Design and Development of an Electronic Referral System and Health Information Exchange for Philippine Health Facilities

Abstract

Department of Health’s Manual of Procedures for the Health Referral System defines a systematic approach on how public health facilities in the Philippines such as rural health units (RHUs), district and provincial hospitals. Various cases such as maternal care complications and emergency cases (o.ed. Accidents, disease complications) are managed by various health care facilities depending on the availability of health manpower, supplies and logistics and services. By practice, referrals of cases are initiated from the rural health unit and shall be endorsed to the next higher facility which is district hospital. District hospitals elevate the unresolved cases to a tertiary hospital such as provincial hospitals and medical centers. After the management of the referred case, the medical information must be relayed back to the rural health unit for the continuity of medical care and archiving purpose. Referrals aims to address situation such that: 1). Patient needs experts advise, 2). Patient needs technical examination that is not available at the health facilities, 3). Patient requires a technical intervention that is beyond the capabilities of the health center and 4). Patient requires in-patient care (i.e. confinement). There were inherent issues with the manual health referral system. When a referral is being made, only the current snapshot of the patient’s medical condition is being sent. Full medical history is essential for the hospital to have better management of the case. Another issue being seen is that a referral is being made to a facility which yet has insufficient resources to manage the case thereby re-referring again the client to another facility. Lastly, once the cas has been treated at the hospital, the patient often does not return to the health center anymore. This leaves a disparity in his/her medical records and appropriate post-referral case management is not being performed. The proposed solution is the design and implementation of an electronic referral system that works across the health center and government hospitals. The technology to be used is a web-based platform that acts as a conduit between various health facilities such as health centers and hospitals. The system provides functionalities such as a search engine for health facilities and services available, a centralized electronic health record and an electronic referral mechanism that tracks the transfer of the patient from one facility to another.