Why PH Government Hospitals Can’t Have National EHR

It must be one of the ultimate dreams of a Health Informatics professional in the Philippines for our government to finally give more support on eHealth initiatives, especially the idea of implementing a national Electronic Health Record that will be used in all government hospitals. In a clinician’s perspective, imagine doing your clinical documentation with ease, and being able to access all your patients health records with integrity to maximize the potential of your healthcare delivery – without worrying about completeness of data shared by your patient during consultation. In a patient’s perspective, picture yourself visiting a government hospital using electronic health records, with reliable connection, and at least a standard device – removing your worries about long queueing, and possible lost of record.

The use of electronic health record in the Philippines is still in its’ formative stage. We may be a little late, but a lot of big hospitals are now adapting to the use of electronic health records, and even small scale clinics are using EHR – however, that is for the private sector. In the Philippines, implementing a national EHR in government hospitals might remain as a dream for quite some time. Here are some of the few challenges that I see in implementing a national EHR for our government hospitals:

COST

Implementing a national EHR for our government hospital will surely be costly. And when we talk about government hospitals, funding should be coming from our Department of Health. In the recent events in our government, the allocated budget for DOH went down to P90.9 billion. Although DOH said that if you add Philhealth’s budget, it will be a total of P141.02B which is actually 15% higher as compared to the previous year’s [1]. Although there is an increase in Health Facilities Enhancement Program in DOH’s budget allocation this year, the focus is more on the expansion and renovation of public health facilities and health centers – as our leaders think that demands for healthcare is increasing alongside with the continues growth of our population, and making healthcare more accessible for every Filipinos [2], so attention on information system improvement is not given at this time.

The drop by almost 50% in the budget for Maintenance and Other Operating Expenses or MOOE, which provide medical supplies, medicine, laboratory supplies, and other needs kind of added burden to Filipino people since it somewhat promotes further commercialization of healthcare, rather than providing service to the people [2]. The expansion now offers pay services like xray and laboratories charging patients sometimes as much as private hospitals do – and the idea of adding another source of expense may potentially affect health care service delivery even more.

Implementing an EHR really does concern a lot about costing and budget – as you need to consider not only the cost of implementing it, but also the cost of maintaining it [3]. Implementing and maintaining ultimately hits hardware, software, time, and training.

ORGANIZATION

Although Department of Health provides the national policy direction, develops plans, make technical standards, and creates guidelines of health in the Philippines, devolution of health services happened because of Local Government Code 1991 – which granted autonomy and responsibility to local government units in the delivery of their health services. [4] Considering implementation  of a national EHR for all government hospitals and the current structure of healthcare delivery in the Philippines, there is a huge possibility of failure in implementing it especially in rural areas as you have to get the buy-ins of some government officials.

RESISTANCE

There is clearly still a social barrier among Filipino healthcare provider with the idea of using an electronic health record. Not to mention, filipinos are quite resistant to change. Most healthcare providers have been accustomed into using paper in documenting data of patients – as we all think that this will be faster process-wise, without even thinking the long-term benefits of easier way of collecting data, and making data more accessible if done electronically. Even in more advanced countries like United States had to make regulatory compliance like the HITECH Act (Health Information Technology  and Clinical Health Act) 2009 to drive healthcare providers into adopting certified EHR [5], and applying that in the Philippines setting, it will surely be challenging to implement such. Although DOH already engaged in long-term planning for eHealth and Information Communication Technology strategies [6], it will be a long shot for us to digest such in our systems.

Applying this in my current practice and coming with a privilege of a private institution, I can still feel the resistance with the people we train in the use of new systems. Healthcare providers will always question “what’s in it for us” to use such system in our practice, and if it will really make their service faster. In developing and implementing an EHR, the forms should not just be translated electronically, but must always have innovative purposes in the practice for healthcare providers to see and appreciate its’ potential.

Although still to consider the targets of Philippine eHealth Strategic Framework and Plan 2014-2020 of Department of Health, we are closely working, at least with private institution, to harmonize various electronic health record systems, there is still a small shed of light in the possibility of implementing a national EHR if governed and done well. However, still, to never set aside the huge barriers to consider.


References:

  1. DOH Budget Actually Higher
  2. Secretary Ubial Proposed Budget
  3. Barriers to the Acceptance of Electronic Health Record by Physician from Systematic Review to Taxonomy and Intervention by Albert Boonstra and Manda Broekhuis
  4. Devolution of Healthcare in the Philippines
  5. The Filipino Healthcare Provider Guide to EHR: Pros and Cons
  6. Philippine eHealth Strategic Workplan

Paving the Way to Physician’s Adoption to EHR

We have all been hearing “Change Is Coming” and they say if you want faster change, a positive reinforcement can help you easily pave the way to that change. At year 2009, HITECH or Health Information Technology for Economic and Clinical Health Act was signed into law – with explicit intention of accelerating the adoption and promoting meaningful use of electronic health record by physicians’ in the United States through appropriation of financial incentives. This incentive is for eligible health care providers implementing electronic health record, with aid of Medicare and Medicaid Electronic Health Record Meaningful Use Program.

EHR use reinforcement was done by US government to promote faster adoption to use of EHR for paperless transaction, and improved exchange of data for knowledge management and clinical decisions in a national level. Interestingly, this coursework given to us this week for our Clinical and Laboratory Information System class is very relatable to my current situation at work as we are in the campaign stage of a project that we need every healthcare provider in our institution to commit into using it.

The study Impact of HITECH Act on Physicians’ Adoption of Electronic Health Record of E Ford et al [1] wanted to evaluate EHR adoption projection with the passing of HITECH Act, and they have found out that skyrocketed adoption to any EHR system was largely driven by an imitation effect as physicians are striving to keep up with their peers in the use of EHR, rather than adopting due to an external influence such as advertising (or giving incentives); and MU programs did not directly affected, or has an ambiguous effect in the increase of adoption to use of EHR in the United States.

Although technology is somewhat becoming a necessity more than a luxury, the challenge in implementing an EHR is still there – especially in the Philippine setting. To support this claim, EHR usage is still scarce in the Philippines as we can only name a very few hospitals who currently implements one, and these are mostly the big ones you can find in the metro. Yet according to Frost & Sullivan [2] that the Asia-Pacific market will continue to grow to 2018 – which we hope applies to Philippines, however there are specific hurdles that are present in our country as we are still ranked 103rd of 166 countries in Information Communication Technology access and usage. If you think we are already advanced, think again. We are still taking our romantic walk alone in the park.

According to a systematic review by Kruse et al [3] that (1) Initial Cost of implementing EHR is still consistently considered the number one barrier in implementing it, followed by (2) Technical Support, (3) Technical Concerns, (4) Maintenance Cost, and (6) Available training which are all related to the number one problem which is financial and human resource, (5) Resistance to change in work habit (9) Workflow Challenges, and (11) Productivity loss are all related to fear of disordering what has been accustomed to practice or the traditional way of health care delivery, whilst (7) Insufficiency in time is a personal challenge of the end user to juggle time learning and continuing with their usual routine, and (8) Privacy Concern is also in the list as there are alarms regarding lost information that may be due to natural disaster or cyberhacks, and finally, (10) Financial Incentives which is actually almost last in the list.

These barriers identified in the study of Kruse et al [3] is very applicable in the Philippine setting as cost being the chief concern in the implementation of an Electronic Health Record. As much as I wanted to consider that if our government would just give much more attention and support to eHealth Strategies and Plan, and perhaps implement such incentive drive like HITECH Act to further advance adoption of EHR in our country, it does not appear to be valid yet in our scenario. Although it might encourage, but scarcity in financial and human resource must be addressed first in most institutions. Also, the study is ambiguous of the idea that HITECH Act actually helped in the promotion of EHR use, however, incline cause is that physicians are keeping up with their peers. In my assessment, as big hospitals are being the main target market in the Metro are now implementing and using EHR, soon other hospitals and even small scale ones will follow the lead, but might take some more time.

 


Sources:

  1. Mennemeyer, S., Menachemi N., Rahurkar S., & Ford E. (2015). Impact of HITECH Act on Physicians’ Adoption of Electronic Health Record. Oxford University Press. American Medical Informatics Association. 23:375–379. doi:10.1093/jamia/ocv103
  2. Frost & Sullivan. (2013). EHR and EMR Market in APAC: Electronic Health Records Will Pave the Way for Healthcare Transformation.
    Retrieved from: Frost & Sullivan
  3. Kruse, C. S., Kristof, C., Jones, B., Mitchell, E., & Martinez, A. (2016). Barriers to Electronic Health Record Adoption: a Systematic Literature Review. Journal of Medical Systems40(12), 252. http://doi.org/10.1007/s10916-016-0628-9

Siem Reap, Cambodia

“Where is home?” Amber asked.

She was a fellow backpacker I met in the bar of this really cool and cheap Central Hostel we stayed in Siem Reap, Cambodia. I was trying to enjoy a bottle of local Cambodian beer that night, before dozing off, which kinda tasted similar to our very own red horse. (Confession: I am not fond of beers – but I can if I love you and you enjoy beer and I am drinking with you. Also, if I’m broke to afford other liquors. And that night, I can only afford a bottle of beer) And I remember pausing for a good minute before responding “Manila, Philippines”. It is not that I am ashamed of my roots, nor I find it difficult to let people know that I am a Filipino – because for some Captain Obvious reasons, my physique can’t be denied of its’ roots, because I’m very much Pinoy. I have always been so proud of my brown skin, my round eyes, and my wavy hair, and has always been really prouder to letting people know how lovely and how happy our country is. But at the back of my head, and to my overthinking nature, I was stunned with the other idea of what constitutes as “home”.

I asked myself over that minute what she meant by home. How does one consider a place home, when you feel home can be anywhere? And is it possible that home can be in multiple places? Is it where you were born? Where you grew up? Where your love ones live? Or where you desire living in the future?

Cambodia is very known for its’ Angkor Wat. And first time tourists are kinda obliged to visit it. It’s a UNESCO heritage site, and the biggest religious monument in the world. And I can’t stop crying on the inside to have finally seen its’ beauty. Out of all the countries I have been, Cambodia really took a significant space in my heart – and I am sure no other place can take up that much space anymore (or maybe Prague, New York, and Grand Canyon – because I have also been daydreaming almost every day seeing them, and possibly visiting back multiple times).

It has always been one of my dreams to see Angkor Wat. I remember just looking at that beautiful scene in photographs taken by friends and people I see in the internet, and be astounded by the looks of it. It looked so unreal in the screen, and even looked more surreal in flesh. For a moment, I got scared by how unbelievably huge and historic it is. For that moment, there’s nothing more frightening than a dream come true. And as much as I would love to endlessly capture everything and take more photographs, I knew that I need to take a pause, feel it, and to just silently watch the golden rim slowly glimmer behind the beautiful monument. That moment made me realized an important lesson of patience. Years of wishing and working hard to see this gorgeous sight was all worth it – because beautiful things take time.

We spent almost the entire sunny day walking around, riding the tuk tuk (you will be needing to rent a tuk tuk for the entire day which was around 20USD) in visiting all temples we can see. It was very exhausting! And it is important to bring a liter of water at least to replace all the sweat you’d be having. To our surprise, one day pass, which we all thought was just for 20USD is already for 37USD. The cost didn’t hurt much because the view and the experience was all worth it anyway. In case you haven’t noticed, I have been mentioning USD in this paragraph. Cambodia does have their own currency which they call riel, however, they use USD in most transactions. Although money is in USD, Cambodia is still relatively cheap compared to other Asian countries I have been. Food has this very interesting feel, and since I was traveling on a budget, food I consumed are mostly those served on the street. Cheap (around 1.5-5USD) but good enough to still give you that Khmer tastebuds experience.

Amber and I shared almost same sentiments about Cambodia that night. We even both agreed that Cambodia is a very hospital country, making you feel at home. Amber was from California, but decided to find her fortune in South East Asia, and has been teaching English in Bangkok for a couple of months. She was in Cambodia for a short stay before heading to Vietnam. When I asked if she misses home, she said California is no longer home for her.

She said that home, as she learned from her journey so far, is not just the place where you were born. She said that it’s the place where you become yourself. All questions I asked myself before our conversation went deeper was answered. That’s when it hit me that where you come from now is much less important than where you are going. She’s right. Home can’t be just the place where you come from. Home would be whatever, or wherever, I have carried around me, and ultimately, a place where I could always, and would always want to go back to.

Some photos taken using iphone6+
8th Photo (self portrait) take by Karl Presentacion

Saigon, Too Soon

It has been a whirlwind of activities since we landed in Vietnam. Touring around with a very limited time felt like we were in some sort of a TV show like The Amazing Race. It was fun and exciting at first, but I have always wished I could just sit down and people watch on top of a building, or a bridge.

We left Mui Ne at midnight, and it was still dark when we landed Saigon. Since we were pressed for time, we opted moving from one place to another during sleeping time. If you are not comfortable sleeping in moving vehicles, I suggest you don’t do this because, surely, you will be starting your day with a terrible headache. And we all don’t like to be around a grumpy traveler. I think sleeping while on the road at night was a wise decision. We were all used to sleeping anywhere, and anytime anyway, but the only downside of the traveling at night by land is that you barely get a sight of anything on the road. Of course, it’s dark. But at least sleeper buses have unbelievably fast and free wifi.

Ho Chi Minh City is commonly known as Saigon. Although Vietnam War only concluded around 35 years ago, Vietnam’s resilience is just amazing. Vietnam still looked stunningly beautiful. And it felt right to me. There are so many things to love about Vietnam, but what was so dear to me was their authentic Pho, and their incredibly cheap and good strong coffee, ready to give you that caffeine fuel. And it’s everywhere!

I have never been to Ho Chi Minh, and it was my first time but the city actually felt so familiar. When the sun rose while we waited outside, I cannot stop thinking about how I get another morning. The weather’s humidity, people’s faces, and the streets are very much like Manila. It’s strange to remember that the familiarity felt like home, when you were completely aware you’re not home.

Sometimes, I don’t understand how you find home in a stranger land. I know it was too soon to say that, because I knew, too, I’d be leaving so soon.

Mui Ne, Vietnam

Here we begin a fast forwarded dream to a Southeast Asian tour.

It was around 1am of April 1st when we arrived in Vietnam – timely to one of my most hated day of the year, when people pull silly pranks on you, because I have always been that trusting and gullible friend. I wished Vietnam was just pulling a prank on us learning that buses aren’t available at the time we arrived, but Vietnam wasn’t kidding about that. So we all decided to take a rest in the airport while we tried to patiently wait. But of course, time is ticking and we all grew impatient after a while. After asking around, we learned there are other options we can actually take going to Mui Ne, so we decided to take the risk of leaving the airport, step outside, and was immediately swarmed by men. “Nice car. Big. For Rent. Going where?”  We rented a private car. It was around another 4 hours of travel from Saigon, 4 hours of sketchy ride with this man who was having a hard time communicating with us. Believe me. I am amazed of how good we are with the English language. Since we were all tired, and it was actually sleeping hours for everyone, we all fell asleep in the car. Very soundly. By the time we arrived in Mui Ne, we realized we lost a million dong. Mommy told me pointing fingers is never good, so I just wished that what happened was only a prank, and we all moved forward from that.

It wasn’t a very nice welcome. It’s a lesson learned for us.

I have actually never heard of Mui Ne, or have seen photos of Mui Ne before, so I have no idea of what to expect. Until I saw it first hand how beautiful it is. It is a perfect example of finding a gem in a desert. Well literally, there is a desert, too. And I guess, traveling to Mui Ne was worthy, still, of losing that million dong. (Help me as I still try to convince myself as I write this)

It’s a very humble town in the Bin Thuan Province of Vientam, which is very popular for their fresh seafood, and beaches. A good summer vacation for me is never complete without the sight of salt water, and Mui Ne was just so right for that.

I’m surprised that apart from relaxing in the beach, and enjoying fresh seafood, there are actually a lot of other activities you can do in Mui Ne. Biking is also popular in this small town, and not taking a package tour in visiting fairy stream, sand dunes, and the fishing village would be a sin.

There are countless of places where you can stay in Mui Ne, and they are actually relatively cheap. Mui Ne is one of those curious little parts of the world, and is very easy to love even for a very short stay. Staying for a while really did not do much justice, and I wish to come back soon.

Make Health A Priority

RHIS in the country still has a long way to go. As defined by Hotchkiss DR [2], Routine Health Information System are systems that provide information at regular intervals of a year or less to meet predictable health information needs. Common misconception with the term “information system” is that it always deals with computers or advance technology, but this may also include paper-based health records, aside from electronic health records, facility, and district management level of information systems.

Before dwelling on the issue of RHIS in the country, defining what HIS of Health Information System is also essential. As defined by World Health Organization, HIS provides support for sound decision-making, and it has four key functions which are 1) data generation, 2) compilation, 3) analysis and synthesis, and 4) communication and use. Health Information Systems aid in the collection of data across health sectors, analyses the data, and ensures the overall quality, relevance, and timeliness, and convert these data into information for health-related decision making. [1]

Studying the RHIS in developing countries like the Philippines is very interesting. Not because of the many loopholes you can find, but you get to appreciate more the elements of a Health Information System, and how it will not be successful if one will not be functioning, and how a strong HIS makes it easier to support progress of the other 5 elements of health system. As discussed in the RHIS Curriculum [3], WHO endorses the strengthening of the six building blocks of health systems which are 1) governance and policy, 2) service delivery, 3) human resource, 4) health commodities, 5) health financing, and 6) health information system.

In a developing country like the Philippines, the problem is not just a one sided issue. However, mostly coming from its’ roots which is the structure of the leadership and governance, and the devolution of health services, its’ fruits and the people working and collecting data also are dealing with their own issues as well.

Department of Health or DOH mandates to provide the national policy direction and develop national plans, technical standards, and guidelines of health in the Philippines. [4] Aside from that, they are the governing body who provide technical assistance, capacity building, and advisory services for disease prevention and control, and the governing body who supplies medicine and vaccine to Filipinos.

Under the Local Government Code (1991), devolution of health services happened and local government units were granted autonomy and responsibility for their own health services delivery. Although National Health Programs are still coordinated by the DOH, the delivery would still depend on the local government unit [7]. The problem with coordination between the governing body which is DOH and local government unit lead to poor implementation of national health programs and policies, and poor functioning of the local government unit. And since that autonomy was given to local government unit, which is regulated by the mayor, health is never the priority of most local government units.


Image 1. Organizational Structure of the Philippine Health Sector After Devolution
Source: Alliance for Improving Health Outcomes Inc. (AIHO)

As responsibility is with the local government unit, the initiative to source pool of skilled health workers, or the lack thereof that are willing in a primary level is also scarce. Not only the human resource, but the skills or trainings that are available is limited. This leads to where the other side of the issue is, which is in the very cellular level of the structure, in which the people collecting data are not as skillful as they are expected to be, thus affecting integrity of data collected, that are essential in health decision making.

Devolution of health service delivery may work in other countries, but studies suggest that it works well in countries that see health as a priority. In many developing countries, traditional health service is highly centralized. It was a top down center design program as well in the Philippines before, but decentralization was decided upon the idea of systematic citizen involvement in setting goals, execution, functioning, financing, monitoring and other functions, thus the increase of local control and accountability [6]. However, one evident factor was overseen in this process. In the past years, studies and surveys suggest that health is not a top priority of Filipinos. It is only in some very recent surveys for the past couple of years that health became one of the top priorities of Filipinos [5], thus involvement in setting up these goals was very low. There should have been participation and consultation from local population and other stakeholders, especially in the governing body of local government unit, as capacity to handle new responsibilities is lacking, and health was never really their priority.

Solving minute issues, perhaps in the local government unit like strict implementation of data gathering to strengthen integrity of data could help, but in the long run may not be very sustainable. If the roots of the problem will not be given its’ treatment, the problem will continue to bear fruits.

As a student of Health Informatics, and a catalyst of change, raising awareness to my reach is very essential. However, this will never be enough to instill change in the mind of Filipinos. In the future, I aspire to be one of the leads to pioneer the drive to make health as a priority, and to bring the centralization back in the delivery of health services. The delivery of health services should be brought back in the hands of health professionals, as health professionals are the ones who are more knowledgeable with health care needs, and are more skilled and making sound decisions in dealing with health care data.

After all, introduction of new processes especially by the governing body should not always be forced. The population would take time to adjust from it, and should be steered slowly while still aiming quality improvements.


Reference:

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Singapore Weekend

A few days ago, I found myself walking in the streets of Singapore. Being the planner type myself, the short and sudden visit was kind of frustrating. If it was not for my sister, I will not be boarding that morning flight to Lion City.

Although she shouldered my ticket flying to Singapore, I literally only had 2 days to plan and settle everything, and even look for a place to stay in. The trip just came out of nowhere, and one Wednesday morning my mom just told me I’m flying with my sister before she leaves for good to work. Fortunately, we have a family in Singapore who were more than willing to help us find a host for the weekend, and I have my good friend Byron who is currently working as a landscape architect in Singapore, and showed me around to calm down the obsessive planner person in me. If it wasn’t for them, I might have already went cray.

Or at least that’s what I thought while writing this.

They say that the things we do unplanned more often than not turn out to be a great memory to keep, and that quick weekend in Singapore was absolutely unforgettable. Since the trip was really unplanned, and my sister only stayed for a few hours with me before she flew to Dubai, I was literally left with no budget for almost anything, so Byron and I went to discovering beautiful, and non-cliche places where transportation and food are the only things we have to spent pennies on. He took me to places that offer cheap and authentic asian food! What I like about Singapore is how multicultural they are, not just in terms of arts, but food diversity is touted as a reason for you to visit and stay longer in Singapore. You get a taste of China, Malaysia, India, and Thailand in one small, and beautiful country. I wish I could post photos here in this blog of all the food I had in Singapore, but in most occasion when we were about to eat, I was too excited (and too hungry, because I’m always almost too excited) to eat than spend another good five minutes to flat lay them and get that photogenic instagram shot. Food was absolutely fantastic (especially chicken rice, and the dry noodles I’ve tried), and it is definitely something to look forward to in the next visit!

But more than the stunning infrastructures, diverse culture, and hybridized cuisine, the quality time of reconnecting with a good old friend, and my cousin Paul from my dad’s side was the very highlight of this unplanned “trip”. It is very rare of me to have such deep and meaningful conversation with my family. Growing up in Manila, it has secluded me from most of cousins from both sides of my parents – with my mom’s mostly in the east coast or in our province, Romblon, and my dad’s in the west coast. It has been always easier for me to open up to my friends or strangers, as I feel that there is a less of a concern about what they will think of me. After a few bottles of red wine, unsure if it was courage or alcohol that began speaking, slowly, I began breaking down my walls, and started sharing to Paul. Our conversation helped me even more in relieving myself from a perpetual plight and perplexity. It has brought me to realization that when you open yourself wider and expose it much to world, you don’t just get validation and acceptance from others, but you get to embrace yourself even more.

To Another

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It is cute and funny how people still expect resolutions every time the year moves forward to another number. Some research says that 80-90% of New Year’s resolutions fail, yet millions of us still make them every single year. I am not sure about you, but I am pretty sure that what happened between the last 365 times the sun and moon appeared above me, I certainly did not commit to even half of the resolutions I did. But at least I tried.

Now I won’t begin to talk about what my resolutions were for this year, neither talk about the promises I would probably break as well in the coming year (because we just love breaking promises, right?), but when people try to dig deep in the conversation and gives you the plan or goal card question, I begin to wonder and question so many things.

I am not sure if it is just me, but when thrown a question like that, it seems that you are obliged to impress somebody. It worries me. Not that I have no plans at all, but majority of people seem to be just preoccupied of the surface of one’s purpose. You probably give them a nice answer, and they give you a rehearsed response of “that’s great”. And you are unsure if it really does sound great to them. Regardless, you continue with the conversation, and probably throw the same question, and the best part is that most of the responses you get may sound better than yours – leaving you dwarfed by someone else’s progress on their ultimate goal.

Entering the “young professional” life, I begin to notice how huge of a jungle it really is outside the confines of university. You can play a wide spectrum of roles to begin with bugs or insects, small birds, fishes, or cutesy mammals which is easily preyed and hunted in the cold and swampy jungle. You are blessed if given the role of a monkey in which you can clown around and outsmart the bullies, or an antelope, looking weak yet gifted with long stride so you can run fast enough to save your life.  But definitely impossible to be crowned as a lion, tiger, or an eagle, when you are very new in the jungle. The jungle just seems to have its’ own bible, and you have to follow the ecosystem.

I am honestly caught off guard how competitive it is here. In a 2016 millennial dictionary reference, I am shookt.

In the evening of Rizal Day, I was catching up with my dear friend, Kar, over an iced Vietnamese coffee in the nearby mall. Kar has always been one of those good friends who will look you into the eye, and completely understands you, without even making any sounds or gestures. I don’t understand what science or magic is behind in such connection, but you get me. It is gem to find people like that in this world. Kar and I has always been so ambitious with our life goals, and being seatmates in our freshman year (although we actually have a person sitting in between us – but he was figuratively non existent to us), I learned while conversing with her that we share common sentiments on how the #goals we perceived before were very skin-deep. Get a nice job, buy expensive things, go here, go there, have a family, and be stable.

This is when it hit me that why do we always go around asking ourselves or people what their goals are, and always wait or anticipate responses citing things like must have, or must experience? I begin to wonder why we are not asking ourselves or others “what can I offer to the immediate world” instead?

I enjoy reflecting a lot in times like this, and days before the year ends, and think about all the challenges, and the fun times. It gives me peace – as I am reminded how transformational were some moments however seemingly difficult they were. I think there is actually nothing wrong with having resolutions or goals, especially when it is a new year since it freshly promises a clean slate again. And having goals absolutely keeps us grounded with what we ultimately want in life. But I would like to have myself to be constantly reminded that to this another page to fill, to focus more on the things we need, and what others immediately need from us, to stop comparing self to others, and to even positively celebrate more tiny victories.

 

Photo by Alexis Lim

Arrivals & Take Offs

DSC_5522Processed with VSCO with 4 preset

Whenever I get randomly sad, I think about airports and flying. I think about airports not because I want to run away. Honestly, the idea of running away is also good, as traveling is one of the best form of escapes I could think of, but I think about airports not because I am fascinated with planes. I’m actually still quite frightened of the idea of flying; but, I always pick the window seat whenever I travel to give myself a fantastic view from the top, and to easily take snaps of beautiful skyline. I can say that it is my favorite form of torture – for the sake of capturing photos of clouds, and slightly overcoming fear of heights.

Planes, however, are actually fascinating in general – how it was amazingly built to connect one place to another making long distances nothing in a matter of minutes or hours. It fascinates me how planes can bring you quite close to your childhood dream of touching clouds, and how I imagine them to be so soft and fluffy. But I think about airports and flying not because I like planes. I think about airports because it comforts me.

Whenever I get sad, I think about airports, and the moment of replaying one of the most sincere scenarios I can remember. Where else in the world you can see balloons, flowers, huge welcome home signs, and a lot of running, hugging, and happy crying happen in one room? It is where I can remember one of the sincerest welcomes, and the sweetest reunions. I haven’t been in that situation yet. Traveling alone most of the time, it is a usual moment for me to just watch people reunite, and moments after, I hop in a cab or book myself an uber ride home. But the heyday of an arrival is tempered by the comforting feeling that you are finally home again.

I think about airports because there is hardly a better place I can think of to people watch. Peruse the crowd at an airport, you are guaranteed to see a huge range of nationalities, races, gender, and social classes. And I sit there, imagining like Theodore in Her, making myself try and feel them as more than just a random person walking by. I imagine what it is like to be them in that moment, what they are feeling, what they had for breakfast, where they are heading to, how deeply they have fallen in love, and how much heartbreak they have all been through.

And though I admit that I am fond of going places, flying still scares me a little. You may find it peculiar but I love the baby panic it gives me whenever I start hearing the plane engine roar, especially during takeoffs. It excites me. Although I am still fidgety when the aircraft matches the beating of my heart, and whenever the pilot says “cabin crew to takeoff stations”, because I know seconds from that, we will soon be detached from the ground. And that very moment we detached from the ground, I feel like I am gambling a huge part of myself, suspended in the air.

It is not just the excitement of the adventure that awaits whenever I step into an airport, but I think about airports and flying as bookends of new chapters, and long-awaited endings. Airports and flying is a constant reminder for me to feel, and that regardless of the emotions you have, we succumb like planes, and let the air fleet us to another feeling.

 

At This Crossroad

There are decisions in life we make that we are uncertain of – probably fifty percent of it we are sure to regret in the future. Taking Health Informatics, however, was part of the other half. Health Informatics 201 as an introductory course in the degree program opened a lot of doors for me – not only that it has given me a great understanding of what I am getting myself into, but it actually helped me realized how vital this course is in the future of our healthcare. There is no stopping for technology to grow faster and now penetrating healthcare even more; however, our time is just limited, but if you come to think if it – time is irrelevant if we leave trails along the way. And our knowledge can be limitless if we adapt to these changes we are facing, and will be facing in the world of healthcare.

In this blog, you will see different posts that are health informatics related – which are tagged under category of health informatics: http://anotheralvin.com/category/health-informatics/. These are actually weekly requirements for school, to read articles, to answer weekly driving questions, and to discuss this in the class. It seemed to be very simple, but it was challenging to juggle it with demands from work, and life. Nonetheless, I honestly enjoyed it because how else we can enjoy technology in healthcare but by sharing it in social media, and through writing which I am fond of.

I can’t say that my knowledge and understanding of the course is now on its’ full bloom state, since I know that I still have so much to learn and unravel. But what I am really happy about is that I can now see myself clearly, and the direction of my journey here is now pointing to many doors in the future which I know will help me fulfil my passion and goals.

I have always been so passionate about so many things: technology, writing, arts, and healthcare. And putting emphasis on health since it is my chosen career – I have also been always passionate on how important it is for us to take good care of ourselves and others. That is why I took Bachelor of Science in Nursing as my degree in the university. I have always wanted to be in the medical field, apart from thinking that becoming one is the greatest achievement I can give back to my parents, but I felt that it is one of the best way to share myself to the society by being an instrument to care, and to heal. However, again, there are decision in life that we make that we are uncertain of – and along the road of my journey in my profession I arrived at this crossroad of should and must.

As writer Ella Luna said, that in life we always take a jump from both should and must. Should as being how others want us to show up in the world, and must is who we are, what we believe, and what we do when we are alone with our truest, most authentic self. At this crossroad, I realized that bed side care is not for me. Although, I think, I do well with bedside care, and I am glad to make others smile when I do my nursing care, but I honestly do not feel fulfilled as a person. I felt that there is something missing, something lacking with what I am really passionate about apart from healthcare. And all my life I have been thinking that the career or the job that I want will be very difficult to find since healthcare professionals are only seen in the hospitals, clinics, or communities.

Now the vision has become clearer because of this course. I have come to realize that your career should not define you, but your career should reflect you. This is when who we are, and what we do become one.  As Mark Twain said that “the two most important days in your life are the day you are born, and the day you find out why”, and now taking a step at this crossroad, and putting my one foot forward to the road of must – although, scary and it seems to be quite difficult, but I feel that is is time to tighten the grip and focus, and continue walking.

 

+B

b

Tuberculosis is a condition caused by Myobacterium tuberculosis, which is acquired by inhalation of droplets containing the said tubercle bacili. Tuberculosis is an airborne disease that is still very apparent in the Philippines – making it still one of the deadliest disease in the country, although cases and deaths due to Tuberculosis was reduced by more than 50% from the 1990 baseline (DOH, 2015). Infectious droplets of this tubercle bacili can be spread by coughing, sneezing, or talking.

A lot of initiatives has been started for the help in the lowering the cases of Tuberculosis in the country. One of which is through the National TB Program that helped the country achieve a global target of 70% in detecting cases of new smear positive Tuberculosis cases, and 89% of these cases were successfully addressed and treated. (DOH, 2015)

However, there are new emerging concerns that still presses this issue to be apparent in the country, putting emphasis on concerns of drug resistance, and lack of education and awareness among infected individuals, and those who are not infected to eradicate stigma and discrimination.

In the interest of our government to reduce by half TB prevalence and mortality compared to 1990 figures by 2015, and for the country to be TB-free, the initiatives done aren’t patterned or designed yet in such a way that the value of communication technology in promoting development objectives will be apparent. 

In 2002, mobile subscribers overtook fixed line subscribers worldwide and this occurred across geographic regions, socio-demographic criteria (gender, income, age) or economic criteria (Kaplan, 2016), and it is about time that a disruptive technology take over this scene, and aid in the eradication of Tuberculosis in the country. 

In the present context, a formal definition of healthcare intervention is an activity that may happen between persons or events for the specific purpose of modifying some health-related outcome or act. Relating this in the intention of using mobile phones, interventions can actually be done through this powerful medium. 

+B is an application I have carefully thought of to be a catalyst of eradicating stigma and discrimination of people when they hear TB or tuberculosis. The name idea came from some reference of studies of changing name must be accompanied by stigma to be forgotten which may lead to better collaboration in treatment, facilitate adherence in medication, and enable inclusion of those who are infected to be more confident in their community, and other social networks.

On top of having such name to erase stigma, this application will empower infected individuals or even those who are not, to be educated properly of the illness, and the course of treatment. This will also allow users to have visibility of his available resources around – like where the nearest DOTS clinic is or if he wishes to consult a private physician, where the nearest pulmonologist is. The application will also help to better the communication between patient and doctor, and allowing doctors to have visibility of their patient’s status on how the are taking the medication – by patient simply noting their intake in the application every time that they are taking the antibiotic. In this way, monitoring is not just done manually, and by how much medicines are left with the patient, but patients are empowered on monitoring their intake by themselves.

Another issue will be medication, and the patient’s compliance in regularly taking their medicine. Drug resistance is one of the leading causes why Tuberculosis is still apparent in our country, and with the help of +B, reminding patients will be easier as they can receive notification on when it is time to take their medication.


  1. http://www.gov.ph/2015/03/23/ph-winning-its-battle-against-tb/
  2. http://www.doh.gov.ph/national-tuberculosis-control-program
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932100/

Equity

equity

I always look forward to weekends. There is this thing they call “weekend warrior” in which people who are like this are the ones who make the most out of their weekends, and I’d like to consider myself one –  a weekend warrior. Timely as it was, my good friends from the creative side (Sino Pinas) invited me for a trip to Zambales – and it was probably one of the best weekend I had this year so far! (Blog about the trip and visual diary will be shared in a different post)

My favorite part of the trip with Sino Pinas was really the trek going back to where we parked our 4×4 cars. Not only because the weather got better that time, and most of my friends were all busy taking photographs, but I had the time to be alone, to discover some new wonders, and to get to know more about the place, and talk to our guide, Clement, who’s a local in the area. Afterall, the best part of every travel is not making everyone around you stay as a stranger.

Clement was born in the evacuation center on the year Pinatubo erupted, so he had no memory of how chaotic it was that time. But his memory of growing up near Pinatubo, and witnessing how this mess turned into a beautiful disaster was still perfectly painted in the interesting stories he shared.

Clement genuinely loves his place, which I admire a lot in our countrymen. He shared to me the challenges they have as locals living in the vicinity of Pinatubo. He shared how electricity can be difficult sometimes, especially at night, and how school is quite difficult as well to reach especially to those living in the mountains. Being a healthcare professional, I asked him questions about their access to healthcare, and I learned that the locals who reside in the mountains hardly get a visit from doctors or nurses since the nearest center is 7-8 kilometres of rocky and slippery trek away.

My heart ached as I listen to Clement, and witness first hand how it is still a long way to go foor healthcare in our country to be accessible especially in rural areas. This has always been an issue in the public health scene, and accessibility is always partnered with equity in this issue.

This is why it has always been in my greatest hopes to achieve accessibility, and equity in healthcare especially in far flung areas – although this would take a lot of effort, but committing to small actions and starting smart like learning inforamtion like this, and practicing knowledge management can be a good start.

Knowledge management as defined is a belief that increases an entity’s capacity in performing an effective action to solve an issue or problem. As this involves strategies or processes for carefully identifying and meticulously structuring organization or individual’s knowledge to create sources and solutions to a sustainable progress – relating well to achieving an equitable healthcare in rural areas.

Our knowledge for this public health issue has been very apparent for a very long time; however, management of this knowledge has not always been well utilized by our government and the people, thus solution to this issue, has always been in pending ever since. There may be researches about some rural areas in the Philippines, and it’s true that data has always been available, but there is a lack of initiative in translating these data to information, and using it as a knowledge to perform corrective actions. However, given the many contributing factor like resistance to accepting such data, lack of communicating data, lack of understanding with the recipient of information, and also external factors like our challenging archipelago being surrounded by a lot of beautiful mountains and bodies of waters, and transfer of  data or information is still limited.

Becerra – Fernandez, et all, 2014 has identified that in the use of knowledge, one has to identify its’ value for it to be utilized well by an organisation or by an individual – as such will also serve as a guide in the doing actions or solutions to these issues. In identifying such issue, a strong support from our government, with emphasis on the local government, must be committed when we speak of accessibility and equity. The collection of data and information must be started or well supported by the local government, , and data must be excellently managed by our local government.

Another issue we have about these available data that we have, is we never really talk about it – or we do, but never give much attention to it. As knowledge should be naturally transferred in every organization or individual, whether or not the process has been managed at all, but there are other underlying issues that causes the delay for this as well: 1) we choose not to care about it, or 2) our government keeps us blinded from this ugly reality.

The worst reality here is that we may have these data available, although scarce, but actions to this public health issues are very minimal too – or actions are not enough to solve the issue.

Mentioning about our archipelago as one of the contributing factors to why it is challenging to have knowledge management in our country, there are emerging technology already that can possibly resolve this – one of which is the utilization of Telehealth.

Telehealth, from its’ Greek word “tele” which means “from a distance, means managing a patient remotely with the use of technology mediated communications that will facilitate health interventions, and can also be used in the exchange of information in relation to the health delivery.

Our government is very supportive on this, as they have created House Bill 6336 or Telehealth Act of 2012 that later became House Bill 4199 or The Telehealth Act of 2014. However, it seems that there is still vagueness in it as it contradicts something in the Medical Act:

Section 10. Acts constituting practice of medicine. A person shall be considered as engaged in the practice of medicine (a) who shall, for compensation, fee, salary or reward in any form, paid to him directly or through another, or even without the same, physical examine any person, and diagnose, treat, operate or prescribe any remedy for any human disease, injury, deformity, physical, mental or physical condition or any ailment, real or imaginary, regardless of the nature of the remedy or treatment administered, prescribed or recommended. 

Also in Section 10 (1) on Who may practice Telehealth of House Bill 4199 or The Telehealth Act of 2014, it is only stated there that 1) a registered medical practitioner holding a valid Philippine license, 2) healthcare provider or licensed individual who provides health care within his scope of his professional license. In my opinion, the delivery of health care with the use of Telehealth will be very much effective if at least these health care professionals do have a background on Health Informatics – as for them to have a deeper grasp of using technology in transforming data to information and knowledge, and how to effectively handle them.

Another would be Section 17. Health Insurance Policy – If the health care services provided through telemedicine are included benefit in a health insurance policy or health plan coverage, such services must be paid in an amount equal to the amount that a health care provider would have been paid had such services been furnished without the use of advanced communications technology. A health insurance policy or health plan may limit coverage for health care services that are provided through telehealth. Which is actually a great idea, however, it limits itself to those who are only covered by Philhealth. Although in the year 2013, Philhealth claimed that 81% of Filipinos are covered (Tubeza, 2013). I think it would be best if we look into supporting more the Local Government Unit as we really have a lot of rural places that are still struggling with accesibble healthcare.

Telehealth is a very bold move in letting technology penetrate our healthcare system here in the Philippines, however, it seems that health care professionals are still doubtful about this, and still has to be educated how beneficial this will be four our countrymen like Clement. Participation and open mindedness of healthcare professional, and also those who are well knowledgable about Health Informatics should happen in the revision of the said bill, so we can achieve an equitable and accessible healthcare for all.


Photo take by Kir Ubungen

  1. Grimshaw JM et al. Knowledge translation of research. Implementation Science 2012,7:50.
  2. Straus et al. Knowledge translation is the use of knowledge in healthcare decision making. J Clinical Epidemiology 2011;64:6-10.
  3. https://business.inquirer.net/134533/philhealth-firm-on-claim-81-of-filipinos-covered
  4. http://www.congress.gov.ph/legisdocs/basic_16/HB04199.pdf

How Protected Are You As A Patient?

One of the major issues a healthcare professional, and even a patient faces in the healthcare setting is privacy, and security of data being collected, shared, and used – such scenario are not only applicable in the hospital setting, but even in community or research.

Although every healthcare professional has swore an oath that put emphasis on the privacy, confidentiality, and security of data of every patient or procedure that they will be handling, they are still pressed with such issue due to inappropriate handling of information, causing the integrity of some healthcare professional to be tainted. 

Protection of such data is important as this may potentially harm a patient if not handled properly. Currently, we have the ff that protect patient’s right to privacy, confidentiality, and security:

  1. Bill of Rights in our 1987 Constitution
  2. Republic Act 10175 or Cybercrime Prevention Act of 2012
  3. Republic Act 10173 or Data Privacy Act of 2012
  4. Philippine Medical Association of Ethics
  5. Magna Carta of Patient’s Bill of Rights and Obligations

Bill of Rights – 1987 Constitution. Article 3, Section 3:

“ The privacy of communication an correspondence shall be inviolable except upon lawful order of the court, or when public safety or order requires otherwise, as prescribed by law.”

Republic Act 10175: Cybercrime Prevention Act of 2012. Chapter II, Section 4:

The following acts constitute the offense of cybercrime punishable under this Act: (a) Offenses against the confidentiality, integrity and availability of computer data and systems: (1) Illegal Access. – The access to the whole or any part of a computer system without right. (2) Illegal Interception. – The interception made by technical means without right of any nonpublic transmission of computer data to, from, or within a computer system including electromagnetic emissions from a computer system carrying such computer data. (3) Data Interference. — The intentional or reckless alteration, damaging, deletion or deterioration of computer data, electronic document, or electronic data message, without right, including the introduction or transmission of viruses. …”

Republic Act 10173: Data Privacy Act of 2012. Section 13 & 19:

“Section 13. Sensitive Personal Information and Privileged Information. The processing of sensitive personal information and privileged information shall be prohibited, …except in the following instances: data subject consent; existing laws and regulations; to protect the life and health of data subject; lawful and noncommercial objectives of public organizations and associations; medical treatment; protection of lawful rights and interest of natural or legal person in court proceedings; or the establishment, exercise, or defense of legal claims; or, when provided to governments or public authority.”

Sec 19. Non Applicability. The …preceding sections are not applicable if the processed personal information are used only for the needs of scientific and statistical research….the personal information shall be held under strict confidentiality and …used only for the declared purpose.

The Philippine Medical Association’s (PMA) Code of Ethics. Article 2:

“Section 6. The physician should hold as sacred and highly confidential whatever may be discovered or learned pertinent to the patient even after death, except when required in the promotion of justice, safety and public health.”

The Magna Carta of Patient’s Bill of Rights and Obligations

“Right To Privacy and Confidentiality–The patient has the right to privacy and protection from unwarranted publicity.  The right to privacy shall include the patient’s right not to be subjected to exposure, private or public, either by photography, publications, video-taping, discussion, or by any other means that would otherwise tend to reveal his person and identity and the circumstances under which he was, he is, or he will be, under medical or surgical care or treatment.  …  All identifiable information about a patient’s health status, medical condition, diagnosis, prognosis and treatment, and all other information of a personal kind, must be kept confidential even after death.  Provided, That descendants may have a right of access to information that will inform them of their health risks.  All identifiable Patient data must also be protected.  The protection of the data must be appropriate as to the manner of its storage.  Human substance from which identifiable data can be derived must be likewise protected.

Confidential information can be disclosed in the following cases: i. When the patient’s medical or physical condition is in controversy in a court litigation and the court, in its discretion, orders the patient to submit to physical or mental examination of a physician; ii. When public health or safety so demands; iii. When the Patient, or in his incapacity, his/her legal representative, expressly gives the consent; iv. When the patient’s medical or surgical condition is discussid in a medical or scientific forum for expert discussion for I his/her benefit or for the advancement of science and 6 medicine, Provided however, That the identity of the Patient should not be revealed; and v. When it is otherwise required by law.”


  1.  http://www.gov.ph/2012/08/15/republic-act-no-10173/.
  2. http://www.gov.ph/2012/09/12/republic-act-no-10175/.
  3.  http://www.gov.ph/constitutions/the-1987-constitution-of-the-republic-of-the-philippines/.
  4.  http://www.senate.gov.ph/lisdata/1597713214!.pdf.  Accessed November 26, 2014.

Anything For You

It has been a while since I last saw mommy and daddy (my grandparents) since they came home from Jersey, and decided to settle back here in the Philippines.  So I decided to pay weekend surprise for them. Here’s a photo diary of my short visit in Tablas, Romblon.

1263 4

I promise. I will visit again soon.

Peak of the South Queen

DSC_5576

Coming back to Cebu for the second time this year was an unexpected event; if it was not for the life’s best work that I do, I would not be in the city again that very soon. The first time I visited the Queen City of the South, I already fell in love with its’ beauty; although the first visit was just short and just around the busy city, which is almost similar with Manila – especially with traffic  – but cleaner and more cozy, and it gives you that Hong Kong feeling, not because of the huge population of Chinese and Koreans around, but the mix of mountains and tall buildings. And you can actually do a lot of things in the city too!

But this time, my life’s best work gave me a different experience of the Queen City of the South. Staying in Cebu for almost a month was quite of a challenge, especially that I was alone, and have not been quite away from home that long. My melodramatic story and life realisation of being away alone for quite some time will be shared in a different post. As much as I wanted to roam around Cebu, my reason for coming there was actually for work, and my week was sadly pre-occupied with it, except for Sundays – which I also devoted in doing homework for graduate school. But I had this one free Sunday when I decided to go down south and check out the beauty everyone was buzzing about.

Initially, the plan was to go whale shark watching in Oslob, but I failed to do one important thing, at least, before doing something spontaneous. Research. I was not aware that whale shark watching in Oslob is only until 12 noon, and traveling from City down south will eat more than 4 hours of your time. I left city at around 9 in the morning, which was the second mistake (best time according to my friends is at 3 or 4am), but not all mistakes lead to a bad memory, since, luckily, on the way down south, there are other tourist spots you can actually check out. So, I decided to just go down in Dalaguete, Cebu, and climb Osmena Peak.

Peak of the South Queen gives you nothing but the surreal feeling. And it is not a difficult climb at all since you will be taking a motorcycle ride (habal-habal) from the start point which was only for 200php for roundtrip – I guess this might be the only challenge for some because it’s a 20-30 minute ride up the mountains. Peak was quite populated with local tourists, maybe because it was a Sunday when I did my climb, but the long drive, and the experience was worth it when you get a glimpse of southern Cebu.

DSC_5539 DSC_5543 copy DSC_5649 DSC_5665 copy DSC_5567DSC_5755

Philippine Health Information Exchange

It has always been a dream for every health care professional in the country to make healthcare efficient – not just to be available and accessible to everyone. Our country now is slowly creating its’ progress with this, especially with the emerging use of Electronic Health Records. Although majority of the hospitals in the Philippines still don’t have this facility, as this is deemed to be very costly, our government is also creating ways in order to begin this revolution like with UP NTHC’s project which they call CHITS or Community Health Information Tracking System. The benefits of Electronic Health Record to healthcare professionals and even to patients are very promising, as this may ease every process in the hospital – aside from making everything paperless.

 

Untitled Diagram

Taking a diabetic patient w/ a non-healing wound for example consulting to a healthcare institution that luckily uses EHR facility, all the processes and management he will go through will be collected, stored, and secured in one database. This is an excellent tool especially if patient usually consults in the same institution or hospital – in which they can just always refer to the available record they have in their own database. Making EHR like the center of the universe, the very core of the process and the care for the patient. However, in some case that the patient decides to move in to a different place and has to consult in a different institution or hospital due to accessibility – the continuity of his care and management might have to go back to square one if data will be unavailable to begin with.

This is the missing link in the healthcare scenario right now. Transfer of these necessary health data of patient is not allowed in most institution as there are no national program or law that mandates this. But, DOST and DOH has been in the works and making efforts to achieving this. Both of this department has signed a Join National Governance on eHealth, making them both the lead in attaining the vision of Philippine eHealth Strategic Framework and Plan or PeHSFP.

To achieve this vision of PeHSFP, one of the tools is Philippine Health Information Exchange – giving way to interoperability of available data among different healthcare institution to universalise approach and care. This amazing platform will give authorisation to healthcare professionals gain access to health information – demographics, health history, managements, care plans, medications or prescription, and other lab or test results. Although security might be one issue with this, I think this has been in works. This will also answer the question “Who owns the medical record?” since all the while, it really is the patient who owns it, however, it’s a challenge for most patients’ to get their medical records – as 1) in most institution it’s costly to get a printed record, 2) it takes time to get it. Through this vision and use of Philippine Health Information Exchange, it is an excellent way to digitally empower patients to take account of their own health.

 


Source: http://ehealth.doh.gov.ph/index.php/phie/overview

Information vs The World

As what I have shared in my previous post relating to Health Informatics, data today is as free as the air we breathe in. But these available data around us can only be considered credible and valuable, if good governance of information is practiced – especially in handling and processing of it. To understand more about how good governance is needed in implementation of a project and use of data, let’s take CHITS for example

CHITS or Community Health Information Tracking System is a UNICEF funded project implemented by UPM NTHC aiming to provide real time monitoring of key maternal and child and governance indicators through the use of ICT or Internet and Communications Technology. It’s a free an open source software electronic health record for local government health center in the Philippines – helping local chief executives create sound and evidence-based decision on how to improve the health outcomes in their local community.

CHITS components include Governance – in which the Municipal Mayor favors the implementation and communication of the project in Rural Health Unit. There are also areas wherein ordinance is mandated for RHU to use CHITS. Legislation, policy, and compliance – Philhealth has approved and has given accreditation to the use of CHITS in RHU. Standards and interoperability  – since CHITS uses Internation Coding of Diseases, and the concepts and definition of terms are aligned in the existing data dictionary of DOH. CHITs also follow what is required for the Philippine Health Information Exchange. Strategy and Investment – funding made in the implementation of CHITS are from DOST and UNICEF. Infrastructure – CHITS perhaps is one of the most cost effective project since it requires minimal infrastructure need. It works using LAN connection, and internet connectivity is not even required for this to function. Human Resource – trainings are being provided in RHU to the health staff and some IT experts on the use of CHITS. e-Health Resolution – and the most important component of CHITs is that it generates eHealth reports, electronic medical records.

The promises of the outcomes of health informatics are great to begin with, but there are a lot of ideas out there that are in need of good governance. Good governance serves the backbone on how information should be treated, especially in Heath Informatics perspective, for e-healthcare services in the country be effective.

Placing E in The Health of Every Juan

HI Infographic

Juan is a 35 year old engineer, and he was sent in Mindanao to work and complete a project. Juan has been suffering with hypertension since his late twenties, due to atherosclerosis or major build up or deposits of fat cells in the passageway of his blood. One afternoon, Juan had a mild myocardial infarction (heart attack) and passed out, and he was immediately sent to the nearest hospital in the small town where he was working. Although unconscious, a certain drug was given to Juan to prevent further complication of his mild heart attack, however, a few minutes later, Juan expired due to narrowing of his airway.

Juan apparently had some adverse allergic reaction to the drug given.

Such situation may occur in an emergency, especially in cases that an unconscious patient without any relatives or companion was sent to a hospital or clinic that holds no records of him. If only medical records of Juan will be easily accessible to other health facilities that may possibly need it, this incident must have been prevented in the first place.

This is one of the many amazing promises of technology in healthcare, especially in the field of Health Informatics.

Hospital medication errors rates can be as high as 1.9% per patient per day (Mayo, Duncan, 2004), and Philippines can not surely be immune from this. This has been a major concern as well especially in remote areas where access to healthcare is limited,  and contact with technology may be scarce.

But where are we in this digital shift in healthcare that is currently happening in the globe?

Propelling technology in the field of healthcare in the Philippines is still quite challenging. More so, Introducing Health Informatics to the general public still gets a slight raise of an eyebrow with a very intuitive look saying “what is that all about, and how do we benefit from it?” 

Although technology has paved its’ way in our everyday lives – making mobile phones and computers somewhat of a necessity in a household, the essence of technology and its’ possible amazing promises in healthcare is not appreciated yet by many. Perhaps with the thought of most hospitals that this system might be costly, especially in maintenance, and integrating technology in a process that has been the practice for a long time would require trainings for familiarisation – which comes along again with cost and time. Ironically, a lot of people are willing to pay for technology that is solely for fun or luxury, but not for one’s health.

Albeit the many initiatives our government has started: eg CHITS (Community Health Information Tracking System), it’s safe to say that we are still in the infancy stage of introducing technology in healthcare. A huge chunk of precipitating factor to this slow progress is the big scarcity of health human resource that may be interested in this field who can perhaps serve as ambassadors of this revolution we’re starting in the healthcare system. Also, it’s quite of a challenge to keeping warm the IT professionals in the Philippines given the competition we have globally. Another aspect is that the program is only offered in one institution in the Philippines which is University of the Philippines – Manila.

In the hopes of completely gaining the attention and understanding of people, how do we really go about this, and what can we do as healthcare providers or anyone who is actually an advocate of health to nurture this infancy and help it grow and develop?

As one of my mentors always tell me, which I’ll be sharing here once more, to always remain a student of my craft, and with the almost daily vast and rapid advancement that’s happening in technology, adapting to its’ global trend is definitely necessary. As Health Informatics in the Philippines isn’t that well-known yet, we can’t just let our health care system continue to suffer the same issues encumbering progress we’re battling since before. That is why it is important to innovate, and to continue striving to improve a process and delivery.

Embracing the possibilities technology can offer is the first step in placing the e in the health of every Juan. If you immerse yourself in the hospital setting, you’d notice that most of the consultants are almost the baby boomers of the society. Not that I have a problem with that, but most of baby boomers are struggling with technology – and introducing new technology in the practice might be challenging to some. Although we have a lot of young, and tech-savvy clinicians, and healthcare professionals now, if the leaders of the institutions they are working for do not see the promises of technology in the healthcare setting, the thirst for change and advancement can be impeded. Enriching knowledge about healthcare informatics, and raising awareness is how we can address this. Enrichment of skills with latest trends in the setting would follow if the support for progress is given. Healthcare providers, the people, and also our government must all have the same mindset of valuing innovation in the practice, to continually improve the process, and improve the life of others.

(Disclaimer: Story shared about Juan is fictional)


References:

  1. Marcelo A. Health Informatics in the Philippines. APAMI/MIST 2006 yearbook.Cain M &
  2. Mittman R. (Institute for the Future) Diffusion of Innovation in Health Care. May 2002.http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/D/PDF%20DiffusionofInnovation.pdf
  3. http://allnurses.com/international-nursing/nurse-patient-ratio-504662.html
  4. http://verafiles.org/health-workers-philippine-healthcare-is-very-sick/
  5. http://www.worldometers.info/world-population/philippines-population/
  6. http://www.ehealth.ph/
  7. http://www.academia.edu/16290627/Factors_Affecting_Medication_Errors_among_Staff_Nurses_Basis_in_the_Formulation_of_Medication_Information_Guide
  8. Image created using piktochart.com

Bridging Informatics with Global Health & eHealth

Map of Ehealth

It has really been a common question of my friends and colleagues to me why informatics is necessary in healthcare, and how does this very alien language to most clinicians would matter in the practice of medicine.

Technology and it’s great wonders truly has played a huge role in the lives of people, making almost everything reachable with just one touch anywhere, and anytime. Imagine how much people there are in this planet, with different timelines, culture, beliefs, and language – separated by these different barriers, but connected in one common universal language – which is the use of technology, because almost everyone is using technology. With the current number of 7.1 billion people in the world, interestingly that almost 6.8 billion people has access to a mobile phone, which is almost 96% of the population around the globe (Quartz, 2014). And utilising or taking advantage of these amazing technology in the field of healthcare, to possibly reach these people, can play a huge involvement and make a great impact in raising awareness, and promoting health.

Taking Philippines as a good example of this immense dependence with the use of technology, Philippines has 110% penetration rate of use of mobile phones, and 89% of Filipinos actually own or use mobile phones (philstar.com, 2013). How else in other countries that are not considered third-world, and have more advanced technology than us?

Informatics x Global Health x EHealth

This is how Health Informatics breaks in the scene, and takes the spotlight. In this modern times, data is as free and available as the air we breathe in. The dilemma here is how we are going to utilise these data, and and who will transform them into relevant, useful, and credible information in the field of healthcare. Health Informatics gives the discipline and science to how these information can be shared for global health use by healthcare professionals, as global health put emphasis on improving health in general with fairness among different population around the globe. And the transformation of these relevant information, can be coined as eHealth, since the information collected has been enhanced and possibly delivered with the aid of vastly growing technology – giving and leaving a tremendous impact on the advancement of delivery and efficiency of health care services to a greater population, even those areas given least attention and access of available healthcare. Albeit the discussion of security issues of Health Informatics playing a big role in global health, this is incalculably outweighed by the benefits of accuracy and timeliness of data and services, as errors are easier to track and avoid with aid of technology. Perhaps, this is something that is still a work in progress in the field of Health Informatics, for it to completely penetrate all healthcare services around the globe.

This is why Health Informatics is necessary in the field of healthcare, because the world is evolving and changing – and for everything to stay relevant, we embrace change with technology in our hands.


References:

  1. Jeffrey P Koplan,  et al (2009) Towards a common defi nition of global health. Lancet 2009
  2. http://www.paho.org/ict4health/index.php?option=com_docman&task=doc_view&gid=8&Itemid=50
  3. http://www.who.int/goe/publications/goe_mhealth_web.pdf
  4. http://www.who.int/goe/publications/goe_mhealth_web.pdf
  5. http://www.who.int/goe/publications/goe_mhealth_web.pdf
  6. http://www.who.int/goe/publications/goe_mhealth_web.pdf
  7. http://www.internetlivestats.com/internet-users/

Why Health Informatics

DSC_5529“What is in it for you?”

That is the first question I always receive from people when I share them a new path I decided to take for my career. Well, I understand how it’s really difficult to grasp a concept of something that’s very foreign to the ear, but I just can’t help but notice this always slight hint of disappointment from people who expects you to just follow the norm, to be this person they expected you to be – to become a doctor one day, anticipated to be sporting that white coat as I do my rounds in hospitals I’m affiliated to.

Since childhood, it has always been my greatest dream of becoming a doctor. Perhaps, an estimated huge chunk of children in the Philippines might have aspired for the same thing since childhood; which is really cute to look back in the past because we all do have the same reason to say as to when they ask us “Why?”, because we all wanted to help those who are sick.

I can, perhaps, consider myself very fortunate to have such supportive parents, with emphasis on my education, because they sent me to one of the best nursing schools in the Philippines – primarily because we all have assumed it’s the best pre-medical program to take. Going through and finishing nursing school was when I realised that my naive aspiration of becoming a doctor just because I wanted to help those who are sick is only superficial. That was also when I realised that helping those who are sick, doesn’t always require you to be sporting that white coat, and becoming a health care professional can be more than that.

I can consider taking Masters in Health Informatics in University of the Philippines – Manila be one of the greatest leaps I made in my life. Not only that planning on taking the program doesn’t involved any approval or advised from my parents, but I decided everything for myself – which was honestly quite a struggle to make, but I felt good after. 

“What’s in it for you?” my mom blurted out of surprise when I told her I applied for the program. That was after I had my interview a day before I flew to Hong Kong alone for a short vacation.

My understanding of what Health Informatics is, and how important it is actually was shaped when I worked for my current company. Although I do have a course of Nursing Informatics during my undergrad years, my interest of the course isn’t blooming yet. Working in my current company, opened my eyes to how amazing the advancement of technology is, and all the great stuff it could possibly do in the health care system. It’s just quite upsetting how much attention and work still has to happen for our country in achieving a better health care system, despite the many initiatives and developments the government started. Yet, I believe we do have the ability to make things happen, and I still trust that there’s still hope in healing our health care system here in the Philippines – hopefully gaining higher quality, higher efficiency, and better opportunities for both health care professionals and patients.

One thing my mentor has reminded me before is to always remain a student of my craft; and with almost the daily vast and rapid advancement that’s happening in technology, adapting to its’ global trend is definitely necessary. As Health Informatics in the Philippines isn’t that well-known yet, we can’t just let our health care system continue to suffer the same issues encumbering progress we’re battling since before. 

Although, I perhaps may no longer be sporting a white coat in the future, I know this new direction I’m taking will open and bring me to better places and opportunities in terms of my career in the future. Taking a brave step to being one to joining in pioneering and leading this change in the Philippine health care system excites me – just imagining the amount of filipinos we could possibly touch and hep live healthier lives.