CHAPTER 19: Field Health Service Information System (FHSIS)

Sound and reliable information

is the groundwork for all decision-making in the healthcare system (WHO, 2008a). On a daily basis, healthcare professionals from all levels, from frontline healthcare workers to managers, utilize such information and data in health system policy development and implementation, governance and regulation, health research, human resources development, health education and training, service delivery and financing (WHO, 2008a).

health information system (HIS)

is a set of components and procedures organized with the objective of generating information which will improve healthcare management decisions at all levels of the health system (Lippeveld et al., 2000).

This system collects data from the healthcare sector and other pertinent sectors; analyzes gathered data; ensures overall data quality, relevance, and timeliness; and, converts the data into information imperative for health- related decision-making (WHO, 2008b). With a good health information system, all relevant partners are brought together to ensure that consumers of health information have access to reliable, authoritative, useable, understandable, comparative data (WHO, 2008a).

is not a separate and independent entity of the health system. Rather, it is integrated in the health system and should be designed to complement the health system delivery (AbouZahr and Boerma, 2005). Since the HIS improves the processes of data handling to extract useful information, the healthcare sectors have had several endeavors on the design, development, and implementation of computerized HIS in different countries

data generation, compilation, analysis and synthesis, and communication and use.

health information system (HIS) has four (4) functions, namely:

gathering, transferring, processing and analyzing the data, and presenting information for use in decision-making.

The information process encompasses the components of

humans, supplies

information management structure involves components like the information systems resources such as ___________ (managers, statisticians, epidemiologists, etc.), _____________ (telephones, computers, report forms and financial resources), which are utilized in a way that produce high-quality and timely information for decision-making, and a set of organizational rules, which are necessary to ensure the optimal use of HIS resources (Yazdi- Feyzabadi et al., 2015).

Field Health Service Information System (FHSIS)

is the health information system utilized in the Philippine Health Care Delivery System. It is the official reporting and recording system of the Philippine Department of Health (DOH), and it is a facility-based and data-generated system from the Barangay Health Stations (BHS) and Rural Health Units (RHU) to the national level.

was later developed and fully operational in 1989 and designated as national health statistics as per Executive Order (EO) 352.

continues to strengthen its goal for evidence-based decision-making at all levels of the health management systems.

1987

Historically, the conceptualization of an efficient system of handling records from the barangay to the national levels started in

Local Government Code of 1991

posed a major challenge in fully maximizing the capacity of the FHSIS. The political responsibilities of both the Department of Health and the local government units had to be redefined and efforts had to be exerted to improve, simplify, and make the FHSIS more responsive and relevant to the devolution of the LGUS. These changes led to the development of the Modified FHSIS (MFHSIS) which was nationally implemented in 1996.

Decentralized FHSIS (DFHSIS) in 2001

Despite the modifications implemented in the MFHSIS, several operational difficulties were experienced including data inaccuracy, poor data utilization, delayed submissions, and incomplete data reports. In response to such problem, the identified weaknesses of the MFHSIS were augmented and led to the development of the

e-FHSIS

which aims to come up with a timely and simplified nationwide computer-based information system

current FHSIS (version 2012)

primarily aims to provide a comprehensive health data bank and to effectively communicate to all levels of health facilities as basis for more evidence-based decision making of various health stakeholders. In particular, the FHSIS aims to: 

1. Provide raw and summary data on health service delivery and selected health program accomplishment indicators from the barangay to national level;

2. Provide a standardized, facility-level data base for program monitoring and evaluation purposes;

3. Provide more evidence-based data for research purposes, policy formulation and basis for health system interventions; and,

4. Minimize documentation burden at the service delivery level in order to allow more time for patient care and health promotion activities.

the recording tools and the reporting tools

Field Health Service Information System (FHSIS) is mainly composed of two tools: ________________________ (Department of Health, 2012).

Recording Tools

- these are detailed, day-to-day, facility-based documents on the health services rendered to patients/clients in the rural health facilities.

individual treatment record (ITR), target client list (TCL), summary table (ST), and monthly consolidation table (MCT).

There are four (4) recording tools used in the FHSIS:

Individual Treatment Record (ITR)

This tool serves as the foundation or primary building block of FHSIS. It is a basic patient consultation record or a bond paper which bears the following information: date, name, address of patient, height, weight, chief complaint and presenting signs and symptoms, the diagnosis (if available), treatment, and date of treatment of each family member who consulted in the health center (see Fig. 19.1).

Examples of ITR also include immunization records of children under five years of age and national tuberculosis program (NTP) treatment record for adults.

Target Client List (TCL)

This list constitutes the secondary building block of FHSIS.

It reflects the list of "target" or eligible clients or individuals for a particular health program. It facilitates the monitoring and supervision of service delivery activities and determines the patient's compliance to a particular program.

Health programs to be maintained under FHSIS version 2012 with Target Client Lists are: Prenatal Care, Post-partum care, nutrition and expanded program for immunization, family planning, sick children. This tool provides a clinic-level data for population-based research.

Summary Table (ST)

• It is a form with 12-month columns filled up on a monthly basic to tally the number of clients in the barangay health facility in terms of health program accomplishments and morbidity diseases.

Health program accomplishment

Morbidity disease

Summary Table (ST) two types

Health program accomplishment

- the personnel records in this form all data found in the TCL. Most importantly, this can serve as a tool for the health personnel to assess their own accomplishments.

Morbidity disease

- this record serves as the source of the ten leading causes of morbidity for the municipality/city. It helps the public health nurse and municipal health officer (MHO) to get the monthly trend of diseases.

Monthly Consolidation Table (MCT)

• This form is filled up by the PHN to put together the data reported by all midwives of the city or municipality. It is an essential form and serves as an output table of the RHU because it consists of the reported data per indicator by each Barangay Health Station or public health midwife. This record will serve as the source document for the public health nurse for the Quarterly Forms.

Reporting Forms

- these are summary data that are transmitted or submitted on a monthly, quarterly, and annual basis to higher organizational levels of the healthcare delivery system. The source of data for this component is dependent on the ST and MCT.

Program Report (M1)

contains selected indicators categorized as maternal care, childcare, family planning, and disease control. The same indicators found in the TCL and Summary Tables are also found in M1. The midwife should copy the data from the Summary Table to the Monthly Form which he/she regularly submits monthly to the public health nurse. It helps the midwife capture the monthly data so that it would be easier for the nurse to consolidate and prepare the quarterly report.

Monthly Morbidity Disease Report

- contains a list of all diseases by age and sex. The midwife uses the form for the monthly consolidation report of Morbidity Diseases and is submitted to the public health nurse for quarterly consolidation.

Quarterly Form

- is the municipality/ city health report and contains the three- month total of indicators categorized as maternal care, family planning, childcare, dental health and disease control. There should only be one Quarterly Form per municipality/city.

o If there are two or more rural health units or health centers in the municipality or city, the consolidation shall be done by or under the direction of the municipal health officer (MHO) or city health officer (CHO) who sits as vice chairperson of the Local Health Board (LHB). The Quarterly Form is submitted to the Provincial Health Office (PHO) for consolidation

Morbidity Report (Q2)

The public health nurse uses the form for the Quarterly Consolidation Report of Morbidity Diseases to consolidate the Monthly Morbidity Diseases taken from the Summary Table. The Quarterly Consolidation Report of Morbidity Diseases is submitted every third week of the first month of the succeeding quarter

The Annual Form 1 (A1)

- consists of data and indicators needed only on a yearly basis on demographic, environmental, natality, and mortality

Annual Form 2 (A2)

is the report enlisting all the diseases which have occurred in a city or municipality over the year according to age and sex. Lastly, Annual Form 3 (A3) reports all mortality cases or deaths in municipality or city over the year according to age and sex. Summary details and flow of reporting of the field health information system are shown on Table 19.1 and Fig. 19.3.

Standards of Documentation in Public Health

1. Contents of a medical record must meet all regulatory, accrediting, and professional organization standards. Common requirements specific to nursing documentation include, but are not limited to, the nursing assessment and care provided; informed consent for any/all procedures; teaching provided either to the client directly or to his/her family, and response and reaction to teaching.

2. Use black permanent ink for entries.

3. Date, time, and sign all entries. Use first initial, last name and title. Full signature and title must be on file in agency.

4. Entries are to be legible with no blank spaces left on a line or in any area of the documentation. If a space is left on a line, draw a line through the space to the end of the line. For large areas not used on a form or page, use diagonal lines to mark through the area.

5. For errors, draw a line through the error, write error, initial and date the line. Do not attempt to erase, obliterate or "white out" the error.

6.Entries are to be factual, complete, accurate, contain observations, clinical signs and symptoms, client quotes when applicable, nursing interventions, and patient reactions. Do not give opinions, make assumptions, or enter vague, meaningless statements (e.g., "is a good parent"). Be specific.

7. Use correct grammar, spelling, and punctuation.

8. Write client's name and other identifying information on each medical record page.

9. Be sure to use only those abbreviation approved by your agency/facility.

10. Always record a client's non-cooperative non-compliant behavior.

11. Never document for someone else or sign another nurse's name in any portion of the medical record.

12. Documentation should occur immediately after care given. Note problems as they occur, resolutions used and changes in client's status.

13. When leaving messages, document time, name, and title of person taking message, and telephone number you called.

14. Record client assessment before and after you administer medications or other treatments.

15. Document any discussion of questionable medical orders, and the directions the physician gave. Include the time and date of discussion and your actions as a result of the discussion and consequent directions. given.

16. Chart an omission as a new entry. Do not backdate or add to previously written entries.

17. When an unusual incident occurs, document the incident on a special incident or occurrence report form. Do not write "incident report" filed in the medical record. Do write what happened to the client and actions taken to assure the client's well- being in the medical record.

18. Record only your own observations, actions. If you receive information from another care giver, state the source of the information.

19. Record the date, time, and content of all telephone client related communications.

20. Remember, if you did not document it, it did not occur.

Target List

The PHN wants to review the degree of compliance of patient with PTB of their DOTS Program. The nurse needs to review which recording tool?

Field Health Service Information System

It is the reporting and recording system of the Philippine Health Care Delivery System

Monthly Consolidation Table

The nurse needs to come up with her Quarterly Report, which recording tools will serve as basis for his/her report?

Family Health Record

A mother brought her child with cough in the health center. Which recording tool should the nurse retrieve?

M2 - Morbidity Report

It is a monthly report of the diseases tallied by age and sex