With the disruptive changes brought upon by COVID-19, the medical community needs to work harder and catch up with what has been lost in the past two years. The world demands a smarter health care system, something that breaks the limitations imposed by the pandemic. Leaders in newborn screening (NBS) made sure that the program is moving in this same track even before the pandemic hit by building smarter systems encompassing the different components of the program - screening, diagnosis, follow-up, management, education, and quality assurance. This makes phasing towards a smarter health care system, the overall theme of the newborn screening program for 2021.

Co-learning among health professionals continued despite physical limitations. This was witnessed in this year’s 19th Newborn Screening Convention held during the NBS Week, which gathered a total of 7,300 participants in online platforms, posting an increase from last year’s 6,600 attendees.

Although training has been hit particularly hard by COVID-19, this did not stop the program in capacitating the NBS health workers. The Department of Health (DOH) Centers for Health Development (CHDs) and Newborn Screening Centers (NSCs) developed virtual training courses to address the need to ensure delivery of health services despite physical restrictions. Along with this, the Newborn Screening Reference Center (NSRC) also prepared to make training and education accessible to health care workers by producing a series of newborn screening webinars entitled “Newborn Screening in Focus.” In partnership with the University of the Philippines’ Internet TV Network TVUP, the NBS series aims to provide a platform for healthcare professionals to have an open dialogue about their experiences in newborn screening, further extending the knowledge, lessons learned, and best practices to all its audiences. The first episode will be available in the 4th quarter of 2021 and will be aired weekly at TVUP.

Digital Platforms

“A SMART healthcare system uses technologies to access information, to connect to people, health resources, and healthcare-related institutions,” said UP Manila Chancellor Dr Carmencita Padilla who is one of the proponents of the NBS program in the country, during her plenary session. In time with the celebration of the National Newborn Screening Week, the program announced the soft launch of the ENBS Mobile App, a one-stop hub for all NBS health workers on everything newborn screening. The app streamlines messages to all health workers about program activities and monitors compliance in health centers and facilities. To encourage more users, the app features a rewards program where users earn points in accomplishing certain tasks in the app, which they can use to redeem goods and services at partner merchants.

Meanwhile, in its effort to educate the general public, the NBS program maximized digital platforms through the program’s website and its social media pages in sharing advocacies and program updates. The overwhelming attendance in this year’s NBS week celebration could be attributed to the organized wide-scale online campaigns by the Newborn Screening Society of the Philippines, Inc. (NSSPI), University of the Philippines (UP) Manila through NSRC, DOH CHDs, Newborn Screening Centers, and other program partners.

As stated by Nurse Nikki Dela Cruz, Project Development Officer of Newborn Screening Center-Central Luzon (NSC-CL) during her plenary session, social media has become a powerful tool in the new normal because of its ability to effectively disseminate information, and cross physical and geographical barriers. The NSC-CL utilizes a variety of social media strategies such as infographics, webinars on disorders, fansign campaigns, Twitter barrage through the Volunteer Youth Leaders for Health (VYLH) Philippines, profile picture frame campaigns, and hashtag campaigns such as #ENBSsaves or #kwentongNBS.

Phasing to a smarter health care system, the NBS program worked on improving the level of its follow-up and management of cases by investing in better management of online medical records through the Continuity Clinic Online Record System (CCORS). The CCORS ver 2.0 is a secured system of data management that consolidates all information about cases, making the monitoring of patients of continuity clinics more efficient.

Another recent undertaking was the development of the NSRC’s monitoring and evaluation of external quality assurance (EQAS) and proficiency test (PT) results of NSCs. What used to be an email-based setup is now going to be done online with the help of the NSRC EQAS program. EQAS is a web-based reporting option that allows the laboratories to enter into a system the results of EQAS and PT that can easily be evaluated and monitored by NSRC. Through this, the program can periodically assess the quality of laboratories’ performance and achieve added confidence in patient test results, while giving the quality officers a real-time assessment of how laboratories are performing.

NBS Portal

Perhaps, one of the biggest advancements in the program digitization for 2021 is the progression of the Newborn Screening Portal into its third phase: cleaning of data and its availability on the internet for some implementers. The Newborn Screening Portal is an online portal that seeks to provide visual stories of NBS data into one platform. It features three dashboards: the Institutional Database Dashboard, which shows the location and status of the NSFs, continuity and satellite clinics, confirmatory centers, and DOH-CHDs; the Quality Indicator Dashboard, which shows the quality indicators of the program, i.e., screening, timings in screening and transmission; and the Disease Map, which shows the geographic distribution of cases at different levels - regional, provincial and municipal. It also features the cases’ follow-up dispositions - recalled or unrecalled, and age and gender distributions.

These features help improve the program in different ways including better allocation of resources such as medical food and medicines; identification of areas for supplementary assistance to ensure diligent follow-up, tracking and monitoring of cases; strategic placement of treatment networks; and identification of areas for intensifying advocacy and awareness campaigns. The NSRC, led by its Program Support Head, Ma Elouisa Reyes, envisions making the portal available to more stakeholders by year 2022.

Telehealth and Telemedicine

This has been a significant health care mechanism in the nation with the Philippines being an archipelagic country. But its importance cannot be overstressed when the physical limitations were brought upon by the COVID-19 pandemic, on top of the shortage in medical specialists in certain locations. Program leaders were quick to intensify telehealth to continue delivering medical services. Thanks to telemedicine, patients can now book and attend their appointments online, and transportation costs in consultations are taken out. Patient referrals, which used to be done manually, are also simplified by digitalizing the process.

However, the limitations to telemedicine were also stressed. According to Dr. Mary Ann Abacan, convention resource person, physicians should be transparent in the limitations of telemedicine and exercise professional judgment in informing whether face to face consultation is required. Padilla believes that the program is in its first steps into the Industrial Revolution 4.0, also known as the digital age, because “we do have some examples already for digital connectivity, automation, patient centric experience, analytics and big data, and holistic and interdisciplinary innovation.”

“We are doing this to make sure that the program gets smarter, and it becomes more efficient so that you, our clients, our newborn screening coordinators, will be able to access our data and probably do your job better if we can give you all the support that we can,” she noted.

First published on Philippine Star, October 17, 2021