INDIVIDUAL AND ORGANIZATIONAL RESPONSES


INDIVIDUAL AND ORGANIZATIONAL RESPONSES: AN ASSESSMENT OF SAN JUAN HEALTH INFORMATION SYSTEM: BASIS FOR POLICY DEVELOPMENT.

A Thesis (Chapters 1-3)
presented to the Faculty of the Graduate School
Polytechnic University of the Philippines
Sta. Mesa Manila
In partial fulfillment of the requirements for Thesis Proposal
Master in Public Administration
Submitted by:
Rosalie. M. Sto. Domingo MD
September 2018
TOC o “1-4” u
Chapter 1 PAGEREF _Toc527039178 h 6
1.1 Introduction PAGEREF _Toc527039179 h 6
1.2.1 History of eHealth in the Philippines PAGEREF _Toc527039180 h 7
1.2.2 City Health Department PAGEREF _Toc527039181 h 8
1.2.3 City Health Department Structure PAGEREF _Toc527039182 h 10
1.10 Definition of Terms PAGEREF _Toc527039183 h 33
Chapter 2 PAGEREF _Toc527039184 h 35
2.4.1.3 Tasks PAGEREF _Toc527039185 h 44

TOC h z “Heading 3” c Table1. Health Centers/ Stations per Barangay PAGEREF _Toc527040047 h 4Table 2 Health Personnel PAGEREF _Toc527040048 h 62.4.1.3 Tasks PAGEREF _Toc527040049 h 39

TABLE OF CONTENTS
CHAPTER 1 PROBLEM AND ITS SETTING …………………………………..4
1.1Introduction …………………………………………………………4
1.2Background of the Study …………………………………………..6
1.3 Theoretical Framework ……………………………………………..9
1.3.1 Technology Acceptance Model ……………………………..9
1.3.2 Leavitt’s Organizational Change Framework ………………11
1.4 Conceptual Framework ……………………………………………….13
1.5 Research Paradigm ……………………………………………………13
1.6 Problem Statement …………………………………………………….14
1.7 Thesis Argument ……………………………………………………….15
1.8 Significance of the Study ………………………………………………18
1.8.1 City Health Department ………………………………………………..18
1.8.2 Department of Health…………………………………………………19
1.8.3 Health Care Provider …………………………………………………19
1.8.4 Local Government Unit ………………………………………………19
1.8.5 Future Researcher ……………………………………………………19
1.9 Scope and Limitation of the Study ……………………………………20
1.10Definition of Terms ………………………………….……………….21
CHAPTER 2 REVIEW OF LITERATURE ……………………………………..21
2.1 E- Governance…………………………………………………………23
2.2 Value of Information Technology ………………………..………….24
2.3 Policy in Health Information Technology …………………………….25
2.4 Information System ……………………………………………………25
2.5 Health System …………………………………………………………26
2.6 History of the Philippine Health Information System ………………27
2.7 Information System in Health Sector …………………………………28
2.8 Organization ……………………………………………………………28
2.8.1 People …………………………..……………………………………29
2.8.2 Tasks …………………………………………………………………29
2.8.3 Structure ……………………………………………………………..29
2.9 Organizational Culture ………………………………………………..30
2.10 Organizational Response to New Health Information System …..31
2.11 Management of Information System ……………………………….32
2.12 Synthesis ………………………………………………………………34
CHAPTER 3 METHODOLOGY …………………………………………………35
3.1Research Design ……………………………………………………35
3.2Population and Sampling …………………………………………..36
3.3Research Instrument …………………………………………………37
3.4Data- Gathering ……………………………………………………38
3.5 Statistical Treatment of Data ………………………………………39
References……………………………………………………………………….41
Appendices ……………………………………………………………………..45
Key Informant Interview ……………………………………………………….45
Focus Group Discussion ……………………………………………………..52
Bibliographical Data ……………………………………………………………53

Chapter 1THE PROBLEM AND ITS SETTING
1.1 IntroductionPublic Health Sectors are adopting changes for the transformation of health care to a higher quality of life and ensure efficient and effective health system. Most health care managers are trying to enhance their performance through different public health interventions. Public health sector have become more and more interested in embracing Health Information Technology (HIT), and have made a remarkable progress over the last few years. Its implementation does not only transform the way government provide services to its constituents, but also reinvent its internal processes to deliver health services efficiently and effectively.

The decision to bring a new health information technology into the health sector is only the first step in an implementation journey. The process of change is a chain reaction that affects everything in the organization and changing one area can impact another. Challenges on existing organizational structures and practices of health care providers can hinder rather than advance the objectives of health information system.
There’s a need to assist the health care providers in taking advantage of the larger transformation powers of health information system within their organizations. Success of health information system requires more complex reform of examining the factors that contribute to the success of the proposed change. Hence, it is essential for public health sector to embrace innovation and change for an enhanced health information system.
Drawing analysis from the current health information system will help overcome the barriers and minimize the risk of failure during the implementation of the new technological change. 
At varying paces, organizations are aggressively pursuing new information technology strategies with the goal of providing effective and efficient health information system. This thesis will examine some key aspects of health information system towards policy development.

1.2 Background of the Study
Decentralization started in 1991, when Local Government Units (LGU’s) were allowed autonomy and responsibility for their own public health service. By decentralizing the health sector, the Philippines hoped to transfer as many resources as possible from central to peripheral authorities, to extend decision-making authority to lower level managers and to enhance the efficiency and effectiveness of health services management (Grundy et al, 2003: 3-4). Within this decentralized setting, the LGUs continue to receive guidance on health matters from the DOH through its network of DOH representatives under the supervision of the regional centers for health and development (CHDs).
1.2.1 History of eHealth in the PhilippinesThe Department of Health (DOH) by virtue of its mandate holds the over-all technical authority in health with three major roles of leadership and regulator in health, enabler and capacity builder; and administrator of special health services. The Philippines has already developed the eHealth Strategic Framework and Plan for the period 2014 to 2020, which aimed to utilize information and communication technologies in the health sector (DOH 2014). This will support the delivery of health services and manage health systems for greater efficiency and effectivity.

As part of the government’s goal to address these issues and further advance the quality of health care in the country, different government agencies such as the Department of Health (DOH) and the Department of Science and Technology (DOST) spearheaded projects that encourage the inclusion of innovative technology in hospitals and other health care facilities especially in different local government units (DOH MOA 2013). It was planned to implement a national eHealth in the country for greater efficiency in health care, workforce productivity, and optimized use of resource.
The Joint Administrative Order No. 2018-00 aims to establish the policies and guidelines in the implementation of validated electronic health record systems in all health facilities particularly those regulated by the DOH and accredited by Philippine Health Insurance (Philhealth). Part of the strategies in investing in eHealth includes the mandate to use electronic records in all health facilities; make online submission of clinical, drug dispensing, administrative and financial records a prerequisite for registration, licensing, and contracting; commission nationwide surveys, streamline information systems, and support efforts to improve local civil registration and vital statistics; automate major business processes and invest in warehousing and business intelligence tools; and facilitate ease of access of researchers to available data.
The Department of Health had standardized its health information system by using technological resources which has led to the development of Electronic Record Systems (EHRS’s), Integrated Clinic Information System (iClinicsys) and the Integrated Hospital Operations and Management Information System (iHOMIS) as reference models for health centers and barangay health stations as well as health information system for hospitals. This aims to provide relevant, timely and evidence- based decisions more towards a more efficient service delivery and facility management.

1.2.2 City Health DepartmentThe LGUs serve as stewards of the local health system in formulating and enforcing local policies and ordinances related to health, nutrition, sanitation and other health-related matters in accordance with national policies and standards.
The City Health Department of San Juan are in-charge with providing primary care including maternal and child care, nutrition services and direct service functions through public health and primary health care centers. The City Health Department provided health services catering ten health centers and eight health stations in the city’s barangay (Table 1). Free consultation and treatment are being provided daily from Monday to Friday during office hours from eight in the morning till five in the afternoon.
Table1.
Health Centers/ Stations per BarangayBarangay Health Centers Barangay Health Stations
Balong-Bato Health Center Addition Hills Health Station
Batis Health Center Ermitaño Health Station
Corazon De Jesus Health Center San Perfecto Health Station
Kabayanan Health Center Pasadena Health Station
Onse Health Center Rivera Health Station
Pedro Cruz Health Center Progreso Health Station
Salapan Health Center Little Baguio Health Station
Sta. Lucia Healthcenter Maytunas Health Station
Tibagan Health Center West Crame Health Center The goal of the City Health Department (CHD) is to provide accessible, responsive and quality health care. It endeavors to provide promotive, preventive, curative and rehabilitative health care services to the constituents of San Juan through various health programs. Services offered at the health facilities include general consultation, maternal care, child care, nutrition services, dental services, communicable diseases, non-communicable diseases, Human Immunodeficiency Virus/Sexually transmitted diseases screening and sanitary inspection. Case investigation during outbreaks under epidemiology and surveillance program as well as medical services and assistance during a disaster under Health emergency management staff are being provided by the Department. The organization of health department provides communities the capacity to prevent disease, promote health, and prepare to respond in cases of disaster.
1.2.3 City Health Department Structure
Organizational structure refers to organizational subunits and the way they relate to the overall organization (Stair 2006). It is how individual and team work within the organization are coordinated and managed. Figure 1 shows the organizational structure of the City Health Department. From the study done by Klein, a vertical, hierarchical, or pyramid form of organizational structure is the result of having a narrow span of control or span of authority and span of management which is seen in the CHD.
This tall organizational structure of the City Health Department has brought long chain of command from the flow of authority from the highest to lowest levels. The City Health Department is led by the City Health Officer (CHO) appointed by the City Mayor who provides supervision and management support to the Department. The CHO is assisted in managing the Department by the Assistant City Health Officer who is also the City Nutrition Action Officer. It this structure the head of the Department gives instructions and makes the decision. The Assistant City Health Officer handles both the administrative and the technical work in the Department.
Figure 1 City Health Department Structure

There is a technical working group assigned responsible for consolidation of reports including the Iclinicsys and other documents of the City Health Department however, there is no adequate health staff since the team composed of the Assistant City Health Officer, 1 Medical officer and 1 clerk that will do both the administrative as well as the technical work.
Table 2 Health Personnel
Indicators Total
2018
Physicians (including the CHO & ACHO) 11
Dentists (including the Supervisor) 12
Nurses (including the Supervisor) 13
Midwives (including the Supervisor) 15
Nutritionist- Dietitians 2
Medical Technologists 5
Sanitary Inspectors 9
Dental Aides 9
Barangay Nutrition Scholars 18
Administrative Aide(Clerk) 5
Utility 8
Driver 2
TOTAL 109
Table 2 shows there are only 11 medical officers including the City Health Officer, and the Assistant City Health Officer (ACHO) who is also the City Nutrition Action Officer (CNAO) while the medical officer of the technical working group handles Sanitation Division and is assigned to different health programs.
Duties and Responsibilities of Health Personnel
In hierarchy every member of the organization is assigned a specific position. Each position has special level of decision-making authority as well as specific responsibilities within the organization. The following are the duties and resposibilities of health personnel:
City Health Officer- Supervises the personnel and staff of CHD; formulate program implementation guidelines and rules and regulations for the operation of said office for the approval of the mayor in order to assist him in the efficient, effective and economical implementation of health services’ programs geared for the realization of health-related projects and activities. Formulates and implement policies, plans, programs and projects to promote the health of the people in the city of San Juan.

Assistant City Health Officer- Assist in the formulation of program implementation guidelines, rules and regulations for the operation of the health office and general supervision of all health personnel in the different divisions. Receives directive from the City Health Officer on various matters pertaining to the different health activities in the office.Medical Officer – Plans, integrates, coordinates and supervises the implementation of the various health programs of the local health department and other services of the division in the delivery of primary health care (preventive, curative and rehabilitative) and provides administrative and technical supervision over the personnel of the health districts. Assesses, with the health centers personnel assigned to their health program on their existing health services and relative to the needs of the community in view of sustaining/improving the standard of public health service delivery.

Dentist Supervisor- Supervises the implementation of dental health programs (records, reports and accomplishments).Provide technical assistance to the District Health Office in relation to the implementation of health programs within the city. Monitors, conducts field visits, and evaluates dental performances in coordination with the City Health Office and give necessary recommendation/immediate measures to problems/gaps.

Dentist- In the absence of the Physician in charge in the Health Center, he dentist acts as the OIC Supervising the dental aid coordinate and the medical staff. Accomplishes and submits weekly, monthly, quarterly, and annual reports on time.Consolidates, analyzes, and submits all reports to the immediate supervisors.

Nurse Supervisor- Participates in the planning and implementation of the health programs of the agency. Guides the public health nurse II interpret the nursing policies, operational instructions, techniques and standard requirements of the service within the area of assignment and supervises the same in the performance of nursing techniques and procedures.
Medical Technologist- Submits reports of activities and accomplishments reports of the unit on time. Performs routine laboratory reports and consolidates all quarterly laboratory reports.

Midwife Supervisor- Provides technical support to midwife. Update and maintained proper recording and reporting of all DOH program. Consolidate and Submit monthly accomplishment report to nurse.
Midwife- Carries out medical and nursing functions in the clinic as first level worker in primary health care programs. Submits and assists nurse accomplishment of reports.Update and maintain proper recording and reporting of all reports. Supervise Barangay Health Aide and Barangay Health Workers.

Nutritionist- Provides administrative support and technical assistance to City Health Office and Barangay Nutrition Scholars. Analyze OPT of all Barangays for City Nutrition Situation. Accomplished and analyze City Nutrition Reports for monitoring and evaluation purposes.

Sanitary Inspector Supervisor- Assist the CHO/Medical Coordinator in planning the program for environmental sanitation and request necessary budget and supplies to authorities concerned to promote the health in the community.

Barangay Nutrition Scholar- Prepares and submit well accomplished written report of all programs and projects in the barangay. Assist in the conduct of primary health care programs and medical / dental preparations.

Dental Aide- Prepare, keeps and updates the patient’s records and files under the supervision of the Dentist.

Administrative Aide/ Clerk- Receives and records all official communications, correspondence, reports, memoranda, orders and course thru channels and files them in their corresponding files. Records, files, and keeps all appointments and other pertinent papers relative thereto of all personnel in the office and releases them only when directed by the proper superiors.
Administrative Aide/ Driver- Service all health staff to their requested destinations (trainings/seminars). Pick up and deliver all medicines at all health center.

Operational structure
The operational level are being catered by the different divisions in the health facilities such as medical, dental, laboratory, sanitation and nutrition headed by the Medical officer of the facility. The number of health staff reporting to each health facility tends to be smaller which provides greater opportunity for the medical officers to supervise and monitor their health staff. The operational structure of the City Health Department is divided into Health Centers and Health Stations as seen in Figure 2 and Figure 3.

Figure 2 Barangay Health Center Structure

Figure 3 Barangay Health Station Structure

Out of 11 physicians, there are only 9 medical officers assigned to 10 health centers that still manage the 8 health stations on top of the different health programs assigned to them. With this kind of set up there has been difficulty in ensuring adequate and appropriate distribution of health services staff to deliver both preventive and curative services in San Juan. According to Kumar et al (2012), the position of the organization as well as its structure directly affects the adoption of health information technology.The transformation of health information of San Juan has contributed to the structural complexity of the health department; hence it is vital to understand the factors that can influence the health staff’s intention to utilize the new health information system for successful implementation of the desired change.
Role of Health Staff to Iclinicsys
City Health Officer/ Assistant City Health Officer
Overall supervision and decision making in planning management task in the City Health Department,
Create and implement policies, goals, and procedures for City Health Department
Provide Capacity-building programs for the health staff on how to use and manage IClinicsys
Strategic policy-making and resource allocation
Evaluation of the overall and individual quality of the staff’s work. 
Iclinicsys medical coordinator
Assume primary responsibility for supporting the National Health Information System (Iclinicsys), ensuring that data are being collected, entered and processed in accordance with standard of procedure and in a timely fashion.

Implementation of recommendations and monitoring of results for delivery of expected Iclinicsys value and benefits, collection, sharing, exchange and submission/reporting of required data and information among concerned eHealth agencies
Conduct monitoring and evaluation on the performance of the system
Medical Health Officer/ Physician-
Take decisions regarding the effective functioning of health facilities and of the health system as a whole.

Coach and mentor health staff, to enable them to assume expanded roles and an increasing level of responsibility for Iclinicsys, while ensuring the quality and completeness data
Supervise and support the Health Information System, ensuring that data from patient are being processed in a routine, accurate and timely fashion
Produce monthly and bi-annual Health Information System Reports, based on the existing templates.

Conduct monthly visits to government health systems to provide feedback and training on their use of the National Health Information System.

Nurses/Midwives
Create and update documents within the electronic health record (EHR),
Locate and retrieve information in the electronic health record for various purposes. encode the data for Iclinicsys,
Ensure completeness of data
Use Iclinicsys to generate reports
Dentists/ Nutritionists/ Sanitary Inspectors/ Barangay Nutrition Scholars
Provide data for Iclinicsys
Analyze and evaluate the accuracy of data
Clerk
Ensure completeness of data
Encode data for IClinicsys
1.2.5 Health Information System of the CHD
One of the principal goals of any health care system is to improve health through the provision of clinical and public health services. In the study done by Jerry Mechling, the leadership of government in information technology innovation is a determining factor for rapid economic growth. The use of information technology helps transform the government health services to a more efficient, responsive and effective health system. It aims to deliver effective and efficient social service and technologically advance governance.

With the decentralized setting, the City Health Department continues to receive guidance on health matters from the DOH through its network of DOH representatives under the supervision of the regional center for health and development (CHDs).
The Health Information System of the City Health Department has been paper-based and manually driven. During the decentralization process, the existing paper-based data collection system, called the Field Health Services Information System (FHSIS), was adopted by the City Health Department. This electronic data reporting aims to minimize the recording and reporting burden of service delivery and provides more time for patient care. However, it did not provide evidence-based population health decision-making at the community level. At the health facility level, data is collected on all patient admitted and entered into the summary table by health personnel. Tally sheets track disease incidents, which are summarized into standard monthly reporting forms for submission to the FHSIS coordinator. At the health facilities, nurses and midwives are tasked with collating and the medical officer is assigned for analyzing data from their areas, however due to multi-tasking of the medical officer data are submitted directly to the FHSIS coordinator for analysis and approval. It is not standard based, health centers and health stations still submit their accomplishment reports monthly to the FHSIS medical coordinator who solely has the health computer system, and in turn pass these reports electronically to the DOH for data interpretation, analysis and come up with appropriate interventions. Most health facilities still uses manual reporting leading to duplication and delayed submission of reports.

As pursuant to the administrative order of the Department of Health (DOH) no. 2015-0037, all health facilities need to comply with the national implementation of health data standards for Health information system standardization and Information Interoperability (Garin 2015). Continuous development and implementation of information technology is one strategic instrument of the DOH to support and facilitate the achievement of the national health system goals for better health outcomes. In an effort to respond to the demands for growth and success, the City Health Department shifted to an electronic data reporting system. It is now on the process of implementing a wider coverage of electronic health system known as IClinicsys, an Integrated Clinic Information System of the Department of Health that would improve overall patient treatment, quality and safety.
1.2.2.2 IClinicsys
The “iClinicSys” is a reference model for electronic medical records and health information system for primary care facilities that satisfies Philippine Health Insurance Corporation (Philhealth) requirements for benefit packages through capitation and DOH reporting necessities including national health data standards. It aims to automate service delivery processes to efficiently and effectively monitor patient care in the health facility (DOH).
Iclinicsys aims to improve overall patient treatment, quality and safety while reducing unnecessary cost and paper works through the use of managed and coordinated technological information for quality health data collection and submission.
Its features include, hybrid software that can run in an offline and online environment, generates electronic medical record of patient that allow providers to track patient’s data overtime, compliant to health data standards for system interoperability with DOH, Philippine Health Insurance Corporation (PHIC) and other government agency’s reporting requirements, produces the required national health statistical requirements such as Field Health Services Information System (FHSIS), Disease Registry Reports etc. and includes SMS notification for patient’s schedule of next visit Free installation and maintenance cost of the software.

Iclinicsys will enhance health workforce productivity in retrieving patient information, record keeping, administration and referrals. It will improve the quality of care, monitoring and reporting and will increase opportunity for continuing innovations and growth (UHMIS DOH).
1.2.2.2 Preparation of IClinicsys
It was only on November 2016, when San Juan City Health Department presented to the Local Health Board the idea of the having eHealth system as initiated by the DOH. The software for iClinicSys was provided by the DOH and the system was installed for free. To ensure success implementation of Iclinicsys, health care organization must educate and train the health care providers. A training orientation was conducted last February 2017 under the fund of DOH Health System Development Program. A 2-day capacity building symposium among health staff were set. Roll out activity to the other health staff was given on April 2017. Funding of computers or laptops was secured from the LGU fund and partly from the Philhealth capitation fund, setting up of internet connections were requested and provided by the LGU. Software was installed at the health centers. Memorandum of agreement was done with different stakeholders.
1.2.2.3 Process of IClinicsys
The Iclinicsys is being used for decision-making and improving operational health services performance. All health centers and stations are to collect process and report routine data relevant both to the national policy and health program objectives and to the needs of health and health providers. The system is integrated in one computer in each health facility so that all existing health programs and general information are encoded together to avoid duplication of health data. Specified data and information flows are included such as the internal flow of information among the health facility, encoding done in different facilities are being checked by the Iclinicsys coordinator.
Data processing and analysis were intended to be primarily conducted by the physician in charge in each health facility, processed into summary values to show changes over time and provide performance indicators at health facility, health department and DOH. It is only after the consolidation of all the reports coming from different health facilities will decision-making is done to provide meaningful data.
Information derived from IClinicsys is intended to be used for formulation, monitoring and evaluating of annual investment plan, monitoring and improvement of health facility service delivery. Reports generated from different health facilities will be used by the City Health Department and DOH for planning and policy formulation.

1.2.2.3 Challenges of IClinicsys
The implementation of IClinicsys is dependent upon individual’s ability and role. The health providers saw the IClinicsys as new and integrated with fewer forms, new strategy for holding information. The implementation of Iclinicsys was not as effective as it should be. Only few sponsored members were encoded and submitted online. Late submission of reports ensues despite many initiatives taken to implement information technology. Health facilities did not process information as expected, many health workers could not graph the data and the IClinicsys coordinator is the only one doing this. Innovation adoption at health units was only partial. There is late in decision-making from the data collected due to late submission of reports. Planning and policy formulation has always been delayed.The major challenges confronting health information system in the CHD are the completeness, accuracy, timeliness and accessibility of health data. One of the challenges of the existing health system is the access to the updated quality health information vital for evidence-based decision making both at the national and local level.

Access to health information technology has transformed the work of the health sector in what they do and how they carry out activities. It changes the way health services are delivered, how information is exchanged within and between organizations. With the increase access to various eHealth services, there is a need to assess the health information system for effective implementation and policy development
The City Health Department is face with challenges on the implementation of IClinicsys. Academicians have reviewed that some of the reasons of project failure is due to the fact that the role of the key actors and activities are not properly analyzed, the same with staff attitude to work – resistance to change (Lam 2005). Most Information Communication and Technology (ICT) projects fail due to various factors including organizational issues and leaders who did not sufficiently consider the organizations reactions to the desired change.
The aim of my study is to assess the health information system of San Juan towards policy development. While the City Health Department moves toward IClinicsys, the need for better understanding of organizational actions and behaviors will provide important aspect for policy development towards successful implementation of the new health information system.
1.3 Theoretical Framework
1.3.2 Leavitt’s Organizational Change Framework
The Leavitt’s organizational change framework provides theoretical base in looking at any change within an organization. The act of change within an organization requires decision-makers to take a step back and considers the impacts. Determining the response of the organization is necessary for the acceptance of new information technology in health settings. The Organizational change framework as seen in Figure 4 provides new approach to look at the organizations. Within this framework, we can notice that each of the four variables interacts with the others.

Figure 4 Leavitt’s Organizational Framework

Every organization consists of four interactive components: Structure, People, Task, and Technology. The interaction of these four components determines the fate
of an organization. Leavitt noted that any alterations in any of these components results in the alteration in the other three (Burke 2002). Before you bring about change in any one of the four components, you should evaluate the impact on the other three components. Each component need to be tweaked to implement change successfully and find the right balance between all of them.
In order to use the model effectively, defining each component is vital to know the exact situation of the organization. The first component is the structure; it determines how the people are grouped within the work unit, the role expectations and rules for who should or can do what and how each task should or can be done. It provides guidelines and framework. Organizations are inter-connected structures, where changing one part can impact many others. With current set up of the City Health Department, the introduction of IClinicsys provided a great impact in the organizational structure; hence it requires modification for the adoption of change.
The next component to be considered is the people, those who carry out the task. The people involved within organization are the integral part of the project. People are often the key consideration in any change initiative, because skill sets, efficiency, knowledge and attitudes greatly affect the success of change in any organization. The people should be trained accordingly as what has been done in the CHD. According to Sargent et al (2012) the user need to change their current methods and procedure to integrate the new task that affects directly their tendency to apply it. Health personnel should continuously upgrade their skills and learn how to adopt and use the new technology.
Another component is task; it is the organizations purpose to provide a service. When change occurs in a system it is often seen that most of the old tasks and job descriptions are replaced with modern task force requirements. Like in the City Health Department, the adoption of Iclinicsys resulted to unintended changes in the way tasks are performed. This change provided great impact to the work and productivity of the health personnel. The new tasks and goals should be properly evaluated and the requirements and benefits of the new task should be identified and should be checked whether it is relevant to the user.
The fourth component is the technology which includes the tools and computers. A simple technological upgrade in one organization will clearly have large effects throughout
the organization. The introduction of the new technology such as the IClinicsys, holds a great potential for transforming the structure, task and people in the City Health Department.
Technology and Task
The tasks of the health providers are most subjected to IClinicsys influences and potential. The introduction of IClinicsys transforms significantly the task of the health staff; it will increase the task efficiency, shorten the required time for executing a task, facilitate and improve information and management (Wigand 2007). However problems may arise as the ambiguity, complexity and non-routineness of a task increases leading to decrease frequency of use of the new technology.
Technology and Structures
Information technologies have the potential to affect the role people play in the process of change. The roles, responsibilities, relationships and distribution of jobs in the health care workforce should always be considered. The new technological change should not be seen by the health care providers as threats. According to Watson (2007), the new technological change could fail if people are not given importance they deserve. Leaders have to balance the need for adaptability in meeting the advantages of the new technology with an atmosphere of stability and concern for the interests of staff. The way technical change is introduced into the organization will influence the health provider’s attitude towards work, the behavior of individuals and groups, and their level of performance.

Technology and People
With the introduction of new information technology, health staff should have to gain new skills and knowledge for successful implementation of IClinicsys. The level of training that people need to upgrade their skills and learn how to use new technologies may also be an obstacle for technology application (Gichoya 2005). Leaders must be able to combine their technological knowledge and develop strategic program management. Inadequate staff competencies hinder utilization of IClinicsys.

For the change to be successful all the components stated above should be analyzed, evaluated and assessed. The Leavitt’s dynamic equilibrium framework will provide an in-depth understanding of the impact of technological change in the health system of San Juan.

1.4 Conceptual Framework
Figure 5 Conceptual Framework
2378075234950PROCESS
00PROCESS
4331335306070OUTPUT
00OUTPUT

2132381302335Assessment, through survey questionnaire
Focus Group
Discussion
Presentation, Analysis and Interpretation of results
00Assessment, through survey questionnaire
Focus Group
Discussion
Presentation, Analysis and Interpretation of results
39782351502INPUT
00INPUT

412940524765Identify Problems in terms of information system
Recommendations to facilitate enhancement of Health Information System
00Identify Problems in terms of information system
Recommendations to facilitate enhancement of Health Information System
11338717602Health Information System
10Perception of the respondents to Health Information System
– Technology
– People
– Task
– Structure
-Willingness towards Policy Development
Actions taken
00Health Information System
10Perception of the respondents to Health Information System
– Technology
– People
– Task
– Structure
-Willingness towards Policy Development
Actions taken

3699164568450014662154445000
39973251308100028003501248910050292018145700
1935480118110FEEDBACK
00FEEDBACK

1.5 Research Paradigm
The researcher perceives the conceptual framework of this study based on the Input- Process- Output (IPO) system approach which is shown in Figure 2. This approach is composed of different elements that are connected with each other and will be the basis for the concept structure required in the research investigation. The study aims to assess the organizational response for the proposed technological change.

The first element is referred to as the Input. The data from the organizational response will provide information on the how the respondents assess the current Health information system, perception of the enhanced health information system according to technology, people, task, structure, willing ness towards Policy Development, actions taken for the development of health information system, thus this will offer valuable input for the execution and completion of this study.
The second factor is the Process. The process will help the researcher acquire information needed for the analysis and interpretation of result in order to provide outcome for the final output. The researcher will use likert survey questionnaire and focus group discussion.

The third factor is the expected output. This will be the final result derived from the input and process. The assessment of the respondent’s perception of health information system will be based on analysis from the final output. This will be formulated and offered for policy development.

The output of the study will be recommended to the head of City Health Department. Hence, whatever actions these organization provides to improve their health information system will again be served as an input and the cycle repeats itself.

1.6 Problem Statement
This thesis aims to determine the response of the City Health Department to the new Health Information System. Such understanding could determine the factors for successful adoption of the new technological change.

The first step to assess the Health Information System of San Juan for policy development is to assess the perception of the respondents to the new health information system. The key findings of this thesis will become the foundations towards an enhanced technological change.

How do the respondents assess the current health information system of the City Health Department?
What is the perception of the respondents to the enhanced health information system?
2.1 Technology
2.2 People
2.3 Task
2.4 Structure
2.5 Willingness towards Policy Development
3. What are the actions taken for the development of Health Information System?
4. What are the suggestions or recommendations to facilitate Policy Development / proposed policy options?
1.7 Thesis Argument
1. Because documentation found in health records is crucial evidence of services provided and the quality of those services, many healthcare settings, particularly in public health care have initiated clinical document improvement. The ultimate goal of every health record is to facilitate communication. A well-designed, well-maintained paper-based health record significantly improves communication among health care providers. However, the paper based records has a number of weaknesses such as difficult to update, misplaced, too expensive and difficult to maintain duplicate copies as paper health records back up. For all these reasons the City Health Department shifts from traditional data to an automated data collection. Because the productivity of the public
health sector depends on the quality of the health systems, organizations decision of using information technology is critically important for high quality health service.
The use of electronic computers and related software programs are the technical foundation, the tools and materials of an enhanced information system. Knowing how computers and computer programs work is important in designing solutions to organizational problems, however it is only a tool for improving the health information system. Despite the benefits that information and communication technology offers to support the health sector, there are bottlenecks in terms of its adoption which hampers the delivery of evidence based health service. Information system requires understanding of the organization, its people, structure, task and use of information technology in shaping the system.
2. Understanding the adoption and use of health information system will help in achieving good health governance. However, most Information Communication and Technology (ICT) projects fail due to various factors including organizational issues and leaders who did not sufficiently consider the organizations reactions to the desired change. In order to provide a better understanding of organizational actions and behaviors in the current innovation a thorough analysis is needed to gather information on the response of the health personnel who serves as main administrators of the system.
The use of electronic health information system is determined by the behavioral intention and the perception of its use to the new technology. The attitude of an individual is not the only factor that determines his use of electronic health information system, but is also based on the influence which it may have on his performance. Perceived benefits are the end products that can be used to judge the success of electronic health information
implementation. If the perceived benefits like easier communication, networking, and system integration, timely, relevant, complete and useful information are not realized, then the system will be perceived to have failed.
3. The implementation of health information system helps improve the quality of health services in the health sector. However, one factor that is widely recognized as critical for achieving technology implementation success is the commitment from all levels during implementation. Manpower is one of the requirements for electronic health information system. Taking into account the commitment of the health personnel would be helpful for electronic health information system to be implemented successfully.
4. The attitude of the health sector towards the desired change is a core factor that encourages or reinforces the implementation of electronic health system. Salient features of organizations that must be addressed by information systems include organizational levels, organizational structure, types of task and decisions, the nature of management support and the sentiments and attitudes of workers who will be using the system. Implementation of new information system is often more difficult than anticipated because of organizational change requirements.

The high impact of the strategy dimension on people means that the value of desired change considers people to be a major component, thus focusing on improving their skills and re-allocating them to suitable information and communication technology trainings. The technical proficiency of health professionals respond positively to changes approved and provided by top management, however those who lack knowledge on the new technology will negatively respond to changes. The Organization should call for specialized human resources and to put in place structures to improve technical proficiencies in information and technology that would lead to a more sustainable implementation of health information system.

5. The use of information and communication technology can transform the government health services to a more efficient, responsive and effective health system; however implementation and adoption face certain challenges. Each factors examined within the City Health Department produces a unique, strong impact on the overall adoption of the new health information system. Therefore, a specific focus should be made on the development of a strong, well-formulated, and comprehensive designed strategy for the success of the desired change, and to ensure commitment to its implementation among all levels of organizational management. A strategic direction will provide a backbone of the whole integration process creating new improvement and eliminate barriers that have traditionally suppressed the flow of the new health information system in the long run. The process to transform will neither be quick nor simple. It will require a coherent strategy, beginning with an examination of the organization, resource, as well as the ability of the organization to adopt and make use of planned technologies.
1.8 Significance of the Study
The study was conducted to benefit the following:
1.8.1 City Health Department
A healthy citizenry is of the utmost importance to the City Health Department of San Juan. With increase expectation and demand from the community to quality health service, the City Health Department aims to provide effective and efficient health information system. Improving the health information system by bridging the gap in the implementation of Iclinicsys with the organization will be beneficial to the City Health Department. Having an access to information will allow the health department to lay foundations for policies and make improvements suited to the needs of its people. In order to provide effective delivery of public health service, adoption of the new technology will be essential in the enhancement of the health information system in San Juan.
1.8.2 Department of Health
The designer of the program can find help from the outcome of the investigation because of the inputs it can give will help the organization develop local policy for Health Information System. This will ensure achievement of health system goals for better health outcomes and provide responsive health system.
1.8.3 Health Care Provider
The health care provider will greatly benefit from this study, being the person involved in data gathering and recording of health records. Providing knowledge on the response of the organization to the new technological change will significantly enhance understanding of technology acceptance for effective implementation of Iclinicsys.
1.8.4 Local Government Unit
Government’s responsibility to protect and advance the interests of society includes the delivery of high-quality health care. Leaders in public health sector are under increasing expectation and rising demand to provide higher quality health care with efficient and technologically advance governance for continuous improvement in the performance and delivery of health service. Providing a well-conducted research is vital to the success of the government. The research will form a foundation for program development and implementation of new policies responsive to the needs and desires of the constituents of San Juan.

1.8.5 Future Researcher
This study will be beneficial to the future researcher with the same topic of interest to gain insights from the output of this investigation. This research will surely contribute knowledge and opportunity to future researcher who wants to explore further in health information system.

1.8.6 Researcher
This study will benefit the researcher being the Assistant City Health officer of san Juan to develop a policy for successful implementation of new Health Information System. To address the gaps and issues of the current Health Information System and assist the health staff in adopting the new technological change.
1.9 Scope and Limitation of the Study
Assessing the health information of San Juan entails several factors that need to be considered to attain an enhanced Health Information System.
The researcher decided to limit the study on the internal factors that affect the introduction of new health Information system of San Juan. Limiting the study in this domain would hamper thoroughness, however covering as many domains as possible would be unrealistic. Adding external factors would have presented a complicated framework and focusing on the internal factors were the main concern of the study. To achieve focus, the study concentrated only on critical issues in a macroscopic perspective and discussed other technological issues that needed solutions.
The health personnel who are involved in the process of health information system were included in the study. Identifying the organization’s main task as well as the organizational structure was considered for analysis of organizational response to the new technological change implemented. Assessment of organizational response to IClinicsys was essentially the preliminary step to reduce the risk of failure. The investigation was conducted last September 2018. Any changes in status of the organization beyond this period were not covered by the framework of the study. Health care providers who are not involved in the process of Iclinicsys such as the utility, dental aide and drivers were excluded in the study.

For the assessment of individual response among health personnel, the researcher used a closed-ended survey followed by an open-ended questionnaire that provided further analysis of the current situation. In this thesis confidentiality and voluntary submission of health professionals to the study was considered.
1.10 Definition of TermsChange Management. This is a process and communication plan development within an organization.

Computer-based information system. This rely on computer hardware and software technology to process and disseminate information.

Culture. The way of life of a group of people who share common rules of behavior and thinking of people.

Departmentalization. The process by which an organization is structurally divided. e-Health. This refers to public health services and information delivered through improved Internet and related technologies.
Information Technology. This refers to the use of systems (especially computers and telecommunications) for storing, retrieving, and sending information.

E- Governance. This responds to the needs of its people for an efficient and effective process of disseminating information as well as improving the performance of government health activities.
E-Government. This is the use of information and communication technologies (ICTs) to improve the activities of public sector organizations. 
Electronic Health records (EHR). This is the health record of an individual that is shared among different health facilities and agencies, expected to improve efficiency and quality of care and, ultimately, reduce costs
Electronic Medical Records (EMR). This refers to the electronic-based health information of a patient that can be created and managed by authorized users in one healthcare organization,
Effectiveness. This is the degree to which something is successful in producing the desired result; success
Efficiency. This is the ability to accomplish something with the least waste of time and effort; competency in performance.
Framework. This is a broad overview, outline, plan of interlinked items which supports a particular approach to a specific objective,
Health Care Provider. A person involves in primary health care, treating illness or disability.

Information system. This is an organizational and management solutions based on information technology.

Health Information System. This is a system that provides information support for the decision-making across all health system, essential for health system policy development and implementation.

Health Management System. This is an information system specially designed to assist in the management and planning of health programs, as opposed to delivery of care
Managers. This is the person responsible for planning and organizing what is needed to be done.

Organization. This is an organized body of people with the same goal, vision, missionPerception. The process by which an individual gives meaning to the environment, it can be attitudes, behaviors and reported interactions of respondents involve in organizing and interpreting various stimuli into a psychological experience.

Technological innovation. This products or process of change
Chapter 2REVIEW OF RELATED LITERATURE AND STUDIES
This chapter provides a summary of related literature significant to the assessment of health information system for policy development. It will explore different kinds of literatures relevant to the study. It will guide the researcher to have an in-depth understanding of the current health information system of San Juan towards policy development.

2.1 E-governance
The world of Information Technology (IT) revolution has taken its course in the 21st century and will bring uprising changes in the next years to come. It has conveyed transformational leadership to the government sector, where benefits of transparency, online government services, feedback on governance and data collection for health services will transform its structure. The adoption of this new technology in government sector emerges new occurrence called e-governance. The e-governance is referred to services provided by government to the citizens, business and local government through information technology.

In order to improve governmental organization and government services, it is expected that governments should start using information and communication technology. “Electronic has brought about glaring transformation in the horizon of Public Administration” (Muhammad et al., 2007). “E-government is the use of government agencies of information technologies that have the ability to transform relations with citizens, businesses and other forms of government (World Bank 2009). For public sector, it would mean to use the most innovative Information and Communication Technology through electronic networks with more convenient access to government information and
services. ‘Electronic government has been defined as a technological application of information and communication in governmental organizations to increase efficiency, effectiveness and transparency’ Tambouris 2001 (as cited by Nejadirani,et al 2011). Government should always aim to provide efficient and effective process of disseminating information as well as improving the performance of government activities. The use of information technology would enhance the delivery of public service from its day to day government work for high quality services and information.
2.3 Policy in Information System
A policy is a deliberate plan of action to guide decisions and achieve rational outcomes. Commonly, governments develop and implement policies to address basic socio-economic issues that are expressed in laws, budgetary actions, international agreements, declarations, contracts or campaigns (ITU 2009). Many governments are seizing the opportunity to establish a government of the information age. The implementation of policy whether legislative, guidance, or action based is designed to initiate change. Policies generally seek to generate improvements in effectiveness, efficiency and more responsive outcomes. The establishment of the National Computer Center (NCC) by Executive Order 322 in 1971 for government computerization is a good indicator of the political will and foresight of the Philippine government for Information and Communication Technology (ICT) implementation (NCC 2012). Governments are ‘reinventing’ themselves to meet new expectations and the priorities of citizens and businesses.
With the advent of the information, many governments create a new vision for their relationship with businesses and citizens, and to create a new organizational structure to fulfill their mandate. This transformation stems from many powerful influences of the information revolution. Leaders in the e-government movement are demonstrating that by combining technology with new ways of operating, government can be more effective and responsive to citizens (Lallana 2002).

2.2 Value of Information System in Health Sector
The introduction of information technology applications has been beneficial to governments in several ways. Most significantly, in the area of public management information system provides information primarily to support manager decision making. Electronic applications have expanded government health sector for continuous quality improvement.
“In delivering public goods and services efficiently and effectively, it is very important that we are aided with support tools enabling the use of all kinds of spatial/data information” (Alex Brillantes Jr., 2008). Information technology improves the quality and safety of the health system through empowerment of health consumers for better management of information thereby reducing medical errors for efficient management of health (DOH 2013). It improves patient healthcare by giving health professionals access to complete, up-to-date health records of past and present conditions. Relevant information is important to deliver the needs of patient, health professionals, and health department. Information technology enhances health services thus increasing the efficiency of the existing flow of work in health facilities. It plays a vital role in establishing a competent organization and modernizes production capacity to deliver better performance in health care.
The application of Information System (IS) within public health administration is used to optimize its internal and external functions and provides health sector, the patients and community with set of tools that can potentially transform the way in which interactions take place, services are delivered, knowledge is utilized, policy is developed and implemented, citizens participation in governance, and public administration reform for good governance to be achieved. It affects every single aspect of modern society.
2.3 Development of Philippine Health Information System (PHIS)
Decentralization of health systems is a common pillar of health sector reform initiatives to improve efficiency and quality of services as well as promote accountability and local governance of the health sector.  A health system consists of all people, institutions, resources, and activities whose primary purpose is to promote, restore, and maintain health (USAID 2015).
Over the years, health care professionals have been used in documenting and storing patient information using paper-based recording. This resulted to overburdened health workers with manually recording and computing all the health programs. In turn, delays ensue because health care workers give it low priority compared to patient’s care. Delay in submission of reports to the national offices ensued.
A potential for healthcare to increase the overall quality of health to be more efficient, effective, transparent, accountable and equitable is by using relevant information technology (Iglesias 2010). Health Information System is considered a prerequisite for the efficient delivery of quality health care. “Health Information System integrates data collection, processing, reporting, and use of information necessary for improving health service effectiveness and efficiency through enhancing management at all levels of health services” (WHO 2004). The Philippine Health Information System facilitates gathering, analysis and dissemination of vital indices for the consumption of different users like planners, policy makers, community leaders and development agencies (Shillabeer 2009).
Every sector is trying to adopt Information system for improving their current working status and to bring efficiency in their operations. The World Health Organization (WHO) identifies Health Information Systems (HIS) as one of the pillars that contribute to the strengthening of Health System (WHO 2010). Enhancing Health Information System can reform and modernize public health administration as well as advance reforms in the ways the health sector conducts their health services from the traditional storage of medical records to a systematic computerized data recording. It aims to provide evidence-based for policy and program decisions to support better health outcomes for individuals and for populations overall.
Access to effective health information system remains a challenge for many Filipinos. The application of information technology in the Philippines has continuously advanced and yielded considerable benefits to an individual and public health (DOH 2013). Adoption and implementation of health information technology produces information that health sector needs for decision making and major organizational solutions to challenges and problems created in the health environment. Coordination, monitoring, evaluation and analysis of health data will boost the quality of health care to provide appropriate health interventions.

Health information systems in the Philippines started in 1960s when the Department of Health (DOH) first ran a national health information system (Marcelo 2010). It was in 1984 in the collaboration with the World Health Organization (WHO) that the system was improved and included primary health care. In 1989, the system was revised with the development of software for Field Health Services Information System (FHSIS) (Manabat 2018). This required health personnel from Rural Health Units (RHU) and Barangay Health Stations to collect data and submit 40 different national health programs through the use of ICT.

With the devolution of health services through the Local Government Code of 1991, the health system faced different challenges such as weakening of the quality of management and services, low staff morale, waning infrastructure, and insufficient funds for operational costs and services (Manabat 2018). Continuous improvement was done which led to the implementation of Modified Field Health Services Information System (MFHSIS) and enhanced with the development of Distributed Field Health Services Information System (DFHSIS).
PHIS data sources come from several government agencies: the National Statistical Office (NSO), National Statistical Coordination Board (NSCB), Food and Nutrition Research Institute (FNRI), National Nutrition Council (NNC), and Philippine Health Insurance Corporation (Philhealth), among others (Canlas 2009). The NSO provides basic census and population data like birth and mortality rates, while FNRI and NNC are sources of information on nutrition. Philhealth is a source of patient records and NSCB is an aggregrator of information to produce vital statistics like national economic and population metrics (Canlas 2009). To facilitate inter-agency coordination, the Department of Health (DOH) spearheaded the creation of the Philippine Health Information Network (PHIN) in 2007 which aims to establish collaboration with different agencies for effective health information (Marcelo 2012). However, several problems were identified such as delay and errors in healthcare decision-making, paper-based and manual reporting systems; all-or-none phenomenon; hierarchical flow of data submission; manipulative target-based reporting; mixing good quality data with bad, fabricated data; disintegrated and paradoxical vertical programs; data cemeteries; and lack of computerized health information standards (Marcelo 2010).

In 2013, a National eHealth Steering Committee, composed of representatives from the DOH, Department of Science and Technology (DOST), Philippine Health Insurance Corporation (PhilHealth), UP Manila, and eventually the Department of Information Communications and Technology (DICT), was formed to lead all eHealth initiatives to implement the Philippine eHealth Strategic Framework and Plan (DOH).

The Duterte administration, led by the DOH, outlined the Philippine Health Agenda (PHA) 2016-2022: All for Health towards Health for All. Under the PHA, the government aims to attain health-related sustainable development goals (SDGs) of financial protection especially for the poor, marginalized, and vulnerable; better health outcomes with no disparity; and a responsive health system where Filipinos feel respected, valued, and empowered. One of the strategies to achieve these goals is to invest in eHealth and health information systems to aid decision-making. The inclusion of eHealth and health information systems in the main thrusts of the DOH points to a high priority given by this administration in developing these initiatives as means of achieving Universal Health Care.

Organizational Factors influencing Health Information System
2.4.1.1 Organizational Structure
Organization is the planned coordination of the activities of more than one person for the achievement of a common purpose or goal. According to Schein (1980), it is accomplished through the division of labor and function and is based on hierarchy of authority and responsibility. According to Weber as cited by Laudon (1995), modern organizations should have the following characteristics: have a clear division of labor, arrange specialists in a hierarchy of authority, with explicit rules and procedures, impartial decision making, technical qualifications for positions and with maximum organizational efficiency. The introduction of a new information system will affect the organizational structure, goals, work, design, values, and competition between interest groups, decision making and day to day behavior (Laudon 1995). The transformation of an organization marked changes in form and nature that occur at all levels of an organization’s environment through the adoption and maturity of new information technology (RNAO 2017).
The people within the organization should be structured for the purpose of achieving its goals and specific purpose for its existing. In hierarchy, every member of the organization is assigned a specific position. Each position carries a specific level of decision-making authority as well as specific responsibilities within the organization.
Organizational structure is a system of formal procedures prescribing the allocation of work and roles and the coordination of employees acting in the framework and around it (Delic 2010). It is a combination of groups and individuals working in a coordinated way in order to achieve the goals of the organization. Organizational structure specifies the way people should act in performing their everyday activities. It is the backbone around which other groups cluster and other organizational components rely on. Organizational structure should deliver on the organization’s mission and objectives and as such has fundamental impact on how employees carry out their tasks, how they behave, and how the organization performs overall (Lynch 2012). An organization’s structure can affect how information systems are viewed and used.

One of the factors that should be considered in assessing the complex process of technological implementation is the role that people play in the process of change. Management plays a key factor for successful adoption of desired change. According to Sayles (2014), there are three basic levels of management: supervisory management, middle management and executive management. The supervisory-level managers work in a small functional workgroups or teams. They direct daily work, create work schedules and monitor the quality of work and productivity of staff. They are important resources in revising procedures and conducting performance reviews because of familiarity in the work unit and performance of individual staff members. The second is middle management. They are concern primarily with facilitating the work performed by the supervisors; they develop, implement and revise organizational policies and procedures under the direction of the executives. On the other hand, the executive-level managers are responsible for setting the organization’s future direction and establishing its strategic plan.
In order to assess the health information system for technological innovation, it is important to understand the organizational structure that influences the implementation of the change initiative most especially the role of managers in shaping the new technological change.

2.4.1.2. People
The effectiveness of an organization is directly linked to the performance of its employees (Belita et al., 2013). Implementation of a new information system is often more difficult than anticipated because of individual change requirements. The proficiency, competency, knowledge, and ability to use the new technology should be taken into account. Implementing the desired change requires remarkable levelling of the system as well as the persons using it. “Individual transformation” refers to the individual forming and restructuring that is enabled by the introduction and sustainment of eHealth solutions in a health care context (RNAO). The people have knowledge and skills that make them important resource to be considered in order to build on and improve the technology being introduced. Like in the case of the implementation of Iclinicsys in San Juan, modification has been done to help the health personnel adopt to the new system.
Manpower planning, programming and development are important in considering technological change. In implementing new technology, people need to adapt and learn to use the new equipment. According to Abrahamse, as cited by Borhani (2016), experienced employees are keen to adopt innovative solutions, however the process to acquire the skills is burden to the employees hence causes barriers to the adoption of the new technology.
2.4.1.3 TasksThe introduction of Iclinicsys transforms significantly the nature of work and daily task of health staff. When a change occurs in a system it is often seen that most of the traditional tasks and job descriptions are replaced with modern task force requirements. The new information technology may disrupt the existing organizational routine, a challenge that usually proves more difficult than anticipated. The implementation of Iclinicsys in the City Health Department has brought change in the daily task of the health personnel.
The qualitative aspect of these new tasks and goals should be properly evaluated and the people should be trained accordingly. Requirements and benefits of the new task should be identified and it should be checked whether it is relevant.

2.4.1.4 Effects of the new Health Information Technology
The impact of information technology has significant effects on the structure, people and task of most organizations.  Conversion to the new technology demands significant changes in workflow, jobs, structure and management of the organization. The introduction of new information technology affects the organizational structure, goals, decision making and day to day behavior. It can change medical health personnel working process and the time spent documenting during the implementation of the new information system.

Assembling an effective, efficient computer system requires an understanding of its relationship between information system and organization (Stair 2006). The new health information system will force changes in basic managerial functions. There will be increased responsibility on management for organization outcomes leading to added emphasis on planning, decision making, control, and coordination (Golson 1997). In order
to reap the benefits of technology, organizational innovations such as changes in culture, values, norms and interest-group alignments must be managed with as much planning and effort as technology changes (Laudon 1995). Creating an information technology that supports the organizations’ goals is of utmost importance. The new Health Information system is one of the many tools available for managers in coping with change. It is an instrument that would require organizational reform for the adoption of change.
Organizations awareness and acceptance of technological change greatly influence the success of the program. A simple technological upgrade in one organization will have large effects throughout the organization. A new information technology requires careful consideration of associated factors such as the organization, its people, structure and the roles of each individual persons involve for the proposed change. People are the most important element in most computer-based information systems. Information systems personnel include all the people who manage, run, program, and maintain the system.

Change is crucial for the organization to function in the most efficient way. Therefore organizations have to embrace change to be more competitive, develop and deliver better public service. The success of health information technology requires fundamental change on how organization works, view and improve their ways. There is no one package strategy but rather requires a holistic change for the success of the desired change. Having an in-depth understanding of the organizational response will help in the transformation process towards an enhanced health information system.

2.11 Management of Information System
Management of Information Systems includes external information in addition to the internal information about the agency’s operation in achieving the goal setting, and
decision-making purposes of the different levels of management in the organization (Orbeta 2016). To understand information systems, one must have a clear view of the problem it is planned to solve and the organizational processes that lead to its solution. To be able to use the information system effectively, one must try to anticipate the various individual reactions of people to the new technological change. An effective and successful implementation of health information system will transform the delivery of health services in accordance with the needs of the organization.
Organizational Change Management is focused on supporting people to change their behaviors in specific, desirable ways, by providing them with the right tools and supports. Those individuals and organizations that directly benefit from the initiative are often the most effective at executing the initiative. However, sometimes employees are inherently resistant to change, and the degree and nature of the resistance affect the successful transition to e-government (Gabrielle Iglesias. 2005). Developments in information technology create organizational responses. Assessing individual and organizational impacts is therefore crucial, as the success of HIS depends not only on the quality of the technology but also on the people and organizations involved (Ammenwerth et al, 2004: 480).

As early as 1960’s the Department of Health already operated a national health information system in 1984 (Marcelo 2010). In 1989, The Field Health Information system was adopted for the collection of data in the different health programs however the existing paper-based data collection system was not reformed. In 1996, the Field Health Services Information System (FHSIS) was modified and enhanced to the development of e-Health, this will provide local decision-makers to make relevant, timely and evidence-based decisions in different health programs.
The Department of Health aims to strengthen the coordination to various programs, projects, standards, systems of policies through a Unified Health Management Information System (UHMIS) (DOH 2016). An electronic health recording of all health programs for data generation, compilation and analysis of the Department of Health. The outputs of the UHMIS will assist in the management and planning of health programs. Providing unified health management information system will transform the current data system to higher
health care. For successful implementation, health care providers must be willing to undergo the transition from the old paper-based system to the new electronic-based HIS. Assessment of the individual and organizational response towards an enhanced health information system will serve as a foundation for successful e-Health innovation.
2.4. Impact of New Health Information System
In spite of the huge potential and opportunities that lie in HIS, more often than not the transformation of health care may appear as reform and modernize as it is on paper. In order for a developing country such as the Philippines to take advantage and apply these readily available tools, an ecosystem has to be built to provide training, implementation, and support for deployment of these technologies in local health organizations (Quesada). Public health often times faced with the challenges of managing the data health records as well as expectations of the community for the health care providers to adopt with technological innovation. According to Goldschmidt as cited by Ngafeeson (2014), the adoption of Information technology in healthcare has been particularly slow and lagging behind compared to the major industries by as much as 10-15 years. Health Information System (HIS) offers the promise of addressing many problems confronting the health care industry, yet their adoption in public health has been slow. Despite the numerous methods and strategies designed to transform healthcare and health care sector, many challenges are evident and need to be considered for successful adoption and implementation.
People
One factor that needs to be considered in the assessment of the complex process of technological implementation is the role health professionals play in the process. Health professionals are the primary users of Health Information System. People should be given special rights and privileges to ensure the system achieve its implementation targets.
From the study done by Mohamadali (2015), the following were the challenges identified among medical practitioners with the implementation of Health Information System in the healthcare; staff resistance in using the implemented system, lack of Information technology knowledge among practitioners in using Health Information System, refuse to share information, and the shortage of Information Technology manpower to regulate the system.
Changes of strategies, structures, and form of service delivery must be accepted by direct care professionals – they must adapt, learn new skills and competences and, above all, acquire and commit to new mindsets and attitudes (Rodrigues 2008). Bringing about changes in the health sector is not merely creating a new system and providing computer in the health facilities, it means much more of installing a new machine.

People need to adapt and learn to use the new technology. Success in the deployment of e-health applications depends on the right mix of skills and commitment to data management responsibilities in all functions at all levels, creating an additional burden to the already demanding professional workload. Resistance to change has become rooted in certain professional roles – the introduction of ICT in healthcare disrupts traditional structures and hierarchies.
There is a view that the health care professionals who have deficiency in Information and Communication Technology skills of management the online health data end up using too much time. Therefore, without adequate ICT knowledge and skills implementation of ICTs becomes difficult (Borketey 2017).

Structure
In order to reap the full bene?t of ICT in a complex environment, organization should have provided a clear de?nition of goals, roles and responsibilities of each health personnel involved in the adoption of the new technology. A low level of awareness about the need for ICT use and Information System implementation may cause delays in the process, which is likely to cause inefficient fund allocation and the overall stagnation of policy implementation.

Health care organizations cannot increase their commitment to e-health applications without strong leadership and vision (Ganesh 2004). For transformation to occur, the new Health Information System must be enabled and supported by the organizational leadership. A shared vision of what the organization is trying to accomplish, a clearly articulated mission and institutional leadership are often crucial determinants of successful e-health programs. Stable, well financed, and coordinated efforts in the areas of resource development, technical services, clinical operations, training, and advocacy for a favorable regulatory and policy infrastructure will go long way in establishing any successful e-health projects. If e-health is to be introduced widely then mobilization of organizational support is essential.
Organizational & Management Challenges includes coordination problems, administrative issues, information sharing problems, standardization of information, availability of multiple and parallel information, organizational culture, fragmented health systems, data interoperability, lack of synchronization, lack of training, absence of strategic organizational processes, Lack of insights and vision, diversity of requirements amongst specialties, insufficient physical assessment parameters, insufficient demonstrability of the outcome, hospital size, level of healthcare, ownership issues, legacy of traditional paper system, variation in health systems, disruptions in workflow, complexity of implementation, diverse sources and user requirements, poor integrations, insufficient health data collection systems, lack of incentives, poor working conditions, lack of agreement amongst stakeholders, logistical issues, inappropriate distribution of the decision making power, low levels of accessibility and availability, services that do not meet the requirements, the dynamic nature of healthcare, variations in purchasing power, neglecting patients’ needs, bad management, lack of guiding principles, type of data as some of it might be on papers whereas others are electronic, concerns about future help from system providers, hospital management, nature of jobs in the healthcare sector, changes in roles and responsibilities within the healthcare team, changes in teaching patterns, vague objectives and values, absence of administrative systems to control operations of health information systems, lack of local champions, performance measurement, change management issues, evaluation issues, in addition to absence of a reform agenda and supportive strategies (Jaros?awski and Saberwal, 2014).

Task
Users’ perceptions about technology can affect exactly how a new information technology is accepted, implemented operationalized. It was established that most users’ are only frightened by the use of ICT in health sector established on their perceptions about it (Achampong, 2012). The perception of health professionals that electronic health record (EHR) would demand and consume additional time adversely influence the duration of time they might spend with patients. Successful implementation of eHealth implementation would demand change of attitudes of health personnel towards eHealth (Achampong, 2012).
From the study done by Murray (2011), new technology was most likely to be successful when implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organizational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower level of success.

Health Personnel should be taken seriously to ensure that the problems are identified and solutions are provided. In the study done by Jalghoum et al (2016) resistance to change can have severe effects on the adoption of the e-health. Different reasons behind the resistance to change were the work overload that takes place during the change. Several health workers became too overwhelmed when e-health projects were introduced and started to get implemented in their health facilities. Having to work on projects related to e-health in addition to the projects they were already working on has created a huge burden on them and doubled the amount of effort and time needed.
Technology
Technology is an important factor influencing e-government success (NSW, 2001). It comprises Information System structure, hardware, and service quality.
The lack of computerized health information standards is one of the technological challenges in Philippine Health InformationSystem. While the Department of Health and Philhealth maintain their respective computerized health information systems, they are not standard based and cannot easily exchange data with each other.
From the study done by Menko et al (2013), there are technological challenges in the implementation of Information factors identified were lack of technological skills and training, poor reliability of the system, hardware failures, connectivity problems, monitoring machines problems, system errors, lack of computer literacy, unnecessary updates and upgrades to current functional software, mistaken functioning of videos, lack of access to technology, lack of computers, lack of electronic communication capabilities, multiplicity of screens, lack of technical support, difficulties dealing with technology, diversity of options and navigational aids, issues in system maintenance and software updates, lack of feasible technological infrastructure, lack of utilization of computers in health, technical issues and concerns, complicated unfriendly systems, inadequate technical staff, poor network coverage, and the amount of data being transferred.

An effective Health Information System is built through the process that starts with understanding what decisions need to be made by these various players and be able to
2.12 Synthesis
The researcher on related literature integrated the Leaviit Model to investigate the response of the organization and the individual on the desired innovation. This is necessary to sort out the situation so that effective management action can be executed. The related literature and studies serve as foundation for an in-depth understanding on the proposed study.

In pursuing the research venture, the related literature helped the researcher in the assessment of organizational response needed for the enhancement of health information system and policy development. A reliable health information system will serve as a foundation for decision-making of all health related programs and services. The process to transform the health information system of the LGU will neither be quick nor simple. It will require a coherent strategy, beginning with an examination of the people, structure, task and technology as well as the ability of the organization to adopt and make use of implemented technology. The success of adoption of new technology requires fundamentally change on how the organization works and how people view the ways in which organization helps them. There is no “one size fits all” strategy in implementing Health Information System, but having identified the response of the organization and the individual involved will help in the transformation process of the new technological change.

Chapter 3
RESEARCH METHODOLOGY
3.2 Research Approach
Assessing the status of the Health Information System of San Juan should follow a detailed methodology which consists of the following:
The Design phase in which objectives are defined and data collection methods are selected.
The Process phase derived from data collected to develop policy for health information. Current Health Information System is assessed and examined.
The Analysis of Results phase in which the scores gained from the process phase are analyzed to improve the current Health Information of San Juan.
3.3 Research Design
The primary objective of this investigation was to gather relevant information pertaining to the perception of the respondents to the current Health Information System. In this thesis, the researcher conducted a descriptive study to generate information regarding the perception of health information system of San Juan. The objective of the descriptive research is to cast light in the current issues or problems through a process of data collection that enables them to describe various aspects of the phenomenon (Fox 2007). This method provided accuracy on the current situation of the health information of San Juan, perception of the end user and the actions taken during the development of the health information system. The Researcher used a mixed method research design which is a combination of a quantitative closed ended questionnaire and a qualitative open ended questionnaire. A quantitative approach was adopted in this study to measure the perception of health staff on the new health information system. However, the survey questionnaire did not provided an in depth understanding of the current health information system. Hence, a qualitative data was used to allow the researcher to obtain a complete picture about the real health information system situation and the perception of the key informants to the new technological change. A face to face interview was drawn upon the key informants’ in order to provide additional insight in several important issues related to the perception of the respondents to the current health information system and the actions taken during the development.
Research Method
A comprehensive research was undertaken on e-governance, health information system, adoption of information technology, and organizational structure. Such researches helped in identifying all critical success factors for a comprehensive assessment of Health Information System and organizational and individual response to the adoption of new information technology. Analysis of such factors revealed that they can be classified into two main groups: internal factors (specific to the organization such as structure, task, its people, knowledge, skills) and external (related to the whole environment such as, economic, political, and regulatory). Although the external factors such as the environment, governance, regulations are proved to be important in assessing the Health Information System, they were not included in this thesis.
The focus of this research was on the internal factors that exist within the City Health Department. The researcher decided to focus on studying the different factors within the organization such as the health providers’ skills, knowledge, its structure, leadership and management which are all factors that can affect the implementation of the new health information system. Adding external factors would have presented a complicated framework and focusing on the internal factors were the main concern of the study.
Based on the Leavitt model, the researcher focused on the assessment of the Health Information System using the four internal factors such as the Structure, task, technology, and people. The researcher believes that the four dimensions are the pillars of success in any information system.
3.2 Population and Sample size and Sampling Technique
The population of the study was composed of the health personnel of the City Health Department who plays a critical role in the process of Iclinicsys. Included were the physicians, dentists, nurses, midwives, nutritionist-dietitians, sanitary inspectors, barangay nutrition scholars and administrative aide as seen in Table 2.
Table 2 Health Personnel Ratio to Population
Indicators Male Female Total
2018
Physicians (including the CHO ; ACHO) 3 8 11
Dentists (including the Supervisor) 5 7 12
Nurses (including the Supervisor) 2 11 13
Midwives (including the Supervisor) 0 15 15
Nutritionist- Dietitians 1 1 2
Sanitary Inspectors 4 5 9
Barangay Nutrition Scholars 0 18 18
Administrative Aide(Clerk) 1 4 5
TOTAL 16 69 85
Table 2 presents the population and sample size of the health care providers included in the study. The population size of male health personnel is 16 while female health personnel is 69, a total of 85 health personnel were included in the study. The population has been categorized by current position as it could be a factor with their response in the survey.
Sampling Design
To gather the needed data through the use of survey questionnaires and interview with structured and semi-structured questions, two-step sampling technique have been employed which are purposive and judgemental sampling procedures. Purposive sampling is a non-probability sampling technique which selects units from a population to be investigated by the researcher. The objective using purposive sampling is to concentrate in evaluating the characteristics of a population.85 Health personnel are scattered in different health facilities in a hierarchical manner. The respondents were chosen using purposive sampling methods based on their involvement in the IClinicsys process.
3.3 Research Instrument
Survey Questionnaire
A quantitative self-made survey questionnaire was used as a main instrument to analyze the status of the current health information system of the Health Department. The first page of the questionnaire contained an introduction that explains some terms included in the questionnaire. The questionnaire consisted of two parts (see Appendix A). The first Part consists of the socio-demographic profile of the respondents such as the age, current position, and years of service. The second three parts measured the perception of the respondents to the health information system where in it is categorized into four parts; the people, structure, technology and task. These research variables were used to know how the respondents rate the current health information system. A ten-point scale was used, 1 being very poor and 10 being very good. Another measurement was done using a 4-point Likert scales, with 1 as strongly agree and 4 strongly disagree. Lastly, a dichotomous survey questionnaire was used to assess the actions taken and the willingness of the respondents for policy development.
An additional set of dichotomous questionnaire was given to the medical supervisors as well as to the middle manager. This will help assess the actions taken for the development of the Health Information System. Comments were asked in each question in order to provide additional information relevant to the study.
Key Informant Interview
A qualitative open ended questionnaire was collected from the key informants using face to face interview. Key informant interviews are considered important in order to provide the researcher additional insight and have an in-depth understanding of the current Health Information System. In this thesis, the key informant was identified as follows.
1. DOH IClinicsys manager- the key informant is involved in the management tasks of the regional health information system (DOH-NCR). The person is assigned at the administrative unit. The justification for selecting this particular person is that he is in the position to give detailed information regarding overall management of current Health Information System in the regional health system.
2. Health Managers- This group represents the actual users of Health Information for Health Management activities. A purposive and judgmental sample of 3 health managers who are involved in planning and management of healthcare services in San Juan Health Department was recruited.
Development of the Interview Guide
Besides conducting interviews, a review of documents has been done to provide great help for analysis of data such as policies and procedures, work process of implementation and the organizational chart. The hierarchical structure is important to understand the different positions and relations between them and to investigate how these positions affected the process of IClinicsys implementation.

There are two types of interviews according to Yin (2002), open-ended interviews prevailing respondents point of views while following the researcher line of inquiry, and interviews producing quantitative data. Qualitative interviews can be divided into structured, semi-structured, and unstructured subcategories which is dependent on the level of formality (Saunders et al., 2009, p. 320). Structured interviews is defined as set of questions for every interview, while semi-structured are based on a set of questions that can be varied dependent on the situation (Saunders et al., 2009, p. 320). Unstructured, or in-depth, interviews are absolutely informal, guided only by the list of topics that might be discussed (Saunders et al., 2009, p. 321) for this thesis a structured and semi-structured interview is used to get comprehensive information. This technique allowed the researcher to focus on areas that were given emphasis by the respondents, while staying within the boundaries of the research topic.

A semi-structured interview with Iclinicsys coordinators and DOH Iclinicsys manager was done by the researcher. This type of interviews did not include specific questions, but just broad areas for investigation aiming mainly to open ideas and thoughts with interviewees. Unstructured interviews encouraged respondents in selected organizations to express their thoughts liberally. This enabled collecting information regarding the main role of Iclinicys in the organization, its value and impact as viewed by the key informant.

Subsequently, semi-structured interviews (see appendix C) – characterised by including a set of questions in a limited time but addressed in a flexible way – were also conducted with top management and IT professionals to allow them to elaborate on issues viewed as crucial from the researcher?s perspective such as, main online and offline services provided by the organisation and the difference between them, level of employees? awareness of the e-government program in the organisation, communication approaches adopted within the organisation and with other public agencies. Semi-structured interviews served also in recognising the number (and availability) of potential respondents capable of answering structured interviews to be conducted later with the employees, and in finetuning the developed questionnaire instrument.
In addition, Observation Method was used to collect data that offered relevant behaviors of the health personnel. Such observations constituted an important source of data that provided significant information on the employees? working environment, the organization’s workflow, the Iclinicsys applications used and their efficiency, the communication mechanisms followed between management and employees, and the communication skills of the employees who have a direct interaction with citizens.
3.4 Data Gathering Procedure
The researcher provided a letter to the City Health Officer Jesus Esteban P. Olano, M.D. requesting permission to conduct the study. Data was gathered after securing the permission from the head Department and collected without hindering the normal activities of the respondents. All permanent health professionals of the City Health Department who are assigned in different health facilities and are involved in the process of Iclinicsys were chosen for this study. The study utilized a survey questionnaire which was given directly to the respondents.

In addition, as a regular routine, the researcher clarified several issues to each questionnaire?s respondent before handing him/her the questionnaire. Each Health personnel were informed about the purpose of the questionnaire and its anonymous nature. Respondents were also told that their participation in this study was voluntary, not required, and that their refusal to participate would not affect them in any way, and that they could withdraw from this study at any time.

3.5 Statistical Treatment of Data
Statistical treatment of data is important for interpretation of data collected vital for the outcome of the study. The following statistical treatment will be used:
1.The Percentage will be used to determine the distribution of the personal related data of the respondents. The formula is:
% = n/N x 100
% = percentage
n = number of respondents
N = total number of respondents
2.Weighted mean will determine the assessments of the respondents with their respondent’s profile. The formula is.

X = F(x) / N
X = weighted mean
F = frequency
x = weight of the response
N = total number of responses
3.Pearson’s Product Moment Correlation Coefficient (r)- a statistical analysis of data will be used to investigate the association or relationship between assessments of the respondents with their respondent’s profile.

4.The Cronbach’s Alpha will be used to test the reliability of the survey questionnaire. It will measure the internal consistency of the test.

5.The Microsoft excel Data Analysis Software will be used to compute the Cronbach’s Alpha.

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INDIVIDUAL AND ORGANIZATIONAL RESPONSE: AN ASSESSMENT OF HEALTH INFORMATION SYSTEM OF SAN JUAN:
BASIS FOR POLICY DEVELOPMENT
Date (dd/mm/yy) Survey
number
SURVEY QUESTIONNAIRE

Directions: The lists below are the statements which are designed to determine the Health Information System of San Juan which will provide basis for policy development. This will take no more than thirty minutes to complete. There will be no anticipated risks associated with your participation. All responses will remain confidential and will be used for statistical summaries and generalizations only.
Please provide an honest rating by checking (?) the box that corresponds to your answer.
Part I. Socio- Demographic Profile of Respondents
Age
Less than 20 y/o 20-30 y/o 31-40 y/0 41-50 y/o 50-60 y/o ;60 years old Current Position
Doctor Dentist Nurse Midwife Sanitation Inspector Barangay Nutrition Scholar Nutritionist Clerk Years of Service
Less than 1 year 1-5 years 6-10 years 10- 15 years 16-20 years More than 21 years
Part II
A. On the scale of 1-10, 1 being very poor and 10 being very good, how would you rate the current Health Information System of San Juan? Please encircle the number that corresponds to your answer.

1. Health Information System RATING SCALE
1.1 People Number of trained health staff for Iclinicsys 1 2 3 4 5 6 7 8 9 10
Competent Health staff using Iclinicsys 1 2 3 4 5 6 7 8 9 10
Health personnel using iClinicSys 1 2 3 4 5 6 7 8 9 10
Health staff require computer skills are insufficient 1 2 3 4 5 6 7 8 9 10
Cooperation and support of Health staff using Iclinicsys 1 2 3 4 5 6 7 8 9 10
Additional technical support is required in using IClinicsys 1 2 3 4 5 6 7 8 9 10
1.2 Structure Leadership support in implementing IClinicsys 1 2 3 4 5 6 7 8 9 10
Roles and responsibilities of health staff are clearly defined in Iclinicsys 1 2 3 4 5 6 7 8 9 10
There is commitment of leaders to implement IClinicsys 1 2 3 4 5 6 7 8 9 10
There is Monitoring and Evaluation Mechanism of Medical supervisors for Iclinicsys 1 2 3 4 5 6 7 8 9 10
There is Division of Labor for Iclinicsys
1 2 3 4 5 6 7 8 9 10
1.3 Technology Iclinicsys makes correct information 1 2 3 4 5 6 7 8 9 10
Iclinicsys prevents duplication of data 1 2 3 4 5 6 7 8 9 10
Iclinicsys offers support in decision making 1 2 3 4 5 6 7 8 9 10
Easy accessibility and availability of health centers for offline storage.

1 2 3 4 5 6 7 8 9 10
Iclinicsys provides worthy analysis on the basis of patient’s data 1 2 3 4 5 6 7 8 9 10
Iclinicsys provides accurate information 1 2 3 4 5 6 7 8 9 10
1.4 Task Iclinicsys is easy to use 1 2 3 4 5 6 7 8 9 10
Iclinicsys useful in daily task 1 2 3 4 5 6 7 8 9 10
Health staff finds it difficult to use IClinicsys 1 2 3 4 5 6 7 8 9 10
There is added burden when using Iclinicsys 1 2 3 4 5 6 7 8 9 10
Iclinicsys improves productivity of workplace 1 2 3 4 5 6 7 8 9 10
Health staff are competent in using IClinicsys 1 2 3 4 5 6 7 8 9 10
B. Perception of Current Status of IClinicsys
Please provide an honest rating by checking (?) the box that corresponds to the number which best reflects your rating using the legend below. All information provided shall be treated as confidential and will be used strictly for academic purposes.

1 2 3 4
Strongly Agree Agree Disagree Strongly Disagree
I. Items on the Perception
1. Technology
Strongly
Agree Agree Disagree Strongly Disagree
1 2 3 4
IClinicsys provides me better analysis of data ICinicsys provides me accuracy in data gatherinig IClinicsys provides me timely data gathering IClinicsys added burden to my daily work IClinicsys provides help in my day to day control of operations I believe that IClinicsys is user- friendly to the user IClinicsys requires too much effort for me when encoding I. Items on the Perception
1. Technology
Strongly
Agree Agree Disagree Strongly Disagree
1 2 3 4
Iclinicsys has no beneficial effect on my daily work Iclinicsys helps me in delivering health services Iclinicsys aids in my decision making by using past and present data I believe that Iclinicsys provides well-defined system of collection and recording 2. People
2.1 Knowledge Strongly
Agree Agree Disagree Strongly Disagree
1 2 3 4
I am not familiar to IClinicsys IClinicsys uses appropriate and familiar medical terms Entering data, loading and executing IClinicsys is easy for me Using Iclinicsys is difficult for me I am knowledgeable enough to use IClinicsys I do not have to remember a lot of things while using Iclinicsys 2.2 Skills Strongly
Agree Agree Disagree Strongly Disagree
1 2 3 4
I have adequate Training for IClinicsys I learnt IClinicsys very quickly I am competent in using IClinicsys I require sufficient technical support while using the system It’s easy for me to use the system while interacting with a patient 3. Manpower Strongly
Agree Agree Disagree Strongly Disagree
1 2 3 4
I believe that there are adequate health personnel in charge of monitoring the progressive transformation from FHSIS to Iclinicsys 3. Manpower Strongly
Agree Agree Disagree Strongly Disagree
1 2 3 4
There is readily available technician in charge for IClinicsys in cases of technical problem I believe there is health personnel for monitoring and evaluation of ICLinicsys I believe there is health personnel to facilitate the implementation of IClinicsys I believe there is no health personnel who provides analysis of data from IClinicsys I believe there is appropriate number of health staff for ICLinicsys implementation I believe there is health personnel assigned to track the progress of IClinicsys I believe there is appropriate number of health personnel for Iclinicsys I believe leaders at all levels are committed to support the implementation of IClinicsys
4. Task Strongly
Agree Agree Disagree Strongly Disagree
1 2 3 4
My daily work improves using ICLinicsys IClinicsys fulfills all my requirements and I do not have to work manually anymore Entering data, loading and executing IClinicsys is easy for me Using Iclinicsys added burden to my daily work I seldom use Iclinicsys in my everyday work 4. Structure Strongly
Agree Agree Disagree Strongly Disagree
1 2 3 4
The objectives of IClinicsys is widely communicated and explained by my superiors 4. Structure Strongly
Agree Agree Disagree Strongly Disagree
1 2 3 4
I believe there is team participation among health staff for IClinicsys implementation I believe there is supervisory monitoring and evaluation for IClinicsys The amount of support provided by my superiors is satisfactory I believe there is technical support for IClinicsys My superior provides decision-making on health status based on IClinicsys I believe there is appropriate leadership management for IClinicsys My superior provides clear information on Iclinicsys C. Do you think there is a need to have an overall policy to strengthen Health Information System?
2420620177800013785851968500 Yes No
Do you have any suggestions on how to improve the current Health Information of San Juan?
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_____________________________
Signature
D. Actions taken for the development of Health Information System
Actions Taken (Medical Coordinators, Supervisors, TWG) Comments
1. Policy Yes No 1.1.1 Does your Department have a Local Policy for Iclinicsys ?1.1.2 Does your Department have Local Plan for Iclinicsys? 1.1.3 Is Iclinicsys meeting both the national and local demands for data analysis? 1.1.4 Do you have standards and guidelines for IClinicsys? 2. Adequate Human Resources Yes No Comments
2.1 Does your IClinicsys program have a committee to coordinate and assist the local activities for Iclinicsys? 2.2 Education programs are vital for successful implementation and maintenance of IClinicsys, please describe what programs for IClinicsys do you have? 2.3 Adequate number of trained staff is another main component to ensure implementation of IClinicsys, please provide a list of your health staff trained for Iclinicsys 3. Adequate Technological Resources Yes No Comments
3.1 Does your Department included Iclinicsys in your Annual Investment Plan? 3.2 Does your annual investment plan have budget allocation for IClinicsys? 3.3 Technical resources are backbone of IClinivsys, Please provide list of resources that your Department have? 3.4 Adequate functioning equipment is a basic element for IClinicsys, please provide a list of functioning equipment provided in your health facility? 4. Task Yes No Comments
4.1 Does the work of the medical officers and health staff improve after using ICLinicsys? Please site examples 4.2 Does Iclinicsys provided ease on your daily work?
4.2 Does your health staff competent in using Icnicsys? Please identify the health facilities 4.4 Does your Department benefit from the new technology. Please specify 5. Structure Yes No Comments
5.1 Does your Department provides strategic direction and vision for Iclinicsys? 5.2 Does your top-managers allocate resources needed for Iclinicsys? 5.3 Does the top-managers manage behaviors and attitudes of health staff that support IClinicsys? 5.4 Does the top managers communicate the vision in a clear manner? 5.5 Does your Department have a systematic mechanism in place for reviewing training needs and requirements? 5.6 Does your Department committed to implement this change? 6. Connectivity Yes No Comments
6.1 Does your Iclinicsys program have computers/laptops? Please provide list of health facilities provided with computers/laptops? 6.2 Does health facilities have access to internet? Please provide list of facility with internet connection. 6.3 Please describe what kind of internet connections do your facilities have? D. Do you think there is a need to have an overall policy to strengthen Health Information System?
2420620177800013785851968500 Yes No
Do you have any suggestions on how to improve the current Health Information of San Juan?
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_____________________________
Thank you!Signature
Key Informant Interview
Introduction
Confidentiality of all answers will be maintained by assigning a code to each response and not recording any personal or identification information. Answers to the study are completely anonymous. Your questionnaire will be destroyed once your responses have been recorded. The summarized findings with no identifying information may be published in an academic journal. There are no foreseeable risks to you as a participant in this project; nor are there any direct benefits. Your sincere reply will provide guidance to the organizational response to the adoption of new technology (iClinicSys).

Key Informant Questions
(IClinicsys TWG- Medical Coordinator, Midwife Coordinator)
Please tell me a little bit about yourself age, years of service at the LGU and your position in the City Health Department.
What is your role in IClinicsys implementation?
How would you assess the employees’ performance compared to performance standards?
Is the system overly complex and difficult to operate?
Are there sufficient personnel to perform the current task for IClinicsys?
What are the changes to information flows in health?
What are the challenges and barriers experienced in delivering IClinicsys?
Does IClinicysy provided a positive/negative impact to the current situation in the City Health Department?
What are the recommendable plans that the City Health Department can do to improve Health Information System of San Juan?
Is there anything you want to add concerning IClinicsys?
Key Informant (DOH)
Please tell me a little bit about yourself age, years of service at the government
What is your current position?
What is your current place of work or institution?
Is there a National Policy for Iclinicsys?
What is your role in IClinicsys implementation?
What are the actions taken by the DOH prior to implementation of Iclinicsys?
Does IClinicsys support the specific goals of various programs? How?
What are the changes to information flows in health systems and services required to meet the goal and objectives of Iclinicsys?
Based on the standards or guidelines or laws, does DOH practice supervision on IClinicsys? How often? What are the results?
Are there adequate training programs for the users at the LGU?
What do you think can be done to enhance IClinicsys use?
What are the strategic recommendations on how IClinicsys should be used?
Is there anything you want to share concerning IClinicsys?
APPENDIX C
KEY INFORMANT INTERVIEW
KEY INFORMANT: Former Medical Coordinator iclinicsys
Good afternoon, I am Rosalie M. Sto. Domingo, a student for Master in Public Administration and I would like to ask your perception on the current Health Information in San Juan. There will be no anticipated risks associated with your participation. All responses will remain confidential and will be used for statistical summaries and generalizations only.
Researcher: Please tell me a little bit about yourself age, years of service at the LGU and your position in the City Health Department.
Respondent: I am a physician and a Medical Officer at San Juan City Health Department (CHD) assigned to be one of the Technical Working Group of the department, a former FHSIS coordinator.

Researcher: What is your role in IClinicsys implementation?
Respondent: As former FHSIS coordinator, I was in charge as an overall medical coordinator in charge of collating the accomplishment of the different programs of the CHD together with a midwife. We presented the iclinicsys to the local health board November of 2014. We were taught by the DOH ICT team on how to go about the Health information system. By 2015, set a 2-day workshop to 22 selected health staff to get the feel of it. The electronic FHSIS reporting that we used to send to DOH, was integrated with the Iclinicsys which also record demographics of the patient as serves as a patient’s record too.
Researcher: Can you narrate what transpired on the transition as a former FHSIS coordinator to the new FHSIS coordinator?
Respondent: By 2016 we conducted a seminar activity on chosen supervisors and some health staff about Iclinic sys thru the local health system fund of DOH composed of 22 participants. After which, we conducted another set of Iclinicsys to a second batch of chosen health staff. We were still having problems as to the procurement of laptops or desktop to use. Kaya hindi pa initially nag materialize yung system. Tapos medyo nagkulang din sa funding noong 2016, hindi naging priority ng health and iclinisys. Walang budget masyado. So hindi sya fully implemented to the extent na maturuan lahat separately ang health staff.

By April 2017, I was assigned as medical coordinator sa Sanitation Department. I left the E-health coordinator part on my assistant sa midwife coordinator namin.  I was assuming two programs, until another doctor took over, but I was not able to properly endorsed to her fully too. I assumed that my midwife coordinator was in depth to know how it goes kaya, naiwan ko na sa kanila ung FHSIS and Iclinicsys program,
Researcher: How would you assess the employees’ performance compared to performance standards in IClinicsys?
Respondent: Way back 2015, when the DOH introduced to us Health Information System thru I clinic. It was a struggle to our health staff, some were hesitant and refuse to make it a day to day basis, maraming backlogs to the fact that most of the health facilities have no laptops or computer to put their accomplishments.
Researcher: Is the system overly complex and difficult to operate?
Respondent: It is hard to do in a sense that some health staff are not familiar in using the computer. It will take them 45 mins to 1 hour just to input the details of the patients. Nagiging double burden sa kanila since they do manual recording then iniipon nila to put it later in the afternoon. There are instances that they have to go to the other health facility who have the laptops just to input it for Philhealth purposes and make the initial implementation of it.

Researcher: Are there sufficient personnel to perform the current task for IClinicsys?
Respondent: Initially you should have at least 4-5 personnel to make it sufficiently enough just to get hang of the system. “Mangangapa pa kasi ung mga tao”, 2 sa front desk, 1 to encode maybe a BHW and a midwife, the other to interview the line of the patients, 1 for the doctor, 1 for the nurse to dispense the medicines.
Researcher: What are the changes to information flows in health?
From manual, it will be electronic system of patient’s record. More information pertaining to the health status of the whole family, in a way of easy capture of the census guide to the patients family.
Researcher: What are the challenges and barriers experienced in delivering IClinicsys?
Respondent: Challenge is the new system of applying the technical part of it. Not all wants the computer, we have many health staff who were employed more than 10 years ago, so it’s hard for them to cope up. Barriers, the technical assistance, because the ICT of the City, is not that familiar to the iclincsys program. Not enough computers to functionally operate the complete system of iclinicsys. The wifi connection is not consistent, although they can keep their report offline, it is much better if the wi fi connection is always available.
Researcher: Does IClinicysy provided a positive/negative impact to the current situation in the City Health Department?
Respondent: Positive because it is a way of introducing e-governance to the CHD we will have a paperless kind of keeping the patient’s records, Negative if the CHD will not be able to support is fully and sustain the health information system, it may be a lost opportunity for the CHD too.

Researcher: What are the recommendable plans that the City Health Department can do to improve Health Information System in San Juan?
Respondent: Ideally there should be at least 3 computers per health center, I hope the CHD will be able to give this to the health facilities. Also to coordinate to the ICT of the city that should be aware of for technical assistance. A strong and steady wifi connectivity. And that the health staff be given a refresher training workshop to know the problems they may be encountering.
Researcher: Is there anything you want to add concerning IClinicsys?
Respondent: I hope the LGU will give more emphasis on its vision, for the CHD to have health information system for patient’s records, more funds especially the upgrade of computer, to have at least 3 computers per health center. With the age of technology, the health system in the health center is slowly adapting what have been existing to hospitals and other health care facilities. Other LGUs have their ICT set up and it will be a big help if there is a IT assigned to the CHD “Para mas madalian ang mga staff sa technical assistance pag nangailangan agad, imbes na sa DOH pa hihingi nga tulong na minsan matatagalan pa”
Lastly, sana maintindihan ng mga health staff yung patutunghan ng iclinicsys, so they will be inspired na ma- motivate matuto. Anything new is a step for a change, minsan ayaw na nila ng bago. But they have to understand the purpose, that their adjustments will pay off in the long run.

Key Informant: Current Medical Coordinator Iclinicsys
Good afternoon, I am Rosalie M. Sto. Domingo, a student for Master in Public Administration and I would like to ask your perception on the current Health Information in San Juan. There will be no anticipated risks associated with your participation. All responses will remain confidential and will be used for statistical summaries and generalizations only.
Researcher: Please tell me a little bit about yourself age, years of service at the LGU and your position in the City Health Department.
Respondent: I am Agnes P. Mariano-Namocatcat, Physician in charge at Kabayanan Health Center, FHSIS and RMNCAHN coordinator, and I’m on my 1st year of service at the City Health Department.

Researcher: What is your role in IClinicsys implementation?
Respondent: I am currently the Iclinicsys Coordinator. I was assigned to be the medical coordinator of Iclinicsys early this year. I am not yet oriented with the program. To be honest I am dependent with my efficient midwife coordinator, who are doing all the monitoring in Iclinicsys. With all the assigned programs given to me, I barely have time to focus on Iclinicsys.
Researcher: How would you assess the employees’ performance compared to performance standards in IClinicsys?
Respondent: Daily updating of iclinicsys was not done on time by the health staff due to multitasking and lack of manpower in some health centers. In some health facilities, the HRH deployed by the DOH are being utilized to facilitate the updating and recording of data.
Researcher: Is the system overly complex and difficult to operate?
Respondent: The system is user friendly and can easily be followed by the staff provided they were given the proper training and instructions. However, caution should be observed when encoding prenatal and immunization records due to various indicators that should be properly filled up.

Researcher: Are there sufficient personnel to perform the current task for IClinicsys?
Respondent: There is adequate number of trained personnel who can perform tasks for iClinicsys.
Researcher: What are the changes to information flows in health?
Respondent: The implementation of iClinicSys provided a realtime record keeping of data. It also allows fast consolidation of data for reporting.
Researcher: What are the challenges and barriers experienced in delivering IClinicsys?
Respondent: Dedication of the health staff in encoding the files, lack of man power and unavailability of internet connection in some facilities greatly affect the full implementation of the system.

Researcher: Does IClinicysy provided a positive/negative impact to the current situation in the City Health Department?
Respondent: IClinicSys provided the CHO, accurate and systematized record updated database. It also allows the CHO to analyze the data being submitted for planning of interventions that will increase the productivity and service delivery in the community.

Researcher: What are the recommendable plans that the City Health Department can do to improve Health Information System in San Juan?
Respondent: Provision of training for health staff in the usage of computers, and the whole system. Updating the skills of the staff will empower them to perform their daily task despite the lack of manpower in some facilities. An institutionalized health information system in San Juan will enable the Department to judiciously plan for the improvement of the health care system. Availability of technical support should be provided for health staff that have difficulty in dealing with the
Researcher: Is there anything you want to add concerning IClinicsys?
Respondent: Provision of an administrative aide in facilities will help aide in the lack of health staff. Delay in the submission of iClinic Sys will affect the Philhealth capitation of the facility.
KEY INFORMANT: Midwife Coordinator Iclinicsys
Good afternoon, I am Rosalie M. Sto. Domingo, a student for Master in Public Administration and I would like to ask your perception on the current Health Information in San Juan. There will be no anticipated risks associated with your participation. All responses will remain confidential and will be used for statistical summaries and generalizations only.
Researcher: Please tell me a little bit about yourself, age, years of service at the LGU and your position in the City Health Department
Respondent: I am Elaine F. Bautista, Midwife 3, Assigned at Kabayanan Health Center, 43 years old, 11 years in service
Researcher: What is your role in iClinicSys implementation?
Respondent: Midwife Coordinator of Iclinicsys, at time nag trouble shooting at the facilities and encoder in my health facility
Researcher: How would you assess the employees performance compared to performance standards in iClinicSys?
Respondent: If we are to compare first with standards of Iclinicsys, some Employees are able to perform their task in Iclinicsy, however there are other health staff that do not meet the standard performance for iClinicSys. Out of 18 facilities, there were only 5 health facilities na nag eencode ng Iclinicsys. While the other 13 facilities, the Public Health assistant (PHA) of the DOH are the one encoding.

Researcher: Do you mean, in other facilities, hindi ang health staff ang nag eencode?
Respondent: Yes po
Researcher: What would you think is the reason behind that?
Respondent: Maybe because of the bulk of patients they have in their facility. And most of them are near 60’s and some are more than 60 years old…. So Nahihrapan na sila mag encode. Some of them have fears na pag nag click sila, baka may mabura sa system. They are afraid to commit mistakes, so even if you give them step by step procedure on how to operate the system…. still takot silang mag encode.
Although Hands on Training was done, most of them eh Hirap pa rin mag encode, yung iba mabagal… It will take them 20-30 minutes to encode one patient and in a day, only 5 patients were encoded. Ideally, it should be 5 mins ang pag encode per patient only
It is important na mabilis ka mag encode, if not mahihrapan ka mag admit ng patient and mag encode at the same time.
So if they don’t use the new technology regularly, Hindi sila maging competent sa pag gamit nito. So there will be burden on the side of the health personnel to adopt the new technology.
Researcher: Do you think the acceptance of the health personnel is important for the adoption of the new technology?
Respondent: Yes, but of most of the health personnel na hindi masyado accept yung Iclinicsys are the “oldies” or “thunders”. So malaking factor ang age. Although nag eencode sila, hindi nga lang ganun kabilis.

Researcher: Do you think age is a big factor why other health staff resists the desired change ?
Respondent: Yes, but and I think even if you provide training in this age group, still yung bagal nila hindi makaktulong
Researcher: So what do you think would be the solution to this problem?
Respondent: To hire young encoder for Iclinicsys not necessarily in all health facilities, out of 10 health centers at least 6 encoders.

Researcher: Can you describe me the process in Iclinicsys, from the time the patient arrives in the health facility.

Respondent: What is happening right now is not yet ideal for Iclinicsys….The normal process is you retrieve the ITR and fill up the data in the ITR, all the necessary data will be encoded in our facility then after it will then be given to the doctor for proper diagnosis and treatment then the patient goes to the Nurse for dispensing of medicines which is also encoded in the Iclinicsys.
However, in the ideal process, by the time the patient arrives at the health facility, all the data needed should be encoded in the computer and data will be transmitted to the doctor for encoding of diagnosis and treatment and to the nurse where the dispensing of medicines will likewise be encoded , dapat lang may internet connection in order to facilitate exchange of data in more than 2 health personnel. The prescription of the doctor will be transmitted to the nurse of the facility for dispensing of medicines. The nurse will then print the prescription and bibigay nay un sa patient after yun po yung flow ng ideal, so there should be 3 computers and internet connection in order to facilitate all those things…
Researcher: Being the Iclinicsys Midwife Coordinator, what can you suggest para maging ideal yung set up for Iclinicsys?
Respondent Sa Ngayon po, all the computers are functioning and all health facilities have already laptops/computers, however if we are going to set upnthe Health Centers…. For every facilities we need 1 desktop para maging mother system for the dispensing of medicines ng mga nurses and 1 laptop for the doctor and 1 for the clerk during admission.

It this facility, we have 2 computers so madali kami nakakapag encode, we only need 1 laptop for the doctor to be ideal na po but at the end of the day nagagawa na po namin ngayon ma encode lahat ng data in the afternoon, so lahat ng data encoded na po namin.

Researcher: Is there a clear defined roles para sa mga health staff. Ano ba ng role ng individual in the process of Iclinicsys?Respondent: We conducted orientation and training to all the nurses and midwives para sa encoding, Sila lang po ngayon ang mga nag eencode, so the burden is sa mga nurses and midwives. Although oriented and trained po ang mga doctors, Hindi po sila nakakapag encode. Sa mga dentists naman po, na orient po naming yung Dentist Supervisor para mag disseminate niya po yung information sa mga dentist na under sa kanya and yung mga Barangay Nutrition Scholar (BNS), ganun din po nag orient kami at that time. ….. Ang dentist and BNS dapat nagbibigay sila ng information to be encoded sa Iclinicsys lke yung weight, height ng mga bata, para nakikita na agad kung malnourish ba or overweight, naanalyze na rin from the admission, kung nabigyan na ba ng Vitamin A yung mga bata ….yun po ang role nila and if wala ang nurse or midwife na mag encode sila din po dapat ang mag encode para ma update everyday ang mga data and maging ideal po ang set up since wala tayo currently na clerk to encode all of the data,….

Researcher: So Bakit Hindi siya nagagwa ngayon?
Respondent: Yun po siguro ang nagging gap doon,…. We have oriented the doctors, nurses, midwives, but not all dentists and BNS are oriented. The problem is, hindi rin na inform yung other dentists sa Iclinicsys ganun din po ang mga BNS due to lack of funds for the orientation kaya hindi po lahat fully aware of their duties and responsibilities in the IClinicsys… Ang gap is hindi na disseminate ng maayos yung information kaya po siguro may gap po tayo doon…. Aside from lack of fund for the orientation….. Kami lang po ng Dr. ko gumagawa noon, si Dr. Maglalang po yung medical coordinator ko… pero after po nun may na assign na sa kanya ibang program so naiwan po ako mag isa to monitor every facility….si Dr. Mariano was assigned to be the medical coordinator for Iclinicsys pero po hindi naman siya oriented pa… so mahihirapan din po siya kasi hindi niya alam gagawin if problem arise sa IClinicsys…. Inadequate Manpower for the technical working group ng Iclinicsys (TWG)…. And lncrease the fund for others resources on top of may mga health staff na medyo oldies and nahihirapan na nila adopt yung Iclinicsys, mabagal nap o kasi sila so, mas matagala na eencode ang mga data.. yun po siguro ang nakikita ko bottleneck sa implementation ng IClinicsys…..

Researcher: Do you think the system is overly complex and difficult to operate?
Respondent: No, for me mas madali siyang gamitin, para siyang facebook…. Mas madali pa nga siya compared kung mag Instagram ka….madali maka adopt naman yung mga staff kasi simple lang yung step by step instructions….

Researcher: So what do you think is the reason kaya mabagal mag encode yung mga staff aside sa age ng health staff na sabi mo isang factor?
Respondent: Siguro dahil they are not that confident in using Iclinicsys….. feeling nila pag may pinindot nila, pede ma erase yung mga na encode nilang data….. so yung knowledge and competency is not enough… and siguro dahil they are not using the Iclinicsys regurly or everyday kaya din po siguro sila nahihirapan…… Kasi kung everyday mo ginagamit later on, magiging competent ka na and magiging mabilis ka na sap ag gamit nito…… Practice po…. The more you use the system… the more you get competent sa mga ginagawa po natin….

And isa po siguro, hindi po lahat ng programs na integrated sa system eh gumagana…. Like po yung folder ng Non-Communicable diseases…. Wala po yun hindi pa nag function sa Iclinicsys…. Sabi integrated na… but in reality hindi pa po…..also yung TB (Tuberculosis) part na data, hindi pa rin gumagana sa system…..

Respondent: Do you think this is added burden for the Health Staff? Since they are still using the paper-based reporting at the same time the electronic data encoding?
Respondent: Maybe sa ngayon… BUT pag na encode na nila lahat sa system… later on madali na po sa kanila mag encode….. Una lang po yung mahirap kasi they need to encode all the patients na dumarating sa kanila sa facility but once the data are encoded…. Hahanapin na lang nila ito and fill up na lang….. Next time pag nag patingin po ulit yung patient nan a encode nila… They do not need magsulat po… like kung ilan ang mga susulat pa nila na patients… in the future hahanapin na lang nila yung name sa system tapos po lalabas nay un, mag add na lng sila ng data… and before they still need to compute ilan ang mga patients na dumarating, time consuming din po yun sa paper based reporting…. Ngayon po yung system na nagbibilang for them so kahit papaano reiable and accurate po ang data natin…….
And problem po at times yung sa system pag may duplication… kasi pop ag encode mo yung name nad doble space nagawa mo before surname and pag search mo ng name in the future, isang spavce lng after ng first name ang nagawa mo, hindi lalabas yung name…. so pag search mo pa ulit makikita mo nag doble entry na dahil lang sa space between the names while encoding so nasa system po ang problem na sa part nay un….

Researcher: Being the midwife supervisor…. Do you do monitoring and evaluation sa mga facilities?
Respondent: Yes, although wala akong monitoring tool , meron ako sa notebook ko kung sino yung mga facilities na active sa IClinicsys and sino yung nag lag behind in encoding… yun po ang pinunpuntahan ko to address the issue….. the problem is mag isa lang ako…. Sana madagdagan yung kasama ko mag monitor… Kahit 2 lang po kami para mas madali ma monitor yung iba… and magkaroon ng transportation allowance during monitoring po sana…
Researcher: During your monitoring visit… How would you assess the current situation for Iclinicsys?
Respondent: Ok naman po… siguro nasa 60% na po tayo if I am going to assess naman po….Provide a systematic way to manage patients records lang siguro po sa mga facilities. If everyday lang ginagawa ng staff makaka bias nap o nila yun and hindi na magiging mahirap po sa kanila in the future…. Less po kasi ang paggamit nila sa system… less po silang maging competent on how to use Iclinicsys
Researcher: So what are the changes from the old traditional reporting to the new technology adopted using Iclinicsys?
Respondent: Currently, the system generates standardized reporting requirements of the DOH ……..Easy to identify patients who are scheduled for visits na po ngayon….. So if you are going to ask yung mga encoded na talaga yung data nila sa system if added burden sa kanila… they will answer no… kasi po madali na po sa kanila once all the data are encoded instead na mag bilang sila, mag encode na lang sila ng data which is mas mabilis na sa kanila ngayon and hindi na nila kailanagan mag search pa sa mga envelope isa isa, ditto stype lang nila sa search tapos lalabas na yung name ng patient…. Much Easier for them…while to those na hindi pa updated sap ag encode and are still lagging, hindi pa po ganun kadali kasi mag encode pa sila so parang ganito po sa kanila….

Researcher: Does iClinicSys provided a positive/negative impact to the current situation in the City Health Department?
Respondent: Positive impact – Enhanced health workforce productivity in retrieving patients records
Positive impact – Improved ability to monitor compliance to medications and other treatment regimens
Positive impact – Improved ability to report and analyze health outcomes
Researcher: What are the recommendable plans that the City Health Department can do to improve Health Information System in San Juan?
Respondent: Hire young health personnel to help in the process of Iclinicsys kasi hindi po pwede naka depend po tayo sa Public Health assistant (PHA) ng Department of Health para po sa pag eencode…More trainings are needed to the health staff not familiar in the system….

Researcher: Is there anything you want to add concerning iClinicSys?
Respondent: Maybe transportation allowance to the coordinator to be used in monitoring…. To provide Local policy for easier implementation of Iclinicsys
Researcher: Thank you so much for your time… Ang laki ng nagging tulong mo sa akin maintindihan ang current situation ng Health Information System ng San Juan
Respondent: Thank you din po
KEY INFORMANT: NURSE
Good afternoon, I am Rosalie M. Sto. Domingo, a student for Master in Public Administration and I would like to ask your perception on the current Health Information in San Juan. There will be no anticipated risks associated with your participation. All responses will remain confidential and will be used for statistical summaries and generalizations only.
Researcher: Please tell me a little bit about yourself age, years of service at the LGU and your position in the City Health Department.
Respondent : My Name is Maruia Christina Basiloy, Iam currently the NTP coordinator of the National TB program Nurse coordinator for the City and my designation is Public Nurse 2 and currently Iam assigned at kabayanan Health Center.

Researcher: Can you tell me what is your role in IClinicsys implementation?
Respondent: My role in IClinicsys implementation aside from the.. sometimes I encode, Sometimes I gather data that would be beneficial for the consolidation of report needed by the Department of Health
Researcher: So your position is Public Health Nurse II, in the process of Iclinicsys, what is your role in the Iclinicsys process…aside from being the encoder, can you tell me the process of Iclinicsys from the time the patient arrives in the health facility.

Respondent: Bale pag nahanap na yung ITR (Individual Treatment Record) so upon admission, actually nag gagamit pa rin, nagagamit pa rin ng manual, nagsusulat pa rin yung nurse, doctor, midwife sa ITR and then from there saka po sila iipunin for encoding during the afternoons na po and then yun po, may mga naka assign naman silang public serial number and then yun lalagyan and then eencode dun sa IClinicsys
Researcher: So the input needed for Iclinicsys will be coming from different health staff? For example in i1 ITR, will the data be coming from 1 BNS? Mangagaling sa dentist? Mangagaling from different health personnel? Na yun yung nag propropvide ng data na eencode na nakalagay pa rin sa paper-based natin
Respondent: yes
Researcher::tapos nun saka natin eencode sabay sabay
Respondent: yes
Researcher::since hindi naman siya updated, kasi you need to gather all the ITR before encoding so what’s the use or benefit of Iclinicsys to the health staff?
Respondent: Yung benefgits niya, at least madaling mag generate ng report, madaling mag access ng detail sa patient para isummarize yung mga existing diseases or kung ano man yung exeiting na check up na meron sa facilitiy , so yun yung nakikitang kong benefits niya,
Kaya lng nag multi-tasked pa rin yung mga health staff kasi aside dun sa writing Itr, Kailanagan mag allot pa rin ng time para sa ITR’s
Researcher: So do you think kailangan pa rin ng encoder specifically for Iclinicsys or yung health staff mismo can afford yung makapag encode and at the same time.

Respondent: Ahh mas maganda mayron pa rin encoder for the IClinicsys kasi pag minsan naiiwan siya mag isa , nag multi-task siya aside dun sa needed niya cater yung patient, need niya rin mag encode siya otherwise mag pile up yung mga records and matatambakan ng trabaho ang mga health staff.
Researcher: Ok so kasi yung Iclinicsys ibinaba na sa atin ng DOH yun para implement so after ng mga orientation nag implement kaagad tayo… Do you think we need to consider the desire of every health staff prior to implementation? Do you think this is vital prior to the implementation of of new technology… Considering there is lack of manpower and there are still a lot of things that need to be considered…. Do you think there was a gap from the time Iclinicsys was implemented?
Respondent: Ahh sa atin po yes, pero ano dapat kasi yung impelemtation niya based on ano on the capacity of the Local Government . ang capacity ng Health Department so dapat kinokonsider yun , yung manpower, yung resources, yung internet and everything so dapat kinonsider muna yun, yung City or kung sino man mag iimplement nun prior to the implementation para nagging smooth talaga yung nagging implementation. Pero it was hard at first kasi nag aadjust ang lahat, nahihirapan mag encode yung iba,the availability of the internet, the availability of the hardware, software so nag contribute sa challenges natin during the start of implementation.
Researcher: So How would you assess the employees’ performance compared to performance standards in IClinicsys?
Respondent: yung performance ng health staff , I think it’s on the average eh,hindi pa siya totally perfect, hindi sila highly performing when it comes to encoding kasi meron pa rin difficulty and I think meron pa rin nag lag na ITR so meron pa rin problem when it comes to trouble shooting kasi hindi pa nila kaya and hindi pa sila totally confident to manage when it comes to the problems they are encountering in Iclinicsys
Researcher : So do you think nasaan ang performance ng health staff sa standard ng Iclinicsys, if you are going to rate it from 1-100%?
Respondent: Ah siguro nasa 60% pa lang
Researcher :ok so dfo you think the system is overly complex and difficult to operate?
Respondent: yes it is difficult
Researcher : Why do you think so?
Respondent: Marami kasi siyang sanga sanga, marami kasi siyang mga branches po Dok,, meron nga minsan parang ano, mga duplication, hard to manage din , yun yung mga mahirap iaddress.
Eh kung minsan yung mga staff hindi siya na advice paano gagawin yun, eh di mag doble yung mga data
Researcher: So still pa rin pede mag duplicate so hindi siya yung pag nakita mo yung data nakita na may duplication, it will not be accepted by the system?
Respondents: No ,Hindi nakikita sa system if may duplication
Researcher: Were you able to address this gap to the DOH?
Respondents: Yes it was brought out, but it was at the LGU level, Kami yun nag solved. Nasa FHSIS coordinator yung nag solve regarding sa issue. So if may duplication pede ma delete yung name pero you have to assign the duplicated number to the next patient to avoid double entry./Researcher: Pero makikita mob a agad from the start if there will be double entry of data?
Respondents: Hindi, hindi kasi siya nag pa pop if may double entry na, walang ganun
Researcher: So sa system na ginawa ng DOH, we still need to polish it…
Respondents: So if the purpose is to provide a reliable data… so yung Iclinicsys hindi rin reliable since there are still duplication of data…There are still arears that needs to improve
Researcher: What are the other areas in the system that needs improvement?
Respondents: Not all health programs are integrated in the IClinicsys… sabi nila yung Tuberculosis programs should be implemented and integrated pero hindi pa rin siya gumagana, taside from that the Risk assessment of Non- communicable diseases… Hindi pa rin nag merge yung mga data from other programs
Researcher; So what programs are included in the Iclinicsys?
Respondents: Only the FHSIS indicators are included in the Iclinicsys
Researcher: Are there adequate personnel to perform the current task for IClinicsys?
Respondents: No, there is no adequate manpower for Iclincsys
Researcher: How about in your facility?
Respondents: In my facility yes, but in other facilities there’s inadequate manpower
Researcher: What are the challenges and barriers experienced in delivering IClinicsys? So from the traditional health information system, what are the changes happen to the new Health Information System?
Respondents: There’s added work and added burden to the health staff. Instead of catering the patients, you still need to consolidate report and encode the report. With limited manpower, there will be no health staff that will validate the report, instead additional time should be given to the encoding of Iclinicsys. So if there is delay in encoding, there will be delay in the reporting of data, hence delay in analysis of data and delay in decision-making. However, the only difficult part is the encoding of data, once the data has been encoded it will be easier for the health staff to have the patient’s information in the system. Next time na mag encode sila they will just type the name of the patient and lalabas na lahat ng encoded data, all you need to do is to provide additional information.

Researcher: So that is the critical stage, yung pag encode ng data ng mga patients at the initial stage.

Respondents: Do you think the role of the leader in your facility , I am pertaining to your medical coordinator is important? Is he equipped in providing the right information for Iclinicsys?
Researcher: At the level of the medical officer , NO.. Because she is not yet trained.So she can not address the problems arising during encoding. When it comes to the hardware, there is no still sufficient computer/laptop, connectivity is a great factor. Ideally, there should have 3 computers in one facility, para hindi rin matatambakan yung health staff sap ag encode
Respondents: What are the other barriers that you would consider in delivering Iclinicsys?
Respondent: The Iclinicsys itself, kasi matagal yung page upload ng Iclinicsys data, So kahit na naipasok na yung data if hindi pa uploaded useless pa rin for analysis. Although it is Hybrid, you can encode the data even if its offline
Researcher: Does IClinicysy provided a positive/negative impact to the current situation in the City Health Department?
Respondents: Postive naman po kasi napadali ang pag generate ng report
Researcher: Do you think the data encoded is the updated report?
Respondent: Updated naman pero yung process ng encoding mas mabilis naman to generate the report needed. As a whole, it provides positive impact to the Department and to the health personnel.

Researcher: What are the recommendable plans that the City Health Department can do to improve Health Information System in San Juan?
Respondent: Additional Manpower, Additional Hardware, additional Training, Capacity Building for the newly hired personnel
Researcher: Do you think having a policy at the start of implementation is vital for successful implementation of Iclinicsys?
Respondent: We should have a local policy in order to support all the resources needed for Iclinicsys. It should have done prior to implementation of the new technology in order to facilitate smooth transition to the new Health Information System.

Researcher: Is there anything you want to add concerning IClinicsys?
Respondent: None
Researcher: Thank you the information provided for Iclinicsys
Respondent: Your welcome po
Researcher: Good afternoon, I’m Dra Rosalie Sto.Domingo, thank you for taking the time to participate in this key informant interview about the Individual and Organizational Response: An Assessment of the Health Information of San Juan: Basis for Policy Development. Participation in this study is voluntary. You do not have to answer every question and you can stop the interview the interview anytime. I will start by asking you a few questions about the taking up Master in Public administration at PUP. I am here for a key informant interview my thesis is Individual and Organizational Response: An assessment of San Juan Health Information System: Basis for Policy Development.

So ina assess ko kasi kung ano ba yung current situation natin sa health when it comes to health information ng San Juan so actually sumagot ka na naman. Ang ano ko lang kasi is kasi nasa transition period tayo e. from the time yung traditional na paper base tayo tapos ngayon na electronic pero along the way dun sa transition kasi may makikita tayo na nagiging problem e ng mga staff setting aside siguro yung mga resources natin kasi kahit papano nakapag provide naman kame, although di pa talagaya yung standard base na dapat na iClinicSys. Ang ano ko lang is aside dito sa ano ang naging process ba natin nung ibibinababa natin sa LGU. I mean nagkaroon ba tayo ng na assess natin yung mga awareness ng mga gagamit ng end user kasi yung desire nila to use. Kasi yung sabi nila kapag nagbibigay tayo ng certain change or dun sa naibibigy natin na new technology kailangan intindihin din natin alamin din ang situation nung end user ng gagamit na yun. Kung baga na iprepare ba natin sila? Kasi ang nagiging problem daw is during implementation pag binaba lang natin yun setting aside kung ano yung ibang mga factors dun tayo nagkaka problem din so yung process pwede mo bang mai ano samin. Ma iprocess?Respondent: Yes Ma’am. During the time of Director Hanairo, there were certain activities that was conducted, one of this is yung pag ro roll out po ng mga electronic versions ng systems. So di pa bo si iclinicsys ang nauna. There were other systems like yung ating FHSIS. Yes meron po siyang data base na kina cascade sa ating mga LGU and there was also one information system that is somehow related siya sa IclinicSys pero halos magkapareho maam yung kanilang deployment strategy this was integrated tuberculosis information system. So yung kanilang deployment is almost the same. So nung nangyari si Integrated TB that was I think around 2010, 2010 siya complete yung transfer niya this was from the manual ginawang web base electronic, so somehow yung ating pong mga health workers sa field meron na silang experience sa transition and bago po nai cascade si Clinicsys sometime around 2012 mineet po naming lahat yung mga main health center staff, yung mga regular staff dito po sa amphitheatre took us 3 months or 4 months sa amphitheatre daily po yung amin pong pag iinform sa kanila na there will be systems like this in the near future na lalabas.

Researcher: Ok so yun yung naging start yung Integrated Tuberculosis?
Respondent: Yes Maam
Researcher: And then naging iClinicSys na?
Respondent: Opo para maging holistic na yung..Researcher: Pero kasi ang nakikita dun sa iclinic system is kasi madami siyang dapat na nandodoon including yung drug dispensing, yung lahat ng mga ano.. Sa tingin mo kasi ikaw yung nasa system. Difficult ba siya when it comes to sa end user? For example Ako bago sa akin with all the data na kailangan kong I encode and kasi ang nagiging problem naming na isa is sabi nila hindi tayo pwede mag proceed sa isang, sa susunod kung hindi mo ito nafill upan
Respondent: Yes maam.

Researcher: So parang from the time let’s say isang patient I eencode ko siya, average ilang minutes para ma encode ko siya? Kung ako ay isang ordinary lang na hindi ko pa, nangangapa ako?
Respondent: Yes maam, sa umpisa po for starters it will take a while 10 to 15 minutes po siguro. Pero kapag ito ay na institutionalize na it will take less than 2. Kasi in comparison maam habang sinusulat niyo maam yung inyong mga magiging findings or yung certain things that are ready of noting sa ating patient the same lang din naman yung kina capture ni Clinicsys meron po tayong required like blood pressure. So that’s only 5 digits or 6, 100/120 so that’s only six digit parehas lang din maam yung input non. Although lahat naman yun dapat irequire kagaya po nong nung ating target na individual treatment record
Researcher: ITR?
Respondent: Yes maam yung ITR, dapat din po lahat yung naka specify. Well this time naging electronic base lang siya. Almost the same lang yung kina capture niya at hindi lang po iyon ang benefit niya, while doing the ITR you’re also finishing na ginagawa moa ng iyong mga reports without you even knowing it. So pag kinumpleto mo yung required dun sa ating ITR meron ka ng TCL automatic di mo na siya kailangang isulat meron ka ng monthly report kasama na rin siya sa annual report so napadali mo yung proseso mo nun ng hindi mo napapansin yun yung hindi nila masyado na aapreciate
Researcher: Kasi ngayon lahat ine encode pa. Umpisa pero once na naincode na yun later on pangalan na lang yung hahanapin mo?
Respondent: Yes Maam. Magdadagdag ka nalang ng ano
Researcher: Kasi ang problem natin isa nag deploy naman kayo ng mga PHA na pwede natin maka tulong. Ang problem natin later on is for this year nalang ata and last year na nila and next year wala na tayong.. tama ba ako?
Respondent: Wala pa pong specific na decision about that. Although natanggal yung budget pero kino contest pa po sa senate yun na maibalik. So wala pa pong specific.

Researcher: Kasi ang magiging problem naming as of now kulang kame ng tao. Narinig ko na yung mga staff kasi ang nagiging daing nila is “Dra. Meron kaming mga kine cater na patients tapos iilan lang kame sa health facility so paano namin” and yun siguro isa pang ano is yung HR namin hindi naman din kaagad kaya mag provide na kung 10 yan 10 agad. Aside dun sa ano pa yung pwede nating maging strategy? Sa tingin mo na para mas mapadali para dun sa mga staff or paano natin para ma adopt nila na? I mean para kasi ang ano natin is difficulty when it come sa pag eencode, lack of manpower, tapos ang isa pang problem namin is yung technical. If ever nagkaroon ng tulad nong case ng west crame na parang sa encoding di ko maintindihan si Elaine e, na parang ipinorward dito yung ano pero parang di pa din maayos kasi di kame maka pag ano sa encryption
Respondent: Ahh yung Encryption. Ang parati ko pong advice kay M’Elaine since malapit lang naman kung kayang dalhin dito yung device magagawa naming yun within the day. Pero in the case of Elaine meron kasi kameng staff na nagha handle nun at pino forward sa central office yung kanilang mga kailangan makuhang data. Well ang nagging issue dun maam is yung encryption key, it’s somewhat like a susi for you to have access or makadaan ka sa isang portal so irerecognize ka niya na you are a legitimate clinicsys user if you have that. Well, for the how to facilitate naman dun sa ating mga workforce natin, siguro lang maam kelangan nilang ipractice eventually dadali yun. Kagaya maam ng banking sytem I’m sure familiar ka, dati during 9:00-3:00 pipila ka to have access to your salary. It took time to adjust ngayon atm nalang tayo. Even the mobile phone pwede ka ng magpadala ng pera. It will take time, kailangan lang po natin I practice para maging familiar. Yun lang po yung kailangan non. Familiarize yourself with the system. Parang facebook, sa una ayaw nila pero nung nakita nilang mas madali compared dun sa mag papadala ka pa ng sulat it will take 2weeks para makarating sa recipient. I chat mo nlang.

Researcher: Meron ba tayong LGU na pwede nating example na ngayon as in maganda na ung system nila yung process nila ng electronic health na yan na pwede nating maging best model?
Respondent: Yes mam. Well I could refer you to Pasig ma’am
Researcher: Pasig, ano ang meron sa Pasig na nakita mo na naging effective sila compare dun sa mga ano?
Respondent: First of all ma’am yung hindi ko talaga, hindi matumbasan yung support ni Mayor Bobby Eusebio with the system sya talaga po yung nagpu-push.

Researcher: So yung local chief executive pag sinuportahan walang problem talaga.

Respondent: Wala pong problem. Walang mangyayaring masyadong malaking issue kapag merong malakas na political support
Researcher: kung dun sa isang facility nila, ilan , sabi ideally 3
Respondent: yes po ideally.
Researcher: so sa Pasig 3 sya?
Respondent: hindi pa po there are.. di ba ah.. health facilities there with less than 2..2 or more pero ang pinaka maliit po nilang health center dun has 2 I think
Researcher: so 2 to 3
Respondent: opo 2 or more. Meron po silang super health facility na merong 5
Researcher: ok 2 to 5
Respondent: opo
Researcher: about dun sa manpower, paano nila inadress yun?
Respondent: umm yung kanilang staff well inabuso po nila yung aming dineploy talaga na staff
Researcher: ah ok (laugh)
Respondent: alagang meron silang targeted na workload for them
Researcher: ah ok
Respondent: at most of their physicians nagha-hands-on na so upon the interview na sa patient meron na silang input na ginagawa doon and then they could always print what they were.

Researcher: so ma-ano talaga kapag leadership eh.Kasi kung si Dr hands on siya kaya nyang ituro
Respondent: yes mam practice lang po
Researcher: Actually yun yung nakikita kong problem din sa amin. Si doctor hindi kaya so hindi..left alone si ano si midwife and nurse. So may mga ibang doctors kami na alam mo na syempre may edad na so ang tendency pag sa technical na ayaw na nila. So yun yung mga nakikita ko kasi na ano..Respondent: well meron po akong nae-encounter na ganyan, pero
Researcher: anong ginawa ba natin doon?
Respondent: umm yun nagsusulat na lang si doc pero meron din syang pinapasahan para ma-encode na agad.

Researcher: so talagang dapat meron na..yun pa palang isa kasi tinanong ko yun kay Elaine. Meron ba tayong defined roles sa bawat isa, wala daw galing ng DOH although dapat sa LGU level meron na tayo
Respondent: mam dun sa Memorandum of Agreement naka define eh.

Researcher: Parang LGU lang kasi siya, binasa ko kasi yung moa nakita ko lang dun na ang LGU is in ano sa technical, sa resources yung mga ganun pero yung clearly defined na si Doctor ito dapat ang gagawin, si nurse ito, si midwife, si BNS hanggang dun sa pinaka end ng staff, nando doon yung team participation ng iba.

Respondent: ay wala po
Respondent: one good thing about the other LGUs kagaya po ni Pasig meron na syang policy with that
Researcher: ok. Ang policy niya is not yung mOa lang. ordinance talaga
Respondent: hindi po internal policies nila yun doon
Researcher: meron kang copy
Respondent: hindi po eh. Hindi po ako binigyan eh..Researcher: pwede ba tayong makahingi? (laugh)
Respondent: pinakita lang sa akin ni Raffy yung number nun pero..Researcher: Kasi yun yung ano ko yun yung plan ko kasi nahihirapan din ako kasi sa reources, kasi nag-allot ako ng budget for this siguro 2 years ago pa every year nakalagay naman e-health noh..ahh siguro mga more than a million eh ang budget ko. Ang problem is hindi kasi yun yung priority ni LGU so hindi ko siya ma-implement. Kung magpo-procure man ako is 1 to 2 computers lng up to 3 maximum and yung Philhealth capitation yung ginagamit ko. Meron ka bang ano policy na pwede nating ano makahingi ka kaya.

Respondent: na magiging model, ahh I’ll try
Researcher: oo para atleast makita ko din ano yung pwede naming, mai-pattern ko
Respondent: opo, opo
Researcher: para mas, actually maganda naman yung iclinicsys kasi kahit saan ka pwede mo na syang..Respondent: opo mam pero, eto nga with the latest development ito po yung mga lalabas ngayon so ito si JAO ng 2018 although hindi pa sya signed nakadaan na sya sa lahat ng technical review. Ahh meron na syang
Researcher: time pa to ni Garin di ba?
Respondent: yes mam, 5 hearings na ito, public hearings at final na siya. For signature na lang ito for this October
Researcher: so for October na to possible
Respondent: yes mandatory na and some of the Philhealth ahh.

Researcher: Philhealth actually ito nakaka-problem din kami kasi nga yun nga..Respondent: Required na sa kanila
Researcher: hindi na nga pwede kami magpasa ng manual actually
Respondent: yes mam
Researcher: ang ano naming is electronic na so hindi nila ine-entertain so yun yung isang problem namin
Respondent: the thing with sa Philhealth kasi ginawa mo na..kunwari kung manual ka you will have to encode it eventually why not do it once, tapos nae-extract na naming yung data and we can forward it directly sa Philhealth without you even doing it twice.

Researcher: uhmm pwede mo rin ba ako matulungan kasi isa pang problem namin yung internet conncetion. Ang internet connection kasi wala bang parang merong isang department ba sa National na pwedeng mag-ano sa atin ng provide ng..Respondent: Pwede po kayong humingi ng assistance kay Department of Information and Communication Technology, although kung mamarapatin nyo mam off the record hindi po maganda yung service nila..Researcher: ohh yung internet?
Respondent: opo hindi ko naman sila sinisiraan pero yun po yung findings.

Researcher: ano yung binibigay nila yung internet conncetion?
Respondent: yes mam ito po yung si JuanConnect
Researcher: ahh Juanconnect, ok
Respondent: si Juanconnect will provide you internet conncetion for your facilities but it is limited up to a certain amount of bandwidth
Researcher: umumm
Respondent: So parang 100mb po yun. Ngayon pag magbukas ka pa lang ng email siguro may mga 20mb ka ng makakain. So hindi po sya ganun ka dependable.

Researcher: Ok. balik ulit tayo sa Pasig. Sir yung Pasig di ba 2 to 5 meron silang tao, ginamit, niutilize nila yung deployed ng DOH para makapag encode lahat. Merong physician, lahat ng physician, most ng physician is hands-on sa system, so from physician ang tanong ko ang dentist ba nakakapag ano din, nage-encode din ba sila doon?
Respondent: meron po. Meron pong role si dentist doonResearcher: oo nga dapat naglalagay sya doonRespondent: opo within the facility meron po silang module na kinikilusan sa loob ng clinicsys, although ang kanilang number one complaint is yung philhealth capitation. So nagkakaroon sila ng hesitation to use the system kasi wala nga silang
Researcher: wala nga naman silang kasama.hindi sila kasama dun sa philhealth
Respondent: hindi sila nakaka-claim. Yun lang naman although maganda yung recording.

Researcher: um um
Respondent: pero up until now medyo hilaw yung nagiging response nila dun sa benefit na nakukuha nila sa clinicsys kasi sa mga regular health center staff they could, nakukuha nila yung PCB (Primary Care Package) capitation of Philhealth via the system pero si dental po hindi nya nararamdaman.

Researcher: wala sya, hindi sya ksama dun sa ano
Respondent: pero yung recordning nya maganda
Researcher: Si dentist, kasi yun yung isang ano nila na uhm yun nga yung parang feeling nila na hndi sila kasama
Respondent: na left out sila
Researcher: oo tapos si BNS, BNS kasi merong OPT plus yung National. Sa amin yun ginagawa yun ng lahat ng mga natimbang nakapasok dun sa system so makikita mo kung may duplication, may mga ano, ah yun ba ay naka ano din sa ano
Respondent: OPT po ano pong OPT?
Researcher: OPT, e-OPT ( Electronic Operation Timbang)
Respondent: Ano pong ibig sabihin nun?
Researcher: electronic OPT (Operation Timbang), meron ang national nutrition council ng electronic OPT, inadopt natin yun eh.

Respondent: tungkol po to sa?
Researcher: Timbang, pagtitimbang nung mga bata
Respondent: meron kami mam
Researcher: kasi ang gawa kasi sa amin, I don’t know kung tama eh. Meron kaming iba yung naka separate yung sa nutrition. Kasi iba yung pagpass dun. Hindi sya naka incorporate sa ano although pwede ipinapasok natin pero ang OPT plus ginagawa naming sa system pinapass naming sa national. Ang gamiit namin e-OPT na coming from national nutrition council
Respondent: iva-validate ko yan mam opt plus na yan pero ang masasabi ko sainyo we also have weight monitoring sa ating clinicsys
Researcher: yes alam ko naman
Respondent: although yung indicators nito might be the same hindi ko lang sure kung saan or kung meron ng agreements with the national
Researcher: oo parang wala pa yung sa national
Respondent: iche-check ko mam and I’ll give you an update
Researcher: kaya hindi pwdeng magproceed si philhealth ng wala yung iclinicsys so iclicnicsys din anyway so yun lang siguro yung nakikita ko kasi yung mga BNS alam na nila yung sa ano..nage encode sila eh.

Respondent: opo nasa nutrition module naming yun, child nutrition care
Researcher: oo yung eOPT. Meron sila e-OPT. maganda naman kasi dati may doble doble ngayon kita mo kaagad
Respondent: yes mam kasi as of the date most of the systems po ng DOH integrated na sya kay iclinicsys even for its financial benefits.

Researcher: Oo
Respondent: si rabies, so once an animal bite occurs ilagay nyo lang sa clinicsys you can send philhealth yung inyong billing and makakatanggap na kayo ng response
Researcher: um um
Respondent: tuberculosis pwede na rin natin iprocess yan. We also have apat yun eh
Researcher: yung sa maternal
Respondent: yes MCB at saka PCB claims so nandoon na po sila lahat
Researcher: actually nakita ko nga madami pati yung sa drugs, yung sa gamot kasi mamo-monitor mo dun ilang yung mga ano na
Respondent: lumalabas, yes what’s comes in and what’s comes out
Researcher: yung inventory po kasi yun yung problem natin na isa pa yung inventory ang situation kasi ngayon is meron tayong electronic pero at the same time meron pa rin tayong paper based
Respondent: yes mam, yung ledgers..or something
Researcher: yung summary table
Researcher: ngayon yung ano natin dun sa iclinicsys kasi at the end of the month pinapass natin so hindi sya ganun ka-updated pa I mean kasi yung ibang mga staff late nakakapag encode so late din yung analysis mo. Kasi yun yung maganda kasi kung kapag talgang efeective na sya makikita mo na kung ano yung problema mo day to day basis
Respondent: opo kung medyo live yung kanilang data or updated atleast medyo mas maganda kasi ganun din mam eh ide-define mo din sa ITR given 1 bottle of paracetamol, why not declare it to the system at the end of the month updated yung record mo. So the thing with manual ilalagay mo sa ITR, ilalagay mo sa TCL ilalagay mo pa sa dispensary. Sa system namin you’ll just have to do it once. At the end of the month magbibilang na sya magisa and sagasa mo na lahat ng report.

Researcher: yung pinaka umpisa lang yung pinaka mahirap actually eh.

Respondent: actually Philhealth gave an advisory tungkol po sa profiling tama?profiling ng atleast yung ating mga indigents
Researcher: NHTS
Respondent: it also has its financial equivalent per head, I think so dun pa lang mam all of the assistance na kailangan i-provide together with the department of health and Philhealth pwede na nating ma-address kasi a profile is equivalent to this amount of sum para po magkaroon ng gana yung ating mga health workers mag –encode susundan na lang po iyon ng mga kasunod nun may mga PCB pa silang claim pag na-expand pa yung PCB lalaki pa lalo yung mga claims, yung capitation pa nilang ma-claims
Researcher: yung capitation. Yung dun sa Pasig if you’re going to rate it kung sabihin na nating 100% na kailangan fully implemented siya or fully functional nasan ang Pasig ngayon?
Respondent: siguro mam sa National, Pasig could be around nasa mga top 20 na best implementors
Researcher: so kung sa percentage out of 100%?
Respondent: it will be 85% I think for NCR
Researcher: How about San Juan?
Respondent: Hindi ko pa mam nakikita yung buong report eh
Researcher: hindi mo pa nakikita, pero if you’re going to rate it dun sa Sistema na nakikita mo currently
Respondent: 60-70%
Researcher: not bad naman pala 60-70%
Respondent: mataas pa compared to the others
Researcher: ok good to hear about that…
Respondent: actually nakikita ko mam nagu-upload sila ng data, nagmo-monitor ako and parati akong in constant communication with Elaine minsan nagbibigay sya sa amin ng iu-upload kaya..Researcher: yung naman nakuha naming yung capitation, yung budget nun sa Philhealth capitation so nakapag provide siguro kami mga around 8 na computers na laptop na kasi para kaya nilang iuwi if ever na may gagawin sila tapos yun lang ung ano natin. So nasa ano kami 60-70?
Respondent: yes mam 60-70
Researcher: yung tingin mo, ano pa yung mga pwede naming maging strategy or recommendations na pwede mo pang mai-ano sa amin para maging fully functional kami.

Respondent: Strategies mam. Unang una yung policies we really have to have that
Researcher: actually nung present ko to, ang tanong sa amin is nasan ang policy nyo? Nag-implement kayo ng isang ano, so sabi ko may MOA but the MOA is not the policy sabi nyang ganyan. Hindi mo sya maco-consider kasi dapat may policy ka. So meron kayong copy ng policy nyo?
Respondent: internal kasi yun within Pasig mam and the other LGUs na naencounter ko. Makati has one ewan ko lang kung makakahingi ako kay Mark pero I’ll try.

Researcher: actually yun yung nakitang problem walang polisiya kasi panget ang implementation syempre bago ka mag implement dapat may susundin kang guidelines kaya yung isa tinatanong ko ano baa ng roles ng bawat isa although nasasabi sa akin ni Elaine kung ano yung role pero nung bumaba ako sa baba tinanong ko hindi nila alam. Meron pa akong isang BNS na siguro matanda na sya, retiree na sya tinanong ko yung iclinicsys ang sinagot nya sa akin “hindi ko nga alam kung ano yung iclinicsys na yan”
Respondent: Barangay Nutrition Scholar?
Researcher: Yes, parang nakakalungkot kasi, nung sinabi ko kay Elaine sabi ko bakit hindi alam?Sabi nya doktora nag-orient ako pero kasi ang naging ano nya is hindi lahat naibaba.

Respondent: there are still midwives, organic mam yung naging target
Researcher: hindi lahat naibaba kahit na siguro dapat pati utility dapat alam eh, kahit yung driver dapat alam nila eh. Kapag sinabi mong iclinicsys ay alam ko yan. Yan yung inorient sakin sa system na ano..Respondent: yes, opo kasama yun sa policy statement mam noh, pagka kasi dinefine health workers yung naging statement nila don. So naca-cascade talaga up to the lowest even the highest to the lowest ranking
Researcher: kung ano yung mga role ng bawat isa kasi naka define yun dun, siguro yun yung nakikita ko na problem aside dun sa, ano ang pwede mong maging when it comes dun sa technical? Kasi ang gawa natin di ba kapag may problema si laptop o si computer pupunta kami dito wala bang process?
Respondent: Si pasig, in-engage namin si Christian yung internal Management Information System (MIS) nila
Researcher: sa amin kasi ICT yun eh
Respondent: si Sir Christian yung kanilang lead
Researcher: parang nagkaroon kayo ng link na parang agreement na kapag may problema ganito
Respondent: we gave them yung technical know-how on how to address issues sa loob ng system
Researcher: pwede ba natin yung gawin
Respondent: pwede natin yung gawin I will just talk with inyong ICT for San Juan para mas mabilis po
Researcher: para magkaroon tayo ng isang session. Kasi ang problem nila yun nga walang technical person na pwedeng ma-address kaagad dun sa time na nagka problema ako aantayin ko pa ng ilang araw na kung up to when. Syempre yung time nun, by the time bumalik ang dami ng nag file up
Respondent: actually si MIS po nila is one of the authors na nagfefeed nung kanilang policy kasi mas kabisado nya yung, each in every LGUs kasi mam may sarili syang behavior or uniqueness?papaano nila wino-work around yung kanilang proseso mas familiar yung internal personnel kaya mas maganda involved din sila
Researcher: yun nga actually kung may policy kasi yun pati si budget wala kaming problem when it comes sa resources kasi nasa polisiya na bigyan mo kami ng budget kasi kelangan naming mag function although nai-present namin ito sa local health board naibigay namin dyan yung ano, pero siguro ang problem namin when it comes dun sa, wala kasi kaming Admin, wala kaming technical. Kumbaga ako assistant ako pero ako yung admin ako yung technical ako pa yung CNAO. So kumbaga multi-task hindi mo talaga totally matutukan. So binigay ko yung responsibility kay Elaine, kaya lang nung tinanong ko si Elaine, sabi ko Elaine sino ba ang talagang point person ng iclinicsys? Sagot nya doktora ako ba? E di bas a Philhealth lang ako?teka wait! Sabi ko ikaw sa iclinicsys kasi FHSIS yan naging iclinicsys lang so sabi kong ganyan so parang dun pa lang, kung si coordinator eh hindi nya alam na yun ang duty nya paano nya maca-cascade din
Respondent: next year yung definitions ng FHSIS would be for 2018 indicators na nagbago is almost 80 indicators ang bago.

Researcher: 80 ang idadagdag nyo?
Respondent: 80 ang gumalaw na indicators
Researcher: so magiiba lahat, magiiba ang target mo, ang eligible population mo, tataas bababa?
Respondent: tataas mam expected yun eh
Researcher: bakit tataas?hirap na nga kami sa eligible population
Respondent: may nagma-migrate, kinosider na yun mga nagmi-migrate at saka yung mga dumadami talaga
Researcher: kasi yan ang isang problema natin actually sa DOH
Respondent: 14M ang nakikita kong lalabas sa census
Researcher: Grabeh.

Respondent: 13M na tayo ngayon eh
Respondent: 13.5 or .4 na ang NCR ngayon
Researcher: pero kasi sa amin madami ng nai-transfer from San Juan to ganito
Respondent: so baka lumiit
Researcher: ang hirap eh, parang ang hirap nung targeted lang kesa dun sa actual. Wala ba kayong way na parang yung actual talaga.

Respondent: di ko po masasagot yung actual kasi we always get our data from the census with PSA
Researcher: kasi kahit saan yung eligible population, ang target population eh. Yung x 2.7 times. Yun ang problema din naming yung eligible population
Respondent: actually mam marami pong nagre-raise nyan. Lalo na yung mga LGUs na maraming high rise kasi wala silang access dun although nabibilang kaya nagre-red yung..Researcher: kami ang Greenhills hindi eh. Makati yan ang problem ng Makati eh.Respondent: Pasig, Ortigas is high rise
Researcher: sana ma-address yung actual talaga
Researcher: tapos ano pa ba, ano pa ba yung mga nakikita kong complaint nila, technical, manpower, connectivity, yung mga iba hindi ano. Ano ang kailangan ko pocket wifi..yung iba kasi hindi ma-access talaga ng internet although pinapuntahan ko na ilang beses na katulad ng west crame. Hindi talaga eh walang signal ang globe. Nagpunta na ang globe dun, madami pa ang kailangang gawin para magka linya lang. ang bottle neck ko is yung LGU namin ayaw yung pocket wifi ang ibigay kasi iuuwi lang daw so wala kang ano na kung nagagamit talaga intended for
Respondent: I could introduce you dun sa mga contacts ko with DISPs. Si PLDT alpha kilala ko po yung mga government representatives nila. Si sir Gelo
Researcher: Kasi ang globe ang panget, mahina ang signal
Respondent: ngayon mam may maganda, bagong player yung converge
Researcher: oo yung converge maganda kaya lang ang LGU kasi globe. I don’t know kung nag ano na kami ng converge pero wala pa kaming iba. Kasi nag globe ako nag sky broadband din ako. Sky broadband initially maganda pero after nung ano nawala.
Respondent: dependent sya sa panahon, pag ganito gloomy ang globe medyo mahina
Researcher: Hindi na sya maganda, yung converge na yung maganda. Siguro pwede ko naman ipropose din na ito
Respondent: eh next year kung matutuloy po yung pangako ni President yung 3rd player po na ISP natin papasok na. that would be next year
Researcher: okay may question ako. Ang sabi mo kanina is mandatory so which means?
Respondent: even the hospital
Researcher: are you going to set a specific date or due date na dapat fully implemented kami and what are the..sabihin na natin na mayroon ba kayong mga sanctions or meron ba kayong mga na para talagang ma-call natin yung ano din ng LGU
Respondent: According dun sa aking na-attendan mam na public hearing for the hospitals, licensing requirement siya so automatic yun
Researcher: ah okay. So pag wala di ka pwedeng mag renew ng license
Respondent: opo para naman sa ating mga lower levels facilities, accreditation requirement naman siya ng Philhealth. As for the sanctions syempre pag hindi ka accredited yung financial benefits mo yun ang magiging problema.
Researcher: actually yun nga yung gusto naming lahat philhealth accredited kasi malaki din yung budget na nakukuha.
Researcher: What are the actions taken by the DOH?yun yung tinanong ko sayo kanina nung umpisa prior to implementation ng iclinicsys pano nyo kinas-cascade, ang sabi mo kasi 3-4 months, specifically sa San Juan paano nyo totally na-cascade na ito lang ba dala-dala mo ang, kailangan kong i-implement ito sainyo and then paano na-consider ang end user?
Respondent: mam there were advisories
Researcher: meron ba tayong mga survey na ginawa?questionnaire?
Respondent: lagi ko po yang hinihingi sa DMO na if in case na magpapadala kayo sakin ng mga point persons po or yung information systems, icheck nila or pwede nilang ishare yung person na pwede nyang maishare sa coworkers nya kung ano yung napag-usapan kasi there are instances talga na medyo wala na sa age group yung participants ko.

Researcher: oo totoo yun. marami kasi samin dun
Respondent: hindi na nya nai-rerelate kaya mine-metaphor ko po yung pagdedeliver ko ng aking mga technical assistance or yung speeches na ginagawa ko kino-compare ko sya sa facebook kasi even yung mga older nagfe-facebook naman dun ko sila dinadaan. ATMs kino-compare ko po sa proseso ng cashiering noon at saka yung ngayon. Kasi yun yung nadaanan na nila
Researcher: Pero meron ba tayong for example nag-orient tayo sa kanila meron ba tayong data nun nakuha ba natin ano ba yung acceptance nila. Initially yung awareness ba nila. Kasi sa orientation mabibigay mo yun pero
Respondent: sa monitoring lalabas
Researcher: yung awareness ba nila, yung desire nila to use. Parang ang isang naging problem na nakita ko konti ang oriented nya, hindi lahat aware. Syempre LGU naman din samin responsibility namin na mainform lahat sila. Yun yung naging problem hindi lahat na-inform. Although 4 years na yung iclinics
Respondent: NCR kasi mam is somewhat unique yung ating deployment strategy kaya kami nag ka-classroom type. Sa ibang regional offices kasi mam, like for example 4B, 4B only has 80 RHUs or health centers yung equivalent ng health centers natin. 80 in a year even half a year pwede nilang 1 by 1 daanan yung lahat. On site yung tutorial, meaning as the whole. Lahat na, pagdating natin dyan daanan na natin yung buong proseso from stage 1 up to paglabaas ng pasyente at pauuwiin na sya. Sa NCR we have 478 hindi po talaga natin kayang gawin yung
Researcher: yung ganon setup
Respondent: yes mam kasi it will take 2-3 days kung mago-onsite tayo na mentoring
Researcher: actually sa nutrition nagawa ko kasi yun na, lahat ng mga BNS nagkaroon sila ng Microsoft training. For 2 weeks na-coordinate ko. siguro yun pwede ko when it comes to the staff kasi yung iba talaga hindi marunong eh.
Respondent: We’ve also provide mam yung mga mentoring
Researcher: Wala ba kayong ganun for example free na pupunta sila para umattend lang ng training ganun
Respondent: yes mam. Just request mam. We gave somewhat that kind of assistance to Makati a few years back, Microsoft excel, basic office, pero non-certificate yun mam
Researcher: So paano yun pupunta sila dito may place ba tayo?
Respondent: Amphitheater, just provide their machines kunyari may dadalhin silang laptop na magagamit.

Researcher: So magre-request lang ako, letter lang?
Respondent: Yes mam, pwede natin silang turuan ng madadaling shortcuts
Researcher: So yun yung pwede kong i-recommend para sa Microsoft kasi sa amin may ganun na training pero how long yun if ever kung may training na ganun it will take 1 day lang would be enough? Yung sa Makati gaano ba katagal?
Respondent: yung sa Makati mam dinaanan naming yung buong office 3 days eh.

Researcher: ah so 3 days
Respondent: Pero nag-concentrate kami sa mga pinaka common na ginagamit nila
Researcher: Kung 3 days lahat ng mga technical nila na nageencode yun yung lahat na pinapunta nila? Or pumili lang sila?
Respondent: Selected maam.

Researcher: Selected siguro yung magagamit kasi pag di na kaya gamitin.

Respondent: Medyo. Although hindi nila alam pero na consider nila na pwedeng makasabay.

Researcher: Oo
Respondent: Opo
Researcher: So yun, pwede yun yung letter dun sa ano. Ok so yung survey masyadong madami kasi kaya ibinababa na natin kasi responsibility na ni LGU na icascade dun sa lahat ng mga staff niya talaga. Dun kasi nag ka problem sap ag cascade.

Respondent: Yung bilang din kasi ng health facility dito.

Researcher: Oo, Alam ko naman kasi yung NCR napaka laki. Ano pa ba aside, kasi ang pinaka catch niyo dito kapag Philhealth, makaka kuha kayo ng philhealth capitation. Ano pa yung pwede nating I anon a marequire talaga si LGU na ma Ipush siya talaga? Although tingin ko naman din mai pupush naman siya.

Respondent: Nandito napo iyon sa mga magiging requirements. Although I’ve given for
Researcher: Eto kapag initernet ko ito? Actually nabasa ko na ito. Itong Duterte. Eto meron din akong copy niyan.

Respondent: JAO
Researcher: Electronic Medical Record System Philhealth sa internet ko lang ito makikita?
Respondent: Yes maam. Sa website ng Philhealth that would be available
Researcher: Meron ka bang manual na specific kahit sa website ko titignan ng iClinicSys?
Respondent: Maam sa kanilang mga iClinicSys in your health center meron pong manual doon na mada download.
Researcher: Makapal yon? Manual of Procedure ba yun?Respondent: Yes maam.200 pager po iyon. Medyo marami. Pwede nilang basahin.Researcher: Pero wala ka sa internet? Wala kang extra?Respondent: Kung mabibgyan niyo ako ng email niyo. Ieemail ko po sa inyo.

Researcher: Sige ibibigay ko sayo. Baka kasi nandodoon yung mga. Wala ba don yung mga duties and responsibilities ng aids?
Respondent: Wala po e.
Researcher: So hindi ba yun yung kasi parang may nakita akong powerpoint e. parang nakita ko lang yung mga baka kasi yun yung summary ng mga gagawin, eto yung mga papasok, yung step by step yung ganon.

Respondent: Ang ginawa po namin dun sa powerpont na yon ay yung health woker yung naka front. Hindi po namin dinefine kung sino siya kasi unqiue per center. Minsan kasi sa center walang midwife, minsan si nurse nandon. Meron silang combination of those plus is doctor may dentist pa. Pero minsan si nurse lang mag isa.

Researcher: Ayun pala may question ako, kasi kami may station.

Respondent: Yes maam
Researcher: So health center and stations. Pero sa stations kelangan mag encode din?
Respondent: Yes maam
Researcher: Ang problem, later on kasi mag ka clustering kame I don’t know siguro mga 2019 hopefully. Clustering na siya so itong si station pupunta na siya maiincorporate na ba siya dun?
Respondent: IClinicSys does that now.

Researcher: Na hindi na siya masasabing Maytunas, kasi ito na siya.

Respondent: Yes maam. As long as the catchment area is the same. We could always cluster yung ating mga patients in our facility.

Researcher: So pag lumabas si report per barangay pa rin siya?
Respondent: Yes maam.

Researcher: Kahit nasa isang cathment area siya?
Respondent: Let’s say si Brgy. Addition Hills. Brgy. Addition hills has 4 health centers pero pag lumabas yung report nila isa nalang per barangay. Pero we could always generate per facility.

Researcher: Ang Mandaluyong hindi pa ganon ka ano?
Respondent: Merong mga facilities ditto maam na kinukulit pa namin. Kinukulit pa naming maghabol. Although gumagamit sila pero hindi sila yung parang seasonal kaya dumadami yung kanilang backlogs. Pero ang pinaka magaling na implementor ko yung andyan sa People’s. Pasig kasi holistic lahat gumagawa pero kung per facility ang ire-rate ko si Dr. Julian ng People’s Health Center ng Mandaluyong. Siya ang pinaka magaling gumamit ng iclinicsys
Researcher: kung titignan mo, ifo-for see mo ang San Juan, tingin mo how many years para naming ma-ano or madali na ba..paano mo sya iaano in the future. Sa current situation naming ngayon?
Respondent: Ngayon ah 60-70%
Researcher: so kung 60-70% , 40%
Respondent: As long as early you’ve given the policies medyo na-engage na natin yung behavioral change. Kasi yun naman yung pinakamahirap eh yung traditional ang hirap pakawalan.Researcher: Actually yung culture
Respondent: Basta meron na tayong policies medyo gumagana na yung culture and behavioral change. It will take less than 6 months pwede kayong pumalo dun sa taas. Yun lang yung kailangan dun ma’am talaga
Researcher: if you’re going to rate it dun sa current situation ng health information na dun sa standard ng iclinicsys na sabi 60-70%, pero minimal na lang, as in mga technicality na lang, pero kahit papaano meron lahat ng facilities. Alam ko nakakapag-encode naman kasi may report kami.

Respondent: One way to update or atleast mapalaki yung rating kagaya ng nabanggit ko is to regularly update yung ating pong database. I-update ng i-update yung records kasi compared with other LGUs regularly meron po silang binibigay na datos na umaakyat sa national database. So kaya ko po nabanggit yun 60-70%. Although hindi naman I’m sure meron pong laman ang inyong database sa ating health facilities although out dated pero kailangan pa rin po itong mai-upload or ma-update din yung ating national database. Kasi dun din kukunin ni Philhealth yung information na kailangan nila. Iu-update lang talaga. Meron na kasing profile, why not i-include yung kanyang maternal check-up, yung check-up nung kanyang anak, post-partum nya, pwede na yun eh susundan na lang.

Researcher: Sa Pasay di ba meron sila nung CHITS, yung CHITS is yung ako andito sa isang lugar makikita ko na kung ano yung case ko dun na patient parang ganun di ba?
Respondent: Sabi nila
Researcher: Sabi nila kasi meron akong kasamahan, si Dra. Maglalang ganun daw. Parang dun sa ano meron sya, kita mo sa cellphone ano yung ano, pwede kang makapag-ano. Dun sa CHITS anong nangyari dun sa Pasay?
Respondent: Mahirap kasi mag-comment dyan, pero eto lang yung sasabihin ko before you believe them let them prove it to you. Magaling silang mag market si UP, punta kayo dun then you observe. Wala na akong sasabihin.

Researcher: Sila yung pinilot eh
Respondent: Punta po kayo dun then you observe by yourselves then kayo na yung mag-create.

Researcher: Tinatanong ko si CHITS ng Pasay
Respondent: Mahirap kasing mag comment dyan.
Researcher: Ngayon yung iclinicsys lahat na. lahat ng program naka corporate sa iclinicsys, even Integrated Tuberculosis System. Ano ang tingin ng DOH mas effective na ba?napadali na sa inyo?Less na yung delay
Respondent: Yes ma’am. Less na yung duplication ng work. Kasi previously kunwari meron akong TB, I have to be encoded sa ITB, nagkaroon ako ng hypertension kailangan ko din ma-encode with same indicators sa non-com disease registry. Nagkaroon ako ng cancer, e-encode na naman ako sa cancer registry. Nagkaroon ako ng injury, this time do it in clinicsys all of those system can benefit sa information. Do it just once. Isang beses na lang.

Researcher: Meron na ba kayong nagging problem na, for example nag bug-down yung system nya sa isang center? Yung laptop ko na-corrupt na virus. Nasa inyo na yung data di ba? So parang i-open ko na lang yun. So never naman nagkaroon na system ng buong DOH ay nagka problem sa isang LGU. For example yung system nila yun etong system dito sa Pasay eh may problema talaga hindi na namin ma-access, may mga pang-backup kayo?
Respondent: Yes ma’am meron po kasi kaming multiple relays. Meaning first relay we automatically create a back-up dun sa local machine. So without you even not knowing it nagba-backup sya weekly. So gagawan nya ng sarili nyang back-up internally na andun lang po sainyo. The second relay po nya or yung aming back-up is once you upload the data the DOH database sa national database may kopya na kami nung buong record nyo. Ito po ay base sa pinaka huling upload na naibigay nyo. So kung nag-upload kayo ng Friday nag encode kayo ng Monday wala pa kaming copy ng Monday na data nyo kasi nasa local pa yun. Pag-akyat po nyan sa DOH meron pa po kaming mga back-up, standby back-up. One of those is located in undisclosed location somewhere in Region 4. Hindi pwedeng sabihin pero nandun yun sa Region 4 para may mirror for the security. Data ni central office is equivalent sa mirror side. Yan na yung third. PHIE also is a mirror side. Philippine Health Information Exchange. Lahat ng data pinapadala ito sa Philhealth nasa Pasig po ang server tapos meron pa syang stage 2 si Philhealth within sa kanyang facility so meron na syang mirror meron pa syang stage 2 mirror. So multiples po yung pinagdadalhan lahat ng data.Researcher: So wala tayong problem when it comes sa data
Respondent: Next year kapag lumabas yung bagong FSHIS clinicsys ver4 2018
Researcher: Anong tawag na?
Respondent: Clinicsys version 4 kasama na ang lahat ng bagong indicators.

BIOGRAPHICAL DATA
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Rosalie M. Sto. Domingo was born in San Juan City on December 22, 1970. She attained her primary and secondary education at Dominican College in San Juan. She received her bachelor’s degree in the field of Botany at the University of Santo Tomas. She studied medicine at the Far Eastern University Nicanor Reyes Medical Foundation in 1997 and specialized in Pediatrics at San Juan Medical Center afterwards. She is also a Diplomate of Philippine Pediatric Society.

At present, Rosalie serves as a councilor of the San Juan Medical Society and, she is the acting Assistant City Health Officer and the City Nutrition Action Officer in San Juan City.