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