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UPM-NThC Community Health Information Tracking System (CHITS) Primer

UPM-NThC Community Health Information Tracking System (CHITS) Primer

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CHITS or Community Health Information Tracking System is the first ever electronic medical record system for Philippine health centers operating in open source-software.
CHITS or Community Health Information Tracking System is the first ever electronic medical record system for Philippine health centers operating in open source-software.

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Published by: PhilippineNursingDirectory.com on Sep 09, 2011
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Community Health Information Tracking System
eRecords eLearning Telemedicine
Transcending the delivery ofhealthcarefor Filipinos throughElectronic Health Recordsin Rural Health Units
Capability-building, Deployment andImplementation of the Community HealthInformation Tracking System (CHITS)
The Plan of Action for CHITS deployment
1. Memorandum of Agreement between UPM-NThC and LGU.2. Identify local technical support (c/o State Collegesand Universities in the Region to be AccreditedCHITS Reference Centers)3. Establishment of Infrastructurea. Secure hardware and network equipmentb. Setup hardware and network c. Install and configure software4. Computer Literacy Capability-buildingfor Health Workers (c/o LGU or local technical support).5. CHITS Capability-building for Health Workers
Benefits of CHITS
Rural Health Units or Health Centers
- Faster patient record retrieval- Patient spent waiting for services are minimized- Streamline workflow of health center transactions- More efficient data entry and storage- Appointment and follow-up scheduling system- Monitor the health of the community throughdata accrual daily- Projection of patient loads- Secure access to health care workers (including audit trail)
Municipal and City Health Offices (MHO, CHO)
- Easier and timely generation of health report thatthe Field Health Service Information System (FHSIS) requires- Potential for inter-health center integration, thusmakes tracking of patient more convenient- Detect possible outbreaks- Review of the health of the community can bedone on a regular basis- Projection of logistical needs to allocatesupplies and manpower
Department of Health (DOH)
- Integrates health programs- Aggregate data to any format required by DOH andPhilHealth- Facilitates epidemiology data analysis- Activities of the RHUs are monitored if compliant withSentrong Sigla standards- Improves quality of FHSIS reporting- Timeliness of submission of reports
Government to Citizen
- Makes information available to stakeholders inthe community for better decision making- Leads to more efficient use of community resources- Visible services to the community- CHITS is a proactive public health tool. It can alert andinform health professionals on possible program defaultersthus increasing the level of health service delivery.
The Need to Deliver Quality Data
At the helm of policy analysis and planning in the public health systemhierarchy in the Philippines is the data for the Field Health ServiceInformation System (FHSIS) which originates during a patient’sencounter at barangay health stations (BHS), city and rural health units(RHU). With the volumes of data being collected in a typical RHU, it hasalways been a challenge to consolidate data into a cohesive andrelevant whole. Reporting health data is still paper based, which is proneto error, destruction, and alteration. Consolidation of data on paperrecords is also time consuming causing severe delays which make theinformation stale and irrelevant.
CHITS: The Open Source for Health Development Initiative
In line with its mandate to increase access to health information andservices through information and communications technology, theUniversity of the Philippines Manila - National Telehealth Center(UPM-NThC) has developed the Community Health Information Tracking System or CHITS, a low cost computerization initiative for localhealth centers. CHITS was envisioned to automate the core processes inthe health center and contribute to effective and efficient delivery of services.CHITS is made up of severalcomponents which work togetherto form a cohesive whole. At thecore of CHITS is its capacity-buildingprogram component that graduallyintroduces important concepts of information systems to healthcenter staff. CHITS employs a freeand/or open source software whichmakes it extremely flexible andcompliant to the needs of the localhealth center and other partners inthe future such as the DOH. OnceCHITS is installed in an RHU, it nowserves as a platform for further enhancements such as e-learning forhealth and telemedicine.
General Objective
It aims to extend the technology resources and services of theUPM-NThC to the level of the local government units. Using healthinformation systems, CHITS hopes to increase the efficiency of the localhealth center in caring for its constituents and to aid in health decisionmaking at the local level.
Specific Objectives
1. To computerize / automate the generationof health center reports;2. To minimize loss and destruction of patient recordsby the use of electronic patient records;3. To improve access to health center data.
Lagrosa Health Center, Pasay City 
Dr. Herman D. Tolentino and Pasay Cityhealth center workers (doctors, nurses,midwives, and barangay health workers)collaborated on the design of CHITS andwas pilot-tested in May 10, 2004.Today, CHITS is installed in 36 healthfacilities* around the country includingPasay City, Marikina City, QuezonProvince, Cavite, Laguna, Bataan,Batanes, Zamboanga, Quezon City,and Tarlac.
-- 
*as of July 2010 
 
Community Health Information Tracking System
eRecords eLearning Telemedicine
How CHITS Work
 The deployment and implementation of the Community HealthInformation Tracking System is composed of four (4) majorcomponents namely: Information Technology Infrastructure,Capability-building, Policy Development, and Data forDecision-making.
I. Information Technology Infrastructure
A. Hardware and Networking
Composed of workstations connected over a network that willallow end-users to enter their health center data to CHITS. Oneworkstation will be assigned to each of the three stations(admissions, consultation and treatment) inside the healthcenter.All workstations are connected via the router thus forming alocal area network or intranet. In order to access CHITS, allcomputers must be connected over the Internet. CHITS is hostedin an external industry-grade and secure application server.Health centers will be provided with login accounts andappropriate access level such that only those that have beenauthorized can access the system.a. Local Workstations – 3 units (admissions, consultation,and treatment)b. Hardware Peripherals – printer, UPSc. Local Area Network Hardware – router, LAN cables orwireless LAN cardsd. Internet Connection – to be catered by a localInternet Service Providere. Workstation Support – to be provided by thehardware distributor
B. Software Services
 The support services intended to runand configure the application in theinitial phase and provide applicationlevel support duringimplementation phase. Theapplication level support has anannual subscription charge and canbe renewed upon the agreement of the stakeholders.Development of additional andmore specialized modules is doneon a separate occasion upon therequest of the CHITS end-users. Work schedule for implementation andcost will be determined based on the number programmingman-hours needed and level of the requirement’s complexity.
a. Data Center 
– houses the health center data. Providessecurity and better management of system maintenancetasks such as back up of data and optimization of serverresources. This service includes purchase of two server racks,system administration support, co-location management,data center power supply and internet connection.
b. Server Configuration
– setting up and configuring theCHITS application and its corresponding databases on thedata center.
c. Annual Subscription for Application Level Support 
support includes phone, SMS, electronic trouble ticket andon-site troubleshooting.
d. Subscription to New Module Releasese. Development of End-User Customized Module
II. Capability- Building
A. Orientation to CHITS
– the session is provided for publichealth practitioners in order to orient them about basicconcepts on health information management and CHITS as apublic health electronic health record.
B. Capability-Building for End-Users
– intended for healthcenters who are about to implement CHITS. This moduleincludes basic electronic health record features of CHITS andspecialized modules based on Field Health ServiceInformation System (FHSIS).
C. Capability Building for CHITS Administrators
– intendedfor the physician or public health nurses who will be acting asthe local CHITS administrator in the health center. Topics thatare included are providing access level to various users,understanding basic system maintenance task, reportgeneration and techniques in maintaining good and qualitydata. This is given free of charge.
III. Policy Development
Refers to the provision or mandate for the 'new way of doingthings' in a particular health facility in a locality. Considered asthe most crucial and delicate part of CHITS deployment, asupportive local government unit who is willing to expresscommitment of support through ordinance or resolution; apro-active MHO who is ready to lead; and RHU personnel whoare aware of the significance of delivering quality health dataand willingness to be trained spells a difference in the success orfailure of the deployment of CHITS in an area.
IV. Data for Decision-Making
Essential data from health programs are integrated in CHITS andviewed by the frontliners (Physician-incharge, MHO, CHO, PHO),and program managers of the DOH. With the inclusion of thePhilHealth module, PhilHealth will benefit from it as data will beused for reimbursement and possible source of funds forsustainability.
“The linking of the CHITS and theE-FHISIS will be helping theFHSIS coordinator a lot as itwould save her time fromencoding municipality and RHUdata into the system. It wouldalso be easier for the FHSIScoordinator to provide the PHOwith summary data usuallyrequested from their office forsubmission to decision makersof the province.”
-Pinky Cacdac FHSIS Coordinator Tarlac Provincial Health Office 

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Analyn Cosim added this note
very informative...more nursing articles at http://rnagainsttheworld.blogspot.com/

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