OUR LADY OF FATIMA UNIVERSITY

CHAPTER 1 The Problem and Its Background Introduction Community health nursing is a special field of nursing that is focused not only in the health care of an individual but also the community as a whole. It plays an integral role in the promotion of health as a part of the public health program. There is a lot of progress made in the health care system with the help of modern technology. One of it is the innovation of the Community Health Information Tracking System (CHITS). Community Health Information Tracking System or CHITS is an extensible, modular, open source information system for rural health units. It collects existing routine health data from vertical programs in the Field Health Service Information System (FHSIS) and integrates them into a unified, comprehensive computerized information system. 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 and health planning. In addition to software, CHITS also includes structured capability-building programs designed to improve the health information
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

systems within local health centers, regardless of the level of automation (medfloss.org). It is hoped to minimize the occurrence of data saturation, missing records and to ease the burden of the health care providers in terms of data management. It is similar to the electronic medical record (EMR) used in the hospital care setting. Health centers often use logbooks in order to keep track of the patient information but this can be unreliable and may contain redundancies. Researchers from the University of the Philippines have identified this problem and came up with CHITS. The use of this software began in Pasay city and is now in 18 health facilities. It is receiving positive response and its researchers are still finding ways to further improve this technology. The implementation of CHITS will certainly make progress in the information management in the community. The researchers conduct this study in order to know the difference and the effect this technology will make in the community health care system. Statement of the Problem The study investigated the effects of Community Health
C O L L E G E O F N U R S I N G

Information Tracking System (CHITS) within the Community Health Care Setting, particularly in Navotas City. 1. What is the profile of the respondents based on; 1.1 Age

OUR LADY OF FATIMA UNIVERSITY

1.2 Gender 1.3 Duration of Experience on using CHITS 1.4 Educational Attainment? 2. What are the perceived advantages and benefits of utilizing CHITS? 3. What are the perceived disadvantages or difficulties encountered by the users regarding CHITS? 4. What are the perceived factors/reasons of the institution for converting from traditional charting to CHITS? 5. Is there a significant difference between CHITS and traditional documentation in the health center set up?

Hypothesis The study is threaded to the hypothesis: there is no significant difference between CHITS and traditional documentation in the health center set up. Significance of the Study The result of this study will benefit the following: Community Health Nurses. The proposed study will benefit the nurses by providing better understanding regarding the use of CHITS. Students. It will provide students an overview of CHITS and how it is used in the community.
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

Health Center Workers. The result of the study will be beneficial to them by providing them information about the utilization of CHITS. Nursing Profession. It will benefit nurses working in different fields by providing them knowledge on how EMR (CHITS) is being used in a community setting. Community. It will provide information about the effects of CHITS in the community thereby detecting any necessary improvement for the betterment of the community. Health care administrators. Findings of this study will help in assessing the effectiveness of CHITS that may be useful for the administrators in improving the software furthermore. Researchers. It will provide us further understanding of the software and how it affects the documentation in the health center setup. Future Researchers. This study will be beneficial to future researchers by providing them reference for future researches.
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

Scope and Limitation of the Study This study determined the effects of utilizing Community Health Information Tracking System in the community health care

documentation system. The researchers focused mainly about the advantages of CHITS, difficulty of utilization of the software, and the factors that affect the utilization of CHITS. Furthermore, the study was limited to forty (40) respondents in the locale of Navotas Health Department.

C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

CHAPTER 2 Review of Related Literature and Studies CHITS CHITS or Community Health Information Tracking System is an innovation made in hope of improving the documentation system in the health center setup. It is a form of electronic medical record or EMR developed by the medical informatics unit of the University of the Philippines. According to the research headed by Tolentino (2004) setting up responsive community-based health information systems is a constant challenge for any national system integrating information technology in health care. Initially, the project was named Community Based Child Injury Surveillance System and was aimed to create a data collection system using short messaging service over cell phones. After preliminary investigations, however, the researchers shifted strategies and created a computer-based information system that served the needs of the health center facility primarily, and of the national public health system secondarily. Thus the project was renamed CHITS (Community Health Information and Tracking System) and was redesigned to circumvent issues associated with the original strategy such as constraints in economics (cost of sending messages) and existing national and local health policies (only government health centers can submit official health data).
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

According to an article by the National Telehealth Center of the University of the Philippines (2009), CHITS is a low cost computerization initiative for local health centers. It was envisioned to automate the core processes in the health center and contribute to effective and efficient delivery of services. Furthermore, CHITS is made up of several components which work together to form a cohesive whole. At the core of CHITS is its capacity-building program component that gradually introduces important concepts of information systems to health center staff. CHITS employs free and/or open source software which makes it extremely flexible and compliant to the needs of the local health center and other partners in the future such as the DOH. Once CHITS is installed in an RHU, it now serves as a platform for further enhancements such as e-learning for health and telemedicine.
C O L L E G E O F N U R S I N G

As stated by Evangelista (2011), 36 health centers around the country utilize CHITS since it was first used in 2004 in Lagrosa Health Center in Pasay City. CHITS training is also conducted in order to familiarize nurses and health workers in utilizing the system. Health advocates from Sultan Kudarat also participated in the 3-day CHITS training provided by the UP Manila- National Telehealth Center. Navotas City will also now utilize the CHITS after signing a Computerized Health Information System Project with the UP Manila National Telehealth

OUR LADY OF FATIMA UNIVERSITY

Center (UPM NTHC) to explore the potential of UPs EMR system for government health centers using smartphones.

EMR Electronic medical record (EMR) is a paperless documentation that uses the computer and the internet. According to Garets and Davis (2005) EMR is an application environment composed of the clinical data repository (CDR), clinical decision support system (CDSS), controlled medical vocabulary (CMV), computerized provider order entry (CPOE), pharmacy electronic and clinical is documentation across applications. inpatient The patient's outpatient

record

supported

and

environments; is used by healthcare practitioners to document, monitor and manage care delivery within the care delivery organization (CDO); and is owned by the CDO. The data in the EMR is the legal record of what happened to the patient during encounters at the CDO.
C O L L E G E O F N U R S I N G

In an article by Thomson (2008), it is stated that Electronic medical record systems lie at the center of any computerized health information system. Without them other modern technologies such as decision support systems cannot be effectively integrated into routine clinical workflow. The paperless, interoperable, multi-provider, multispecialty, multi-discipline computerized medical record, which has been

OUR LADY OF FATIMA UNIVERSITY

a goal for many researchers, healthcare professionals, administrators and politicians for the past 20 years, is however about to become reality in many western countries.

Brooks and Grotz (2010) stated that electronic medical records (EMRs) are the newest form of documenting a patients medical record. An EMR is a system that contains a patients personal medical history, test results, dictations, and other medical and financial information EMRs will improve healthcare by enhancing patient care, preventative health, and provider convenience and is an extreme improvement to an already highly technological healthcare corporation. The implementation wave is not happening just because it is an improvement to healthcare, but it is also moving forward because it is required by the U.S. government. President Obama recently employed a stimulus package that will assist healthcare establishments with startup of electronic medical records. Along with the great improvements and advantages come inconveniences, challenges, and high costs. Electronic medical record implementation is complex, but the benefits of
C O L L E G E O F N U R S I N G

organization and improved healthcare outweigh the minor setbacks.

OUR LADY OF FATIMA UNIVERSITY

10

Advantages and Disadvantages of Using EMR According to a study conducted by Terry, et al. (2008)

implementing electronic health records (EHRs) in primary health care is important, yet it poses many challenges. There is growing recognition of the role of EHRs in the provision of health care, particularly because they can enhance the quality of health care provided through decision support functions, increase collaboration among members of care teams, and address health care providers need for information. Also, use of information technology systems has been linked to a decrease in medical errors. Using EHRs could improve patients health outcomes through enhanced disease management and increased levels of preventive care. Finally, some efficiency can be realized through eliminating routine tasks, such as pulling paper-based charts. Despite the benefits of EHRs, particularly in the areas of patient safety and improved quality of health care, adoption has been slow.
C O L L E G E O F N U R S I N G

Hillestad (2005) stated that it is widely believed that broad adoption of electronic medical record (EMR) systems will lead to major health care savings, reduce medical errors, and improve health. But there has been little progress toward attaining these benefits. The United States trails a number of other countries in the use of EMR systems. Only 1520 percent of U.S. physicians offices and 2025 percent of

OUR LADY OF FATIMA UNIVERSITY

11

hospitals have adopted such systems. Barriers to adoption include high costs, lack of certification and standardization, concerns about privacy, and a disconnection between who pays for EMR systems and who profits from them.

In a study conducted by the Southern California Evidence-based Practice Center (2006), it was stated that the ability of Electronic Health Records (EHRs) to improve the quality of care in ambulatory care settings was demonstrated in a small series of studies conducted at four sites (three U.S. medical centers and one in the Netherlands). The studies demonstrated improvements in provider performance when clinical information management and decision support tools were made available within an EHR system, particularly when the EHRs had the capacity to store data with high fidelity, to make those data readily accessible, and to help translate them into context specific information that can empower providers in their work. Health information technology (HIT) has the potential to enable a dramatic transformation in the delivery of health care, making it safer, more effective, and more efficient. Some organizations have already realized major gains through the
C O L L E G E O F N U R S I N G

implementation of multifunctional, interoperable HIT systems built around an EHR. However, widespread implementation of HIT has been limited by a lack of generalizable knowledge about what types of HIT and

OUR LADY OF FATIMA UNIVERSITY

12

implementation methods will improve care and manage costs for specific health organizations.

In a study by Smelcer, et al. (2009) it was stated that obvious problems with EMRs, such as loss of productivity and long training times, have deeper causes. These stem from the complex interaction of highly skilled physicians trying to complete tasks in a challenging work environment with a complex a not always usable medical information system. Yet, by applying user-centered design in this complex

environment usability professionals can contribute significantly to improving EMR usability. According to Baez (2011) there are possibilities of expanding the features of CHITS in tracking mothers and babies using indicators of the Joint Programme on Maternal and Neonatal Health (JPMNH).
C O L L E G E O F N U R S I N G

Furthermore, CHITS is to aggregate relevant health information from 5 health districts, 7 lying-in clinics, 3 social hygiene clinics, and 63 health centers without using papers, folders and envelopes. This enables more than 3 million residents to have their consultation and health care services record stored and retrieved electronically. Through CHITS, long waiting time for patients seeking medical services is reduced. Data management, report generation, and inventory system are centralized to facilitate decision-making and planning purposes for the Citys health

OUR LADY OF FATIMA UNIVERSITY

13

officers. It has programs that could store data on typical health center services such as consultation, maternal and child health, immunization, anti-tuberculosis, dental, family planning, leprosy, laboratory and notifiable diseases. It also features a PhilHealth module which monitors health services rendered to its members and dependents. It automatically generates reports that are compliant with the DOHs Field Health Service Information System (FHSIS). Reasons Why Convert from Traditional to EMR Charting As stated by Tolentino, et al. (2005), in busy community health centers, data entry of patient information over several logbooks can be inefficient and is characterized by redundant and inaccurate entries. As early as 1995, a case study of Philippine public health information systems by Jayasuria revealed proliferation of reports consuming 40% of the time of field personnel, high levels of duplication and delays due to manual processing, a situation that has persisted to the present. Currently, there are no data quality control and validation procedures where paper forms are used and community health workers generally do not get feedback from reports that they submit. The collection of large amounts of health data without feedback to the collectors seems to be the practice not only in the Philippines but in other settings where national vertical programs are used. Vertical programs are generally useful particularly when there is a need to urgently address a public
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

14

health problem because they can achieve economies of scale and focus resources and manpower on a specific problem. To make information management efficient and to ensure a good supply of quality information, we needed to integrate existing interfaces to vertical programs at the community level, as we work our way upwards for higher level integration of information systems at level of the city health office.

According to Nurit (2005), as medical treatment becomes more technically sophisticated, there is a growing need for transfer of information between care sites. However, only low rates of patients present a referral letter or discharge letter that includes relevant information. Therefore, Clalit (2009) identified the need for an integrated medical record system to facilitate access of physicians at different sites to the relevant medical information needed for providing high quality care. The integrated electronic medical record is designed to collect medical data in an automatic, on-line manner from seemingly
C O L L E G E O F N U R S I N G

incompatible data sources, which are decentralized. The data is brought together as information that is reliable and available for all care providers, at each site of care.

OUR LADY OF FATIMA UNIVERSITY

15

Difference of EMR and Traditional Charting According to an article in e-mds.com (2009), a paper patient record is identified by name, some kind of medical record number, and other identifiers that make it easier to find in the filing system. An EMR provides distinct identifying information for each patient, and identifiers to locate the digital record among any number of other records. Paper charts typically contain demographic and insurance

information, along with a list of medical problems, medications, and allergies. These must be readily updated and should stay current and accurate. An EMR maintains this information, and shares any updated information wherever it is needed. When updated insurance information is provided, that information is automatically passed to billing so that the information is consistent and current, without the need for duplicate data entry. In addition, clinical information such as problem lists and medication lists are readily updated without duplicate data entry, so that changing medications within the charting application automatically updates the patient's medication list. Traditional charting contains office or progress notes in chronological sequence. These are "browsed" by literally flipping through pages, until the desired entry is located. Progress notes in a traditional paper record might be produced by dictation/transcription, free handwriting, or form completion. EMR
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

16

stores progress notes and provides quick access by date of visit, provider, or other search criteria and the ability to browse by diagnosis and prescription. A full function EMR automatically creates the progress notes as the visit is produced. Laboratory and radiology reports, as well as correspondence, are filed in more or less chronological order. Access to specific entries is no more efficient than it is with progress notes. An EMR stores reports in any number of ways to provide rapid access and quick reference, such as scanned images, direct lab result posting, and even on-line lab information applications. Using common demographic and identifying information, access to specific lab results or other patient reports is highly efficient and useable. If a paper chart is filed correctly in the medical records system, a staff member must go to the stacks of charts and, using some quick identifier code, locate the correct last name. The first name is located and confirmed, and then the chart is "pulled", but not before a placeholder is inserted, in order to 1) make re-filing easier and 2) record where the chart is headed. The issues surrounding finding a chart that is "out" somewhere, or has been incorrectly filed, are easily imagined. An electronic chart is never lost, out, or misfiled. It is always exactly where it should be, even if you aren't. That is to say that an electronic record may

C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

17

be accessed from any point in a healthcare facility that has access to medical records. In a paper chart system, a healthcare provider typically writes a paper prescription for the patient to take to a pharmacy. There are often one or more added steps, such as consulting a reference for the commonly prescribed drugs for a given condition, verifying the

prescription form or strength, verifying the patient's allergy status, checking for potential drug interactions, and verifying the patient's formulary requirements. Once this information has been satisfactorily obtained, the paper prescription is handed to the patient. It is then necessary for the provider to document the process that just took place, including the negative potential for drug interactions and allergies, as well as the drug, form, strength, quantity, and directions for the prescribed drug. Electronic medical records with robust clinical decision support offer reference information regarding optimal treatment, such as treatment guidelines or "best practice" standards.
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

18

An EMR with prescription writing capability performs the allergy and drug interaction checking, or at least provides a quick reference for manually checking, when the desired drug is selected. In addition, an EMR with electronic prescribing capability can send the prescription to a designated pharmacy directly, while at the same time documenting the prescribing process and updating the patient's medication record.

C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

19

Paradigm Input

Process Quantitative Approach:

Researchers obtained consent Constructed the questionnaire

Output
Proved that using CHITS as the method of documentation will ease the burden of health care providers in the community setting. Has an in depth knowledge of CHITS. Knew the reasons for converting from traditional charting to CHITS. The significant difference between CHITS and traditional documentation in the health center set up.

Profile of the respondents: 1) Age 2) Gender 3) Duration of experience on using CHITS 4) Educational attainment Perceived advantages and benefits of utilizing CHITS. Perceived disadvantages or difficulties encountered by the users regarding CHITS. Perceived factors/reasons of the institution for converting from traditional charting to CHITS? Significant difference between CHITS and traditional documentation in the health center set up

Validated the questionnaire Floated the tool in the locale

Waited for the response of the respondents Tallied the collected data Analyzed the data through statistical treatment

C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

20

Conceptual Framework In this study, the researchers gathered inquiries by identifying the following: (1) the perceived advantages and benefits of utilizing CHITS, (2) the perceived disadvantages and difficulties encountered by the users, (3) the perceived factors or reasons of the institution of converting from traditional charting to CHITS. The researchers utilized quantitative design. approach, With this using non

experimental,

descriptive-comparative

approach,

researchers will obtain consent forms that will be sign by the Dean of College of Nursing and City health officer of Navotas City wherein the health centers were located. Sets of questionnaires will be validated by experts in the field of nursing informatics. The researchers then will conduct the research in the health centers of Navotas City. The researchers will gather and tally the responses and information from the respondents. The data gathered will be analyzed by using statistical treatment. At the end of the study, the researchers aimed to obtain the following results: (1) proved that using CHITS as the method of documentation will ease the burden of health care providers in the community setting, (2) has an in depth knowledge of CHITS, (3) knew the reasons for converting from traditional charting to CHITS, and (4) the
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

21

significant difference between CHITS and traditional documentation in the health center set up.

Definition of Terms For proper understanding of the study, the researchers defined the following terminologies used in this study:

EMR.

This refers to the paperless documentation that is composed of

the clinical data repository (CDR), clinical decision support system (CDSS), controlled medical vocabulary (CMV), computerized provider order entry (CPOE), pharmacy and clinical documentation applications (Garets & Davis, 2005).
C O L L E G E O F N U R S I N G

CHITS.

It refers to the electronic medical record created by the

University of the Philippines for the community health center.

Traditional charting. It refers to the paper-and-pen documentation system that is mainly used in the Philippine health care setting.

Documentation System. This refers to the process of storing records of patients in a health care institution.

OUR LADY OF FATIMA UNIVERSITY

22

Nursing Informatics. This is one of the many special fields of nursing. In this field it tackles all about technology used in the nursing field. It can be an instrument used in delivering care or technology used for documenting data of patients. Health Informatics. This refers to technology used in documenting patients record in any health care setting. It deals with storage, retrieval, and optimal use for problem solving and decision making. Telehealth. This is the delivery of health-related services and

information via telecommunications technologies. It could be as simple as two health professionals discussing a case over the telephone Clinical Information System. This is a system designed to manage the medical, administrative, financial and legal aspects of a hospital and its service processing. Information System. This refers to the interaction between people,
C O L L E G E O F N U R S I N G

processes, data and technology.

OUR LADY OF FATIMA UNIVERSITY

CHAPTER 3 Research Methodology Research Design In this study the researchers utilized a quantitative approach. The non experimental, descriptive-comparative design was used. This design describes some phenomenon and documents its characteristics. It also investigates the relationship of one variable to another by examining differences on the dependent variable between two groups of subjects. Using this method, the researchers gathered data to know the difference of CHITS to the traditional method and to describe the different advantages and disadvantages of CHITS in the documentation system in the health center. Locale and Population of the Study This study was limited to the information gathered regarding the effects and experiences of the respondents in utilizing Community Health Information Tracking System in the community health care
C O L L E G E O F N U R S I N G

documentation system. There were forty (40) respondents of the study. It was conducted at nine (9) health centers in Navotas City. A formal letter of request was given to respective institutions.

OUR LADY OF FATIMA UNIVERSITY

24

Description of the Respondents/Sample Size The respondents consisted of health care providers assigned at the community health care setting that is utilizing CHITS in Navotas City. The sample population consisted of forty (40) health care providers from the locale. The researchers used the purposive sampling technique. In this technique, the researchers have set criteria that determined the respondents. The criteria of the respondents were doctors, nurses, and midwives who are working in a health center that is utilizing CHITS. They should also have an experience in using the software.

Instrumentation The instrument that was used to gather necessary information for this study was the questionnaire. The research tool was constructed with the guide of the accumulated literature and the objectives of the study. It has five parts which consist of the following: (1) demographic profile, (2) advantages of using CHITS, (3) disadvantages of using CHITS, (4) reasons for converting traditional charting to CHITS, and (5) comparison of traditional and CHITS charting in terms of effectiveness. It was validated by Mr. Michael Joseph Dio, NCM 104a and 105a coordinator and Mr. Ryan Pagente, a professor in nursing informatics. A pilot study was done to test the reliability of the questionnaire. It has a cronbachs alpha of 0.72-0.74 which means the questionnaire is reliable.
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

25

Data Gathering The researchers floated the tool to the respondents after asking formal permission from the Dean of college of nursing and city health officer of the locale. The researchers waited for the responses of the respondents to have one hundred percent retrieval. The results was tallied and analyzed through the use of statistics.

Data Analysis Method The responses gathered were tallied and computed through the use of tables of frequency distribution, percentage and t-test. Frequency distribution and percentage was utilized to answer the questions regarding the respondents age, gender and duration of experience of using CHITS, together with the benefits, disadvantages and reasons for using CHITS. The t-test was used to reveal if there is a significant difference between CHITS and traditional charting in the implementation of the documentation system in the health care set up. Frequency distribution is the tabulation of frequencies or
C O L L E G E O F N U R S I N G

occurrences in each variable. Percentage is a numerical expression that includes a percent sign, with 100 assumed as the denominator. It has a formula of:

OUR LADY OF FATIMA UNIVERSITY

26

where: Percentage frequency Total number of frequency

The researchers utilized the t-test for correlated or dependent samples. It is used when you have one sample of subjects who are tested several times but under different conditions. That is, each subject is measured on the same dependent variable, but under different levels of an independent variable. You compare performance of the subjects between the different levels of this independent variable. FORMULA:

where: difference between means standard error of the difference between means total number of population

C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

CHAPTER 4 Presentation, Analysis, and Interpretation of Data The present study was conducted to cite the differences between traditional charting and Community Health Information Tracking System (CHITS) in terms of its effectivity in processing patients data and to prove that the application of EMR in a community setting will increase the efficiency of patients data recording. The study focused on the responses of the health workers regarding the advantages and

disadvantages of CHITS, reasons for converting to CHITS, and the comparison between pen-and-paper system and CHITS.

Respondents Profile Table 1 shows the profile variables of the health workers. The demographic profile includes age, gender, educational attainment and duration of using CHITS. It can be gleaned from the table that the majority of the respondents are female (82.5%), belonging to the 20-25 years old bracket (27.5%) with 2-3 months of experience in using CHITS (65%) and with BSN degree (57.5%).
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

28

Table 1 Frequency Distribution of Respondents Demographic Profile Profile Variable Age 20-25 26-30 31-35 36-40 41-45 46-50 51 and above Total Gender Male Female Total Educational Attainment BSN With Masters units Masters With PHD units PHD Midwife Total Duration Of Using CHITS Less than 1 month 2-3 months 3-4 months Above 5 months Total Frequency 11 4 5 5 7 2 6 40 7 33 40 23 2 2 0 0 13 40 0 26 12 2 40 Percentage 27.5 10 12.5 12.5 17.5 5 15 100 17.5 82.5 100 57.5 5 5 0 0 32.5 100 0 65 30 5 100

C O L L E G E O F N U R S I N G

Equal proportion of respondents (12.5%) from the age group of 3135 and 36-40 was obtained. The age group of 26-30, 41-45, and above 50 yielded 10%, 17.5%, and 15% respectively. Only five percent (5%) belonged to the 46-50 age group.

OUR LADY OF FATIMA UNIVERSITY

29

Among the respondents 32.5% are midwife, and 5% have masters units and masters degree. In terms of duration in using CHITS, 30% of the health workers have 3-4 months of experience while 5% have five (5) months and above of experience. The finding on the demographic profile shows the prevalence of the young adults and adults in the health center. It may be a result of the influx of nurses during the past years. According to Auerbach (2011) in the 1980s and 1990s, a decline in the number of women ages 2326 who were choosing nursing as a career led to concerns that there would be future nurse shortages unless the trend was reversed. Between 2002 and 2009, however, the number of full-time-equivalent registered nurses ages 2326 increased by 62 percent. It also shows that the nursing profession is femaleC O L L E G E O F N U R S I N G

dominated.Many female dominant positions, including nursing, have failed to attract male recruits. This can be attributed to in part of issues such as status and pay, but it is also a result of the gender role stereotyping of the profession. Thus; it has become identified as a profession deeply embedded in the gender based power relations of society (Cash 1997, Meadus 2000). The table also shows that majority of the respondents only have 23 months of experience in using the software since it was recently implemented in the locale.

OUR LADY OF FATIMA UNIVERSITY

30

Advantages of Using CHITS This table depicts the possible benefits that can be gained from utilizing CHITS. It can be seen that 95% agreed that one of the advantages is fast recording, followed by accurate records of patients with 92.5%

Table 2 Frequency Distribution of Advantages of Using CHITS Advantages Fast recording Reliable information about the patient Accurate records of patients Improves quality of care Efficient Effective Provides medical alerts and reminders Yes 38 36 37 36 36 35 33 N= 40 Moreover, three (3) of the given benefits, which are reliable information about the patient, improved quality of care, and efficient yielded 90%. 87.5% of the respondents agreed on its advantage as an effective tool in documenting while 82.5% said that providing medical alerts and reminders is one of the benefits. All the given advantages received a reasonable numbers from the respondents concerned. Fast recording of patients data is the most Percentage 95 90 92.5 90 90 87.5 82.5 No 2 4 3 4 4 5 7 Percentage 5 10 7.5 10 10 12.5 17.5
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

31

common advantage that can be observed in using CHITS. This may imply that delays in recording and updating the patients data are lessened. Traditionally, patient-level information has been manually

recorded on paper, a process that is not only time consuming, but also error prone. With CHITS, patient care has improved and patient visits are more efficient, having reduced the four to five minutes needed to search paper records to just seconds. The ability to easily view, record, and share patient information across the multiple computers within a health clinic means that health workers are able to complete patient consultations earlier in the day in order to provide more support to community health workers (CHMI, 2012).

Disadvantages of Using CHITS Table 3 depicts the possible weaknesses and difficulties that can be encountered in utilizing CHITS. It can be seen that 67.5% agreed that one of the major problem is that it is expensive to implement followed by time consuming with 50%.
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

32

Table 3 Frequency Distribution of Disadvantages of Using CHITS Disadvantages Time consuming Difficult to learn Expensive to implement Lack of knowledge about CHITS Yes 22 5 27 12 N=40 Furthermore, 87.5% disagreed that it is difficult to learn and 70% discords that lack of knowledge is a disadvantage. The findings suggest that CHITS isa costly software. This would mean that implementing this documentation system in other Percentage 55 12.5 67.5 30 No 18 35 13 28 Percentage 45 87.5 32.5 70

communities might be difficult budget-wise. Although according to an article by the National Telehealth Center of the University of the Philippines (2009), it is a low cost computerization initiative for local health centers. It was envisioned to automate the core processes in the health center and contribute to effective and efficient delivery of services. It also shows that majority of the respondents find CHITS as timeconsuming. This may mean that it is time consuming because they have to undergo trainings and seminars on how to use CHITS since it was just recently implemented in the health centers. On one hand, significant number of respondents agrees that CHITS is not difficult to learn and lack of knowledge about it is not an
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

33

issue. This implies that despite being implemented just recently in the locale, health workers find the record system user-friendly. Also, the trainings that have been conducted regarding utilization of CHITS is helpful in preparing the health workers in using the software. The CHITS project went into full swing with the preliminary visits and capability-building program of health workers by familiarizing with the ins and outs of using an electronic medical record system. Early this April, CHITS Capacity-building Team started training Navotas health workers on using CHITS. This was followed-up by a 2-day coaching session in their actual health centers (Evangelista, 2012).

Reasons for Converting to CHITS This table presents the reasons for choosing CHITS rather than traditional charting as their recording system. It can be gleaned that 87.5% agreed that CHITS can provide quick reference, 82.5% corresponds that CHITS can ensure good quality information, and 80% said that CHITS can provide rapid access
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

34

Table 4 Frequency Distribution of Reasons for Converting to CHITS Reasons For faster return of income Lessen redundancies Lessen inaccurate entries Avoid duplication and delays Ensure good quality information Integrated medical record Distinct identifying information for patient Rapid access Provide quick reference Frequency 6 17 21 31 33 30 22 32 35 Percentage 15 42.5 52.5 77.5 82.5 75 55 80 87.5

As can be seen on the table, providing quick reference, rapid access of the patients data and ensuring good quality information are the three major reasons for choosing CHITS over traditional charting. This may indicate that the respondents primary reasons for utilizing CHITS are for easy access and good quality of patients files. They dont have to do the tedious task of pulling the data from the cabinet file. Since all data are computerized, they just have to click and they can immediately view what they are looking for. Moreover, the data can be read clearly unlike if it is written so miscommunication can be avoided. Implementing electronic health records (EHRs) in primary health care is important. There is growing recognition of the role of EHRs in the provision of health care, particularly because they can enhance the
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

35

quality of health care provided through decision support functions, increase collaboration among members of care teams, and address health care providers need for information. Also, use of information technology systems has been linked to a decrease in medical errors. Finally, some efficiency can be realized through eliminating routine tasks, such as pulling paper-based charts (Terry, et al, 2008).In a study conducted by the Southern California Evidence-based Practice Center (2006), it was stated that the ability of Electronic Health Records (EHRs) to improve the quality of care in ambulatory care settings was demonstrated in a small series of studies conducted at four sites. The studies demonstrated improvements in provider performance when clinical information management and decision support tools were made available within an EHR system, particularly when the EHRs had the capacity to store data with high fidelity, to make those data readily accessible, and to help translate them into context specific information that can empower providers in their work.
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

36

Comparison of the Documentation Systems Comparison and interpretation of the traditional charting and CHITS in terms of effectiveness based on the respondents response can be gleaned on table 5. Table 5 Comparison of Traditional Charting and CHITS in Terms of Effectiveness Documentation System Traditional CHITS N 40 11.87 40 0.681 Reject Ho Computed tvalue Tabular t-value (0.05) Decision

Since the computed value of 11.87 is greater than the tabular value of 0.681, the null hypothesis is rejected. Therefore there is a significant difference between CHITS and traditional documentation in the health center set up. This implies that the implementation of CHITS in the health centers improved the quality of documentation system. As stated by Tolentino, et al. (2009), in busy community health centers, data entry of patient information over several logbooks can be inefficient and is characterized by redundant and inaccurate entries. In order to make information management efficient and to ensure a good supply of quality
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

37

information, we needed to integrate existing interfaces to vertical programs at the community level. Furthermore, with CHITS, patient care has improved and patient visits are more efficient, having reduced the four to five minutes needed to search paper records to just seconds. The ability to easily view, record, and share patient information across the multiple computers within a health clinic means that health workers are able to complete patient consultations earlier in the day in order to provide more support to community health workers (CHMI, 2012).

C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

CHAPTER 5 Summary of Findings, Conclusions, and Recommendations

This chapter provides the summary of findings gathered from the study and the problems stated in Chapter 1. It also provides the conclusions drawn from the findings and the researchers

recommendations.

Summary of Findings The following summarizes the quantitative findings problems stated in Chapter 1: 1. Respondents Profile The following data summarizes the profile of the respondents in terms of age, gender, educational attainment, and duration of using CHITS. Age.Majority of the respondents had an age ranges within 20-25 (27.5%). It was followed by age ranges 40-45 (17.5%) and 50 and above ages (15%). Age ranges within 31-35 and 36-40 had the same percentage (12.5%). Some of the respondents fall within the age bracket of 26-30 (10%) and 46-50 (5%). Gender.33 female health workers with the percentage of 82.5 were surveyed and 7 male health workers with the percentage of 17.5.
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

39

Educational Attainment.Majority of the respondents are Bachelor of Science in Nursing (BSN) degree holder with a percentage of 57.5 or 23 respondents, then followed by 13 midwives with a percentage of 32.5. 5% of the respondents are still pursuing their masters degree (2

respondents), same with the Masters Degree holder who also had a percentage of 5 (2 respondents). No PHD respondents were surveyed even those who still pursuing their PHD degree. Duration of using CHITS.Majority of the respondents have been using CHITS for 2-3 months with the number of 26 respondents or 65%. While 30% of them were using CHITS for 3-4 months (value=12). None of the respondents were using CHITS less than a month.
2. Advantages of using CHITS Perceived advantages and benefits of utilizing CHITS.95% of the
C O L L E G E O F N U R S I N G

respondents agreed that CHITS provides fast recording, 92.5% agreed that it provides accurate records of patients. 90% of them also agreed that CHITS provides them with reliable information about patients, improves quality care and is efficient. And 87.5 of them agreed that CHITS is effective and only 82.5% agreed that CHITS provide medical alerts and reminders.

OUR LADY OF FATIMA UNIVERSITY

40

3. Disadvantages of using CHITS Perceived disadvantages or difficulties encountered by the users regarding CHITS. 55% of the respondents declared that CHITS is time consuming. 67.5% of them believe that CHITS is expensive to implement. And 30% of them agreed that lack of knowledge about CHITS is one of its disadvantages and 12.5% of them believe that it is difficult to learn.

4. Reasons for Converting to CHITS Perceived reasons of the institution for converting from traditional charting to CHITS.87.5% of the respondents (35) answered that CHITS provide quick reference. 82.5% of them (33) agreed that it ensure good quality information, 80% of them (32) also agreed that it provides a rapid access. 77.5% (31) respondents answered that it avoids duplication and delays. 75% or 30 of the respondents agreed that it provides integrated medical record.55% of respondents (22) also agreed that CHITS provide distinct identifying information for patients. And 52.5% of them (21) respondents believes that CHITS lessens inaccurate entries and 42.5% or 17 respondents answered that it lessens redundancies.
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

41

5. Comparison of the Documentation Systems Comparison of traditional charting and CHITS.There is a significant difference between CHITS ad the traditional charting in terms of effectiveness since the computed value of 11.87 is greater than the tabular value of 0.681.

Conclusion The study presented a clear validating difference between CHITS and traditional documentation in the health center set up through quantitative means. CHITS improves the quality of documentation system in the health centers. It is costly software but it provides fast and accurate recording of patient's information. Health workers are still learning how to use CHITS since it was recently implemented in the locale. CHITS enable health care provider to make quicker, more informed decisions because they have all patients' information at their fingertips when they need it.
C O L L E G E O F N U R S I N G

OUR LADY OF FATIMA UNIVERSITY

42

Recommendations

Based on the findings and conclusions drawn on this study, the researcher proposes the following recommendations.

1. Review, enhance, upgrade. There is no perfect software system. Community health workers must continuously review the

performance of the data.

2. Conduct regular seminars for the health care workers to increase technical literacy in operating the system and

3. Increase the allotted budget for the facilities and seminars.

C O L L E G E O F N U R S I N G

4. Monitor the data accrual daily with CHITS to monitor the health of the system and the health of the community

OUR LADY OF FATIMA UNIVERSITY

43

5. Collaboration

and

coordination

of

Community

health

staff.

Continued guidance to members who cannot easily utilize CHITS to develop and enhance their skills.

6. The researchers recommend conducting a study that focuses on a specific health care provider to further know how each health care worker utilize CHITS in the community setting in order to have a much comprehensive knowledge regarding this documentation system.

C O L L E G E O F N U R S I N G