CHECKLIST/MONITORING FOR LHS-ML

INFO 1: INFORMATION MANAGEMENT SYSTEM

ASSESSMENT PERIOD: From _______________________ To ________________________

GENERAL INFORMATION

REGION: CENTRAL VISAYAS

NAME OF HEALTH FACILITY: ___________________________________________________

TOTAL POPULATION: _____________________________________

INCOME CLASS:
 1st Class  3rd Class  5th Class
 2nd Class  4th Class  6th Class

TOTAL # OF BARANGAYS: ____________________________

TOTAL # OF BARANGAY HEALTH STATIONS:_____________________________

TOTAL # OF DOH-IDENTIFIED GIDA BARANGAYS: __________________________

INFORMATION MANAGEMENT SYSTEM (IMS) INVENTORY

DESIGNATED IMS PLANNER

Name of Health Facility/Office: ______________________________________________________________

Name of IMS Planner: ______________________________________________________________

Division/ Section/ Unit: ______________________________________________________________

Position/ Designation: ______________________________________________________________

Email Address: ______________________________________________________________

Contact Number/s: ______________________________________________________________

ORGANIZATIONAL PROFILE

Total No. of Employees: ______________________________________________________________

(Indicate the total number of employees, including those on part-time or full-time basis, regular, contractual
and casual employees, and those assigned to provincial/city and other offices that are within the jurisdiction
of the P/CHB)

ANNUAL ICT BUDGET

Current Annual ICT Budget:

______________________________________________________________
(Indicate the total annual ICT budget for the current fiscal year)

Other Sources of Funds: ______________________________________________________________

(Other possible sources of funds should be indicated separately)
 HARDWARE AND OTHER ICT EQUIPMENT

1. Number of Computing Devices and Peripherals by Type and by Year Acquired

Total Number of Functioning Units by Year Acquired

More than 3 Years
TYPES
Last Year Last 2 Years Last 3 Years Ago
Owned Leased Owned Leased Owned Leased Owned Leased
Mainframe
Servers
Desktop PC
Laptop/ Notebook/
Netbook PC
Mobile Phone (including
smart phone)
Tablet PC
Multi-function Printer
(print, copy, etc)
Printer only
Digital Camera (include
DSLR, if any)
Wide-format Printer or
Plotter
Small Scanner (ex. Flatbed
scanner)
Smart Card Scanner
Wide-format Scanner
External Hard Drive
Generator Set
Others, please specify

2. Number of Computing Devices and Peripherals

TYPES Current Year

Servers
Desktop PC
Laptop/ Notebook/ Netbook PC
Multi-function Printer (Print, copy,
etc)
Printer only
Others, please specify

3. Number of Servers by Capacity and by Location

Location
Total Capacity by HDD
In-House Co-Located
Above 4 TB
2 TB to 4 TB
Below 2 TB
 4. Issues & Challenges Encountered relating to Hardware and Other ICT Equipment

ISSUE/ CHALLENGE Recommended Interventions/ Technical Assistance

(Note: List down common priority issues and Needed
challenges encountered among health (Note: List down corresponding recommended
facilities/offices within the P/CWHS relating to interventions/technical assistance needed to address identified
hardware and other ICT equipment) issues/challenges)
 IMS SOFTWARE, APPLICATION SYSTEMS, INFORMATION SYSTEMS AND DATABASES

1. Operating System for Workstations (Desktops & Laptops)

If not, write below the year of

Operating System Lifetime License?
expiration
Older than Windows XP Yes ; No
Windows NT Yes ; No
Windows XP Yes ; No
Windows Vista Yes ; No
Windows 7 Yes ; No
Windows 8 and up Yes ; No
Solaris Yes ; No
Linux Yes ; No
Mac OS Yes ; No
Mac OS X Yes ; No
Others, please specify Yes ; No

2. Operating System for Servers

If not, write below the year of

Operating System Lifetime License?
expiration
Windows NT Yes ; No
Windows 2000 Yes ; No
Windows Server 2003 Yes ; No
Windows Server 2008 Yes ; No
Windows Server 2012 Yes ; No
Solaris Yes ; No
Open Solaris Yes ; No
OS/2 Yes ; No
Linux Yes ; No
Mac OS X Server Yes ; No
Others, please specify Yes ; No

NETWORK AND INTERNET CONNECTIVITY IMPLEMENTATION

1. Network and Internet Connectivity Implementation

Parameter Response Options Remarks

1. Does your facility/office have a Local
Yes ; No
Area Network (LAN)?
2. Does your facility/office have an
Yes ; No
Intranet?
3. If yes, does your facility/office have a
Yes ; No
Virtual Private Network (VPN)?
4. Does your facility/office have a Wide
Yes ; No
Area Network (WAN)?
5. Does your facility/office have a Private
Automatic Branch Exchange (PABX or Yes ; No
PBX)?
6. If yes, what is the PABX/PBX setup? Private ; Hosted ;
VoIP PBX ; Hosted IP
7. Is your facility/office connected to the
Yes ; No
internet?
8. If yes, what is/are your facility's/office's Dial-up ; DSL ; Note: List down all items that are
mode of access to the internet? ISDN ; Leased Line ; applicable.
Mobile Phone ; Satellite
; Wi-Fi ; Others, please
specify
9. Who is (are) your Internet Service Note: If more than one, please state
Provider(s)? who is the primary and who is the
secondary provider

10. What is the combined internet

bandwidth (voice and data)?
11. How many workstations have access to
the internet in the facility/office?

2. Issues and Challenges Encountered relating to Network and Internet Connectivity

Issue/ Challenge Recommended Interventions/ Technical

(Note: List down common priority issues and Assistance Needed
challenges encountered among health (Note: List down corresponding recommended
facilities/offices within the P/CWHS relating to interventions/ technical assistance needed to address
network and internet connectivity) identified issues/challenges)
HEALTHCARE PROVIDER NETWORK (HCPN) SETUP
(Draw your existing HCPN Setup. Indicate the primary care facilities, hospitals providing secondary and tertiary
care, and designated apex hospital in the illustration. For hospitals, put legend for the type of ownership/control
—i.e. national government [DOH], local government, or private)
 INFORMATION MANAGEMENT SYSTEM STRATEGY

STRATEGIC CONCERNS FOR IMS IMPLEMENTATION

PROBLEMS
(Describe the barriers/obstacles that hinder or cause delay in
IMS ACTION AREA the operations of the IMS action area/activities)
1. Electronic Medical Records

2. Telemedicine

3. Registries

4. Electronic Referral Management

System

5. Other Ongoing or Currently

Implemented Information
Systems/Application

6. ICT Infrastructure
a. Network and Internet Connectivity

b. Data Center/ Server Room/ Web

Hosting Services

c. Functional/ Serviceable Hardware,

Software, and other ICT Equipment

d. Recovery Site and Back-up

7. Human Resources for ICT

8. Cross-cutting ICT Implementation

Areas
a. Standards Compliance

b. Interoperability

c. Data Privacy

d. Cybersecurity
 EXISTING ICT ORGANIZATIONAL STRUCTURE

a. Existing ICT Organizational Structure

(Draw your existing ICT Organizational Structure at the health facility. Indicate the plantilla position,
and the number of permanent, contractual, outsourced or project-based manpower by position)

b. Proposed ICT Organizational Structure

(Illustrate the proposed ICT Organizational Structure at the health facility. Indicate the plantilla
position, and the number of permanent, contractual, outsourced or project-based manpower by
position)