OBJECTIVES

Timely access to appropriate levels of care is essential for improving maternal, newborn,
and child health outcomes. To address persistent service delivery fragmentation and strengthen referral systems, the Philippine Department of Health issued Administrative Order 2020-0019 to guide the design of Health Care Provider Networks (HCPNs) under the Universal Health Care Act of 2019. This study assessed the extent to which sixteen municipalities across four provinces in Eastern Visayas comply with the HCPN service delivery guidelines in the context of maternal and newborn care.

The study employed a descriptive cross-sectional mixed-methods design, utilizing structured facility checklists to assess compliance with HCPN standards. Qualitative data were gathered through key informant interviews and focus group discussions with purposively selected stakeholders—decision makers, health personnel, and mothers—to contextualize findings. A three-lever framework for integrated care (policy, operational, and cross- cutting) guided the analysis

The findings revealed significant gaps between the current capacities of study health facilities and the requirements outlined in the HCPN guidelines. Major gaps included (1) weak cooperative governance mechanisms to support network-wide coordination; (2) limited systematic linkages between facilities, including fragmented referral protocols and non-interoperable health information systems; (3) inadequate investments in infrastructure, health human resources, and medical commodities; and (4) absence of performance monitoring systems across HCPNs.

BACKGROUND AND OBJECTIVE

There are mixed reports on nurses’ satisfaction with electronic medical records (EMR) in literature, and facilitators and barriers to its adoption were reported frequently. A Philippine public tertiary hospital developed an EMR to facilitate remote access to patient charts outside its COVID-designated areas during the pandemic. This study aims to assess nurses’ satisfaction with EMR use in order to improve their user experience. The Delone and McLean Information System (D&M IS) Success Model was used as its framework. This offers a unique perspective to EMR adoption by accounting for the effects of the pandemic.

A descriptive, cross-sectional, quantitatively driven, concurrent mixed-methods design was employed. Nurses from the hospital were recruited for the survey (n=353) and the focus group discussions (n=14). Ethical approval was obtained prior to its conduct. Analysis was done through descriptive statistics, multiple linear regression, and thematic analysis. Data were integrated to appreciate the differences in their experiences from the point of adoption up to their current experiences.

Nurses initially faced challenges with the EMR when it was introduced, but improvements and continuous use have led to their current high satisfaction. Despite mandatory use and high usage scores, some daily tasks are still done manually. Use, length of service, number of patients handled, designation, and area of assignment were found to be associated with satisfaction. Thematic analysis highlighted several adoption prerequisites in this setup, including assessment of user competence and experience, and the provision of training, structural necessities, and organizational support.

This study found high use and satisfaction scores, aligning with the D&M IS Success Model, despite initial adoption challenges. Recommendations include maintaining high EMR use and improving efficiency, communication, and collaboration. Emphasis was placed on the provisions of better training and continuous feedback gathering.

Background and Objective: There are mixed reports on nurses’ satisfaction with electronic medical records (EMR) in literature, and facilitators and barriers to its adoption were reported frequently. A Philippine public tertiary hospital developed an EMR to facilitate remote access to patient charts outside its COVID-designated areas during the pandemic. This study aims to assess nurses’ satisfaction with EMR use in order to improve their user experience. The Delone and McLean Information System (D&M IS) Success Model was used as its framework. This offers a unique perspective to EMR adoption by accounting for the effects of the pandemic. Methods: A descriptive, cross-sectional, quantitatively driven, concurrent mixed-methods design was employed. Nurses from the hospital were recruited for the survey (n=353) and the focus group discussions (n=14). Ethical approval was obtained prior to its conduct. Analysis was done through descriptive statistics, multiple linear regression, and thematic analysis. Data were integrated to appreciate the differences in their experiences from the point of adoption up to their current experiences. Results: Nurses initially faced challenges with the EMR when it was introduced, but improvements and continuous use have led to their current high satisfaction. Despite mandatory use and high usage scores, some daily tasks are still done manually. Use, length of service, number of patients handled, designation, and area of assignment were found to be associated with satisfaction. Thematic analysis highlighted several adoption prerequisites in this setup, including assessment of user competence and experience, and the provision of training, structural necessities, and organizational support. Conclusions This study found high use and satisfaction scores, aligning with the D&M IS Success Model, despite initial adoption challenges. Recommendations include maintaining high EMR use and improving efficiency, communication, and collaboration. Emphasis was placed on the provisions of better training and continuous feedback gathering.
Human ; electronic health records ; health information systems ; nurses ; pandemics ; Philippines

Objectives: This study explores the potential of the HeLe Service Delivery Model, a community-based newborn hearing screening (NHS) program supported by a web-based referral system, in improving provision of hearing care services. Methods: This prospective observational study evaluated the HeLe Service Delivery Model based on records review and user perspectives. We collected system usage logs from July to October 2018 and data on patient outcomes. Semi-structured interviews and review of field reports were conducted to identify implementation challenges and facilitating factors. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data, respectively. Results: Six hundred ninety-two (692) babies were screened: 110 in the RHUs and 582 in the Category A NHS hospital. Mean age at screening was 1.4±1.05 months for those screened in the RHU and 0.46±0.74 month for those in the Category A site. 47.3% of babies screened at the RHU were ≤1 month old in contrast to 86.6% in the Category A hospital. A total of 10 babies (1.4%) received a positive NHS result. Eight of these ten patients were referred via the NHS Appointment and Referral System; seven were confirmed to have bilateral profound hearing loss, while one patient missed his confirmatory testing appointment. The average wait time between screening and confirmatory testing was 17.1±14.5 days. Facilitating factors for NHS implementation include the presence of champions, early technology adopters, legislations, and capacity-building programs. Challenges identified include perceived inconvenience in using information systems, cost concerns for the patients, costly hearing screening equipment, and unstable internet connectivity. The lack of nearby facilities providing NHS diagnostic and intervention services remains a major block in ensuring early diagnosis and management of hearing loss in the community. Conclusion The eHealth-enabled HeLe Service Delivery Model for NHS is promising. It addresses the challenges and needs of community-based NHS by establishing a healthcare provider network for NHS in the locale, providing a capacity-building program to train NHS screeners, and deploying health information systems that allows for documentation, web-based referral and tracking of NHS patients. The model has the potential to be implemented on a larger scale — a deliberate step towards universal hearing health for all Filipinos.
Neonatal Screening ; Hearing Loss ; Health Information Systems ; Community Health Services ; Delivery of Health Care

Background: Health information systems (HIS) such as Electronic Medical Record (EMR) systems are essential in the integration of fragmented local health systems. Investing in HIS is crosscutting; it can address multiple interrelated health system gaps. However, public health authorities, especially those in resource-constrained communities, are often faced with the dual challenge of upgrading and digitalizing local HIS and addressing other more apparent health system gaps. Objectives: The study aimed to identify and document strategies that not only motivate policy change towards adoption of electronic HIS but also address other health system gaps. Methodology: The author, in his capacity as a local health official in a resource-constrained community, developed, implemented, and documented a social marketing strategy wherein community stakeholders were influenced to invest in an electronic medical record (EMR) system because it was shown to also have the capacity to address other priority health system gaps identified. Results: The strategy, based on situational, stakeholder, and risk analyses, prompted local governance to first invest in improving the delivery of services accredited by the national health insurance program (PhilHealth), for which reimbursements would require electronically submitted claim forms. Community stakeholders then supported the proposal to invest in an EMR system because they were persuaded that it can facilitate increased financing from PhilHealth claims reimbursements, which could be used to enable not only improvement in existing health services but to also initiate other health programs. Conclusion Social marketing using the perspective of health as an investment influenced stakeholders to invest in an EMR system.
Public Health ; Health Information Systems ; Health Communication ; Social Marketing

PURPOSE: An injury surveillance information system (ISIS) collects, analyzes, and distributes data on injuries to promote health care delivery. The present study aimed to review the data elements and functional requirements of this system. METHOD: This study was conducted in 2019. Studies related to injury surveillance system were searched from January 2000 to September 2019 via the databases of PubMed, Web of Knowledge, ScienceDirect, and Scopus. Articles related to the epidemiology of injury, population survey, and letters to the editor were excluded, while the review and research articles related to ISISs were included in the study. Initially 324 articles were identified, and finally 22 studies were selected for review. Having reviewed the articles, the data needed were extracted and the results were synthesized narratively. RESULTS: The results showed that most of the systems reviewed in this study used the minimum data set suggested by the World Health Organization injury surveillance guidelines along with supplementary data. The main functions considered for the system were injury track, data analysis, report, data linkage, electronic monitoring and data dissemination. CONCLUSION ISISs can help to improve healthcare planning and injury prevention. Since different countries have various technical and organizational infrastructures, it is essential to identify system requirements in different settings.
Datasets as Topic ; Delivery of Health Care ; Health Information Systems ; Health Planning ; Humans ; Public Health Surveillance ; methods ; Wounds and Injuries ; prevention & control

OBJECTIVES: The objective of this case report is to introduce the development process, structure, characteristics, and effectiveness of the web database (DB) system developed for the hypertension management program in the primary health care setting in the low-income urban areas of Peru. METHODS: A Korean research team cooperated with a Peruvian IT startup company to develop a web DB system to improve the data management of the hypertension management program. The entire web application infrastructure was hosted using the Amazon Web Service. Two different web platforms were established for the user groups of health workers and researchers (program managers). RESULTS: A total of 2,827 program participants were registered in the web DB system until December 2017. Health professionals can input the participant data while providing consultation to the program participants, and the data is accumulated in the web DB in real time. Input errors or data loss is prevented by setting restrictions in the data entry system. During the 4-year project period, 7,696 hours of working time and USD 39,536.48 for data management were saved as the result of web DB system utilization. CONCLUSIONS: The developed web DB system contributed to improve the health condition of the health program participants by providing necessary information to the health professionals at the right time. This case report could be a reference for other researcher to develop web databases for their own context, especially in developing countries.
Developing Countries ; Electronic Health Records ; Health Information Systems ; Health Occupations ; Hypertension* ; Peru* ; Primary Health Care*

OBJECTIVES: In this study an enterprise architecture (EA) was developed for a health referral information system (HRIS) for individual healthcare in Indonesia with reference to the Open Group Architecture Framework (TOGAF) 9.1. The HRIS includes patient referrals for vertical and horizontal references (internal and external), specimen referrals, and health personnel referrals. METHODS: This research was a qualitative study that used the interview and observation method of the Primary Health Care Information System (SIMPUS) application developed by the Agency for Assessment and Application of Technology (BPPT). The interviews were conducted at South Tangerang City Government Health Office with five resource persons who were responsible for conducting health referral processes. RESULTS: The EA of the HRIS includes the principles of architecture, business, application, data, and technology architecture. Twelve principles, four referral processes, and three application reference modules and centralized applications comprise the architecture of the HRIS. The HRIS is a centralized integrated application that uses application program interface (API) to integrate with SIMPUS. CONCLUSIONS: The proposed architecture was developed in an integrated and comprehensive manner for the individual healthcare referral process, which can be implemented by regulators and healthcare facilities. This architecture can also help regulators and healthcare facilities to standardize and integrate health referral data and related processes.
Commerce ; Delivery of Health Care ; Health Information Systems ; Health Personnel ; Humans ; Indonesia* ; Information Systems ; Local Government ; Methods ; Primary Health Care ; Referral and Consultation*

BACKGROUND: Since 2003, Korea has consistently shown the highest suicide rate among the Organization for Economic Cooperation and Development countries, and suicide remains the major cause of death. In particular, men are 2–3 times more likely to commit suicide than women, which called the ‘gender paradox of suicide.’ The areas with frequent suicide have spatially clustered patterns because suicide with a social contagion spreads around the neighborhood. The purpose of this study was twofold. The first was to estimate the hotspot areas of age-standardized male suicide mortality from 2008 to 2015. The second was to analyze the relationship between the hotspot areas and the regional characteristics for study years. METHODS: The data was collected through the Korean Statistical Information Service. The study areas were 227 si · gun · gu administrative districts in Korea. The hotspot area was used as a dependent variable. Socio-demographic variables (number of marriages per 1,000 population, number of divorces per 1,000 population, and urbanization rate), financial variables (financial independence and social security budget), and health behaviors (EuroQol-5 dimension [EQ-5D], and depression experience rate) were used as independents variables. RESULTS: The hotspot areas were commonly located in Gangwon-do, Chungcheongnam-do, Gyeongsangbuk-do, and Chungceongbuk-do. According to the results of panel logit regression, the number of divorces per 1,000 population, social security budget, and EQ-5D were statistically significant variables. CONCLUSION: The results of hotspot analysis showed the need for establishing a prevention zone of suicide using hotspot areas. Also, medical resources could be considered to be preferentially placed in the prevention zone of suicide. This study could be used as basic data for health policymakers to establish a suicide-related policy.
Budgets ; Cause of Death ; Chungcheongnam-do ; Depression ; Divorce ; Female ; Gangwon-do ; Geographic Information Systems ; Gyeongsangbuk-do ; Health Behavior ; Humans ; Information Services ; Korea ; Male ; Marriage ; Mortality ; Organisation for Economic Co-Operation and Development ; Residence Characteristics ; Social Security ; Suicide ; Urbanization

OBJECTIVES: The aim of this study is to demonstrate how an integrated information system of mother and toddler cohorts can be developed as a basis of the continuum of care approach that subsequently can be used as the basis of early detection of risk factors of maternal mortality. METHODS: This research was carried out qualitatively. The data was collected through three techniques: in-depth interviews, focus group discussion, and document studies at six public health centers located in four sub-districts of Surabaya, Indonesia. This research was conducted from 2016 to 2018. RESULTS: The data collected from this research has become a basis input data requirement analysis for an integrated mother and toddler cohort information system. The system accommodates all the variables in each period of pre-marriage, pregnancy, labor, infancy and toddlerhood. The system facilitates healthcare workers to retrieve data and information related to mother and toddler health status. CONCLUSIONS: The availability of various pieces of information enables the health status of mothers and toddlers to be monitored thoroughly throughout their long-life cycle. This continuum of care approach is beneficial in the early detection and management of risk factors of maternal mortality, such as pregnancy complications as well as childbirth and postpartum complications.
Cohort Studies ; Continuity of Patient Care ; Delivery of Health Care ; Focus Groups ; Humans ; Indonesia ; Information Systems ; Maternal Mortality ; Maternal-Child Health Services ; Mothers ; Parturition ; Postpartum Period ; Pregnancy ; Pregnancy Complications ; Public Health ; Risk Factors