philippine initiatives in health informatics
TRANSCRIPT
Philippine InitiativesPhilippine Initiativesinin
Health InformaticsHealth Informatics
Christian S. DiciocoChristian S. Dicioco
ObjectivesObjectives
• Enumerate initiatives on health informatics in Enumerate initiatives on health informatics in the countrythe country
• Give highlights on national electronic health Give highlights on national electronic health record system (CHITS) record system (CHITS)
• Explain role of government in regulating ICT Explain role of government in regulating ICT • Discuss current issues in health informaticsDiscuss current issues in health informatics
UP Manila and the development of UP Manila and the development of health informaticshealth informatics• MIU or Medical Informatics UnitMIU or Medical Informatics Unit
– Core group formed by faculty members in UPM trained on Core group formed by faculty members in UPM trained on medical informatics in US and Englandmedical informatics in US and England
– Initiated researches on community health information Initiated researches on community health information system, one product of which is CHITS (2004)system, one product of which is CHITS (2004)
• CHITSCHITS– Community health information tracking systemCommunity health information tracking system
• Master of Science in Health InformaticsMaster of Science in Health Informatics– Emphasis on community-based and community-managed Emphasis on community-based and community-managed
health information system (2005)health information system (2005)
• Buddy WorksBuddy Works– Use of electronic information and communication Use of electronic information and communication
technology to provide health care to remote communitiestechnology to provide health care to remote communities
UP Manila and the development of UP Manila and the development of health informatics health informatics (cont.)(cont.)
• National Telehealth Center (UPM-NThC) (1998)National Telehealth Center (UPM-NThC) (1998)– One network on eHealth – eRecords, eLearning and One network on eHealth – eRecords, eLearning and
eMedicineeMedicine
– seminars on health informaticsseminars on health informatics
• Other projectsOther projects– BLIMP (Blood Bank Information Management program)BLIMP (Blood Bank Information Management program)
– Philippine Malaria Information SystemPhilippine Malaria Information System
– Statistics, Policy, Research, and Archive Database Statistics, Policy, Research, and Archive Database (SPREaD) of the Philippine Health Insurance (SPREaD) of the Philippine Health Insurance Corporation Corporation
SHIP99SHIP99
• Standards for Health Information in the PhilippinesStandards for Health Information in the Philippines• Initiated by National Institute of Health in 1999Initiated by National Institute of Health in 1999• Goal to formulate sets of recommendation for the Goal to formulate sets of recommendation for the
standardized method of collection, storage, standardized method of collection, storage, transmission, and dissemination of health data transmission, and dissemination of health data throughout the country.throughout the country.
• Standards Standards – Data Elements for Emergency Department Systems Data Elements for Emergency Department Systems
(DEEDS) for standard set of data elements(DEEDS) for standard set of data elements
– Health Level Seven (HL7) standard for health data Health Level Seven (HL7) standard for health data interchangeinterchange
– International Classification of Diseases (ICD10) International Classification of Diseases (ICD10) standard for codingstandard for coding
CHITSCHITS
• Community Health Information Tracking Community Health Information Tracking SystemSystem
• A computerized patient record system for A computerized patient record system for quality health care and management even in quality health care and management even in remote areasremote areas
• Created in 2004 by Herman Tolentino through Created in 2004 by Herman Tolentino through a grant from international Development a grant from international Development Research Center (IDRC) of Canada Research Center (IDRC) of Canada
• Managed by UP Manila National Telehealth Managed by UP Manila National Telehealth Center (UP Manila NThC) headed by Dr. Alvin Center (UP Manila NThC) headed by Dr. Alvin MarceloMarcelo
Features of CHITSFeatures of CHITS
• Installed in government health centersInstalled in government health centers• Collects routine health data from vertical Collects routine health data from vertical
programs in the Field Health Service programs in the Field Health Service Information System (FHSIS) and integrates Information System (FHSIS) and integrates them into a unified, comprehensive them into a unified, comprehensive computerized information systemcomputerized information system
• Community-basedCommunity-based• FOSS-basedFOSS-based
Consult modules in CHITSConsult modules in CHITS
• Health centerHealth center• ICD10ICD10• IMCIIMCI• InjuryInjury• Notifiable diseasesNotifiable diseases• PhilhealthPhilhealth• Clinical remindersClinical reminders• VaccineVaccine
Advantages of CHITSAdvantages of CHITS
• Enables community to use data for local decision-Enables community to use data for local decision-making and health planningmaking and health planning– Health monitoring, morbidity and mortality rates, prediction Health monitoring, morbidity and mortality rates, prediction
of outbreaks, immunizationof outbreaks, immunization
• Ensures sufficient drug supplies to health centersEnsures sufficient drug supplies to health centers• Telehealth servicesTelehealth services
– Consultations with PGH, patient monitoring, patient/care Consultations with PGH, patient monitoring, patient/care provider education, teleconferencingprovider education, teleconferencing
• Data consolidation among clinics and hospitalsData consolidation among clinics and hospitals– Integration of services, decision support, researchIntegration of services, decision support, research
• Nationwide network potential with 1900 rural health Nationwide network potential with 1900 rural health unts (RHUs) across the countryunts (RHUs) across the country
How is CHITS set up?How is CHITS set up?
• Creation of CHITS teamCreation of CHITS team– Physician, nurse, aide, barangay health worker, Physician, nurse, aide, barangay health worker,
mayor, IT workermayor, IT worker
• One high end PC, two low end PCs, printerOne high end PC, two low end PCs, printer• Internet connectionInternet connection• UPM NThC for program consultation, UPM NThC for program consultation,
installation, configuration, training and installation, configuration, training and maintenancemaintenance
How does CHITS work?How does CHITS work?
CHITS health center setupCHITS health center setup
admissionadmission pharmacypharmacy
physicianphysician
routerrouter
InternetInternet
Open MRSOpen MRS
• Open medical record systemOpen medical record system• involves minimal use of free text and involves minimal use of free text and
maximum use of codes and standard maximum use of codes and standard informationinformation
• with concept dictionary at its core which with concept dictionary at its core which stores all diagnoses, tests, procedures, stores all diagnoses, tests, procedures, drugs and other general questions and drugs and other general questions and potential answerspotential answers
• client-server application and works best in a client-server application and works best in a networked environmentnetworked environment
m-Healthm-Health
• Mobile healthMobile health• Cellular phone technologiesCellular phone technologies– SMS or Text MessagingSMS or Text Messaging– MMS Picture MessagingMMS Picture Messaging– ChatChat– Voice Mail ServerVoice Mail Server– Broadcast MessagesBroadcast Messages– Global Positioning SystemGlobal Positioning System– Special programs like Txt2medlineSpecial programs like Txt2medline
Txt2medlineTxt2medline
• System for processing incoming Short System for processing incoming Short Message Service (SMS) queries, retrieving Message Service (SMS) queries, retrieving medical journal citations from medical journal citations from MEDLINE/PubMed and sending them back to MEDLINE/PubMed and sending them back to the user in the text message formatthe user in the text message format
• Size of text in journal citations and abstracts Size of text in journal citations and abstracts is reduced using a database of medical is reduced using a database of medical terminology abbreviations and acronyms terminology abbreviations and acronyms (because of the 160-character per message (because of the 160-character per message limit of text messages)limit of text messages)
How Txt2medline worksHow Txt2medline works
How Txt2medline worksHow Txt2medline works
• The mobile device sends a text message to NLM’s The mobile device sends a text message to NLM’s GSM modem (240-461-7765) through a wireless GSM modem (240-461-7765) through a wireless carrier.carrier.
• The SMS center processes the incoming message The SMS center processes the incoming message and forwards it to PubMed.and forwards it to PubMed.
• Using PubMed’s E-utilities, message abbreviation Using PubMed’s E-utilities, message abbreviation and “the bottom line” (TBL) algorithm, the journal and “the bottom line” (TBL) algorithm, the journal citation is retrieved and processed to the SMS citation is retrieved and processed to the SMS format.format.
• SMS center sends out the text message through the SMS center sends out the text message through the GSM modem or sends to the user as e-mail.GSM modem or sends to the user as e-mail.
• Mobile phone receives search result as a text Mobile phone receives search result as a text message.message.
Conversion of abstract to TBL (the Conversion of abstract to TBL (the bottom line) summarybottom line) summary
The system uses an The system uses an algorithm that reduces algorithm that reduces citation size by 77.5 ± 7.9%.citation size by 77.5 ± 7.9%.
Sample view of textSample view of text
National Epidemiology CenterNational Epidemiology Center• Epi InfoEpi Info
– allows rapid setup of new entry forms and data files, easily allows rapid setup of new entry forms and data files, easily customized data entry, and many data management and customized data entry, and many data management and analysis techniques. analysis techniques.
• Epi MapEpi Map– displays counts or rates on geographic maps supplied or displays counts or rates on geographic maps supplied or
drawn on the screen. Colors, shading, dots, or drawn on the screen. Colors, shading, dots, or noncontiguous cartograms can be used to show any type of noncontiguous cartograms can be used to show any type of numeric data related to map boundaries. numeric data related to map boundaries.
• Do EpiDo Epi– a series of educational studies and computer exercises a series of educational studies and computer exercises
designed to teach both epidemiology and the use of Epi designed to teach both epidemiology and the use of Epi Info™. An instructor's module is included.Info™. An instructor's module is included.
NESSSNESSS(National Epidemic Sentinel Surveillance System)(National Epidemic Sentinel Surveillance System)
• Network of hospital sentinel sites nationwideNetwork of hospital sentinel sites nationwide• Utilizes hospital admissions to monitor Utilizes hospital admissions to monitor
occurrence of diseasesoccurrence of diseases• Surveillance data entry using EPI INFOSurveillance data entry using EPI INFO• Analysis and reports; estimates endemicity Analysis and reports; estimates endemicity
of a disease in a given areaof a disease in a given area• Systems extensively utilized by the DOH for Systems extensively utilized by the DOH for
policy formulation and program evaluationpolicy formulation and program evaluation
PNHRSPNHRS(Philippine National Health Research System)(Philippine National Health Research System)
• proposed by Sen. Angara to address current proposed by Sen. Angara to address current health problems through researchhealth problems through research
• Build a network of researchersBuild a network of researchers• New knowledge and products through New knowledge and products through
researchresearch• Standards in researchStandards in research• Regulates public access to research Regulates public access to research
informationinformation
DOH databasesDOH databases
• HERDIN NeON HERDIN NeON - contains more than 23,000 bibliographic - contains more than 23,000 bibliographic citations with abstracts and few full-text of published and citations with abstracts and few full-text of published and unpublished local materials on health and health related topics. unpublished local materials on health and health related topics.
• MIMSMIMS - Searchable database that contains drug information - Searchable database that contains drug information such as drug interaction, images, latest drug updates, such as drug interaction, images, latest drug updates, diagnoses, patient education on drugs and medical events.diagnoses, patient education on drugs and medical events.
• Philippine e-Lib Philippine e-Lib - A catalog of theses/dissertations/research - A catalog of theses/dissertations/research from National Library, UP, DOST, Department of Agriculture from National Library, UP, DOST, Department of Agriculture (DA), and CHED.(DA), and CHED.
• Union List of Health Periodicals Union List of Health Periodicals - contains list of medical and - contains list of medical and health periodical holdings of the leading medical and health health periodical holdings of the leading medical and health libraries in the country.libraries in the country.
Other librariesOther libraries
• DOH Central Library DOH Central Library - an open stack area consisting the - an open stack area consisting the General Collection, WHO Publications and DOH Publications General Collection, WHO Publications and DOH Publications sections. There are six OPAC stations with access to Internet.sections. There are six OPAC stations with access to Internet.
• Resource Center for Health System Development (RCHSD) Resource Center for Health System Development (RCHSD) - - one-stop research site for all, with access to the full text of one-stop research site for all, with access to the full text of health system development materials, list of experts and health system development materials, list of experts and discussion boarddiscussion board
• National Epidemiology Center Library National Epidemiology Center Library - formerly Field - formerly Field Epidemiology Training Program Library (1989). Dr. Mark E. Epidemiology Training Program Library (1989). Dr. Mark E. White donated most of the library holdings. It provides White donated most of the library holdings. It provides materials and services to meet the instructional research and materials and services to meet the instructional research and extension needs of all FETP fellows and staff. extension needs of all FETP fellows and staff.
Nursing Informatics developmentsNursing Informatics developments
• Curriculum modificationCurriculum modification– CMO No. 5 s 2008CMO No. 5 s 2008– CMO No. 14 s 2009CMO No. 14 s 2009
• Faculty developmentFaculty development– Association of Deans of Philippine Colleges of Association of Deans of Philippine Colleges of
Nursing (ADPCN)Nursing (ADPCN)– Philippine Nursing Education Academy (PNEA)Philippine Nursing Education Academy (PNEA)– Informatics seminars in schoolsInformatics seminars in schools
• Online Nursing Informatics CoursesOnline Nursing Informatics Courses• In-house NI trainingIn-house NI training• Deployment of nurses in the rural areasDeployment of nurses in the rural areas
CMO No. 5 s 2008CMO No. 5 s 2008
Faculty development programsFaculty development programs(ADPCN and PNEA)(ADPCN and PNEA)
• Develop core competency of the nursing Develop core competency of the nursing faculty in handling and managing NI course faculty in handling and managing NI course syllabussyllabus
• Develop critical mass of certified nursing Develop critical mass of certified nursing informatics instructorsinformatics instructors
• Adoption of FOSS as preferred platform for Adoption of FOSS as preferred platform for NI course deliveryNI course delivery
Philippine HospitalsPhilippine Hospitals
• Most tertiary hospitals (government and Most tertiary hospitals (government and private) have automated healthcare private) have automated healthcare information system (HIS) information system (HIS)
• A handful of tertiary hospitals have A handful of tertiary hospitals have automated information systems up to automated information systems up to order order entry-results reportingentry-results reporting level of functioning level of functioning
• Increasing number of accreditation with Increasing number of accreditation with international standard organizationsinternational standard organizations
Some Health Informatics GroupsSome Health Informatics Groups
• PMIS PMIS (Philippine Medical Informatics Society)(Philippine Medical Informatics Society)
• PNIA PNIA (Philippine Nursing Informatics Association)(Philippine Nursing Informatics Association)
Government in eHealthGovernment in eHealth
• COMSTE – Commission on Science and Technology COMSTE – Commission on Science and Technology and Engineering (Angara)and Engineering (Angara)– catalyst in upgrading e-health in the countrycatalyst in upgrading e-health in the country
• ERDT (Engineering Research and Development of ERDT (Engineering Research and Development of Technology)Technology)– low cost biomedical devices and ICT technologieslow cost biomedical devices and ICT technologies
• DICT (Department of Information and DICT (Department of Information and Communication Technology) proposedCommunication Technology) proposed– permanent entity that promotes ICT utilization and to permanent entity that promotes ICT utilization and to
effectively coordinate and implement national and local ICT effectively coordinate and implement national and local ICT servicesservices
• National Telehealth Service Act of 2009 (Abaya)National Telehealth Service Act of 2009 (Abaya)– Deployment of a telehealth system across the countryDeployment of a telehealth system across the country
Regulatory LawsRegulatory Laws
• Standards of medical and nursing practice Standards of medical and nursing practice • RA 9239 - regulation of mastering, RA 9239 - regulation of mastering,
manufacture, replication, importation or manufacture, replication, importation or exportation of optical mediaexportation of optical media
• RA 8293 - Intellectual Property Code of the RA 8293 - Intellectual Property Code of the Philippines ActPhilippines Act
• PD 49 – protection of intellectual propertyPD 49 – protection of intellectual property• Article 189 of the revised penal code – unfair Article 189 of the revised penal code – unfair
competitioncompetition
Issues in Health InformaticsIssues in Health Informatics
• Initiatives and support gradually picking up Initiatives and support gradually picking up in government sector and private sectorin government sector and private sector
• Compliance no. 1 obstacle in government Compliance no. 1 obstacle in government sectorsector
• Budget constraints no. 1 obstacle in private Budget constraints no. 1 obstacle in private sectorsector
• Future of HI is bright with constant support Future of HI is bright with constant support from the government and non government from the government and non government organizationsorganizations
““Investments in telehealth are reflected in the Investments in telehealth are reflected in the government appropriations acts (GAA) of 2009 and government appropriations acts (GAA) of 2009 and 2010. These projects will be expected to launch in 2010. These projects will be expected to launch in the latter part of 2010 and will require the hiring of the latter part of 2010 and will require the hiring of many health informatics professionals to do work in many health informatics professionals to do work in areas such as electronic health records, e-learning areas such as electronic health records, e-learning for health and telemedicine.”for health and telemedicine.”
(Marcelo, 2010)(Marcelo, 2010)
