literally

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Building and Deploying a Community Health
Information Tracking System (CHITS) in
Developing Countries Experiences and Lessons
from the Collaboration Network of IOSN
(International Open Source Network ASEAN 3)
ALEX I. GAVINO, MD Coordinator for Telehealth
Services University of the Philippines Manila -
National Telehealth Center
(literally)
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University of the Philippines Manila -National
Telehealth Center

• Forerunner of eHealth Telemedicine in the
  Philippines
• Base of the International Open Source Network
  (IOSN) ASEAN 3 -- Center of Excellence for Free
  and Open Source Software

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IOSN Centers of Excellence for FOSS
IOSN ASEAN3 University of the Philippines
Manila National Telehealth Center Manila,
Philippines
IOSN South Asia Centre for Development of
Advanced Computing (CDAC)? Chennai, India
IOSN Pacific Island Countries The University of
the South Pacific Consortium Suva, Fiji
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IOSN ASEAN 3
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University of the Philippines Manila -National
Telehealth Center

• ONeHEALTH Program (One Network on eHEALTH)
• eRecords
• eLearning
• Emedicine
• Deliver health information and services to remote
  and hard to reach areas of the country through
  ICT

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eRECORDS ELECTRONIC HEALTH RECORDSCommunity
Health Information Tracking System (CHITS)
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THE NATIONAL HEALTH INFORMATION SYSTEM
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FHSIS

• Field Health Service Information System
• A manual, paper-based system that required
  aggregation of data at several levels of the
  hierarchy
• Data collection done by midwives consolidation
  and analysis by public health nurses and
  municipal health officers

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Problems with FHSIS

• Also contained vertical programs that had their
  own vertical information systems
• Expanded Program on Immunization
• National TB Program
• Family Planning
• Maternal Care
• and others

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Vertical Programs Disintegrating at the Health
Center Level
Philhealth
Maternal Care
Child Care
Family Planning
Leprosy
Overworked, underpaid, demoralized government hea
lth worker
Filariasis
Schisto
Patient
Family
Barangay
What quality of data will we get? Will it be good
enough for decision making?
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CHITS INTEGRATION AT THE LEVEL OF CARE
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CHITS

• Started out as CHild Injury Tracking System
• Obtained small grant from the International
  Development Research Center (IDRC) Canada
• Intended to create a cellphone-based reporting
  system for child injury in Pasay City
• Immersed project team in local health centers
• Health centers as the frontline of the formal
  health system

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CHITS

• Community Health Information Tracking System
• an open-source, web-based Electronic Health
  Record system specifically designed for
  Government Health Centers
• has the ability to quickly and automatically
  generate standard reports for local, provincial,
  regional and national use
• Dr. Herman Tolentino of the Medical Informatics
  Unit, UP College of Medicine was the architect
  and lead developer

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Design Philosophy

• Create computer program side by side with health
  workers inside the actual environment
• Build up the morale of health workers and allow
  them to participate in the development
• Extend the system to the community (BHW)?

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Design Philosophy

• Integrate the disintegrated vertical programs
  (provide a common interface)?
• Close the loop by empowering the community to
  analyze their own data

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Design Philosophy

• Design data structures like Lego blocks so we
  can build health information systems that
  interoperate

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Integrating health information through data
modeling and business process re-engineering
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Current CHITS Installations

• Pasay City (6)
• Marikina City (3)
• Quezon Province (2)
• Capiz (4)
• Cavite (2)
• Batanes (3)
• Zamboanga (2)

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HOW IT WORKS
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Components

• Information Technology Infrastructure
• Capability-Building
• Policy Development
• Data for Decision Making

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IT Infrastructure

• Ordinary computers and readily available hardware
• Standard computer networking
• Open source software

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Capability-Building

• Project team
• Programmers knowledge on the health care flow
  and vocabulary (the language of health)?
• Doctors data and process modelling (the language
  of programming)

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Capability-Building

• Health Center staff (BHW, midwives, RN, MD)
• Basic computer skills
• Introduction to Health Information Systems
• (Yes! Midwives can use Linux!)?

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CHITS Level 1 training in Quezon RHU with Perez
and Alabat
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CHITS Level 1 Training in Mendez, Cavite
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Policy Development

• Provision of mandate for the 'new way of doing
  things'
• Most difficult/delicate part of the project

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Data for Decision Making

• Quick access to patient records
• Integrated view for frontliners (TB,maternal
  care, vaccination, etc)
• Vertical view for program managers

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FOSS, HIS Capability Building

• Easy and free access to software applications
• Community of users and developers who help each
  other in enhancing the HIS

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Lessons Learned

• People are important ? capability-building
• FOSS enables healthworkers to access software
  without cost for licenses
• Constant use of technology allows users to
  integrate it to their system
• Customization to suit the workflow is important
• FOSS platform allows modifications after
  deployment to accommodate the dynamic nature of
  healthcare

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Conclusion

• Open Standards / Open Source Software make
  interoperability possible
• FOSS facilitates training dissemination by
  allowing free distribution of software
• FOSS offers unbridled customizability allowing
  for localization of HIS

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Thank You!
www.chits.ph