review should indicate the necessary enhancements to be made and these should cascade to all CHITS installations.

Solution: provide CHITS locally in a server but with synchronization capacity for upgrades from a master server