What is CHITS?

About CHITS

CHITS stands for the Community Health Information Tracking System. It is an extensible, modular system that leverages existing routine health information systems (vertical programs) in public health to serve as a starting point for implementing comprehensive information system integration. Through CHITS, community-based health information is made available not only to public health agencies requiring community level information but also to the community itself which generates the information. It enables the community to use this information for local decision-making.

CHITS is about:

1. Innovation. We leverage existing information resources (routine health information systems) and made them digital. We create value by putting health information in their own context and not isolated in vertical information systems at the community level. We create social capital in the community by enhancing the capabilities of community health workers to manage health information with quality in mind. We bring back to the community something that traditional information technology has potentially taken away, the use of information where it is generated and by the people who generate it.
2. Convergence. The community is a place where all stakeholders meet, whether from health care, computer science, health informatics, the political organization, the academe, other concerned groups and the common folk. CHITS provides an environment wherein different stakeholders can chip in to make the load of community development lighter - "bayanihan" style. "Bayanihan" is an old Filipino custom which enables communities to carry out a big task through cooperation and working together.
3. Inclusion. CHITS has something for everybody. Whether that somebody is concerned with fighting TB (tuberculosis), promoting childhood immunization, enhancing maternal care, promoting primary care, CHITS can provide an information environment for different collaborations to thrive. CHITS aims to create this information ecosystem to enable the seamless flow of information from one stakeholder to another. As an open source application, we even invite participation of software developers so they can meaningfully produce work that benefits whole populations, including themselves. We support the government's Field Health Surveillance and Information System (FHSIS) by incorporating relevant programs as CHITS modules.
4. Equal opportunity. CHITS does not discriminate in terms of gender, age and ability. Information work can be done "bayanihan" style such that even the simplest information work (e.g., weighing the patient, reading vaccine labels) is deemed an important building block of high quality health information to be used for decision-making.
5. Sustainability. We aim for information ecosystem sustainability. We do this by making stakeholders responsible for and obtain benefit from the health information managed by CHITS. We do this by setting up partnerships with local government units, who agree to terms and conditions of deploying and maintaining CHITS installations in their communities. These communities, in turn, benefit from making health information readily available, whether it is for the care of a patient or of the whole community.

As a system, it consists of the following:

1. A software development platform called Generic Architecture for a Modular Enterprise (GAME)∞ that allows developers to create plugin, uploadable modules to the CHITS intranet application.
2. The CHITS application itself, which is a modular, multilingual, computerized patient record.
3. Training modules for the different stakeholders: community health workers, municipal/physician health officers and city health officers and staff.
4. Modules to integrate the different Philippine vertical public health programs: EPI, Maternal and Child Health, National TB Program, Philhealth Indigent Program, National Notifiable Diseases, Electronic Report/Graph Generation for the different modules and others
5. In addition, it has modules for Electronic Patient Records, Health Center Calendar and Appointment System, SMS Clinical Reminder System

CHITS project implementation was made possible by a grant from PANASIA-ICT∞, a joint funding effort by the International Development Research Centre∞ of Canada and the United Nations Development Programme∞.

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Project Highlights

Project Vision
Improved health delivery and decision-making through interoperable health information systems

Project Objective
Vertical programs by various funding agencies have inadvertently created a fragmentation of health information systems in the Philippines. Strong advocacies in vaccine preventable diseases, maternal and child care and tuberculosis have instilled their own program's information system to the detriment of the end users at the community level. What resulted were separate forms and reports for each of the program which took a long time to consolidated and resulted in three to four times more work for health workers on the ground just to comply with the reporting requirements of the programs.

Project Beneficiaries
Community health workers, local governments, health ministry, like-minded non-governmental organizations, academe

Project Milestones
1997: The Medical Informatics Unit (MIU) of the University of the Philippines Manila was created to monitor the implementation of a local are network of the UP College of Medicine. Since its inception the MIU has developed several information system projects in support of efficient and effective health care information systems.

2002: The MIU developed software to integrate disease surveillance systems from six countries in the Mekong Basin. The members thought it would also be a good idea to do the same to the public health information systems in the Philippines.

2003: The MIU conceptualized the proposal for an SMS-based child injury surveillance system to integrate the community health workers into the information management activities of the community. The MIU called the project the Child Injury Telephony-based Surveillance System (CHITS) and submitted the proposal to PANASIA for funding.

2004: The Community Health Information Tracking System (CHITS – formerly Child Health Surveillance Information System) project was funded by PANASIA in January 2004 and ran for twelve months. It is currently installed in two local health centers in Pasay city and is set for installation in the whole of Marikina City, a WHO recognized healthy city.

2005: Work is continuing to (1) deploy CHITS in two other cities, and (2) complete the inter-health center record exchange for a truly distributed health information system. The scientific paper describing the work on CHITS has been read in the American Medical Informatics Annual Symposium in Washington, DC, and published in the Journal Studies in Health Information Technology of the European Federation of Medical Informatics.

Project Technology
Free/Libre Open Source Software (FLOSS)

Implementation Strategy
We paid attention to health center cultural factors and workflow in designing the information system. We used the incremental approach to module development and tested with end users while module is being used. We employed open source software running on off the shelf software which did not require massive processing power. The open source software used were: Linux operating system, PHP Hypertext Pre-processor, Apache webserver, MySQL database management system. In addition, we developed a generic architecture for modular enterpises (GAME) to make further expansion of the CHITS easy for any developer with a modicum of training in scripting languages.

CHITS Paradigm

The value of information systems in health care lies not in the immediate benefit one gets out of electronic health information. The value lies in how much the information system has caused a transformation in the way the key stakeholders view their situation in the conceptual framework of information management as agents of change and partners in development.