REVIEW OF RELATED LITERATURE

With the advent of time and technology, health care is now being delivered in a more
dynamic, complex but easier and faster way. Due to the ever changing environments,
continuously changing medical treatments, changing regulations and protocols, growing
population and increasing demands of an efficient healthcare system, it is imperative that clinical
information is made readily available for easier access. With these presenting factors, computer
systems are being devised to collect, store, retrieve, analyze and communicate health status and
health care information. It can aid in collecting, storing, retrieving and analyzing patient care
data when the systems are based on concepts from informatics. Appropriately designed and
deployed computerized systems of information can transform patient care data into clinically
relevant and useful information and knowledge.

Health sector is one of the largest consumer oriented fields which can device substantial
benefits from the computerization. Last few years have been continually witnessing an
increasing number of health professionals and set ups using electronic and information
technology to improvise the delivery of healthcare at different levels such as primary care,
ambulatory care and tertiary level care. 

With the tremendous advances in medical science the challenge for nursing continues to
be the integration of many specialized resources in the care of patients. Nursing decisions are
often limited by access to necessary information available from these specialized sources; thus
ease of access in a timely manner to all pertinent patient information is necessity.

Babu. D. Nursing Information Systems. Asian J. Nur. Edu. & Research 2(2): April-June
2012; Page 76-78.

Community nursing information has been largely provided for by management systems
developed and purchased to meet information requirements. It has been difficult to find computer
solutions that offer benefit to operational nurses, midwives and health visitors. Solutions are
required that support patient-orientated developments in practice. The trend towards greater
patient involvement in the planning of their own care requires solutions that support patient held
records and allows professionals to have instant access to information away from their base of
work. Current community systems often concentrate on service activity. Community information
systems must be able to:

 Provide a clinically useful person-based record

 Track people across providers
 Support contracting for packages of care
 Support quality monitoring
 Support the evaluation of outcomes
  Support the sharing of information between community service providers and other
organizations, subject to security and confidentiality safeguards.
Toromanovic, S., Hasanovic, E., & Masic, I. (2010). Nursing information systems. Materia
socio-medica,  22(3), 168–171. https://doi.org/10.5455/msm.2010.22.168-171

Information is highly imperative to actualize knowledge-based decision-making at all

Levels of health care. Indeed, valid and reliable information is fundamental precondition
For a more effective, efficient and equitable health care system.
Information is highly imperative to actualize knowledge-based decision-making at all
Levels of health care. Indeed, valid and reliable information is fundamental precondition
For a more effective, efficient and equitable health care system.
Information is highly imperative to actualize knowledge-based decision-making at all
Levels of health care. Indeed, valid and reliable information is fundamental precondition
For a more effective, efficient and equitable health care system

The use of Information Technology in the Healthcare Setting

Information is highly imperative to actualize knowledge-based decision-making at all levels

of health care. Indeed, valid and reliable information is fundamental precondition for a more
effective, efficient and equitable health care system.

The use of ICT for health or e-health is recognized as one of the key enabling strategic
instruments supporting and facilitating the achievement of the national health system goals. As
early as 1987, the DOH had operationalized this strategy by establishing an office responsible for
ICT and management information system (MIS) headed by a director-level officer. The current
KMITS of the DOH leads ICT/MIS activities.

The Integrated Hospital Operations and Management Information System (iHOMIS) is one
of the tools implementing the integrated hospital operations and management strategy of the
DOH. As of 31 March 2016, the iHOMIS was used in 91 DOH and LGU hospitals. The iHOMIS
functions as an electronic medical record, hospital information system and health information
system. It captures patients’ medical histories and encounters. It records patients’ vital signs,
diagnoses, laboratory results, medications and hospital bills, among others. It generates
information 140 for decision support and reports on diseases. The iHOMIS is used as
PhilHealth’s electronic system for membership verification, claims processing and status
verification.

The Integrated Clinic Information System (iClinicSys) is used at the primary level in health
centres. For the two-year period 2013–2015, the users of iClinicSys increased by an average
annual rate of 34% with 376 users registered by the end of 2015. The iClinicSys has a patient
consultation module that captures vital signs and doctor’s orders and an e-prescription module
that prepares prescriptions for patients. It later links post-prescription inventories with the
National Online Stock Inventory Reporting System (NOSIRS). A health programme module
records the health service provided by name of the programme, e.g. malaria. Specific
functionalities of the iClinicSys include scheduling patients, tracking vaccinations and verifying
recipients of the 4Ps and PhilHealth programmes.

The Electronic Field Health Service Information System (eFHSIS) provides the basic service
data needed to monitor the activities of various public health programmes. The early version of
FHSIS was developed in the late 1980s. Specifically, it provides summary data on health service
delivery and selected programme indicators at the barangay, municipality/city, district,
provincial, regional and national levels. It consists of (i) web based online reporting for
programmes such as MCH, TB, malaria; (ii) batch offline client-based reporting system; (iii) a
web-based data uploading system; and (iv) a report generation system that consolidates data and
produces reports, including charts and graphs.

The Philippines Health System Review. Vol.1 No.2. Manila: World Health Organization,
Regional Office for the Western Pacific, 2011.

World Health Organization. (2018). The Philippines Health System Review. Health Systems
in Transition, 8(2), 138–140.
https://apps.who.int/iris/bitstream/handle/10665/274579/9789290226734-eng.pdf

WIRELESS ACCESS FOR HEALTH

The Philippine Field Health Service Information System (FHSIS) is the government’s
major resource for managing public health data. Data from the system is used for policy analysis
and planning at all levels of the public health system. Most of the data originates during patient
care at barangay health stations, city health centers, rural health units (RHUs) and hospitals. It is
up to the doctors, nurses and other health care providers at these facilities to treat patients, record
their information and assemble clinic-wide reports. An electronic medical record (EMR) system
has the potential to improve access to quality patient records for clinicians and data to the
FHSIS.

Challenge

 RHUs provide critical health care services to families and communities throughout
the Philippines.
 Patient-level information enables health care workers to provide individuals with
more effective, efficient and comprehensive care.
 Clinic-level information is critical for maintaining the appropriate amount of life-
saving drug supplies and identifying human resource needs. Municipal-, provincial-
 and regional-level information can help identify disease outbreaks and inform
decision makers on the most efficient allocation of resources.
 RHU-level information is critical for public health-related decision and policy
making.
 Traditionally, this information has been manually recorded on paper — a process that
is not only time consuming, but also error prone. Accessing and managing
information in this manner is labor intensive and the data can often be outdated or
incorrect.
 The inability to easily access and trust the accuracy of the patient information also
makes it difficult for RHUs to feel a sense of ownership of the data and the FHSIS
system.

Solution

 Supported by Qualcomm Wireless Reach, in collaboration with various stakeholders

through a multi-sector collaboration, Wireless Access for Health (WAH) is designed
to improve health care in the Philippines by reducing the time required to record and
report health data while also improving access to accurate and relevant patient
information for clinicians and decision makers.
 WAH leverages new and innovative technologies to improve the quality and
timeliness of data at health clinics in the Philippines. Specific technologies include:
o 3G wireless technology: A high-speed 3G wireless data network brings fast and
reliable Internet services to health clinics. Reports that used to be delivered by
people using motorcycles or jeepneys (a local mode of transportation) can now be
sent instantly via 3G directly to the people who need them most.
o Low cost hardware: Mobile devices including netbooks, tablets and smartphones
on an advanced wireless network are now available enough to become a standard
tool for health care providers.
o Open source software: WAH makes its code available online in conjunction with
principles of open source programming and sharing. The platform runs on Ubuntu
Linux, MySQL, and PHP. It is a completely free and community supported
system.
 In addition to the technology, WAH unites a diverse group of stakeholders with a
common vision. Their combined expertise, influence and resources have been critical
to the project’s achievements.

Impact

 Capacity Building, Scale-Up As of December 2017, the WAH Initiative has:

 o Successfully scaled-up its digital platform in 160 clinics located in 26
provinces – five are committed to province-wide scale-up – in the Philippines,
serving more than 9,000 patients a day.
o Helped record over 6.3 million patient consultations (morbidity diseases,
maternal care, child care, and family planning) and helped manage more than
2 million patient records.
o Trained more than 3,000 clinicians and many have confirmed improvements
in their ability to record, report, generate, and analyze health data and reports.
o Paved the way for faster and better delivery of health care services; cutting in
half the average patient waiting time to see the doctor in a primary health care
facility.
 Improved Care and Capacity
o Patient care has improved and patient visits have increased as they are handled
more efficiently:
 The four to five minutes needed to search paper records is reduced to
just seconds.
 The average waiting time for consultation is reduced by half. Clinics
receive more capitation funds as they now have the capability to
submit Philippine Health Insurance electronic claims for primary care
benefit and case-rate packages.
 Improved Record Keeping
o The ability to easily view, record and share patient information across
multiple computers within a health clinic allows clinicians to complete patient
consultations earlier in the day in order to provide more support to community
health workers.
 Government Support
o Over 120 partner local government units have committed to sustaining the
WAH Initiative, signed legal agreements with the organization and have
incorporated expenses and funds for training in their budgets, including
allocations for mobile devices, personnel and system maintenance
 Stakeholder Collaboration
o Various stakeholders are collaborating to make the WAH platform a
standalone, open-source, communal health information system across the
Philippines that complies with the standards of and inter-operates with the
health information platform of the Department of Health (DOH) and the
Philippine Health Insurance Corporation (PhilHealth).
 Platform Expansion
o WAH has expanded its groundbreaking EMR system that supported medical
data collection and reporting at the clinic level to a full-fledged digital health
platform for local governments. The platform features recording and reporting
 of health data at various points of care – barangays/ villages, primary clinics,
and primary hospitals and allows for aggregation and dis-aggregation of data
online up to the provincial and barangay level, respectively. It also allows
clinicians using the platform to send health alerts and reminders to patients via
SMS.

Qualcomm Wireless Reach. (2018, September). Wireless Access for Health.

https://www.qualcomm.com/media/documents/files/philippines-wireless-access-for-health.pdf

The Field Health Service Information System or FHSIS provides the Department of
Health (DOH) data it can use to monitor diseases and intervention activities at the
Grassroots level experienced by local health units. Its original objective is to provide
short-term data needs of the DOH managerial and supervisory staff in the municipal, city,
province, region and national levels. This objective was held in dispute with the highly
institutionalized nationwide