NCM 104

CHN 1
MODULE 5
New Technologies Related to Public Health
Electronic Information

MARIA CORAZON LOURDES C. LUCIN, RN,MAN,LPT

SUBJECT INSTRUCTOR

[Pick the date]

New Technologies Related to Public Health Electronic Information
Innovations in health care are continuously introduced. Health care providers apply best
practices from latest researches and use appropriate tools to enhance the quality of health care
delivered.

Patients appear to become more engaged in their care (Rozenblum and Bates, 2013),
through information available on the Internet, radio, and television. Communication problems
between patients and health care providers, brought about by geographical disparity, are easily
solved by mobile phones. Computers are used to store, retrieve, and process important health
data for better decision making. Information and Communications Technologies (ICTs) are
becoming indispensable tools in addressing some challenges in health care.

ICTs are defined as, “diverse set of technological tools and resources used to
communicate, and to create, disseminate, store and manage information.” These technologies
include computers, the Internet, broadcasting technologies (radio and television), and telephony
(Blurton 2002).

What is Health?

eHealth is the use of ICT for health (world Health Organization, 2012). On May 25, 2005,
during the Fifty-Eight World Health Assembly (WHA), 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).

Given the extensive, capabilities of ICT, eHealth can be considered in any of, but not limited
to the following:
 Communicating with patient through a teleconference, electronic mail (e-mail), short
message service (SMS).
 Recording, retrieving, and mining data in an electronic medical record (EMR).
 Providing patient teachings with the aid of electronic tools such as radio, television,
computers, smartphones, and tablets.
eHealth, often confused with telehealth or telemedicine, is the overall, 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.
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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 eHealth practitioner to know the importance and difference between the two.

Data are the fundamental elements of cognition (Gudea, 2005), and are defined as
unanalyzed raw facts that do not imply meaning. When meaning is attributed to data and when
data are processed and analyzed, then data become information.

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. Rosemarie. Number 39 now has a meaning to the nurse and has
become information. Based on the nurse’s knowledge that Rosemarie’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 health care system builds heavily on accurate recording of obtained data. 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 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 compromised as
information is not readily available and up-to-date on a daily basis.

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 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 similar health 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 concerns 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 as is an important way in which to better illuminate how
humans interact with their environment to create or deter health (Ricketts, 2003).
2. 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.
3. Redundancy of data is minimized.

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 Patient data that are frequently required in various health forms such as unique
identifying information (e.g., 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.
4. Data for clinical research becomes more 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.
5. Resources are used efficiently.
By making patient information more readily 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 in reduced transcription
costs through point-of-care documentation and other structured documentation
procedures (Menachemi and Collun, 2011). In developing countries, health care
information systems have been driven mainly by the need to report aggregate statistics
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).

Good data qualities

The nursing process begins with obtaining data through assessing the patient’s signs and
symptoms. These data are interpreted by the health care professional into useful information and
a diagnosis. This is then followed by necessary interventions and again ends with gathering new
data from evaluating the results. Without data, it will be difficult for a health professional to
assist the patient.

Human error, viruses, bugs, and hardware issues pose a great threat to the integrity of
data. ICT can help decrease these errors by putting safeguards in place, such as backing up files
on a routine basis and error detection (mcGonigle and Mastrian, 2009). In order for information
to be valuable, data must have the following characteristics (Abdelhak et al., 2012):

1. Accuracy. This ensures that documentation 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 electronic systems, format requirements must be followed (e.g., if date
required is mm-dd-yyyy, then it should be presented as 03-24-1989).

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 2. Accessibility. This is a data characteristic which ascertains data availability should the
patient or any member of the health care staff needs it. An example is readily available
reports or statistics when needed by decision makers.
3. Comprehensiveness. Data inputted should be complete. This is done by making sure
that all required fields in the patient’s record are properly filled up.
4. Consistency/reliability. Having no discrepancies in data recorded makes it consistent.
This means that when John Lloyd Dela Cruz is written on the first page 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. Currency. All data must be up-to-date and timely. This is exemplified when the
community health nurse records data at the point-of-care or when it happened.
6. Definition. Data should be properly labeled and clearly defined. For example, 36is just
an ordinary number unless it is labeled as an age of a person.

eHEALTH SITUATION IN THE PHILIPPINES

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 internet services in the

Philippines create a promising ground for eHealth access. In 2001, roughly 2.5 % of the
country’s population had Internet access. In the span of 10 years, this rate steadily increased to
29% (International Telecommunications Union, 2011). The Philippines has also a mobile phone
penetration rate of 80%, with 73 million subscribers as of 2009. In addition, the country is
ranked first in terms of short messaging service (SMS) usage in the entire world (BusinessWire,
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, 2012d).

Factors affecting eHealth in the country

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 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

The budget allocation for health care is relatively small. This is one of the many reasons
advancements in eHealth are postponed. ICT projects usually require a huge budget, take a long
period to implement and are occasionally seen as risky endeavors.

An example of a “failed” eHealth project was the United Kingdom’s National Health
Service (NHS) National Program for IT (NPfiT), which was launched in 2002 with a budget of
£11.4 billion. The objective of the program was to “ensure every NHS patient 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 NPfiT as it was regarded as incapable of
meeting its target objective, given the limited available remaining resources.

The emergence of free and open source software

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 software to remain locked in to the seller’s 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.

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 A perfect example of a successful FOSS for health in the Philippines is the Community
Health Information Tracking System (CHITS), currently managed by the University of the
Philippines Manila-National Telehealth Center (UPM_NTHC). Interested software developers
and students from UP Manila, taking into consideration recommendations of community health
professionals, are able to contribute to the development and improvement of CHITS because its
source code is made openly available (UPM-NTHC, 2012a).

Decentralized government

Under RA 7160 or the Local Government Code of 1991, local government unit (LGUs)
are autonomous, and therefore in control of their own basic health services, including the budget.
Because of this, it is typical to see diverse and unrelated eHealth projects developing all over the
country such as the Wireless Access for Health (WAH) in Tarlac, the Secured Health
Information and Network Exchanged (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. But unifying and
harmonizing the different existing systems for this future benefit, though not impossible, will
expectedly be difficult.

Target users are unfamiliar with the technology

eHealth is not only about technology. Along with software development and hardware
procurement, staff training and maintenance of the system are key factors in determining its
effectiveness. Recognition of the cultural aspects of community life is important in starting them
off into a new direction such as computerization and automation (IDRC, 2009).
One possible pitfall of eHealth implementations 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 eHealth and telemedicine occur to communities when the technology
present 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).

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 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 eb-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 lesson learned from the early BuddyWorks experience, the project switched to
the use of technology that is more appropriate to Filipinos-mobile phones. The switched 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 too long ago we had nothing to think about except the board exams. And before that,
we 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.

I 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 article “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).

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 One of the measures of the DOH to address the accumulation of unemployed professional
nurses is the Registered Nurses for Health Enhancement and Local Services (RN Heals) Project.
It aims to provide nurses with one year employment in underserved and remote areas in the
country as well as to provide underserved areas with additional 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 in its use of eHealth specifically affects

community health will be taken up in greater detail in the next section.

USING eHEALTH IN THE COMMUNITY

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 archipelagic distribution of the country-with7,107 islands-
makes health care delivery even more challenging.

A series of health reforms have been implemented. The DOH, through Administrative
Order No. 2010-0036, outlined the policy directions of Universal Health Care. Also known as
Kalusugan Pangkalahatan (KP), this reform agenda has three priority health directions:

1. Financial risk protection through expansion in National Health Insurance Program

enrolment and benefit delivery
2. Improved access to quality hospitals and health care facilities
3. Attainment of the health-related Millennium Development Goals (MDGs)

One of the aims of KP is to attain efficiency by using IT in all aspects of health care.
One of the key instruments it underlines is the use of Health Information to establish a
modern information system that shall provide evidence for policy and program development and

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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

EMRs are basically comprehensive patient records that are stored and accessed from a
computer or server. Community health centers have the capacity to rapidly adapt EMRs because
they utilize a standard process nationwide. For example, the workflow with a 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 its own system of documentation. Even government-
owned hospitals do not have a standard system of health service provision and of maintaining
patient records. This difficulty in implementing information systems in the health sector
highlights the importance of creating standards.

Another reason EMRs are vital to community health centers is that each patient record is
usually used more frequently. For instance, a patient undergoing treatment for tuberculosis
needs to make regular visits to the health center for TB_DOTS (Tuberculosis Directly-Observed
Treatment 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 certain diseases and provide
appropriate health promotion and prevention measures.

Ideally, 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 patterns
and health indicators within their catchment area. Vital statistical indicators such as mortality
and morbidity rates must come 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.

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 One of the most widely used community-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 and on-site follow-ups of the health workers were done. This resulted in EMR
features that are customized to the needs of the health center and 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.

Telemedicine

One of the five strategic goals of the DOH’s National eHealth Strategic Framework for
2010-2016 is to capitalized on ICT. This in order to reach and provide better health services to
geographically isolated and disadvantaged areas (GIDAs), to support MDG attainment, and to
disseminate information to 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
diseases 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. 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.

In the Philippines, the UPM-NTHC has been using telemedicine to provide health
services to remote and underserved areas of the country since 2004. It is a partner of the DOH in
the Doctors to the Barrios program. It enabled Municipal Health Officers to teleconsult difficult
cases with trained telehealth medical specialists via SMS or e-mail. The teleconsults, which are
received by a server, are then triaged by the NTHC telehealth nurses to appropriate medical
specialists.

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 In collaboration with the Philippine Council for Health Research and Development of the
Department of Science and Technology (DOST-PCHRD), the BuddyWorks project of UPM-
NTHC was continued from 2007 to 2010 as the national Telehealth Service Program (NTSP)
(PCHRD-DOST, 2011).

A specific example of how telemedicine was applied in the community was the discovery
of a rare skin disease called tinea imbricate in a tribe from Kiamba, Saranggani in Mindanao.
The Municipal Health Office of Kiamba, Saranggani referred multiple cases of strange, ring-like
formations on a patient’s skin. Images were sent to the UPM_NTHC telehealth nurse and were
referred to a dermatology specialist at the Philippine General Hospital, who gave the initial
diagnosis of tinea imbricate-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 dermatologist in cooperation with the local government of Kiamba to help the patients
affected by the disease.

As can be seen from the 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 in not a universal solution and may be applicable only in 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.

eLearning

Health education, which is essential in health promotion and maintenance can be

facilitated by ICT.

eLearning is basically the use of electronic tools to aid in teaching. It can be done
synchronously, asynchronously, or in a combination of both. This can be in the form of simple
instructional videos and information textblasts to social network help groups and interactive
simulations. eLearning can be especially useful in correcting misconceptions about health and
health care. It permits access to reliable information about health. For example, control of
communicable diseases frequently requires community participation. With the use of eLearning
technology, community health nurses can elicit community interest by showing instructional
videos on measures to control a particular disease.

eLearning can also be used to educate fellow health professionals. With eLearning,
continuing education sessions can be frequently availed of, with less time, effort and expense
involved in the process. Continuing professional education of nurses can be undertaken by

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attending online and virtual seminars through teleconferences and multiuser virtual
environments.

Examples of eHealth projects in 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.

ROLES OF COMMUNITY HEALTH NURSES IN eHEALTH

Community health nurses’ roles are significantly diversified by eHealth. With the advent
of eHealth, nurses are made available to several clients at a single time, making health care
delivery more efficient. Advances in IT may also help the nurse in optimizing efforts towards
maintaining an open line of communication with clients, paving the way for establishing and
maintaining rapport. IT 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 nurses-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:

Data and records manager

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
participate in regular data audits.

Change agent

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 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 appropriate ICT tools.

Change 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 build on the baseline eHealth knowledge and help develop
appropriate eHealth tools for the community.

Table 15.1 eHealth projects in the Philippines used in community health practice
Name Type Key information
BuddyWorks Telemedicine and - Implemented in 2004 by the University of the
eLearning 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 send telereferrals

to medical specialist at the Philippine General Hospital
(PGH) via short message service (SMS) and e-mail.
CHITS (Community Electronic medical - Developed in 2004 by Dr. Herman Tolentino of the
Health Information record UPM College of Medicine-Medical Informatics Unit
Tracking System) (MIU). Project initially began in Pasay health centers
and has been implemented in more than 48 health
centers since then.

- Program is divided into different modules based on

existing DOH programs (EPI, NTP, etc) and is a Free
and Open Source Software (FOSS)

- A demo of CHITS can be accessed online at

https://demo2010.chit.ph (username: user, password:
user) (UPM, NTHC 2010).

eFHSIS (Electronic Health information - An online version of the FHSIS developed by the DOH
Field Health Service system and electronic where you can upload FHSIS data.
Information System) reporting

eIMCI (Electronic eLearning - Developed in 2009 by the Ateneo Innovation Center.

Integrated
Management of - An electronic version of IMCI accessible in mobile
Childhood Illness) devices.

NTHC eLearning eLearning - Funded by the United States Agency for International
videos Development (USAID) and developed by UPM-NTHC.

- Created eLearning videos on tuberculosis, stroke, bird

flu, and child poisoning.

RxBox Telemedicine - Funded by the DOST-PCHRD and developed through

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 the collaborative efforts of the University of the
Philippines Manila-Electrical and Electronics
Engineering Institute (UPM-EEEI). University of the
Philippines Manila-National Institute of Physics (UPM-
NIP) and UPM-NTHC.

- 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.

- It is also able to store and send patient information and

allow video and chat conferencing with a medical
specialist.

SEGRHIS (Segworks Electronic medical - An electronic medical record created for rural health
Rural Health record units.
Information System
- Developed by Segworks, a local software company
based in Davao.
SHINE (Secure Health Electronic medical - An electronic medical record developed by Smart
Information Network record and SMS Communications.
Exchange) reporting
- A demo can be accessed online at https://shine.ph.

SPASMS SMS alert system - Add-on to WAH (Wireless Access for Health).
(Synchronized Patient SPASMS is an SMS reminder system for patients who
Alert via SMS) are due for follow-up.

SPEED (Surveillance Disaster management - A project of the World Health Organization (WHO) and
in Post Extreme and SMS reporting the Department of Health – Health Emergency
Emergencies and Management Staff (DOH-HEMS).
Disasters)
- Allows community health nurses to submit daily reports
of prevalent diseases immediately after disasters via
SMS, e-mail, and other information and communication
technologies.

- SPEED also sends immediate notification alerts (INAs)

to community health nurses for possible outbreaks based
on available data.

WAH (Wireless Health information - Implemented in 2010 in the Tarlac province through the
Access for Health) system and electronic Public-Private Partnership (PPP) of Qualcom, Center for
medical record Health Development (CHD) Region III, RTI
International, National Epidemiological Center (NEC),
Tarlac State University, and the local government.

- WAH augmented the existing CHITS by connecting

health centers through broadband Internet access.

- WAH Website: sites.google.com/site/wahphil.

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Educator

Nurses provide health to individuals and families through ICT tools (e.g., teleconference,
SMS, e-mail, and virtual/stimulated environment). They may also participate in making
eLearning videos on specific diseases (e.g., diabetes mellitus, tuberculosis), which the patients
can watch during their waiting time at health centers. Such videos may also be installed in the
client’s 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,
telemedicine, and other eHealth tools. Nurses must ensure that personal and health information
handling through eHealth (i.e., collection, storage, and transmission) is well explained. Clients
must sign an informed consent, if necessary.

Nurses must also guarantee that all eHealth interventions are performed in a safe and
ethical manner, making sure that personnel involved in eHealth are competent and have received
eHealth training/certification.

Researcher

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 Using eHealth tools (e.g., 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 a 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.

Answer this:

Make a summary of the topic above. It should not be less than 2 pages of a long paper size.

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