HANDOUT IV: E-HEALTH IN COMMUNITY SETTING

STRICTLY FOR CLASSROOM USE ONLY

eHEALTH IN THE COMMUNITY SETTING

• What is ICT?
INFORMATION & COMMUNICATIONS TECHNOLOGY
– A diverse set of technological tools and resources used to communicate, create, disseminate,
store, and manage information (Blurton, 2002)
– Example technologies
• Computers
• The Internet
• Television
• Mobile phones
• Differentiating Data and Information
• Data – unanalyzed raw facts that do not imply meaning (Gudea, 2005)
Ex: The number ’39’
• Information – data with meaning
Ex: The number ‘39’ as the patient’s respiratory rate
Is different from
– The number ‘39’ as the patient’s age
• The health care system heavily relies on accurate recording of data and information

Good Data Qualities

• In order for information to be valuable, data must have the following characteristics (Abdelhak et al.,
2012):
– Accurate / Accessible / Comprehensive Consistent / Reliable / Current / Defined

What is eHealth?
• eHealth is the use of ICT for health (World Health Organization, 2012).
• May 25, 2005
– 58th World Health Assembly (WHA)
– Resolution: adopted by the WHO member states
• Recognizing eHealth as the cost effective way of using ICT in health care services,
health surveillance, health literature, health education, & research (WHA, 2005)
• Examples of eHealth:
– Communicating with patients through a teleconference, e-mail, SMS
– Recording, retrieving and mining data in an electronic medical record
– Providing patient teachings with the aid of electronic tools (computers, television, tablets)

eHealth is the Umbrella Term

According to the WHO, eHealth encompasses three main areas:
• The delivery of health information, for health professionals and health consumers, through the
internet and telecommunications.
• Using the power of information technology (IT) and e-commerce to improve public health
services, for example, through the education and training of health workers.
• The use of e-commerce and e-business practices in health systems management.
ICT in the Philippines
• Internet Access (ITU, 2011)
– 2001 – 2.5% of Filipinos had Internet access
– 2011 – increased to 29%
• Mobile Phone Usage
– 2009 - 80% of Filipinos own a mobile phone
– 73M subscribers
– The Philippines is ranked first in SMS usage in the entire world (BusinessWire, 2010)
– eHealth in the Philippines
 • Factors to consider
– Limited health budget
– Emergence of Free and Open Source Software (FOSS)
– Decentralized government
– Target users are unfamiliar with the technology
– Surplus of digital native-registered nurses

USING eHEALTH IN THE COMMUNITY

UNIVERSAL HEALTH CARE & ICT

– DOH: AO No. 2010-0036
• Outlined the policy directions of Universal Health Care
• ‘Kalusugan Pangkalahatan’ or “KP”
– Reform agenda
– One of its aims is to attain efficiency by using ICT in all aspects of health care
– DOH 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 (EMRs)

– Comprehensive patient records that are stored and accessed from a computer or server.
• Example: Community Health Information Tracking System (CHITS) of the UP Manila
– Vital in health centers: undergoing treatment for TB needs to make regular visits to HC for
TB-DOTS.
– Easy access to vital health statistics

TELEMEDICINE
• delivery of health care services by all health care professionals using ICT for:
(without an in-person office visit; done primarily online with internet access on computer, tablet, or
smartphone)
– exchange of valid information for diagnosis
– treatment & prevention of disease & injuries
– research & evaluation
– for the continuing education of health care providers
• Four elements specific to Telemedicine - WHO
1. Its purpose is to provide clinical support.
2. It is intended to overcome geographical barriers, connecting users who are not in the same
physical location.
3. It involves the use of various types of ICT.
4. Its goal is to improve health outcomes
Example: National Telehealth Service Program (NTSP).

eLearning
– use of electronic tools to aid in teaching
– Instructional videos, informational text blasts, interactive simulations
– Educate fellow health professionals
• Continuing education sessions / continuing professional education
– Online & virtual seminar through teleconferences & multiuser virtual
environments

eHealth PROJECTS IN THE COMMUNITY

 BuddyWorks – allowed RHU physicians to send telereferrals to clinical specialists in PGH via
SMS and eMail

 CHITS Community Health Information and Tracking System

o an EMR (Electronic Medical Record), designed for and by the community health workers,
divided into different modules based on existing DOH programs
  Electronic Field Health Service Information System (eFHSIS)
o An online version of the FHSIS developed by the DOH

• Electronic Integrated Management of Childhood Illness (eIMCI)

o An electronic version of IMCI accessible in mobile devices
• NTHC (National TeleHealth Center) eLearning videos
o funded by USAID, created eLearning videos on tuberculosis, stroke, bird flu, and child
poisoning
• Segworks Rural Health Information System (SEGRHIS)
o An EMR created for rural health units by Segworks, local software company in Davao
• RxBox
o It is a mobile computer connected with medical devices such as ECG, pulse oximeter and
electronic blood pressure and heart rate monitors that is intended for mobile deployment
to rural health centers
• Secure Health Information Network Exchange (SHINE)
o An EMR developed by Smart Communications
• Synchronized Patient Alert via SMS (SPASMS)
o an SMS reminder system for patients who are due for follow-up
• Surveillance in Post Extreme Emergencies and Disasters (SPEED)
o Allows community health nurses to submit daily reports of prevalent diseases immediately
after disasters via SMS, e-mail, and other information and communication technologies
• Wireless Access for Health (WAH)
o WAH augmented the existing CHITS by connecting health centers through broadband
Internet access ;
o 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 III, RTI International, National Epidemiological Center (NEC), Tarlac State
University, and the local government

COMMUNITY EHEALTH NURSES’ ROLES

1. Data and Records Manager
– CHNs monitor the trends of diseases through the electronic medical records (EMR), allowing
for targeted interventions for health promotions, disease prevention, curative services or
rehabilitation
2. Change Agent
– Working closely with the community & implementing eHealth with them & not for them
– Build baseline eHealth knowledge & help develop appropriate eHealth tools for the
community
3. Educator
– Provide health education to individuals & families through ICT tools (teleconference,
virtual/simulated environment)
4. Client Advocate
– CHNs must safeguard patient records, ensuring that security, confidentiality,& privacy of all
patient information are being upheld
5. Telepresenter
– Present patient’s case to a remote medical specialist, noting salient points for case
assessment, evaluation, & treatment
6. Researcher
– using eHealth tools, patient records can easily be retrieved & analyzed retrospectively by
CeHNs
• Responsible for identifying possible points for research & developing a framework,
based on data aggregated by the system