CHITS as a Clinical Decision Support System

There are 6 parameters that has been set in evaluating the CHITS:

a.     Ease of Use

b.     Completeness

c.      Longitudinal tracking of patient

d.     Compatible with the DOH programs

e.     Generation of Reports

f.      Adherence to the WHO standards of a good data quality

Data Element: CHITS	Comments
Patient Queue	CHITS utilizes a queue, it lists down the patients who went to the RHU for their services for the day.
Patient Search	The PATIENT SEARCH on CHITS requires only 2 characters to search for the patients, that shortens the time to look for the health profile of the patient,
ECCD	All options under this module are complete from the ECCD program (immunization, delivery information, NBS, childcare remarks, patient info, service record - vit A, iron and deworming, dental services and breast feeding). Chart of weight for age, length for age and weight for length CHARTS is also available.
General Consults	The General Consults Module shows the DOH programs that the patient is currently enrolled, the doctor can view the flow of the patients and which needs his attention, it shows the patient’s chart which includes the anthropometric measurements of the patient which can automatically computes the Body Mass Index of the patient. This can alert the Health worker if the patient needed to be taught on possible risks of improper BMI. Vital signs can be entered on this module, when the archive button is clicked the history of VS will be shown. Medical History, pertinent medical condition can be added through a tick box. The complaints and complaints note can be utilized when triaging the patients. ICD 10 can be search and selected automatically and under the complaint notes can be used as free text space where the HW can type in verbalized (subjective) complaints of the patient. History of present illness, Physical exam, diagnosis and treatment plan have a features a template that can be utilized by the health worker on head to toe, systems assessment, while the diagnosis and treatment plan templates are useful for the physician. The prescription and other instructions of the doctor can be updated on this module, this can be viewed by the pharmacy or the drug dispenser.
Dental Module	Show the presence Dental Caries Gingivitis/ Periodontal, Disease, Debris, Calculus. Abnormal Growth.Cleft Lip/ Palate and Others and numbers of Permanent Teeth Present No. of Decayed Teeth (D) Total DMF Teeth No. of Temporary Sound Teeth No. of Missing Teeth (f), Show dental condition of the patient according to the dental health module of the DOH.
Screening Report, Special Consult Forms, PIDSR Case Report forms	Under Forms module of CHITS – Screening Report, Special forms and PIDSR forms can be accessed and utilized for reporting. NCD monitoring form can be added on the patients health record, as well as the disability record, primary preventive services for health promotion and education services report can be updated when the patient joined these services. Risk assessment can be updated and be utilized by the health workers for preventive medicine.
Maternal Care Program	All data elements on ClinicSystem is on CHITS.  CHITS user interface features the obstetric clinical picture of the patient in one page including all the pertinent services that a parturient patient needs.
National Leprosy Program Module	The leprosy module on CHITS includes the Drug Collection Chart, Household collection chart, PE, Med Hx and the Diagnostic and Treatment details for leprosy
Family planning Program Module	CHITS features a full assessment pertinent to the enrollment of a patient to this program, when completed, the patient may be referred to the physician if risk factors are ticked and if the health worker assessment needed to be seen by the physician.
Laboratory Module	In the laboratory module of CHITS, request and results can be updated and viewed
Dispense Drugs	CHITS Drug Dispense Module’s feature – it is shows the history of all prescribed, dispensed and administerd to the patient. It can be updated in the general consults page under the treatment and diagnosis.
National TB Program Module	All feature and data elements of ITIS.

Upon observation, the Healthworkers are confident and comfortable in using CHITS as their EMR even at the point of care. This study was made to check the completeness of the data elements of CHITS, all data elements mainly on the demographics – are complete. With these elements present on CHITS, longitudinal tracking of the patient’s health may easily be monitored using CHITS.  Moreover, CHITS modules are compatible with the existing programs of the DOH, up until the reporting.  CHITS is being developed with WHO’s definition of good quality data: ¹

Accuracy and validity – of the original source data;

Reliability – data are consistent and information generated is understandable

Completeness – all required data are present

Legibility – data are readable

Currency and timeliness – data are recorded at the time of observation

Accessibility – data are available to authorized persons when and where needed;

Meaning or Usefulness – information is pertinent and useful

Confidentiality and Security – both important particularly to the patient and in legal matters

CHITS was designed to work in sync with the workflow of the RHU.  Moreover, it was designed to be used at the point of care. CHITS gives alerts on risks and reminds the health worker to ask all the pertinent question to the patient and the patients can be grouped under their family folders and data quality checking is definitely lessened – these are just some of the features of CHITS.  CHITS user interface follows the normal patient’s chart – for easy monitoring.

CHITS is an electronic medical record currently being used by many regional health units nationwide. Think of a clinical scenario and suggest a clinical decision support system embedded within CHITS to address this.

Rural Health Units and Health Centers cater to primary and preventive care, mainly public health care service delivery.  CHITS has been used, maintained and continuously being developed for the use of RHUs and Health Centers.  CHITS is an ICT solution that is geared for better health care outcomes through ensuring the quality of the data, ease of use, job fit and meets the needs not only the health workers but the stakeholders who have so much impact on the decisions they make for their communities.

According to the WHO, Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases.

For CHITS be able to obtain its main objective of improve the quality of health (of the community/public), it must support the needs of the health workers on retrieving data for decision making at their level, and the stakeholders like the Provincial Level health officers, the local chief executives, etc.

A scenario that I think is fit for CHITS is community health care scenario.

The scenario would involve an urban community that for a period of 2 weeks, 3 neighboring health centers has been catering to school age children who has Dengue.

Data elements that are pertinent on this scenario are

Age of the Children

Address

Where can we get these data?

Weekly morbidity reports that can be aggregated by barangay

Possible decision of different stakeholders

health workers – field work – the health health workers determine the barangays where the children are living or spending time like the school, they would find out that there is a “artificial pond” in the school where these children of the three barangays are attending.

The healthworkers would then use the morbidity report and use visual tools to explain the scenario to the school officials and the possible solutions for the problem.

School officials, using the information from the health workers, will then decide to agree on the solution provided by the health workers. However the school is highly dependent on the funding from the local government unit.

Local government unit will be met by the health workers and the school officials and explain their case, and provide the data, and the possible solutions. The LCE will then decide how can he provide assistance (funding, resources and manpower).

PROBLEM RESOLVED through good data (easily retrievable data)

On a patient level, CHITS CDSS features would be,

The vital signs data field – the data is charted for easier checking on fever

There are templates for the planning the treatment, for dengue the template on CHITS would be

“-Meds:

Paracetamol __ mg/ml every 4-6 hours

-Non-pharma:

Tepid Sponge Bath

Watch out for: black vomitus, abdominal pain, skin petechiae

Follow up in 2 days if fever persists or child show signs of bleeding

-Advised.”

This text is editable, but having this template makes it easier for the health workers be guided on planning the treatment of the patient.