Usability testing of the Philippine Electronic National Newborn Hearing Screening Registry (ENNHSR).

PURPOSE AND OBJECTIVES: The study determined the usability of the online and offline versions of the Philippine Electronic National Newborn Hearing Screening Registry (ENNHSR) as well as user perspectives and satisfaction on the training modules and the online and offline systems. The steps in creating the systems, training modules, and evaluation of the user training manual and video training modules, accuracy and time and motion studies on data entry as well as determination of user perspectives and satisfaction were the specific objectives. METHODOLOGY: With the combined efforts of the staff of Newborn Hearing Screening Reference Center (NHSRC), Philippine National Ear Institute (PNEI) and the National Telehealth Center (NTHC) of the National Institutes of Health UP Manila, the development of the online and offline versions of the ENNHSR took six (6) months from January 2021 to June 2021 to complete. Creation of the user manual and training modules took three (3) months from July 2021 to September 2021. The pilot of the systems was carried out in 2 Zoom Conferencing sessions with the participation of 28 existing certified newborn hearing center users with different roles, backgrounds, demographics from all over the Philippines. Written evaluation as well as focused group discussions on the training modules and the database were conducted during the sessions. Effectivity of the training modules was determined using a 10-point learning check. The time and accuracies in encoding each data field per user were also determined. RESULTS: All 28 participants were able to attend and actively participate in the required Zoom Conferencing sessions as well as submit the 2 evaluation surveys for the training modules and the ENNHSR. During the learning check 93% or 26 out of 28 passed. The surgical intervention module took the longest time to encode while the fastest module to complete was for speech therapy. The average mean time to complete all modules was 3382 s or around 57 min while the time range was between 32 and 104 min. A screener would need 18 min while an implant programmer who is a clinical audiologist would need 52 min to enter data. The accuracy in encoding patient data was 92% while hearing screening results was 88.64%. The system usability scale (SUS) score of ENNHSR was computed at 75.5 which was the average of individual SUS scores, falling within grade B or 74.1 to 77.1 as its corresponding numerical score range in percentile. Most of the participants noted that it was easy to find patient data, results and that it was streamlined with easy to track information. CONCLUSIONS AND RECOMMENDATIONS: Data gathering and analysis both play important roles in health management, policy implementation and quality assurance. We were able to uncover areas where the system performed well - effectively, efficiently, and with satisfaction. We realize that all the possible problems cannot be detected with a small number of participants and variety in information. This testing will serve as both a means to record or benchmark current usability, but also to identify areas where improvements must be made.

Real-time regular routine reporting for health (R4Health): Lessons from the implementation of a large scale mobile health system for routine health services in the Philippines

BACKGROUND: The Philippine government aims for a modern information system to enhance data quality and provide more rational evidence to support timely and efficient delivery of health care, management of health systems, programs and policy. Hence, the Real-time Regular Routine Reporting for Health (R4Health) mHealth application was developed and field tested in 246 isolated and disadvantaged municipalities to support the campaign for Universal Health Care and the achievement of the Millennium Development Goals. The R4Health collected point-of-care-specific data on services routinely provided at the rural health facilities, aggregated them and presented in a dashboard for use by program managers and policy makers. OBJECTIVE: This paper describes the use of R4Health, a mobile technology-based health reporting system. It will discuss the context of the R4Health implementation, its development and deployment to 246 municipalities in the Philippines. Furthermore, the paper sought to determine enablers and challenges to the adoption of R4Health in routine health care. METHODS: Data was collected through surveys, focus group discussions, participant-observation and review of project reports. Quantitative data was summarized using descriptive statistical methods; qualitative data underwent content analysis.    RESULTS AND CONCLUSION: A total of 515,855 R4Health reports equivalent to 48,856 patient transactions were received from 246 municipalities within a nine-month observation period, supporting the viability of the R4Health as an alternative option to the existing manual and paper based health information management to improve the quality of data. R4Health utilizes a tool that everyone is familiar with, can easily be incorporated in their workflow, can be brought and used anywhere and has an application that is clear, understandable, and easy to learn and use. R4Health data elements, however, have overlaps with other government health reporting systems and is already misconstrued to further duplicate work. More discussions are warranted to coordinate and integrate systems. Given the general positive perspectives, integration of this alternative system to the RHU workflow, an improved R4Health, has a high potential of being accepted and adopted by the first-line health workers across the country. 

Community health information and tracking system (CHITS): Lessons from eight years implementation of a pioneer electronic medical record system in the Philippines

The CHITS (Community Health Information and Tracking System), the first electronic medical record system in the Philippines that is used widely, has persevered through time and slowly extended its geographic footprint, even without a national policy. This study describes the process of CHITS development, its enabling factors and challenges affecting its adoption, and its continuing use and expansion through eight years of implementation (2004 to 2012) using the HOT-fit model. This paper used a case study approach. CHITS was developed through a collaborative and participative user-centric strategies. Increased efficiency, improved data quality, streamlined records management and improved morale among government health workers are benefits attributed to CHITS. Its longevity and expansion through peer and local policy adoption speaks of an eHealth technology built for and by the people. While computerization has been adapted by an increasing number of local governments, needs of end-users, program managers and policy-makers continue to evolve. Challenges in keeping CHITS technically robust, up-to-date and scalable are already encountered. Lack of standards hampers meaningful data exchange and use across different information systems. Infrastructure for electricity and connectivity especially in the countryside must be established more urgently to meet over-all development goals specially. Policy and operational gaps identified in this study have to be addressed using people-centric perspective and participatory strategies with the urgency to achieve universal health care. Further rigorous research studies need be done to evaluate CHITS' effects on public health program management, and on clinical outcomes.

Formulating the national policy on telehealth for the Philippines through stakeholders' involvement and partnership

The Philippine Department of Health (DOH) recognized the potentials of information and communication technology (ICT) as a valuable aid to achieve Kalusugan Pangkalahatan (KP) or Universal Health Care for all Filipinos. In 2011, the Development of the National Telehealth Service Program (NTSP) in the DOH Project was proposed and implemented as a collaborative and developmental project of the DOH, with the University of the Philippines-Manila through the National Telehealth Center. The Project defined operational and policy issues critical in incorporating telehealth as a standard program, service delivery and information management mode in the DOH. To sustain this beyond the current Project financing and political leadership, as well as to provide a policy framework to guide the implementation of telehealth in the country, a DOH administrative order (AO) was proposed. Stakeholder feedback was sought to surface views and concerns to ensure better relevance and effective policy implementation. Four public fora were held from 2012 to 2014 participated in by 241 individuals from the national agencies and local governments, project implementers, academe, and the private sector. General comments centered on governance and ensuring representation by patient advocate groups and the local governments. Capacity building and financing of telehealth, and regulation especially with regards to ethical use and protection of patients' privacy were prominent concerns. Participants affirm the preference for the poor and marginalized, although envision that telehealth and digital health information systems should be standard components of health care in the country. Other comments were specific to telemedicine and using mobile phones to report on health services from the frontline clinics. Recommendations are presented.

Elaborating and discoursing the ethics in eHealth in the Philippines: Recommendations for health care practice and research

OBJECTIVES: The objectives of the research study were to determine ethical guidelines and principles applicable in the practice and research of eHealth and telehealth in the Philippines, how these are applicable to the Philippines, and to differentiate between the ethical issues in research and in clinical practice of eHealth. METHODS: This research study used: 1) review of ethics manuscripts, guidelines and literature; 2) focused group discussion and key informant interviews of experts; and 3) triangulation. The information sought for the review were- 1) relevant policies, guidelines in eHealth that are pertinent to the discussion of eHealth ethics in the Philippines; 2) components of ethics in eHealth research; and 3) components of ethics in eHealth practice. The framework of the consultation with experts was to identify mechanisms and strategies in incorporating ethics in both eHealthpractice and eHealth research within the following- 1) in reference to existing laws, policies, and guidelines on ethics in medicine and health; and 2) in the context of the Philippine setting. RESULTS: Based on the review, there are pertinent codes of ethics, applicable laws, policies and guidelines in eHealth, both in the international and local settings. The focus group discussion and key informant interview with experts yielded significant and deeper understanding on how to address the gaps and lapses of ethics applied to eHealth in the country. These recommendations were given which distinguish between the ethics in clinical practice and ethics in the planning and implementation of eHealth systems. There is also a need to resolve the problem of whose primary responsibility the patient is- the referring, commonly referred to as the attending physician in the local community, or the specialist from the center. The proposed resolution was also presented. CONCLUSION: The study has shown how important eHealth in potentially promoting timely and improved health care access. However, there are still lapses and gaps in the implementation of policies and guidelines on and relating to eHealth in the Philippines as shown by the data culled from the review and the focus group discussions with the experts. With more specific ethical guidelines and relevant policies, the development and practice of eHealth and telehealth will be on its way in bridging the gap and aiding in health systems development in the Philippines, especially with the support of the national government and collaboration of various agencies and stakeholders.