By Jennika Simbillo
“Just as the Public Health Nursing bag is a tool in Community Health Nursing, a notebook or an iPad with Community Health Informatics Tracking System will be next tool in fostering healthcare among Filipino communities.” – University of the Philippines-National Telehealth Center
Intensifying the vision of being future nurses in the profession, senior students of University of Santo Tomas College of Nursing organized and attended a colloquium entitled, A Seminar on Health Informatics: Putting Health in the Hands of the People, last August 11 held at the St. Martin de Porres (Medicine) Cinematorium, St. Martin de Porres Building. The University of the Philippines-National Telehealth Center (UP-NThC) was invited for the whole-day event, organized by Sections 2, 4, 7, 8 and 9 in line with the Nursing Management course.
e-Health, Telehealth and Health Informatics
According to Alvin B. Marcelo, M.D., Director of NThC, Telehealth and Health Informatics are sub-domains of e-Health, which is under Global Health. Telehealth involves communication between two points, while Health Informatics comprises decision support systems, surveillance systems and electronic records. Dr. Marcelo stated, “This is actually a seminar on e-Health,” not solely on Health Informatics.
Health Informatics was introduced in Asia Pacific countries, including Pakistan, Indonesia, Malaysia, and the Philippines, through Professor Richard Scott of the University of Calgary. The Philippine standards were proposed by Dr. Marcelo through a letter to the Department of Health (DOH), but it was ignored on the first scheme. The current recognized standards include the International Classification of Diseases 10 (ICD10), a World Health Organization (WHO) standard for diagnoses. The NThC team affirmed that the “most successful standard in this generation is the internet.”
An overview of the NThC programs and projects, collectively dubbed as One Network for e-Health or simply OneHEALTH, were elucidated by Alex I. Gavino, M.D., coordinator of NThC. Since health is inaccessible in our country, they established the said program “to improve the health of Filipinos through the optimal use of information and telecommunications technology.”
The PHN bag replaced with an iPad
Dominantly, health information management is “slow because it is complex.” Some reasons why some institutions do not shift to electronic medical records (EMR) include the HIS’s expensive cost, the diverse models of EMRs, and the reluctance of senior health professionals. As a solution, NThC introduced the Free and Open Source Software (FOSS), the Community Health Information Tracking System (CHITS), Open Medical Records System (OpenMRS), and iPath. “Use FOSS-based HIS while your staff nurses go through the learning process,” Dr. Marcelo said. “It requires customization and you can hire anyone you wish to maintain your system.”
Noel A. Bañez, R.N., coordinator for Primary Health Care Informatics and CHITS, stressed that CHITS is the emergence of Community Health Nursing (CHN) and Nursing Informatics. It would “close the loop” by empowering the community to analyze their data. The Commission on Higher Education (CHED) Memorandum 14 series of 2009 describes that the Nursing Informatics course should have a “laboratory session provided for practice application,” especially that CHITS was designed for government health centers. “Say goodbye to the brown envelopes,” Mr. Bañez said.
CBA project coordinator and OpenMRS trainer Jonathan D. Galingan, M.D. enumerates the advantages of OpenMRS: free, web-based, JAVA-based, modular, forms-based and scalar. Developed by Regenstrief Institute Inc. and partners in health in 2004, OpenMRS is used for 30 years in 20 countries including South Africa, Haiti, China, and the US. This is “to create self-reliant implementation networks within resource-constrained environment.”
Started in University of Basel in Switzerland for Telepathology, iPath is a system which is similar to the famous social network Facebook. Paul Nimrod B. Firaza, M.D., showed the iPath page which allows users to comment and upload pictures on existing cases. He reminded that Ethical Principles apply in the utilization of the system because everyone can freely react to the cases and at times, it becomes a window for chatting. Dr. Firaza quoted St. Thomas Aquinas: “All the efforts of the human mind cannot exhaust the essence of a single fly.”
Mapping for health was underlined by chemical engineer Wayne Dell L. Manuel of NThC. He gave the 1854 Broad Street Cholera Outbreak as an example to show the importance of geographical information systems in health, and demonstrated online tools such as Google Map Maker and Open Street Map. Points of references in maps include satellites, images of municipal halls, churches, schools and hospitals.
Isidor F. Cardenas, R.N., a UST College of Nursing graduate and a 2nd Generation Telehealth Nurse, highlighted that “Telehealth is adjunct, not a replacement, to traditional healthcare.” He explained that the Philippines’ geographical division, the tight budget, brain drain, and the surplus of nurses may lead to the surfacing of Telehealth Nursing. There are 60,000 new registered nurses per year and these nurses may end up not practicing their profession. “Telehealth is the use of electronic information and telecommunications technologies to support long distance clinical health care,” Mr. Cardenas declared. “[One is] still [practicing] the nursing roles.” He presented the fact that “7 out of 10 die without even seeing a health practitioner.” There is really no oversupply of nurses in the Philippines since they seemingly are trained for export only. Telehealth Nursing positively provides new avenues for nurses.
Nursing Informatics is younger than Telehealth Nursing, and a specialization of the former is yet to be implemented in our country with the blessing of the Board of Nursing (BON). Dr. Marcelo finally said to the seniors, “You can listen to us the whole day, but it’s better if you download [the systems] and use them for your benefit.”
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