Scaling Up CHITS

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

CHITS and Halalan 2010

There is some confusion going around about CHITS (UP Manila’s Community Health Information Tracking System) and FHSIS (DOH’s Field Health Service Information System). Off the bat, CHITS is not FHSIS and FHSIS is not CHITS. These are two different systems but they are related. CHITS collects service level data from RHUs. FHSIS collects data for epidemiology purposes from the LGUs.

The automated election system (AES) is most useful in explaining how CHITS works.

The PCOS machine where you fed your ballot is very similar to CHITS. It collects the data on a per precinct level.

The Consolidation/Canvassing System (or CCS) is similar to FHSIS (Field Health Service Information System) which receives data from the PCOS machines and puts them together to come up with city-wide, province-wide, region-wide results. If you go to ibanangayon.ph, that is what FHSIS would ideally look like. Enhancements can be added but at the minimum, ibanangayon.ph will show you the current statistics by region, province, city, municipality, barangay, and precinct.

The PCOS and the CCS are made up of different software. The PCOS software is designed to be very good at collecting precinct level data. The CCS software is very good at collecting data from these PCOS machines and putting them together to get population level data (but not allowing the CCS to see who made the votes). Though composed of different software, they are able to talk to each other via election markup language (eml).

That is what is missing right now in the Philippine national health information system — the FHSIS-markup language (fml) — the language that connects the CHITS (and other electronic health records) to the FHSIS.

Now that we have a new president, we can look forward to the FHSIS markup language. And soon, we will have timely health data from the field.

First Region-wide CHITS-EMR Conference a Success

The first region-wide CHITS-EMR conference was held at the Azaya, Capas, Tarlac with over sixty participants. CHD3 ARD Dr Arca invited the various provincial and city health offices in the region and the Wireless Access for Health Project (led by Dr Ric Ramos, PHO Tarlac) proudly presented their output. UP Manila (Drs Alex Gavino and Alvin Marcelo) were on hand to provide history and capacity-building opportunities while Smart put up a booth and offered a discounted package for all interested RHUs.

A partial list of CHOs, PHOs, and MHOs represented were: San Fernando, Pamapanga (Dr Eloisa Aquino), Plaridel, Bulacan, Angeles, Pampanga, and Cabanatuan City. (longer list to follow)

The four pilot areas of tarlac represented by their MHOs and PHNs ably demontstrated CHITS to their colleagues and shared the ups and downs of health center automation. All in all, though none said it was smooth sailing, everyone did say that it was gratifying and fulfilling.

Managing the Wireless Access for Health is Ms Jona Cabaguio while lead technical support is Mr. Alison Perez. Tarlac State University, a designated CHITS Provincial Reference Center, was represented by Mr. Angelo de Guzman.