The Community Health Information Tracking System (CHITS) is a low-cost, open-source electronic medical record (EMR) system designed and developed for government health facilities. This system facilitates the responsiveness of public health decision-making and the improvement of effectiveness and efficiency of the delivery of healthcare services by local government units (LGUs).
Background and Problem
Since the 1990s, public health institutions have recognized the critical role of health information systems (HIS) in delivering prompt and effective health services, developing sound health policies and programs, and making informed decisions for setting public health agenda. Unfortunately, existing HIS at the time were mostly manual (paper-based) systems that required data aggregation at several levels of the health system, which made health data prone to delay, manipulation, and human error. Further aggravating these concerns in HIS was the fragmentation of the healthcare delivery system in the Philippines due to the devolution of healthcare from a monolithic health system into several independent health systems.
Solution and Impact
The Community Health Information Tracking System (CHITS), as the first homegrown EMR system in the Philippines, employs an open-source, user-friendly, modular, and extensible system that enables automation of core processes in health centers and thereby contributes to the effective and efficient delivery of services. As a digital health application, CHITS helps health centers and rural health units (RHUs) in improving the delivery of health services by facilitating efficient data entry and storage through secure access of records by healthcare workers, expediting patient record retrieval, and minimizing waiting time of patients in clinics and RHUs. It helps health program managers and local chief executives with resource allocation strategies and organizational development by helping project patient load and understanding the usage of resources. Likewise, it provides a more efficient system for appointment and follow-up scheduling and, on a broader scale, a more responsive means of monitoring the health of the community through the data it accrues daily. Additionally, because CHITS facilitates timely entry of data at the local level, it has become easier for municipal and city health offices (M/CHOs) to generate the necessary health reports they will integrate into the Field Health Service Information System (FHSIS), the official reporting and recording system of the Department of Health (DOH) of the Philippines. The availability of updated, on-the-ground information from RHUs allows them to employ inter-health center integration within their jurisdiction in order to better track patients. This integration of community health data allows them to project logistical needs, which in turn enables them to efficiently and more effectively allocate supplies and human resources at the local level. Moreover, CHITS enhances their capability to regularly review the health of communities and detect possible outbreaks.
Nationally, CHITS is electronically connected to the Department of Health (DOH) and Philippine Health Insurance Corporation (PHIC) offices. This makes it easier for the DOH and related health institutions to receive and integrate reliable and up-to-date data from the local health facilities, which then helps improve the quality and timeliness of FHSIS reports and makes for better integration of data into various health programs. Through CHITS, the data from the communities is provided to DOH in a timely fashion and allows DOH to better monitor the implementation status of health programs and administrative performances of local offices. Aggregation of available health data according to required formats becomes uncomplicated. As for PHIC-related needs, CHITS was one of the earliest EMRs certified by PHIC and has been submitting claims to PHIC electronically as per directive since 2016.
CHITS started as a research project on computer-based information systems at the University of the Philippines Manila (UP Manila) in 2004. At the time, it was only being implemented in two health centers in Pasay City. By the end of 2010, there were already 50 health centers across the country— from Batanes (Northern Philippines) all the way to the Zamboanga Peninsula (Southern Philippines)— that have begun using CHITS for their government health facilities. In 2011, CHITS expanded its features to include Real-Time Monitoring of Maternal, Child Health, and Governance Indicators (rCHITS), a tool that attempts to improve health information system management in geographically isolated and disadvantaged areas (GIDA). In 2012, CHITS revised its base system by adopting the more internationally known Open Medical Records System (OpenMRS). It also started using a mobile reporting tool and an LGU dashboard to improve the collection, storage, and analysis of health data from communities. At the time, there were already 208 local health facilities using CHITS. In 2014, through the support of a non-government organization extending funding for Philippine government eHealth projects, rCHITS was able to integrate a mobile midwife platform that can capture aggregate patient data at the barangay level and send patient alerts through Synchronized Patient Alert via SMS. The RxBox, a telemedicine device used for diagnosing common medical problems and is one of the products by the UPM-NTHC, also uses CHITS in a store-and-forward capacity.
In 2015, other innovations such as the Mag-ina Telereferral System (MInTS) were conceptualized and incorporated. The MInTS facilitates access to healthcare facilities that provide life-saving services for pregnancy and delivery by tracking referral requests when parturient mothers need to be transferred from a BEMONC facility (lying-in clinic) to a CEMONC facility (tertiary hospital) for more specialized care. In 2016, the UPM-NTHC continued to expand the geographical coverage of CHITS through city-wide partnerships with Quezon City, Pasay City, and Navotas City. By then, it had expanded to 251 sites across the country. In the same year, the CHITS software program was enhanced and upgraded into a CHITS version 3 to cater to new health sector protocols and reportorial requirements of the DOH. Several new DOH modules such as the Mental Health, HIV/AIDS, Adolescents, and Senior Citizens programs were added to the core modules as a result. It was also in 2016 when CHITS became one of the first EMRs to receive the PHIC certification for electronic Primary Care Benefits (PCB) claims submission. In 2018, this feature was expanded to include the electronic claims (eClaims) submission protocol for other cases for PHIC reimbursement at the primary care level. To date, there are 171 active CHITS-using health facilities in the country. As the UPM-NTHC continues to design, develop, test, and implement innovations in health information systems for improving the delivery of healthcare services, CHITS has continued to adopt newer standards and innovations. At present, CHITS has become a framework for other novelties such as incorporating a newborn hearing screening module for the Healing for Life project in 2017 and as part of a multi-component health information exchange ecosystem for X-linked Dystonia Parkinsonism patients in 2018.