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

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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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.

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.

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.