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

Leave a Reply