You Decide!

As a healthcare worker, you have to make a lot of important decisions. After all, these decisions affect the health of many individuals. Before, healthcare providers used what they learned from their apprenticeship and experience to make healthcare decisions. This evolved into the creation of clinical practice guidelines, documents that give guiding decisions and criteria for diagnosis and management in specific topics of health. At the present age of evidence-based medicine, modern guidelines use multiple clinical studies as basis for clinical guidelines. 

Clinical Decision Support System (CDSS) is the next step in healthcare decision-making. It is described as an electronic system that utilizes patient health data to assist healthcare workers with clinical decision-making tasks. CDSS are often coupled with EHRs for them to be patient-specific. Improvement of healthcare decision-making varies with the use of CDSS. CDSS can sometimes be synergistic with the healthcare provider, or detrimental. The speed of the system, length of electronic forms, types of indicators, and input choices can all affect the provider’s acceptance of the system. On the other hand, the healthcare provider’s practice, such as when to input data during consultation and basic knowledge in using electronic systems, can affect the usefulness and efficiency of the system.

For this week, the assignment is to think of a scenario where a CDSS embedded within CHITS can assist. What’s CHITS? I may have mentioned this many entries ago, CHITS, short for Community Health Information Tracking System is an open source electronic medical record for local health centers in the Philippines. Created by Dr. Herman Tolentino in 2004, it was first put into use in the City of Pasay. Currently, the use of CHITS has been expanding to other cities in Metro Manila, as well as other provinces nationwide.

Because it is specifically designed for health centers, CHITS focuses on primary healthcare. This involves health problems that are seen in majority of the population, such as maternal and pediatric healthcare, and selected diseases like tuberculosis and leprosy. CHITS also features preventive healthcare, another important function of local health units. Preventive healthcare involves the regular check-up of healthy individuals, screening them for possible health problems, and educating them of the risks.

In this clinical scenario we will see how CDSS can assist someone new get used to their role in the local health center.

A young general practitioner is assigned to practice in a small health center in a barangay in the city. He learns from his co-worker, a midwife, that they have been using CHITS in their health center for some time. With her and other healthcare workers help, he learns the basic use of the system. Eager to try it out for himself, the physician sees his first patient.

A mother and her 4 year old child enter. She has been bringing her son to the health center since his birth. The doctor searches CHITS for his electronic health record. He finds that the child is scheduled for his DTaP, polio and influenza vaccine boosters based on a notice on his vaccination record. He looks at the weight and height measured by the barangay health worker and finds that the boy’s weight is 15 kg and height of 103 cm (CHITS determined the weight for height z-score as -1), making him concerned of the child’s nutritional status. After this, he does his own physical examination of the child, noting any signs of underlying illness causing the low weight, and interviews the mother for additional information regarding his feeding habits. He inputs all this information into a new entry on the health record.

Based on this, the physician gives the child his DTaP, polio and influenza shots and tells the mother that his next vaccination will be after 1 year. He also advises the mother on how to increase the boy’s weight by introducing a variety of foods with high caloric content and establishing regular meal schedules. He then tells them when the next consultation is, which he also enters in the child’s health record and his own electronic calendar in his phone.

As you can see in this situation, CDSS helped the physician get up to speed with the patient’s (the child) situation and provide the appropriate management he needed. While very simple, notices, indicators, and even entry forms can help healthcare providers remember what important information they need to obtain in order to come to a well thought-out diagnosis and management and avoid errors. However, we have to remember that CDSS is still only a tool. Just like guidelines, it can only give suggestions. It is still up to the healthcare provider to make their own decisions regarding healthcare.

Sources:

1. Basic Information on CHITS-EMR. Accessed from Wireless Access for Health website: https://sites.google.com/site/wahphil/chits-emr-faq.
2. Community Health Information Tracking System (CHITS). Accessed from Center for Health Market Innovations website: http://healthmarketinnovations.org/program/community-health-information-tracking-system-chits.