Connect and Communicate

Week 10 Assignment: Standards and Interoperability

Scenario 4

Several city and municipal health units in Zamboanga have a basic EMR called BasicHealth. DOH wants to get all cases of Hypertension, Diabetes Mellitus and Cancer for their national registry. The DOH registry is an online system using software called RegistryTech.

1. State the scenario you chose. Why did you choose that scenario?

Scenario 4 is a very familiar setting for my line of work. The organization where I currently work, is a proprietor of an electronic medical record that is “community” in nature. This EMR has a feature that consolidates everything from TCL’s (Target Client Lists), Philhealth reports down to mortality and morbidity reports. This information is very essential to community health centers/ units. It provides them the number of people that availed their services and at the same time count the commodities that they disbursed for inventory purposes. For national institutions like the Main DOH and CHD’s, this information is vital for decision support. It can immediately pin point what areas are lacking particular medications or services through identifying the red areas from the gathered reports from the primary care level. The decision support feature of each EMR can also be utilized the primary care units and provincial health offices. They can be alerted upon seeing the results and they can act on it immediately by allocating the needed services and medications focusing on a particular alert area.

2. What organizations/entities are involved in the scenario?

 

a. The Barangay Health Stations- manned by designated Health Stations heads (midwives, nurses or Rural Health Physicians (for large catchment areas))

b. The City and Municipal Health Offices- headed by the Municipal Health Officer, manned by the RHU main staff (dentists, nurses, midwies, medtechs, etc.)

c. The Provincial Health Office of Zambaonga- headed by their PHO, manned by PHTL (Provincial Health Team Leaders / supervisors)

d. The Region IX Health Office/ CHD- lead by the Regional Director, manned by supervisors

e. The DOH main office- Secretary, undersecretaries, assistant secretaries of health

f. The national government- congressional and senate committees on health and the president    

3. What applications within the different organizations need to talk to each other?

I prefer a canonical data transfer (from grassrootsàMHOàPHOàCHDàNational) rather than from the MHO to National level bypassing the PHO and CHD. The reason why I am an advocate of this method is that the next higher level offices can validate and act on this data immediately having a more accurate data as a result.

a. The BasicHealth installed on a local server in the BHS (Barangay Health Stations) should consolidate all the hypertension, DM and cancers within their assigned areas. These are forwarded in the main RHU of the municipality or city.

b. The Municipal/City Health Offices together with their data from their catchment area, gathers the forwarded information in their BasicHealth municipal server.

c. The Provincial Health Office that is using BasicHealth Dashboard for data consolidation collects all the reports from the municipalities of Zamboanga (given the scenario that the all Zamboanga municipalities and cities are using BasicHealth as their EMR). From here standards should be involved.

d. The Regional Health Office or the CHD of Region IX receives all the provincial reports, including Zamboanga’s. They are also using the iClinicsys Report Consolidator (not stipulated in the scenario) as their collecting system. All the regional CHD’s will submit the collected data of the provinces. They are forwarded to the DOH main office in the RegistryTech main server.

e. The DOH secretary and other concerned officials (including the president) have a RegistryTech Dashboard (not stipulated in the scenario) for viewing all the data submitted by the regions in one click or view. 

4. List 3–5 specific project goals for making the organizations/applications talk to each other.   

a. All units should be connected to the internet.

b. Follow the standard operating procedure of submitting reports.

c. Avoid duplication of data. Follow-up check-ups of the same the patient with the same disease should be tallied as one in the reports.

d. CHO/ RHU inventory should be included in the reports.

e. Patient demographics should be accurate.

f. Make sure that data is encrypted before data transfer.  

5.  List 5–10 data elements that should be transferred.  

Each application (BasicHealth, iClinicsys and RegistryTech) should have the same format of the different registries.

A.  Patient ID

B.  Patient demographics (Fullname, Age, Gender, Address, Birthday)

C.  Facility ID

D. Terminologies for diagnosis (ICD10)

E.  Medication Codes (PNDF)

F.  Services (DOH vertical programs, i.e. Non Communicable Diseases (NCD))

6. At what point (activity or event) in the process should the transfer of information happen, e.g patient discharge, after clinic visit?

For BHS, CHO/MHO BasicHealth- transfer of information should happen in real time. During admission interview, service rendering and medication dispensing, data gathered. The entire data will be saved and summarized as an encounter during “end consultations”.

For the levels of data submission:

a. BHS submits reports electronically to CHO/MHO on a daily basis before office hours ends.

b. MHO to generate and verify data submitted. Weekly submission of reports to PHO should be done.  

c. Verification and submission of reports o regional level should be accomplished by the Provincial Health Office bi-monthly. 

            d. Regional consolidation should be done and be submitted to national level monthly.

7.  At what point in the application/software process should the transfer of information happen?

Figure 1 narrative:

The data should be summarized after “End consultation”. It will be saved in the CHO/MHO’s local server after submission and synching of BHS reports. The reports for NCD (hypertension, cancers, DM) will be generated and will be forwarded to the Province of Zamboanga’s BasicHealth server. Data should be encrypted to add more protection to the raw data. The province’s BasicHealth Dashboard should not have a problem reading the encrypted data from the primary level since they have the same coding with that of BasicHealth EMR. After verification and clearing, it will be encrypted again and forwarded to the CHD’s iClinicSys. Given that it is compliant to the agreed HIE standards, iClinicsys Report Consolidator server should be able to recognize the encrypted data as its own. Data will be again subjected to verification and clearing before forwarding to DOH main RegistryTech server. The RegistryTech dashboard usually held by DOH and Government officials will be updated real time.