Using Smart 3G Wireless Broadband: Automation of health care starts in Tarlac

MANILA, Philippines - After the Philippines successfully automated the voting process in the last elections, we may now be on the road to automating public health care in the country. Serendipitously, the breakthrough may take place in the home province of president-elect Benigno “Noynoy” Aquino III.

Under an initiative called the Wireless Access for Health (WAH), rural health clinics in four towns of Tarlac have been equipped with netbooks and wireless broadband connectivity so that they can computerize medical records of their patients using a locally developed open-source software and transmit vital information to health authorities.

Digitizing medical records enables these clinics to treat patients more quickly and effectively, and provides provincial and national health officials more accurate, real-time data that will support better decision-making.

“By using technology efficiently, we will improve the lives of more Filipinos. We are giving our commitment to make this project even more successful by ensuring we provide the manpower and the needed budget resources. All our mayors will increase their health spending to the USAID-recommended 20 percent per annum,” said Tarlac Gov. Victor Yap at the formal launch of the project last week.

Public-private partnership

The initiative is a multi-sectoral, public-private partnership. US wireless technology leader Qualcomm provided funding and management with the assistance of RTI International and the US Agency for International Development.

Leading cellular operator Smart Communications Inc. gave technical assistance and carried the data on its 3G network. The National Telehealth Center of the University of the Philippines supplied the electronic health record system called CHITS — or the Community Health Information Tracking System — which was further developed by the Tarlac State University to meet the requirements of the Department of Health, which provided technical assistance. Quarterbacking the whole effort was the Tarlac provincial government through its provincial health office.

Dr. Ricardo Ramos, chief provincial health officer of Tarlac, said the project “benefits the entire public health system — from patients to doctors to health care authorities at the local, regional and national levels.”

“Using 3G wireless technology, timely health information can be transmitted to health care workers, decision-makers and other stakeholders, resulting in happier, healthier communities,” added Orlando Vea, chief wireless advisor of Smart.

The initial beneficiaries of the project have been the patients and health workers at the rural clinics of the municipalities of Gerona, Moncada, Paniqui and Victoria where the Wireless Access for Health Project conducted its pilot phase. I

In these clinics, patient-handling is paperless — information regarding their health complaints or condition are directly keyed into the clinic database using netbooks and PCs.

For example, when Ana Llana, 44, a full-time housewife and mother of four, arrived at the Moncada Rural Health Unit 1 complaining about dizziness last week, clinic personnel quickly retrieved her electronic health records with a few key strokes. Her file showed that she has a history of high blood pressure that started three years ago after giving birth to her youngest child.

“Sasabihin ko ang pangalan ko tapos hahanapin lang nila sa computer. Madali lang (I just give them my name and they search for my file in the computer. It’s that simple),” Llana said. 

Electronic medical record

The electronic medical record is accessible through any of the clinic’s eight netbooks - two at the admission, another two at the nurse station, and one each for the doctor, dentist, laboratory and the sanitary inspector.

Information on the patient’s latest complaint is added to his or her electronic medical record. Depending on the complaint, a patient is referred to the nurse or doctor. After consultation, the patient’s information is again updated.

“In the retrieval of patient records alone, there is already a big change. We used to do it manually but now with just one click, we are able to get the data we need,” said Dr. Marissa Miguel of the Paniqui Health Clinic, which receives between 100 and 150 patients in a day.  

“We need dynamic and real-time data management to address the needs of the client and the service provider, as well as the local chief executive’s need to know what is happening in his area. This could be the mayor at the municipal level, the governor, and if you go up, the secretary of the Department of Health,” Ramos said.

In the past 14 years that Dr. Nelin Cuaresma-Tacasa has served as medical health officer (MHO) of Victoria, she always had to wait for the monthly report of the midwives to know the health situation in the barangays. This has changed with the advent of the Wireless Access for Health project.

“I can now check the data in the afternoon when the midwives have encoded their daily report. It is easier to see the areas where we need to improve. For instance, I can monitor if we are on track in meeting monthly targets for the expanded immunization program of the DOH, and tell the midwives to step up efforts in the barangays if we are lagging behind,” Cuaresma-Tacasa said.

A big help

For Dr. Juliet Ofiana-Cabunoc, MHO at the Gerona Health Clinic, the Wireless Access for Health project is a big help in the monthly and quarterly reports that they have to submit to the provincial health office. 

“The system automatically updates the record with every data added so that it becomes easier to prepare the reports. For example, the computer can show you right away how many patients from a particular barangay, of a specific age, developed a certain disease,” she said.

With Internet connectivity, reports can be sent via e-mail instead of the old practice of having copies delivered via messenger. 

Timely submission of a report is vital given its importance. “It is the basis for the budget, as well as the analysis and recommendation of solutions to a certain problem,” explained Cabunoc.     

She cited a report on an increased incidence of dengue that is immediately brought to the attention of the provincial health office. This allows for quick actions like a visit to the affected site and information dissemination. 

“Reports sent to our office are reviewed in terms of morbidity or incidence of the disease in an area. We then forward it to the DOH. This is the Field Health Service Information System or FHSIS report,” said Ramos.

The FHSIS is the government’s major resource for managing public health data, and is used for policy analysis and planning at all levels of the public health system. CHITS can readily generate all 23 of the health department’s FHSIS reports required in Tarlac.

“Before, our office had to collate the raw data from the rural health units, put it all together and submit it to the DOH. That took too long. Now, we don’t need to collate anymore, so it is easier to look at the reports, interpret, analyze then come up with solutions,” added Ramos.

Following the successful completion of the pilot phase of the Wireless Access for Health, the collaborators and proponents of the project are looking to replicate the project in other municipalities of Tarlac, the rest of Region 3, and ultimately the entire country.