ehealth

Task 6 #MSMHI #HI201: Managing the Complexity of a National Health Information System PH

This week’s driving question: If a hospital information system in one facility is a complex process by itself, how much more complex will a national health information system be? How can government manage this complexity?

There is not doubt that the complexity of the national health information system, in this case, the Philippines is formidable. Data sources come from different sites, sources, platforms. The sources of information include the health centres, field reports, regional health units, the Field Health Services and Information System, Surveillance in Post Extreme Emergencies and Disasters (SPEED), Philippine Health Insurance Corporation databases (includes patient (client), provider, procedure, terminology and even payment registry), the National Institute of Health, the Philippine Health Information Network, Philippine Network for Injury Data Management System, the ICT4H networks among many others.

How does a country manage these data complexity? It starts with setting our goals, identifying our objectives, having the right mix of health sector champions and a driven technical group espousing “two concepts”: Information Technology (IT) Governance, and Enterprise Architecture. IT governance takes care of seven key components for successful national eHealth Strategy–(1) leadership and governance, (2) strategy and investment, (3) Services and applications, (4) Standards and interoperability, (5) Infrastructure, (6) Human resources, and (7) eHealth Solutions (information sources, delivery of services, information flows).

To date, the Philippines has already has two versions of a Philippine eHealth Strategic Framework and Plan, the latest of which is published in 2014, for 2014-2020, a manual that contains our dreams, our goals, our achievements, our assignments, as patient, citizen, health care provider, as a stakeholder in our own health system.

It should not stop with knowing IT governance and creating an enterprise architecture. The government should follow through, defining standards for interoperability, implement capacity-building programs, create services and applications based on these standards, and create a compliance and monitoring system for the whole enterprise to fly high. (3)

In the end, the challenge is not answering HOW to manage this complexity, but rather HOW to implement, sustain and improve on management of the challenges presented by the complex health system that is the Philippines.

References:

1. Philippines eHealth Strategic Framework and Plan 2014-2020.

2. WHO-ITU Toolkit. http://www.searo.who.int/entity/health_situation_trends/documents/full_version_national_ehealth_toolkit.pdf

3. Marcelo A. The Philippines eHealth Strategic Framework and Plan: The Story of its Evolution. Last modified Sep 24, 2014. http://ehealth.atlassian.net

BUILDING A NATIONAL INFORMATION INFRASTRUCTURE: Do we need the government?

Task 5 for #HI201 #MSMHI

This week’s driving question asks if free market forces alone are adequate for providing appropriate deployment of the national information infrastructure in support of health and health care in the Philippines?

In the Philippines, we need our PPPs–public-private partnerships to build a robust national information infrastructure (NII) supporting health and healthcare. Free market forces alone cannot be adequate if the NII is envisioned for the country’s greater good. There is a realisation, however, that we need both the private sector (driven by market forces) and our own government represented by the Department of Health (DOH) and the Department of Science and Technology (DOST) see this through. For the Philippines, key movers led to the creation of the technical working group, now under the leadership of the DOH-DOST Steering Committee. For several years, our national information infrastructure has been slowly taking shape.

“The DOH is mandated to be the overall technical authority on health that provides national policy direction and develop national plans, technical standards and guidelines on health.”(1). It is the regulator, provider, policy maker, health financier (together with the Philippine Health Insurance Corporation), developer of standards and softwares, ensurer of equitable healthcare delivery and access, protector of rights of privacy, intellectual property and security, and the entity tasked to overcome jurisdictional barriers to cooperation. (1, 2) The DOH recognised the need for internet technology (IT) governance including the health sector need for an enterprise architecture. Only government can convene stakeholders, discuss standards, publish them and implement the same. Only government can rein in the players in the wide open field of health informatics.

The Department of Science and Technology on the other hand, possess the technical knowhow. It is the “director, provider, leader, coordinator of the country’s scientific and technological efforts…It is mandated to provide central direction, leadership and coordination of scientific and technological efforts, and ensure that the results thereof are geared and used in areas of maximum economic and social benefits for the people.”

Thus, these two agencies are at the very core of the government’s efforts for a national health information infrastructure.

It is not unusual to expect free market forces to be driven by profit. It is naiveté to expect free market forces to influence players morally to think about health and healthcare much less provide a NII. Privacy, interoperability, and even setting of standards cannot be expected of private enterprise without government regulation. In the country known for monopolies and cartels, only the moral persuasion of the government can regulate this business milieu. In a free market system, that which is not profitable, is not sustainable, and is unavailable. Only government can change that.

The noble cause of providing for an NII for health and health care should be the responsibility of government. Only when government cannot do this alone is there a need to tap into the private sector. Allowing government to take the lead role in this undertaking should be built on trust, as only the government can lead such an enormous project. Only government can assure equitability of health care benefits across the country.

In the Philippines, we need both government and the free market economy to work together for a NII for health and health care.

References:

1. Harmonize and strengthen health information systems. Health Policy Nots of the Department of Health 2008; 2(3).

2. Shortliffee EH, Bleigh HL, Caine CG et al. The federal role in the health information infrastructure: a debate of the pros and cons of government intervention. J Am Med Informatics Assoc 1996; 3 (4), 249-257.

3. Republic of the Philippines, Executive Order 128.

4. Philippines eHealth Strategic Framework & Plan 2013-2017. http://uhmis1.doh.gov.ph/UnifiedHMIS/draft-issuances/229-philippines-ehealth-strategic-framework-and-plan-2013-2017-version-3-0.html

5. Why do we need COBIT5? http://www.csi-india.org/c/document_library/get_file?uuid=6d3e2cd0-8004-48b7-91ab-b2823215dbcd&groupId=10157

Developing a National eHealth Strategy (It’s more fun in the Philippines)

Relying on free market forces for information infrastructure in health