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RCMB-BNI Partnership for Health

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by Architect Cecile Vega & Dr. Pauline Santiago

The Rotary Club of Manila Bay (RCMB), with its Rotarians and Anns, together with the Business Network International (BNI) Philippines, found a common goal: protect one frontliner at a time…

The beginning

Our journey to support our medical front liners continues…

…with the set-up of a Research & Design Development viber group with several donor groups [Rotary Club of Manila Bay (RCMB), “AnJ” represented by Rosendo Go, Alex Chiu and Jeffrey Kho, UST College of Architecture and Fine Arts Batch85 (USTCAFA85), Business Network International (BNI)] by RCMB Past President Alvin Vega, led by RCMB Dr. Pauline Santiago and AnJ Dr. Rory K. Go, as Donor Groups’ medical consultants to collaborate with their colleagues. Design modifications were introduced on the original Anesthesia Intubation Box (AIB) unit designed by Anesthesiologist, Dr. Lai Hsien-Yung of the Mennonite Christian Hospital in Hualian, Taiwan.

Dr. Lai Hsien-Yung created an anesthesia intubation box and shared his specifications widely on the web.
https://imgcdn.cna.com.tw

The following prototypes and accessories, following evaluation by end users, were developed to enhance the use of the AIB Units:

  • 2 Holes – Anesthesia Intubation Box (AIB), diameter of which was increased to 13.0 cm.
  • 6 Holes – Surgical Procedure Box
  • 4 Holes & 6 Holes – Neonatal Box, 30cm for use with basinettes 
  • 4 holes and 6 Holes – Neonatal Box 44 cm for use with Neonatal warmers 
  •  Accessories:
    • extended safety sleeves
    • covers, and
    • sliding door mechanisms for arm holes.
The 6 holes surgical procedure box for head and neck procedures.
A neonatal box used on a baby warmer. Covers of four holes shown use sliding door mechanism.

RCMB Dr. Pauline Santiago and BNI Arch. Sharon Roberto further collaborated and explored on the  following design modifications for the AIB – V3S Prototype to respond to end users’ requirements:

  • arm hole diameter @ 13 cm for sufficient arm  movement
  • a slanted top to reduce glare and also allows doctors to lean closer to patient and improve visibility
  • incorporate Dr. Rory Go’s  safety cylinder to help reduce the virus load/contamination
  • trapezoidal (with a wider opening  at patient’s  side) for stackability to maximize delivery for ground or air transport
  • 3mm thick acrylic as a minimum specification for structural  soundness  and strength to withstand frequent  usage
Latest version of the AIB V3S-c+

With these modifications made by RCMB-BNI, the “AIB – V3S” prototype provides a WIDER RANGE OF USE for doctors, making the unit MULTI-FUNCTIONAL for the following medical examinations and procedures:

  • Eye examination of children and adults
  • Eye Injections for ROP babies and adults 
  • Surgical procedures and examinations in the head and neck
    • e.g., Excision, suturing

Slit lamp breath shields

Arch. Sharon Roberto first broached the idea of slit-lamp breath shields that could help protect the eyeMD. The slit-lamp is a vertical microscope that allows the eyeMD to view the eyes using very high magnification. This proximity puts the eyeMD at an increased risk of respiratory and droplet infection.

Traditional breath shields before the SARSCoV2 virus only covered the patient’s lower face.

Slit-lamp breath shield by Torrefranca & Santiago

The new breath shields design by Dr. Aramis Torrefranca and Dr. Pauline Santiago, spanned beyond the head rest, way beyond the patient’s head and almost to the upper chest, protecting both patient and physician.

Although appropriate for most eyeMDs, physicians with smaller arms may have some difficulty with this design. It was Arch. Sharon Roberto and Arch. Cecile Vega who came up with the “Ironman” Breath Shields, the specifications of which are shown below. This permits a physician with shorter arms to operate and examine the patients through the narrower lower third.

What this novel corona virus has done, was bring strangers, friends, family, colleagues, together, to fight against a common enemy. It brought the best in our human spirit. We will continue to fight, we will continue to stand together. We can only win as one, as #WeHealasONE.

#Thesisko, #Kayako, #Tatapusinko: Muni-muni ng Pinagdaraanan Ko Tungo sa Pagtatapos (?) ng Aking Thesis

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“A Continuing Saga”

(hindi ko alam i-Tagalog, ahahay)

2014 yun–matanda na ako…bakit nga ba ako nag-enrol sa Master of Science in Health Informatics?  Ika nga ni Dr. Iris Thiele Isip-Tan noong unang araw ng klase ko sa HI 201.  Ang sagot ko sa aking pagka-alala… siguro mid-life (or post-menopausal?) crisis ko ito. Yung pa-isa-isang klase, aba natatapos rin pala!  Sa wakas, gru-maduate na ako…sa MRR napapunta.  Sa mga hindi naka-kaalam… ang MRR ay maximum residency rule.  Sa madaling salita, over-staying student na ako sa kurso.  Ano ang nagkulang? Thesis! sus ginoo, ang hirap mag-umpisa.

https://sa.kapamilya.com/absnews/abscbnnews/media/2017/news/04/19/uphilippines-oblation-041917.jpg
https://www.thedailystar.net/shout/education/what-not-do-during-your-thesis-1548235

Itong taong ito, ang aking MRR ay may kaakibat na penalty course… ah este, enrichment course na pala.  Nakikiuso pa sa pagigiging “politically correct” at tsaka para hindi daw masyadong “nega.”  Ang penalty course ko… Research Methods (HI299 po, under Dr. Emer Faraon).  Hala, ang nag-technical review ng mga papel ng residente…kailangan mahimasmasang muli ng basic research methods. Kinabahan na nga ako ng unang araw ng klase…kasi ang pagkakatanda ko noong una ko itong kinuha, minarapat ni Doc Emer noon, na dapat ay may matapos na pananaliksik at may nakasulat na papel.  Meron akong nagawa noon na maikling papel… pero ang layunin ko ngayon ay umandar ang isusulat na thesis proposal.  Nakahinga ako ng maluwag, kasi written proposal na lang ang kailangan.  Malaking tulong sa aking problemang maumpisahan ang pagsulat ng proposal.

Maraming pinagdaanan yung aking health informatics thesis proposal.  Pati Research Forum ng National Teachers Training Center for Health Professions nag-attend ako… binayaran ng aking home department–ang Department of Ophthalmology and Visual Sciences ng UP-Philippine General Hospital.  Nainip na rin siguro sila. Ang research na topic ng Integrated Faculty Development Program (IFDP) ng UP College of Medicine, pinasukan ko din–hindi para sa pangakong promosyon (sumuko na ako matagal na), kundi magkaroon ng katuparan ang minimithing #thesisko.

https://www.elitecme.com/resource-center/nursing/informatics-the-future-of-nursing-practice/

A-este… ang una kong proposal:  “User-centered design with expert content development of a decision support system for prescribing eyeglasses in kindergarten children…” Sa pagsangguni ko sa adviser na si Dr. Iris…ay wala palang research question! Namalayan ko yan, midway na sa aking enrichment course.  Imagine… lahat ng pinag-gagawa kong submission ay tungkol don… paano ako matatapos? Isip-isip.  “Mag-law na lang kaya ako?” o dili kaya, lumipat ng masters course na walang thesis.  Kinailangan kong mahimasmasan sa tulong ng aking mentor at propesor… si Dr. Mario Valenton.  Ano daw gagawin ko sa law? loko, haha.

https://abovethelaw.com/2019/02/law-school-meme-roundup/

Naghunos dili, at itinuloy ang pag-isip-isip.  O sige, baguhin natin ng kaunti, para naman hindi masayang ang aking nauna ng napag-aralan.  “Changing prescribing patterns of non-pediatric ophthalmologists with a novel decision support system…”  Si Dr. Iris, matinik talaga.  Hindi ko na naman masagot…”anong ibig mong sabihin sa CHANGE?”  A e… kelangan pa palang i-“define” ang pagbabago. At ang statistics na naisip ko… aba e mali naman pala.  T-test ang akala ko…ay sus ginoo… Mc Nemar, Binomial, Spearman regression, lahat narinig ko sa pagkunsulta kay Dr. Aljo Molino.  Nakatataranta rin pag kumunsulta kay Dr. Molino…parang walang katapusang thesis.  Nakaisip ba namang palawakin ang aking proposal at gawing experimental pa ang aking proposal.  Descriptive na nga lang at quasi-experimental, di na magkadaugaga, experimental pa daw o.  Nagbibiro lang siguro sya.  Sabi ko nalang next paper siguro. Asa pa ako, pang PhD?!  Si Dr. Molino…iba. Ang proposal ko, convenience sampling–sabi nya random sampling ang gawin.  Ang sabi ko n=12 lang sabi sa literature review, pwede na… kahit na, at least n=30 daw.  Nanlaki na ang aking mga matang singkit.  Tapos yung isang grupo ng espesyalista, halos kwarenta lang sila… aba e, kunin ko raw silang lahat!  Nagbibiro kaya sya? Parang hindi naman.  Kasi pagkunsulta ko ulit, ng binago ko ang research topic, yun pa rin ang kanyang rekomendasyon.

Kinakabahan ako ng nagpakita ako ng topic at proposal sa aking adviser.  Eh kasi, pwedeng lahat mali, ulitan. Sabi ko sa sarili ko…ah, pag ito hindi na-approve yung topic, aayaw na ako.  Aba eh, sa kabutihang palad…ang sinambit…okay yan, pero marami ka pang kulang (euphemism lang kaya?).  Literature review ka ulit.  Step 1.  Mahaba pa ang landas na tatahakin ng #thesisko.  Pero #kayako at #tatapusinko… sana :-).

https://www.pexels.com/photo/silhouette-of-man-walking-on-hall-735199

(eh kung imbes na nagsulat ka ng blog, nag literature review ka kaya?  Pabayaan nyo na ako sa aking simpleng kaligayahan.  Na-miss ko lang si WORDPRESS. :-))

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My COVID19 Journey

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Story of a COVID19 Survivor

Exposure

I was exposed last March 8, 2020. In a meeting, there were two who had recent travel to Malaysia. At that time, Malaysia was not in the list of “high risk” destinations, not until 2 days after our meeting. One of them was asymptomatic, the other rapidly deteriorated by the second week and was intubated. Thankfully, she has now pulled through and is on her way to full recovery. As many of us in that meeting (10 of 14) started having symptoms, 2 of whom believed it was “asthma,” for the rest it had to be COVID19. At that time, however, we did not qualify for testing, test kits were few, and we were just all on home quarantine. None of us who had symptoms were tested, except for the one severe case that was admitted.

My Symptoms

https://fj.usembassy.gov/latest-travel-restrictions-on-covid-19/

I had dry cough that was prolonged for about two weeks, had a one day malaise and tiredness, but had no sense of smell or taste for about a week, and a few sporadic episodes of diarrhea. I needed to be persistent, I was persistent. I was bothering and texting Dr. Karl Henson, every so often, and watched the Department of Health’s guidelines on testing almost daily. Finally, especially after our index case had deteriorated, I was finally told, that I could already be tested. My nasopharyngeal and oropharyngeal swabs were taken on day 11 from my onset of symptoms, or day 14 from my exposure. My real time-reverse transcription polymerase chain reactive (RT-PCR) test came back negative 3 days later.

Believe It or Not

Trained as a physician, I knew that not all tests were a 100% accurate. None of existing tests are a 100% sensitive. We base diagnosis and management on clinical history and presentation, more than just “treating a test result.” I felt I was a “false negative” — I was tested too late, or I had recovered by the time my swabs were taken, or the test was simply incorrect. When I had the opportunity to be tested for antibodies specific against COVID19, I had myself tested.

My results on the COVID19 Rapid Antibody Test
performed by Dr. Minguita Padilla

Thanks to Dr. Minguita Padilla who had access to test kits and graciously performed the rapid antibody test on me. I turned IgG positive, implying that as I had suspected, I indeed had a prior COVID19 infection. [IgG is short for immunoglobulin-G, antibodies that form after you have recovered from an infection in the past].

Processing

I had mixed emotions. I felt fear: I could have turned for the worse too. I was not ready. My son was not ready. Is anyone really ready? There was relief, somehow, I survived the ordeal and now have antibodies to fight the disease. Then there was this deep sense of responsibility: if my antibodies will help someone get well, I needed to donate my plasma.

Donating Plasma

Convalescent Plasma Donation 04/20/2020

I was initially rejected as a donor. Most centers doing plasmapheresis required a positive RT-PCR test, that will turn negative at least twice. I only had an RT-PCR test done once, that turned out negative and did not meet the usual criteria. I nagged Dr. Karl to give me my results from the Destura test kit, maybe that turned out positive. I was initially “rejected” too at the University of the Philippines-Philippine General Hospital, being the first potential donor that did not have an RT-PCR test that was positive. I told them about the parallel testing on the UP-NIH test kit for validation, and hope they could gain access to it.

It was Dr. Jonas del Rosario who rechecked parameters for donation. There was a third parameter –a “positive result for anti-SARS-CoV-2 IgG antibody-based test done on recovery.” Yey! I absolved Dr. Karl, God bless him for all the work he does, he needed a break from me!

After at least 28 days of no symptoms, on April 20, 2020, I finally donated convalescent plasma (that yellow-orange fluid component you see inside the bag) at the University of the Philippines College of Medicine, Paz Mendoza Building Room 108 in the hope that it can help someone fighting COVID19 who was not as lucky as I was. Room 108 brought back all good memories…I was a student again of health informatics in this room at fifty. I learned new skills here. This time, however, the feeling was even better. I can donate every two weeks, at most twelve times in a year, God-willing I hope I can fulfill that responsibility.

Why donate?

I could not be at the frontlines. This was the only way I could think of to give back. I owe it to all of you staying in your houses, to all of you donating and finding ways to help our frontliners, frontliners on the streets, residents, fellows, teachers, mentors and colleagues, and other health care workers at the hospital frontlines, some of whom had paid dearly for this with their own lives.

SARS-CoV2, the virus responsible for COVID19 will be beaten. The heart and soul of mankind will win. Our task is daunting, but #WeHealasONE and #WeWinasOne.

Evaluating WebMD’s Personal Health Record

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#MI227 #4

Evaluation of an Electronic Health Record: the Personal Health Record or PHR

 

As part of course work for #MI227 Clinical and Laboratory Information Systems, we were tasked to evaluate an electronic health record system using published tools. I have chosen to evaluate webMD’s personal health record (www. webMD.com/phr) using as basis for evaluation the paper published by Pushpangadan S and Seckman C, on Consumer perspective on personal health records: a review of the literature.

 

Personal Health Record (or PHR) by definition is “an electronic, lifelong resource of health information needed by individuals to make health decisions.”( The American Health Information Management Association (AHIMA) in Burrington-Brown et al., 2005, p.4). With the PHR, an individual can manage, maintain and interact with his personal health information, personalizing and tracking health information. PHRs collect, track and store medical data in one accessible source. WebMD makes this accessible via the web, so that only an address, an internet access, and the individual’s password will allow sharing of this data. PHRs supply a means to monitor, maintain and support healthcare activities throughout an individual’s life span.

 

The following evaluates the PHR using the WebMD platform.

 

Usability

Is it user friendly?                                  4/5

Prescriptions and Refills                      0/5

Viewing of

Medical History                                                               4/5

Test Results                                                                      4/5

Medication History and Current Medications          4/5

Drug Interactions and Warning                                   4/5

 

I created a PHR for my mother because of the numerous ailments and medications she is taking. I found it user friendly, with her medical records viewable with date of diagnosis. Test results are entered manually (this can be tedious) and can be plotted over time if tracked.   The results can also be scanned or uploaded. Current medications and history are listed clearly, with clear drug interactions and warnings. However, I wasn’t able to access the direct usability for prescriptions and refills, but this may be because I am a user from the Philippines and not the US.

 

Communication

PHRs improve communication with providers                      5/5

Provider communication

Via email                                                                                         3/5

Scheduling of appointments and reminders                           3/5

Sharing of results                                                                          5/5

Resources and recommendations regarding health issues   4/5

Capable of being incorporated into an EMR                            3/5

 

Using my mother’s example, the PHR listing provides good communication with providers as the PHR can be printed as a pdf file. Repeated history taking and date recall become a breeze with the PHR. Full communication with the provider, however, via email, and scheduling of appointments as well as reminders are not fully utilized (perchance because of my location). Sharing of results is easy either via full access of the PHR with a link or password, or via soft or hard copy sharing of pdf files, but full interoperability with an EMR remains to be proven. References and recommendations are provided if one is interested.

 

 

Medical terminology

Was medical terminology explained and understandable?             4/5

Was medical terminology in simpler words or layman’s terms?    3/5

Was an online dictionary embedded for easy reference?                 3/5

Resources and recommendations                                                         4/5

Health information and health promotion                                         4/5

 

While medical terminologies are not explained on the outset, links and reading materials are provided for better understanding. An embedded dictionary, however, is lacking, as the resources provided are also difficult reads for the layman. The information is readily available, however, to the interested PHR user. Health information and health promotion is aided by health tracking and education.

 

 

Privacy and Security

Is it HIPAA compliant?                                                                      4/5

Can patient control with whom they want to share data with? 4/5

 

To a certain extent, HIPAA compliance is probably a given, as the platform is used widely in the US with strict privacy and confidentiality rules. To a certain extent, the patient controls with who data is shared with. Latest terms and conditions, however, have clauses that permit data sharing of some personal information and is a concern.

 

 

 

References:

 

  1. Pushpangadan S, Seckman C. Consumer perspective on Personal Health Records: A Review of the Literature. http://www.himss.org/ResourceLibrary/GenResourceDetail.aspx?ItemNumber=39756. Accessed March 25, 2016.

 

  1. Burrington-Brown, J., Fishel, J., Fox, L., Friedman, B., Ginnangelo, K., Jacobs, E.,… & AHIMA e-HIM Personal Health Record Work Group. (2005). Defining the personal health record. AHIMA releases definition, attributes of consumer health record. Journal of AHIMA/American Health Information Management Association, 76(6), 24.

 

  1. Abramson, E.L, Patel , V., Edwards, A. & Kaushal, R. (2013). Consumer perspectives on Personal Health Records: A 4- community study. American Journal of Managed Care. 20(4):287-96.

 

  1. Somner, J., Sii, F., Bourne, R., Cross, V., & Shah, P. (2013). What do patients with glaucoma think about personal health records? Journal of Ophthalmic Physiological Optics,33, 627-633. doi: 10.1111/opo.12084

 

  1. Fricton, J. R., & Davies, D. (2008). Personal Health Records to improve health information exchange and patient safety.Agency for Healthcare Research and Quality. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK43760/

 

  1. Patel, V., Abramson, E., Edwards, A., Cheung, M., Dhopeshwarkar, V., & Kaushal, R. (2011). Consumer attitudes toward personal health records in a beacon community. American Journal on Managed Care, 17, 104-120.

Health Information Security

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#MI227 Coursework #5: Health Information Security

 

This week we were asked to “be part of a group practice that has decided to implement an electronic solution for clinical documentation. However, you have come across many horror stories regarding health information security that have led to failed clinical information system implementations. How would you prevent this from happening to your group practice?  Create an article listing down questions that your group practice should be able to answer to identify risks to securing electronic health information.”

 

On Confidentiality

  1. Is it HIPAA compliant?
  2. Is it compliant with the Philippines Data Privacy Act of 2012?
  3. How do we deal with security breaches?
  4. How can we ensure confidentiality of entries?

 

On Availability

  1. Where is storage?
  2. How is the system backed-up?
  3. How will data to be retrieved from storage?
  4. How fast can data be retrieved?

 

On Integrity

  1. How do we ensure that data is not manipulated, corrupted or lost?
  2. How do we maintain data integrity?
  3. Who has access to data?
  4. Who can modify data entries?
  5. Is there a code of ethics for data handlers?

 

These are some of the questions that needs answers before one could feel secure about considering an electronic solution for clinical documentation.