45) eHealth in the Community Setting ¢ Cardenas, Melissa J. Pedrefia aie keoeed introduction is eHealth? wrrowes of data and information Good data qualities — sealth Situation in the Philippines eevyactors affecting eHealth in the country Using eHealth in the Community Universal Health Care and ICT glecronic medical records Telemedicine elearning Examples of eHealth projects in the community Roles of Community Health Nurses in eHealth Data and records manager change agent Educator Telepresenter Gient advocate Researcher Summary Genes Upon completion of this chapter, the reader should be able to: 1. Explain the importance of information and communications technology (ICT) for public health. 2. Describe the exists ICT for public heal 3. List the various nurses have in Public health, ing implementation of Ith in the Philippines, roles community health implementing ICT for information and communications technology (ICT) eHealth electronic medical records (EMR) telemedicine eLearning Geographic Information Systems (Gis) health informatics Innovations in health care are continuously introduced. Health cate providers apply best practices from fatesteresearchessand use appropriate tools to ‘enivancestherquealitysof health caredelivered Patients appear to become more engaged in their care (Rozenblum and Bates, 2013), through information available on the Internet, radio, and television. Communication 357problems between patients and health care brought about by geographical providers disparity, are easily solved by mobile phones. Computers are used to store, retrieve, and process important health data for better decisionmaking id becoming indispensable tools in addressing allenges in health care. defined as, some ¢ ICTs oRMMTENTERT, ac! (0 SARE, GHANA ae anatemamnxpesintormation.” These technologies include @immpoters. (he meme, oaieasting UMRAO (radio and television), and MAEPHOAVPBlurton, 2002) This chapter explores the actual potential applications of ICTS geared town’ improving people's access and utilises of health care in the Philippine community health setting What is eHealth? (Gttealely js the MsemnthGiefombeaish (World Health Organization, 2012). On May 25 + ArverSEmTeTENI® 2005 2005, during the Fifty-Eighth World Health Assembly (WHA), a resolution , a resolution was adopted by the World Health Organization {wHo) member states recognizing eHealth as the cost-effective way of using ICT in health care services, health surveillance, health literature health education, and research (WHA, 2005),re ies of ICT, ensive capa Given tHe, Gpsidered in aay of, ut not eHealth © the following: . as srvice (SMS). shoe een. 28 seat, often confused with ‘eimaieonor pe “e the overall, UROFSHEMTErR. remding 0 the WHO, eHealth encompasses : a. health professionals and health fr gamers, through the Intemet and telecommunications. * (ir) exem@ommerce” to improve public health services, for example, through the ‘education and training of health worke « The practices in health systems management. the power of data and information Nurses are knowledge managers. They constantly process raw patient data into valuable information to deliver evidence- based and individualized interventions. It is imperative for every etfealth practitioner to know the importance and difference between the two. (HH are the fundamental elements of cognition (Gudea, 2005), and are defined as MNOTAIRCUMTaTEMacts thar COMONTINply meaning. When meaningrisettribatederoredsta and when datasaresprocessed and Gielveed? then data become @mfermnnation. Consider, for instance, the number 39. It can be an age, house number, jersey number, etc. This is data. The school nurse noted that it was written on the respiratory rate field of the record of Grade 5 student Rosematie. Number 39 now has a meaning to the nurse ee iit acingsicanecamesct eemectronic mail (e-mail) and has become information. Based on the nurse's knowledge that Rosemaric's respiratory rate is above normal and considering other findings, the nurse concludes that she is hyperventilating. The nurse gave Rosemarie a brown paper bag to breathe into. ‘The eet Suletsatveacityon Aecuratesrecordingsofsobtained™aats Paper based methods may bring inconvenience especially when it comes to interoperability of health services, information backup, and instant data access. A number of bigger problems may also emerge 1. Continuity and interoperability of care stops in the unlikely event that a record gets misplaced If the patient suffers from a chronic condition, previous findings supporting this diagnosis, drug allergies, preexisting conditions, or even past accounts of the patient's previous visits may no longer be accessed unless the health providers have made several copies of the same record. The patient may also need to recount his/her condition for every transfer of care. 2. Illegible handwriting poses misinterpretation of data A direct. observational study of medication administration found opportunities for errors associated with incomplete or illegible prescriptions (Tissot et al., 2003). 3. Patient privacy is compromised. ‘Traditional, paper-based patient records are vulnerable to unauthorized viewing since there is no audit trail of the usage of the chart. The disclosure of highly private information arising from such an incident can lead to loss of trust in the health facility or even legal risks 4, Data are difficult to aggregate. Manual data recording and tallying significantly delays implementation ‘of interventions and targeted health programs. Health care monitoring is 359compromised as information is not readily available and up-to-date on a daily basis. 5. Actual time for patient care gets limited, Time spent by the community health worker searching for a paper-based record is time lost for actual care. Likewise, for both clinical and community settings, the overall impact of the problems related to manual/traditional data-gathering is articulated as follows: Internal and external changes affecting health care informatics (Englebardt and Nelson, 2001): 1. The ability to manipulate large amounts of data 2. The ability to relate data to cohorts of people who share similarhealth problems 3. The ability to link to genomic data In contrast, having a well-managed patient information system can have the following benefits: 1, Data are readily mapped, enabling more targeted interventions and feedback. ‘Through a system that delivers real- time and accurate patient and community information, health care providers are able to deliver patient-centered care and targeted disease prevention and management programs. The facility and staff are also provided feedback on their performance through computer alerts, enabling them to continually comply with standard guidelines and monitor monthly, quarterly, or yearly health targets. From the societal public health perspective, adhering to these guidelines keeps individuals healthy and lowers the risk of disease outbreaks in communities (Menachemi and Collum, 2011). Health professionals can also track the frequency and locale of diseases in real time through an EMR and Geographic Information System (GIS) like the Philippine Health Atlas of the Department of Health (DOH, 2012a) GIS technology enables detailed maps to be generated with relative speed and ease. In turn, this provides public health practitioners with the ability to provide quick responses to questions or concems raised in a community meeting (Richards et al., 1999). GIS is not the complete solution to understanding the distribution of disease and the problems of public health, but at is an important way in which to better illuminate how humans interact with their environment to create or deter health (Ricketts, 2003) Data can be easily retrieved and recovered, In the event of force majeure, retrieval of patient information is not a problem since data are automatically backed-up periodically in a secure server. Redundancy of data is minimized. Patient data that are frequently required in various health forms such as unique identifying information (eg, name, birthday, age, gender) need to be recorded only once. These can be linked and organized automatically into related record types through a database, allowing a better record management and ease-of- use. Data for cli available, The potential impact of health research in the country is often hindered by the lack of quality data. Whenever data is gathered, it is often not communicated to the rest of the research community. Having quality data stored in databases provides faster and more reliable research outputs that may eventually be translated to health care innovations and actual interventions, Resources are used efficiently By making patient information more teadily available, EMRs reduce costs related to chart pulls as well as supplies needed to maintain paper charts. Studies have also shown that having an EMR as opposed to a paper file can result I research becomes more| | be reduced transcription costs through invofcare documentation and other poured documentation procedures Sienacherni and Collum, 2011). In Seloping countries, health care information systems have been driven mainly by the need to report aggregate faaistcs for government or funding agencies. Improvements in drug supply management using medication data from EMR systems can offer the most measurable cost benefits at present; a ‘well-managed drug supply also improves availability and quality of patient care (Fraser et al., 2005). in Good data qualities The nursing process begins with obtaining ata through assessing the patient’s signs and symptoms. These data are interpreted ty the health care professional into useful information and a diagnosis. This is then followed by necessary interventions and again ‘ods with gathering new data from evaluating tbe esults. Without data, it will be difficult for a healt professional to assist the patient. Human error, viruses, bugs, and hardware fssus pose a great threat to the integrity of daz. ICT can help decrease these errors by puting safeguards in place, such as backing ‘files on a routine basis and error detection (\McGonigle and Mastrian, 2009). In order for lnformation to be valuable, data must have = a characteristics (Abdelhak et al., 2}: 1. AcuraeyrThisensuresthatdocumentation reflects the event as it happened. All values should be correct and valid. In a computerized system, a computer can be instructed to check specific fields for validity and alert the user to a potential data collection error (WHO, 2003). In lecttonic systems, format requirements must be followed (eg,, if date required is mm-ld-yyyy, then it should be presented 35 03-24-1989) 2, Gaesnibility. This isa data characteristic which ascertains data availability should the patient or any member of the health care staff needs it. An example is readil available repors or statistics when needed by decision makers Data input should be complete. This is deme wy making sure that all required fields in the Patient's record are properly filled up. ; Having no discrepancies in data recorded makes it consistent. This means that when John Lloyd Dela Cruz is written on the first age of the patient record, it should not be Jon Loyd Dela Cruz in the next. This Potential error is reduced through error detection and alerts by the computer. 5. Gumency. All data must be epstordate ‘@HGMHAETY. This is exemplified when the community health nurse records data at the point-of-care or when it happened. 6. Befinitionsy Data should be properly labeled and clearly defined. For example, 36 is just an ordinary number unless it is labeled as an age of a person. ‘The developing world suffers from inadequate health care and medical services. Lack of health care professionals and infrastructure contributes to this problem, making it more difficult to deliver health care to people in rural and remote communities of the developing world (IDRC, 2009). The ubiquity of mobile technologies and availability of Intemet services in the Philippines create a promising ground for eHealth access. In 2001, roughly 2.5% fof the country’s population had Internet access. In the span of 10 years, this rate steadily increased to 29% (Intemational Telecommunications Union, 2011). The Philippines has also a mobile phone 361penetration rate of 80%, with 73 million subscribers as of 2009. In addition, the y is FRAC. in terms of WO in the entire , 2010) ICT has changed how Filipinos access information and how the government has utilized this to inform its citizenry. Examples of these include regular updates of traffic conditions, current events, and critical weather reports through various social media. The health sector has also begun utilizing ICT to improve its services. The DOH has introduced a number of health information systems that aim to improve the access of health data, such as the Electronic Field Health Service Information System (DOH, 2012b), Online National Electronic Injury Surveillance System (DOH, 2012c), the Philippine Health Atlas, and the Unified Health Management Information System (DOH, 20124). Factors affecting eHealth inethe-country As mentioned earlier, numerous limitations impede the development of eHealth in the country, especially in the community setting However, various innovations have allowed eHealth implementations to gain ground. Both limiting and advancing factors are discussed in this section, Limited health:budget ‘As mentioned in Chapter 1, the budget allocation for health care is relatively small. This is one of the many reasons advancements in eHealth are postponed. ICT projects usually mequire-arhuge-budge', GmApIEMAER:, and are occasionally seen as skye endeavors, An example of a “failed” etlealth project was the United Kingdom's National Health Service (NHS) National Program for IT (NPAT), which was launched in 2002 with a budget of £11.4 billion. The objective of the Program was to “ensure every NHS patient 362 had an individual electronic care record which could be rapidly transmitted between different parts of the NHS" (House of Commons, 2009). However, after 9 years in development and after spending almost £7 billion, the UK government decided to revise NPAT ag it was regarded as incapable of meeting its target objective, given the limited available remaining resources, (Theremergencevofifree’and openssourcer Goftware In eHealth, the cost of software procurement or development often takes up a huge portion of the budget. In addition, using ready-made proprietary software can be limiting at times, especially when users want to modify the software to fit their workflow better. To modify the software, its source code needs to be changed. The source code is like the ingredients of a recipe. If one wants to modify the recipe, one will need to adjust some of the ingredients. Like some recipes, some source codes are kept secret too, which may cause the buyer of the proprietary sofiware to remain locked in to the sellers support and maintenance. Since the sellers own the source code of the program, they are the only ones who can modify the program. This may entail additional and unplanned costs, adding to the problem of health budgetary limitations. ‘An emerging trend all over the world is the development and increasing popularity of Free and Open Source Software (FOSS). In a nutshell, FOSS makes the source code of a program freely available for everyone, hence the name “open source.” Using the same recipe analogy, information on the ingredients is made accessible to the public, allowing anyone to “cook something up.” This allows anyone with the knowledge of programming to contribute to the source code, improving the program and sharing the improvement with everyone, To some extent, FOSS can theoretically cut costs in developing the softwaresect example of a successful FOSS for ‘nthe Philippines is the Community information Tracking System (CHITS), "yy managed by the University of the cunt y'es Manila-National Telehealth POIPPHUPM-NTHC). Interested software ceopers and students fom UP Manila, seipe into consideration recommendations peemmunity health professionals, are Sie to contribute 0 the development and imorverent of CHITS because its source vaae is made openly available (UPM-NTHC, 20123) pecentralized'government under RA 7160 or the Local Government code of 1991, local government units (UGUs) are autonomous, and therefore in control of their own basic health services, induding the budget. Because of this, it is sypical to see diverse and unrelated etiealth projects developing all over the county such as the Wireless Access for Health (WAH) in Tarlac, the Secured Health Information and Network Exchange (SHINE) in Iloilo, and the numerous CHITS installations in municipalities all over the Philippines. LGUs may develop their own systems. These efforts have accelerated the development of eHealth in community health. However, to maximize advantages derived from these systems and to produce a nationwide impact, the different health information systems will eventually need to connect with each other. Having one EMR system for all health centers will make consulting in different facilities easier. Sut unifying and harmonizing the different ‘isting systems for this future benefit, though Not impossible, will expectedly be difficult. Apel pealth Health th is not only about technology. Along Software development and hardware fement, staff training and maintenance System are key factors in determining Us effectiveness. Recognition of the cultural aspects of community life is important in Starting them off into a new direction such Is computerization and aut Saal omation (IDRC, One possible pitfall of etvealth implemen. tations is focusing on software development before accomplishing an assessment of the needs of health professionals in the field. Most health center personnel are not familiar with the use of computers. Implementing an eHealth system requires training of health Personnel on basic computer skills, use of software, and maintenance of the equipment. No matter how technologically advanced the tools are, the success of an eHealth implementation will eventually depend on the end-user’s willingness to learn and accept the technology. The benefits of etlealth and telemedicine ‘occur to communities when the technology Presents itself (1) as an enhancement to existing human relationships that have been established through conventional routes or (2) as a solution to a long-felt community need (IDRC, 2009). To illustrate, in 2004, the National Telehealth Center initiated the BuddyWorks project, which was funded under the eGov Fund from the Commission on Information and Communications Technology (CICT). Its aim was to provide medical specialist. support through a structured telereferral system for physicians situated in geographically isolated communities. Initially the project utilized a web-based system, However, the lack of a reliable Internet connection in remote areas made the system unreliable. The physicians were also unfamiliar with the use of the system. Thus, in a 2-year period, the project was only able to process eight referrals (Center for Health Market Innovations, 2012). Based on lessons learned from the early BuddyWorks experience, the project switched to the use of technology that is more appropriate to Filipinos—mobile phones. 363The switch made BuddyWorks more accessible as it utilized preexisting communication systems such as SMS offered by mobile phone service providers. After the transition, the number of referrals drastically increased to 1,939 in a period of 17 months (Center for Health Market Innovations, 2012). Surplus of “digital native” registered nurses *Not t00 long ago we had nothing to think about except the board exams. And before that, wwe had to make sure we were qualified to take the exams by completing the requirements, along with many other adversities. Sure, passing the exams was a reason to celebrate, but I was celebrating yesterday, not tomorrow. 1 knew darker days lay ahead. The United States was in the midst of trying to reform their health care system (again). US President Barack Obama wanted to solve their nursing shortage from within instead of importing foreign nurses. Other countries were not accepting new ‘graduates and required a minimum of one year's experience. This created a domino effect no one wanted. With the foreign-bound staff nurses choosing to keep their local jobs, the 30,000 new registered nurses of Batch 2009 were basically left with just their Professional Regulation Commission licenses to be proud of.” From the anicle “Cleaning Up.” Published by the Philippine Daily Inquirer, September 6, 2011 Because of logistic limitations, government hospitals and health centers are mostly understaffed despite the estimated 200,000 underemployed or unemployed nurses in the country (Mallari, 2011). One of the measures of the DOH to address a employed professional red Nurses for Health Services (RN Heals) fide nurses with one- nderserved and remote as well as to provide ‘ional professional health workers. A term coined by educator and writer Marc Prensky (2001), digital native describes a person who grew up and is familiar with digital technologies, and who uses them in daily living. The entry of digital native nurses into the profession and their nationwide deployment to communities may potentially aid the implementation of various ICT projects in health care, Overall, the Philippines is progressing use of eHealth for the benefit of its citizens How eHealth specifically affects community health will be taken up in greater detail in the next section ‘As mentioned earlier in this book, the major goal of community health nursing is to preserve the health of the community. This is best achieved by focusing on health promotion and health maintenance of individuals, families, and groups within the community, This section gives details as to how eHealth enables the community health nurse in contributing towards the achievement of this goal. Universal Health Care and ICT In the Philippines, making health care accessible to all remains a great challenge Lack of financial health care coverage leads to high out-of-pocket expenses. The marked mass migration of health professionals leaves the remote and rural areas of the country with limited access to specialized health care. The archepelagic distribution of the country—with 7,107 islands—makes health care delivery even 8. A series of health reforms have been implemented. The DOH, through Administrative Order No, 2010-0036, outlined the policy directions of Universal Health Care.own 25 SeahangameRangialahars og es reform agenda has three priority (ith directions: —— a through 1 "Gipansion in National Health Insurance Program enrolment and benefit delivery hospitals and health care facilities ne of the aims of KP is to attain efficiency by using Tin all aspects of health care. ‘One of the key instruments it underlines is the use of Health Information to establish a modem information system that shall provide evidence for policy and program development and support for immediate and efficient provision of health care and management of province-wide health systems. The DOH also recognizes the valuable purpose of ICT for health and has drafted its National eHealth Strategic Framework for 2010-2016, with the vision of ICT supporting UHC to improve health care access, quality, efficiency, and patient's safety and satisfaction, for reducing cost and enabling policy makers, providers, individuals, and communities to make the best possible health decisions. Electronic medical records ‘Bah are basically COMPENSATE PATEM femmmis that are OFetimndmaccessecefromy ‘SomputeoMsere Community health centers have the capacity to rapidly adapt EMRs because they utilize a standard process nationwide. For example, the workflow with 4 patient at a health center in Quezon City is basically the same as that of a health center at Batanes, In contrast, EMRs are more difficult to implement in hospitals because each hospital has its own set of protocols coupled with is own system of documentation. Even Sovernment-owned hospitals do not have a Standard system of health service provision and of maintaining patient records. This implementing informat systems in the health sector highlight the importance of creating standards. Another reason EMR ate vital to community health centers is that each patien fecord is usually used more frequently. For stance, a patient undergoing treatment for tuberculosis needs to make regular Wisits to the health center for TRDOTS Cuberculosis Directly.Observed Treatmens Shortcourse). A young child is brought to the health center regularly for child care health services, such as immunizations, deworming and micronutrient supplementation. Community health centers make health care services available to families, enabling the community health worker to observe familial Predispositions to cerain diseases and provide appropriate health promotion and prevention measures. deally, a person can utilize health center services from womb to tomb. This ideal scenario is made more likely if each patient encounter is properly documented and the patient recording system is set up with accuracy and efficiency in mind AS stated earlier in the book, community health nurses should be aware of health Pattems and health indicators within their catchment area. Vital statistical indicators such as mortality and morbidity rates must come from reliable data, which can be derived from accurate and thorough EMRs. EMR systems also allow computerized processing of indicators, making it easier for nurses to focus ‘on other important aspects of health care. One of the most widely used communi based EMR in the country is CHITS, which began in 2004 and was funded by the International Development Research Centre (IDRC). It_was created by Dr. Herman Tolentino of the University of the Philippines Medical Informatics Unit (UP-MIU) and is currently being implemented at health centers in Pasay, Navotas, Quezon City, and several other municipalities nationwide. Training on how to optimize the EMR for community use 365and onsite follow-ups of the health workers were done. This resulted in EMR features that are customized to the needs of the health center and the community. More importantly, involving the target end users in the development process of the EMR gave them a sense of ownership of the program, allowing easy acceptance and utilization of CHITS. elemedicine- and Giexdvantapedsareass(GIDAS), to Sport ‘wPGemauainment, and to M@isseminate ‘mferemation (0 citizens and providers through telemedicine and mobile health (mHealth) services (DOH, 2012e), ‘The WHO defines telemedicine as, “the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communications technologies for the exchange of valid information for diagnosis treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities’ WHO further underscores four elements that are specific to telemedicine: 1. SiO is co PRORIGRTEH TEASERS 2 It is intended (amawercomengeographicaly (aMMetS. connecting users who are not in the same physical location, 3. Itinvolves the SS ReaTOUSIPERORICT. 4 ts goa! ‘sttantmprovesheattinomteonies In the Philippines, the UPM-NIHC has e B e provide health d areas of program. Officers to with trained telehealth medical specialists via e-mail, The teleconsults, which are S'S. °F by a server, are then triaged by theeeved telehealth nurses to approy ‘ specialists ei In collaboration with the Phi i for Health Research and Deane the Department of Science and Technol uw (DOST-PCHRD), the BuddyWorks projec UPM-NTHC was continued from 2007 we snot as the National Telehealth Service poe” (NTSP) (PCHRD-DOST, 2011), i A specific example of how telems applied in the community was the a rare skin disease called tinea im urbe from Kiamba, Saranggani in The Municipal Health Office ae Saranggani referred multiple cases of strang., like formations on a patients sky Images were sent to the UPM-NTHC telehealh nurse and were referred t0 a dermatolo specialist at the Philippine General Hospital who gave the initial diagnosis of tines imbricata—which has only been reported in the Philippines three times since 1789. The recommended treatment was effective. Case finding for patients with a similar condition sought. This eventually led to a medical mission by the dermatology specialist and her fellow dermatologists in cooperation with the local government of Kiamba to help the patients affected by the disease As can be seen from example, telemedicine has the capacity to bridge the gaps in the health referral system. It is understandable that this is not a universal solution and may be applicable only specific scenarios. The goal of a patient receiving the best care as soon as possible despite an unfavorable location or other adverse circumstances may be reached through telemedicine. Setearning Health education, which is essential in health promotion and maintenance, can be edicine was discovery of bricata in a theis basically the qsemofeelectromtier eee It can be @@He ‘asmreTOnOUsIy? or imme oon . This can be in the mv imple instructional videos and form oon textblasts to social network help informa interactive simulations. eLearning ours am gpecially useful in correcting «at peeptions about health and health care rsceits access 10 reliable information about ah For example, control of communicable diseases frequently requires community paricipation. With the use of eLearning Pepnology, community health nurses iy elicit community interest by showing sauiructional videos on measures to control a particular disease. ‘learning can also be used to educate fellow health professionals. With eLearning, continuing education sessions. canbe frequently availed of, with less time, effort and expense involved in the process. Continuing professional education of nurses can be undertaken by attending online and sirual seminars through teleconferences and multiuser virtual environments Examples of eHealth projects the community Table 15.1 is a summary of eHealth projects, past and present, that target community health Note that some projects are a combination of EMRs, telemedicine, eLearning, and other ways by which ICTs impact health The similarities among the projects and their implementations are noteworthy. Also, they are scattered in different parts of the country. The working of these projects usually does not interfere each other, creating potential Problems as previously explained. OLES OF COMMUNITY HEALTH IN cHEALTH roles are significantly diversified by eHealth. With the Community health nurses’ advent of eHealth, nurses are to several clients at a single health care delivery more effici in IT may also help the nurse made available time, making lent. Advances in optimizin, efforts towards maintaining an open line of communication with clients, paving the way for establishing and maintaining rapport. 1f literally at the fingertips of the nurse provides greater opportunity to learn more about clients and their conditions; eHealth, however, cannot be a replacement for actual patient care. It is best viewed as a powerful tool for hnurses—bridging gaps and improving access especially in a resource-constrained country like the Philippines. The following are the major roles of an eHealth nurse in the Philippine community setting: (Datarand:records:manage As data and records managers, community health nurses monitor the trends of diseases through the EMR, allowing for targeted interventions for health promotion, disease prevention, curative services, or rehabilitation. Nurses also maintain the quality of data inputs in the EMRs, making sure that information is accurate, complete, consistent, correct, and current. Nurses also pai regular data audits. Nurses act as change agents by working closely with the community and implementing eHealth with them and not for them. Change agents do not force technology on the community, but inform and guide the community in selecting and applying sriate ICT tools. aronge agents also collaborate with health leaders, policy makers, stakeholders, and other community health professionals to determine their knowledge and awareness on eHealth and appropriate ICT tools. Nurses then a on the baseline eHealth knowledge and help 1p appropriate eHealth tools for the develo] community. 367Table 151 eHealth projects in the Philippines used in community health practice Name Type Key information Telemedicine and eLearning = Implemented in 2004 by the University of the Philippines Manila-National Telehealth Center (UPM-NTHC) through the eGovernment Fund of the Commission on Information and Communications Technology (CICT). ~ Allowed RHU physicians in GIDAS to Samp Via short message service (SMS) and e-mail ) Wackina Syste) Electronic medical record ~ Developed in 2004 by Dr. Herman Tolentino of the UPM College of Medicine-Medical Informatics Unit (MIU). Project intially began in Pasay health centers and has been implemented in more than 48 health centers since then, = Program is ‘G@mexistingwDOHprograms (EPI, NTP, etc) ands a Free and Open Source Software (FOSS). ~ A demo of CHITS can be accessed online at httpsidemo2010.chit.ph (username: user, Password: user) (UPM, NTHC 2010). Health information system and electronic reporting — An GRNFTEWEsIOMOfatberRHSIStdeveloped by the DOH where you can upload FHSIS data, eLearning ~ Developed in 2009 by the Ateneo Innovation Center. — An @lectroniceversionmotmMial accessible in mobile devices, eLearning ~ Funded by the United States Agency for International Development (USAID) and developed by UPM-NTHC = Created Stroke, BiRdiflu, and NESSIE, Teter = Funded by the DOST-PCHRD and developed through the collaborative efforts of the University of the Philippines Manila-Electical and Electronics Engineering institut (UPM- EEE, University of the Philipines Manila Nation Institute of Physics (UPM — NIP) and UPM-NT! 368. t able 15-4 etteath projects n the Philipines used in community health practice ~ coma ‘Name Type Key information tt is 2 mobilemcomputersconnectediaai, MecicaiadevicesssucteasECS, SUSSMmeter and GHORMOPS that is intended for mobile deploymey to rural health centers. ~ Iisa and allow video and chi at conferencing with a medical specialist. Electronic medical record ~ An éIRetrORCHnedicaliteCOre? crestedetoranural tealinam' ~ Developed by Segworks, a local software company based in Davao, Electronic medical record and SMS reporting ~ An electronic medical record @lewelOpeibySiman ‘Gommunications, ~ A demo can be accessed online at https:/shine ph. SMS alert system ~ Add-on to WAH (Wireless Access for Health), SPASMS is an} _whersre'due forfollowsup, we Disaster management and SMS reporting ~A project of the World Health Organization (WHO) and the Department of Health ~ Health Emergency Management Staff (DOH-HEMS), ‘Teportsnofeprevalentadiseases immediately after disasters (SSMS? GAGE, and other information and communication technologies. ~ SPEED also SSRGStFFIPIECRSES RORTESTTOR alert: _Nés) tolcommunity health nUrsestor Dosible Outbreaks based on availableidats | Health information system and electronic medical record = Implemented in 2010 in the Tarlac province through the Public-Private Partnership (PPP) of Qualcomm, UPM-NTHC, USAID, Smart, DOH-IMS, Center for Health Development (CHD) Region Ill, RTI International, National Epidemiological Center (NEC), Tarlac State University, and the local government. ~ WAH cred connecting health centers through: broadbar: ffiternetiacces: — WAH Website: sites google.com/sitehvahphil 369rovide health education to individuals’ and families through 1CT = (eg. teleconference, SMS. e-mail. and vir simulated environment). They may also participate in making eLearning videos on specific diseases (eg, diabetes mellitus, tuberculosis), which the patients can watch during their waiting time at health centers. Such videos may also be installed in the dlients’ personal phones (if supported) and watched at a time convenient to them. Nurses may also use scheduled text messages to patients among the catchment population to send important health information, reminders, etc Telepresenter In the event that a patient needs to be referred to a remote medical specialist through telemedicine, nurses may function as a telepresenter. This means that the nurse may need to present the patient's case to a remote medical specialist. noting salient Points for case assessment, evaluation, and treatment. This usually occurs via a teleconference. Client advocate As client advocates, community health nurses must safeguard patient records, ensuring that security, confidentiality, and Privacy of all patient information are being upheld. This becomes more challenging especially because with technology, transfer of information can happen instantly. The client must also be well informed about the benefits and challenges of EMRs, ersonal and health eHealth (ie, mission) is well n an informed e that all eHealth d in a safe and ethical manner, making sure that personnel involved in eHealth are competent and have received eHealth training/certification, Researcher Using eHealth tools (eg. EMRs), patient records can easily be retrieved and analyzed retrospectively by community eHealth nurses. They are responsible for identifying possible points for research and developing framework based on data aggregated by the system. An eHealth nurse researcher also pursues continuing nursing informatics education, with the goal of developing a research framework which will be beneficial to the community. EEE Fundamental to technological development is the establishment of human, political and economic arrangement that ensures the efficient use and application of technology (Locsin, 2005, p. 25). And although more often than not. the perception that a technologically competent nurse is a person who demonstrates less caring to the patient, it should be emphasized that technology was never meant to replace the nurse to provide quality and holistic care, but rather to make each caring situations meaningful both for the nurse and for the patient. Time and again, the purpose of technology is to make our lives easier. Similarly, eHealth has improved community health by empowering its workers with eLeaming making information accessible using EMRS. and bridging the gaps of communication through telemedicine. However, itis important to note that these tools make the job of community health nurses easier. These tools, however, will ultimately be useless if not utilized properly.