I’m in the Philippines now to work on deploying Moca here locally. In partnership with the University of Philippines Manila, National Telehealth Center, Moca is sending 3 team members (myself, Ted Chan, and Leo Celi) this summer to help bring the technology to a real life clinical setting and also help create the infrastructure necessary for sustainable telemedicine practices in the Philippines.
Sponsored by an MIT Public Service Center summer fellowship and Google Summer of Code with OpenMRS, I will be working on 3 main deliverables while in the Philippines:
- Test/Deploy Moca on the ground in the Philippines
- Business Proposal on telemedicine services for PhilHealth Insurance Corporation and the Philippines Department of Health
- Media viewer for images, audio, video in the OpenMRS electronic medical record system (see earlier blog posts)
It’s been quite an adventure and time just zooms by, so here goes my update!
PROMOTING LOCAL AWARENESS AND UTILIZATION OF OPENMRS
Soon after I arrived in Manila, I was able to pass on my knowledge of OpenMRS to the National Telehealth Center (NThC) team to help them to assess whether it would fit the needs of the Philippines healthcare system. Previously they weren’t familiar with the system at all, aside from what was mentioned in the Moca demo video. Hence, I delivered a powerpoint presentation to 3 doctors, 3 research assistants, and 1 nurse at the Telehealth Center about OpenMRS, its design architecture and data model, customization capabilities, and case studies of successful implementation sites. They received the information very well and are interested in learning more about how to create forms targeted for clinical health scenarios like dermatology and radiology. A possibility they are exploring is to deploy OpenMRS in the hospitals in the Philippines integrated with CHITS (a University-of-Philippines-designed electronic medical record system for midwives in local health clinics).
I spent the first two weeks or so working with Randy Fernandez, one of the research assistants, on installing OpenMRS onto the linux box in the center. Ultimately we were successful, so now the Telehealth Center has its own instance of OpenMRS! Yay! Hopefully Randy can now be the local expert who can help deploy OpenMRS in other sites in the country, or at least other research sites for now (like Ateneo University).
LEARN ABOUT LOCAL TELEHEALTH INITIATIVES
The Telehealth Center has many great initiatives going on. I will post a summary of them in my next blog entry, but I was able to learn about them through several key meetings during my first week in Manila. The first was at a joint meeting with University of Philippines Diliman (sister campus to UP Manila). It was an amazingly long meeting that took almost the whole workday but there was free lunch so it was all good! We discussed practically all the new telehealth projects in development by the programmers at NthC and UP Diliman: RxBox (suitcase-like box that contains ECG, tape measure, and other tools for basic biometric measurements and transmits it to a specialist via GPRS), nurse triage system (to receive/assign telemedicine referrals to specialists), optics projects, and knowledge base project. The team was enormous - about 26 people attended the meeting, but it still felt like we needed 15 more full-time developers! It takes quite an army to produce good software/hardware for telemedicine.
Another day, I attended the RTI meeting about CHITS (local electronic health record system for community health centers). It was another day-long event that involved people from the provincs of Tarlac interested in deploying CHIT in their province. I met Ramon Duremdes, a businessman from the SMART telco; Mike McKay from RTI who had traveled and worked with Baobab in Malawi as well as other projects in Africa; plus Joel Zapanta, the assistant to the governor of the Cavite province (I hope I got all their names/titles correct..). Alison Perez, the last man standing on CHITS (there used to be many programmers on CHITS but now there is only one left to support everything!), presented the in-depth technical details and demo of CHITS.
PROMOTING LOCAL AWARENESS OF MOCA
At the RTI meeting, I also presented Moca in a short talk to the attendees (about 20 people perhaps). I emphasized that our goal was to transmit medical data (images, video, audio) included information on the key strong points of Moca: seamless integration with OpenMRS the electronic medical record system, fully customizable procedures downloadable onto the phone, and connectivity even in remote areas with synchronization and packetization. I also covered use cases like cervical cancer screening, radiology, surgery follow-up, and prenatal ultrasound screening.
The other day, I went with Xands Bernal (Telehealth nurse) and Raymond Sarmiento (Telehealth doctor) to visit the radiology department in PGH (Philippines General Hopsital). We met with the radiologist Dr. Edilberto Joaquin Fragante, who has already been reading x-ray plates through telerefferal emails from Batanes (remote island without a radiologist, hundreds of km away). Basically instead of mailing the paper x-rays to Manila and waiting for a diagnosis by mail (which takes 2+ weeks), we can use teleradiology so that the radiology technician in Batanes can just take a snapshot of the paper xray and send it as an attached image of an email to the telehealth center to route to the radiologist. With Moca, we envision
RESEARCH FOR BUSINESS PROPOSAL FOR PHILHEALTH
To prep for my meeting my Ms. Gitch Diaz, Head of the Corporate Planning Department at PhilHealth, I did an extensive literature review of telemedicine practices in other countries. I must have read 40 or so articles. By referencing documents written by Dr. Alex Gavino and consulting with Alison Perez and Dr. Alvin Marcelo from the National Telehealth Center team, I compiled a 1-page summary of eHealth services from the NThC and how PhilHealth could benefit from them.
University of Philippines National Telehealth Center
Obstacles to Quality Healthcare in the Philippines
• Shortage of trained medical professionals, recruiting/retaining qualified staff
• Shortage of quality health facilities, urban areas have more and better facilities than rural areas
• Limited transportation accessibility and infrastructure
• High cost of medicine compared to other countries
• Barriers of distance, isolation of rural health practitioners
• Lack of data standards for health records
• Lack of unique national ID system
ONeHEALTH is the flagship program of the University of Philippines’ National Telehealth Center developed to address such obstacles. ONeHEALTH stands for “One Network on eHEALTH.” With advanced new technologies comes much potential to deliver quality health services to remote areas of the country.
eRecords: electronic health records essential for quality management of patient and treatment information, for use at all levels of health system (existing services: CHITS, BuddyWorks, ISIS)
• Collect and integrate patient data from many remote sites, enable smooth patient transfers
• Monitor patients over long period of time, especially for those with chronic diseases
• Minimize information loss/error (i.e. from regional language differences in symptom/treatment terminology), improve data quality with guidelines/alerts if wrong data entered
• Bridge communication gaps among levels of health system
• Reduce costs with proper drug prediction, ensure uninterrupted supply of drugs
• Enable disease surveillance and rapid response (i.e. for the H1N1 virus)
• Auto-generate standard reports at any time
• Track which PhilHealth benefits are utilized by members
• Drive policy making process with systematic information and evidence
eLearning: a form of education and support for healthworkers - doctors, nurses, midwives and health volunteers - through interactive online content on community healthcare (existing services: videos for Stroke, Avian Influenza, Basic Management of Childhood Poisoning, TB)
• Provide opportunities for barangay healthcare workers (BHWs) to acquire and utilize new knowledge
• Increase local capacity for proper patient care, decreased hospitalization time and faster recovery
• Create collaborative social network of health facilities and universities
• Empower healthcare workers through demonstrated improvements in competence, confidence, and morale
• Promote discussion and sharing of ideas among staff on site
eMedicine: draw on expertise of medical specialists far away using telecommunications technology, telereferral services for general medicine, pediatrics, surgery, radiology, dermatology, ophthalmology, psychiatry (existing services: BuddyWork, SMS, MMS, email telemedicine)
• Provide critical clinical decision support for BHWs
• Increase access to specialized care for rural citizens
• Reduce need for patient transfers, decreased travel time and cost
• Decrease cost to patients and hospitals with improved accuracy of diagnosis and quicker recovery time
Tags: GSOC Media Viewer, MIT Public Service Center, Moca, OpenMRS, Philippines, UP Manila National Telehealth Center