Governance and Management in Health Informatics

Why are Governance and Management important in Health Informatics?

In the recent posts, we determined that there are issues impeding the advancement of health informatics in the Philippines. Taking the discussion outside of the Philippine context, we also looked at the issue of sustainability in developing countries and found that there are common problems facing sustainability in developing countries, such as (i) the use of the top-down approach, and (ii) donor support for health projects are short term in nature and there is a lack of adequate resources being allocated, on a long-term basis, according to the needs of the users.

We also identified steps that may be taken to achieve the advancement of health informatics in the Philippines, namely:

  1. That e-health be part of the official curriculum of medical students.
  2. Formal training be given to medical staff.
  3. Identification and adoption of best practices.
  4. Tailor-fitting health informatics to the Philippine situation.

It was also suggested that there be harmony instead of misalignment of the interests, roles and responsibilities of the parties involved in the process of implementing a health informatics system.

Governance and management, if used effectively, may provide the backbone and foundation to support and implement the solutions to advance sustainable health informatics systems in the Philippines as well as in developing countries.

Let us first define these 2 words – governance and management – to give us a better appreciation of their use in health informatics. As we are focusing on health informatics, it is best suited to use the definitions for information governance and information management as used by the American Health Information Management Association (AHIMA).

Information Governance: an organization-wide framework for managing information throughout its lifecycle and supporting the organization’s strategy, operations, regulatory, legal, risk, and environmental requirements.

Information Management: the generation, collection, organization, validation, analysis, storage, and integration of data as well as the dissemination, communication, presentation, utilization, transmission, and safeguarding of the information.

Now that we have the definition of these concepts, let us proceed with discussing their importance in health informatics.

Governance can be used to set goals. Management ensures goals are implemented effectively and efficiently.  

Governance, in a broad setting, such as government sets out the policies or goals of a country or a branch or department. Leaders may establish health informatics as required curriculum in schools. They can also require that hospitals provide medical staff with continuous training and education to keep them updated with advances in technology.  These can be done through laws and regulations. Governance, in a specific setting, such as within the industry, by hospitals, schools, clinics and practitioner can set out the program to be implemented.

Adoption of an information governance program underscores the organization’s commitment to managing its information as a valued strategic asset. Governance of clinical and operational information:

  • Improves quality of care and patient safety
  • Improves population health
  • Increases operational efficiency and effectiveness
  • Reduces costs
  • Reduces risk

On the other hand, management is a tool to ensure that the required information is disseminated, communicated and presented by the implementers and to the beneficiaries thereof.  Management promotes effectiveness by ensuring that the right persons have access to information and are put in place to implement the programs. The management of resources and the promotion of their efficient use is key in a developing country such as the Philippines.

Governance and Management foster trust – an important aspect of ensuring that health informatics is viewed as reliable and sustainable

Trust is an important aspect in the delivery of healthcare as patients entrust their private and personal information to healthcare organizations. These organizations must always value and protect the trust and confidence of the patients by showing a commitment to ethical and responsible handling of personal information. Healthcare organizations, through governance, define the policies and practices in governing the use of information.

Below is a list of some of the principles of information governance, known as the Information Governance Principles for Healthcare (IGHC). They do not set forth a legal rule for which strict adherence is required by every organization in every circumstance, but are intended to be interpreted and applied depending upon an organization’s type, size, role, mission, sophistication, legal environment and resources. (Source: Information Governance: Principles for Healthcare (IGPHC)

  • Principle of Accountability – The governing body of the organization is ultimately accountable for the adoption of information governance practices and should require regular reporting by the designated member of senior leadership. The organization should adopt policies and procedures to guide its workforce and agents and ensure its program can be audited and continually improved to support the organization’s goals.
  • Principle of Transparency – An organization’s processes and activities relating to information governance shall be documented in an open and verifiable manner. Documentation shall be available to the organization’s workforce and other appropriate interested parties within any legal or regulatory limitations, and consistent with the organization’s business needs.
  • Principle of Integrity – An information governance program shall be constructed so the information generated by, managed for, and provided to the organization has a reasonable and suitable guarantee of authenticity and reliability.
  • Principle of Protection – An information governance program must ensure the appropriate levels of protection from breach, corruption and loss are provided for information that is private, confidential, secret, classified, essential to business continuity, or otherwise requires protection
  • Principle of Compliance – An information governance program shall be constructed to comply with applicable laws, regulations, standards, and organizational policies
  • Principle of Availability – An organization shall maintain information in a manner that ensures timely, accurate, and efficient Stakeholder trust in information and in the healthcare operations themselves is impacted by an organization’s ability to ensure the timely, accurate, and efficiency of information availability.
  • Principle of Retention – An organization shall maintain its information for an appropriate time, taking into account its legal, regulatory, fiscal, operational, risk, and historical requirements.
  • Principle of Disposition – An organization shall provide secure and appropriate disposition for information no longer required to be maintained by applicable laws and the organization’s policies.

The above principles promote trust in the use of a health information system. These principles are put into action by management. People – whether as doctors, nurses and other healthcare professionals, patients – will rely on these principles, to feel that medical information and technology is accurate, reliable, safe and secure. The sustainability of a system is reliant on the widespread adoption and use by people of the same.

It is important to note that a healthcare organization must value not only the clinical information of the patients, but non clinical information as well such as human resources, operational, financial, legal and marketing information. Reliable information is always important in the reduction of delivery costs and improvement of operational inefficiencies. These are the reasons why the establishment and implementation of principles for governance of clinical and non clinical information increases in value and significance.

As discussed in the Philippine eHealth Strategic Framework and Plan 2014-2020 (source: http://uhmis.doh.gov.ph/downloads/forms/229-philippines-ehealth-strategic-framework-and-plan-2013-2017.html), eHealth projects are composed of 7 major parts namely:

  1. Governance
    • Directs and coordinate eHealth activities at all levels like hospitals and health care providers
  2. Legislation, Policy and Compliance
    • Formulation of the required legislations, polices and compliance to support the attainment of eHealth vision.
  3. Standards and Interoperability
    • Promotes and enables exchange of health information across geographical and health sector boundaries through use of common standards on data structure, terminologies and messaging
  4. Strategy and Investment
    • Develops, operates and sustains the national eHealth vision.
  5. Infrastructure
    • Establishes and supports health information exchange, i.e. the sharing of health information across geographical and health sector boundaries, and implementation of innovative ways to deliver health services and information.
  6. Human Resources
    • Workforce or manpower to develop, operate or implement the national eHealth environment such as the health workers who will be using eHealth in their line of works, health care providers, information and communication technology workers and others.
  7. eHealth Solutions
    • required services and applications to enable widespread access to health care service, health information. Health reports, health care activities, and securely share and exchange patient’s information in support to health system goals.

Governance is an element of (1) to (4). On the other hand, management is necessary for the implementation of (5) to (7). By breaking down an eHealth project in a Philippine setting into its parts, we can see that no Philippine eHealth project may be executed without governance and management.

In sum, the following are the reasons why Governance and Management are important in health informatics:

  • Governance can be used to set goals to advance health informatics. Management ensures goals are implemented effectively and efficiently.
  • Governance and Management foster trust and, as a consequence reliability and sustainability.
  • Governance and Management are recognized as fundamental components of Philippine eHealth Projects.

 

Sources:
Information Governance: Principles for Healthcare (IGPHC)
http://uhmis.doh.gov.ph/downloads/forms/229-philippines-ehealth-strategic-framework-and-plan-2013-2017.html

 

#MSHI #HI201

Allons-y!

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Health Information Systems in Developing Countries

How can Health Informatics Systems be sustainable in developing countries?

According to the paper of Kimaro HC & HNhampossa JL, the major factor that contributes to the development of unsustainable Health Informatics System (HIS) is the “misalignment of the interests, roles and responsibilities of the actors involved in the process (the donors, developers and Ministry of Health (MoH)). Effective collaboration between these actors is fundamental to sustain the changes achieved in the long run.”

What does this mean? Who are these actors? Why the need for sustainable HIS? In order to answer these questions effectively, we go back to the study made by Kimaro HC & HNhampossa JL. In the paper, they made a comparative study on how the HIS was handled by 2 developing countries, namely Mozambique and Tanzania. In any HIS, there will always be the actors, namely the donors, developers and Ministry of Health, which is, effectively, the government arm. The donors are the ones providing the funds for the project, the developers are the technical people creating the project and the government will be the one expected to implement the project within their locality/territory.

With the introduction of Health Informatics, there is always the promise of helping to manage scarce resources, increase efficiencies, reduce workload, and increase work productivity. The need is usually magnified in developing countries as the existing conditions and inefficiencies abound. Organizations like World Bank and World Health Organization always play an important role in shaping this promise for the developing countries. At first glance, it appears to that with multilateral donors providing funds, it is logical that there should be continued use of HIS in developing countries. However, this is not always the case.

Sustainability consists of a process, starting from inception of the system, to the various processes around design, development, support and implementation. Sustainability concerns the longevity of these processes and how they co exist over time, especially once external support is withdrawn (Braa et al. 2003).

The common problems facing sustainability in developing countries are: (i) the use of the top-down approach, and (ii) donor support for health projects are short term in nature and there is a lack of adequate resources being allocated, on a long-term basis, according to the needs of the users. The use of top-down approach means that the project is basically handled by the top management and the actual users are not part of the negotiation and decision-making processes. The actual users are usually not consulted, thus they were not able to give their own inputs in the design and creation of the system. Short term support for health projects means that a particular health project will be started with a bang, but will end with a whimper. HIS projects may take a long time to be fully institutionalized and sufficient resources are needed to build the capacity to support and sustain the project even after the withdrawal of multilateral donors. Local capacity is necessary to ensure that there is sufficient technical, managerial and financial support for the users to keep the HIS sustainable on their own.

The donors, developers and MoH (government) should all be on the same page when implementing a health informatics project. A conflict in one will affect the project as a whole. For instance, in Tanzania, the users and MoH (government) were not part in the designing of the project. The donors contracted and paid the developers directly for the creation of the HIS. The MoH had no hand or voice in telling the developers to design the program on how it will be utilized in its territory. There was a setback that should have involved simple troubleshooting posed a very big problem as the developers would not provide support, stating that it is outside the scope of contract between the donors and developers. There was a misalignment of the interests of the donors, developers and MoH. Meanwhile in Mozambique, a HIS was created for data gathering. With the help of different donors, the HIS was able to relatively have good data gathering using the system. The problem was that the data gathered were not useful for planning purposes for the MoH as a whole. This was due to the fact that that the program created was for a range of health services, but was actually being only used in 2 health programs in the country. There was also a lack of clear direction as there was competition among officials implementing donor-backed projects. This resulted in an improper allocation of human resources as the concern was to have certain people for the projects, presumably to justify flow of funds, instead of having the right teams for the right projects. This is also a clear example of misalignment in the interests of the donors, developers and MoH. The problems that faced Mozambique and Tanzania shared a similar result – that is, the lack of human resources or personnel who are skilled enough to run efficiently the HIS implemented and introduced in their respective countries.

To ensure longevity of a Health Information System, there should be harmony instead of misalignment of the interests, roles and responsibilities of the parties involved in the process of implementing such Health Information System. It cannot be overemphasized that the donors, developers and government health agencies should have effective planning, foresight and collaboration among themselves to sustain, in the long run, the positive changes achieved.

#MSHI #HI201

Allons-y!

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Reference: Kimaro HC & Nhampossa JL. The challenges of sustainability of health information systems in developing countries: comparative case studies of Mozambique and Tanzania. J Health Informatics in Developing Countries 2007;1(1):1-10 http://www.jhidc.org/index.php/jhidc/article/viewFile/6/34

Future of Health Informatics in the Philippines

Week 3 Infographic

According to Dr. Alvin Marcelo in his 2005 paper “Health Informatics in the Philippines”, there are three issues that impede the progress of health informatics: [1]

  1. “Foremost is the lack of health human resource interested in the field”
  2. “Second problem is the network infrastructure (which also involves IT human resources”
  3. “Third, the benefits of information technology have not yet dawned to many decision-makers in the health sector.”

To give an idea on how far back 2005 was in terms of technological innovations, the first generation iPhone did not launch until June 2007 and the iPad did not launch until April 2010. The entire world was using Nokia and Motorola phones which were basically limited to calls and sending of sms. Gmail was not publicly available until February 2007 and almost everyone had either a Yahoo or Hotmail email account. Facebook was launched from a dormitory room in 2004 and was merely an infant social networking site compared to the dominant Friendster and MySpace sites.

Fast forward to 2016. Nokia and Motorola are not even among the top 2 smartphone makers in the world as they have been overtaken by Samsung and Apple. Google has dislodged Yahoo and Hotmail in terms of email and search engine services. Lastly, Facebook has 1.59 Billion active users each month, meaning it survived and surpassed the likes of MySpace and Friendster social networking sites many times over.

In a span of 10 years or so, much has changed in terms of technology. In the same way, much has changed the field of health informatics. The issues mentioned by Dr. Alvin Marcelo in 2005 have been addressed. There is no longer a lack of health human resource interested in the field. The increase in interest can be seen through the people studying in the field of health informatics. The numbers may not yet be the same as that of traditional medical and nursing students, but even a minimal increase in applicants for the course is a very significant change. Education plays an important role in teaching and bringing awareness to the human resource about the field of health informatics. The increase in active participation in health informatics will eventually lead to the concept of health informatics becoming a mainstream subject and topic of discussion in more health and education facilities.

The cost of network infrastructure is already much less expensive than it use to be. With the widespread advancement of technology, the cost for producing network equipment, computers and smartphones have drastically gone down and the performance for the same items have improved greatly as compared to the available technology in 2005. This means that a smartphone in 2016 can outperform a home computer used in 2005. This improvement in this part of technology will also greatly help in the future of health informatics in the country.

The benefits of information technology have been recognized by, and already form a part of the business model of almost all companies in this planet. The same can also be said for the health and medical industry. Clinics have computerized records and a number of hospitals have wifi.

Now that the three identified issues have been addressed in the span of ten years, the question confronting us is, “what’s next?” How do we, as medical practitioners, advance the field of health informatics in the Philippines? To answer this, it is necessary to first identify the indicators of advancement. For me there are four indicators that health informatics has advanced:

(1) Ehealth technology has become accessible and widespread

(2) There is beneficial and efficient use of ehealth. The use of technology actually improves services.

(3) The people who use the technology are comfortable and knowledgeable. There is ease of use.

(4) Overall, there is a general awareness of information technology not only of decision-makers but even of medical practitioners and end-users. The general population accepts and promotes the use of technology in the healthcare profession.

For the foregoing to be achieved, the following steps may be taken:

  1. Ehealth can form part of the official curriculum of medical students. Students will be exposed early on to the various technology that is available and how they can be used in actual practice.
  2. Formal staff training. Medical staff will be given continuous training programs on how to use technology. Constant use and practice will make them comfortable with the technology that is available. This exposure will also enable them to think about how else technology can be improved to cater to real-life situations.
  3. Institutions – education, government, private – should promote research into the field, particularly in studying and evaluating what health informatics systems are being used in developed countries.
  4. Identification and adoption of best practices. A survey can be made of best practices of health informatics, whether in pioneer hospitals, or in other countries.
  5. Tailor-fitting health informatics to the Philippine situation. In order to truly advance health informatics in the Philippines, we should be aware of the specific needs in communities and assess how the technology can be used to addressed these needs. The best practices that have been identified can be used as a starting point but should be customized to respond to on-the-ground situations in the Philippines. When people can see how technology improves the effectiveness and efficiency of healthcare, they will accept and promote its use. Health informatics will be seen not as something novel but as something that is part and parcel of healthcare.

#MSHI #HI201

Allons-y!

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Reference

[1]Marcelo A. Health Informatics in the Philippines. APAMI/MIST 2006 yearbook.

The ever changing world of Informatics, Global Health and eHealth.

As a student of Master of Science in Health Informatics in University of the Philippines, Manila, one crucial requirement is to create your own blog. As a newbie blogger, this will be my official blog for the subject HI201 – Health Informatics under Dr. Iris Thiele Isip-Tan. The same will act as my personal blog when I am servicing the Tardis, upon the request of the Doctor. When I applied for this course, I had a somewhat limited understanding of what I was getting into. I learned from my interview, that the role of health informatics is to act as the middleman between Information Technology and Health Sciences. A more specific definition is stated below.

Health informatics is the study of resources and methods for the management of health information. This area of study supports health information technology, medical practice, medical research and medical informatics. [1]

Driving Question:
What is the relevance of informatics to global health and eHealth?

As you can see, the Concept Map is quite simple. This is to lay out in the simplest terms the relevance of informatics to global health and eHealth.

 

Week1 Concept Map

 

To better start the discussion, a definition of terms will give us a background to work with. From this ever changing definition of terms, we can hopefully give a clear cut explanation on the driving question for the week.

 

Definition of  Informatics

Informatics is the study of the structure, behaviour, and interactions of natural and engineered computational systems. [2]

Definition of Global Health

Global health is derived from public health and international health, which, in turn, evolved from hygiene and tropical medicine. Global health can be thought of as a notion (a world of healthy people, a condition of global health), or a mix of scholarships, research, and practice (with many questions, issues, skills, and competencies) [3]

Definition of eHealth

There were many variations on the definition that characterizes eHealth as the “use of information technology in the delivery of health care” [4]

Each one of us may already have our own ideas of connecting these 3 definitions. As this is my blog, then what I put down here is how I personally see the relevance of these 3 concepts.

We can see from the concept map that both public health and international health make up the definition of global health. Public health can be defined as the health of the general population as a whole and as regulated by the government. International health, on the other hand, is similar to public health, but deals with a larger area of coverage, usually by size of countries or state. Global health covers a bigger area than public health and international health combined. The general population included here is bigger than the community or state, and involves combinations of small community and states on a global level.

The term informatics was first used and developed by a Russian engineer / scientist during the 1960s. [5] The era of computers further improved the use and concept of informatics to facilitate the practice of information processing. The boom of the internet in the 1990s further improved the concept and use of informatics with the faster connectivity around the globe with the help of internet connectivity. The concept of informatics is relatively new compared to the concepts of global health, public health and international health. The latter are already established even before the idea and concept of informatics was born.

The term eHealth encompasses a set of disparate concepts, including health, technology, and commerce. [6]  “In the paper by Oh, et. al., it was discussed how the definition of eHealth is ever changing and the conclusion did not clamp down on any single definition.”[7] ibid For now, the concept of eHealth will always be changing until groups of people and experts agree and approve a single and unifying definition for eHealth.

The way I see it, informatics brought about the concept and idea of eHealth by merging itself with global health. Without the arrival of informatics, we would be fixed with the concept of global health and the concept of eHealth might not even be born. Informatics acted as the catalyst to provide the concept of eHealth as derived from global health.

We are not anchored to the current concept of eHealth, as it is,  as pointed out earlier, ever changing, evolving and improving. From the concept map, eHealth plus new technology will provide us the future of eHealth. I say future because everyday, an improvement or development can change , modify and update the current status of eHealth the same way that the concept of global health was modified by informatics to give us eHealth. Artificial intelligence that can help doctors diagnose patients is a once future technology that is already here. I recently saw this from a tweet — IBM Watson pinpoints rare form of leukemia after doctors misdiagnosed patient”  [8]  The use of artificial intelligence may not yet be accepted globally at present, but it may possibly be the accepted medical standard of care a few years from now. Not too long ago some people thought that the computers will have no use in a household. Similarly, people didn’t think that the use of mobile phones will make the use of payphones obsolete. Now these forms of technology are universal. The human race still has a long way to go in terms of technology and medicine, but health informatics will be a core part of the integrated development of these fields.

#MSHI #HI201

Allons-y!

 

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References:

[1] http://searchhealthit.techtarget.com/definition/health-informatics

[2] www.ed.ac.uk/files/atoms/files/what20is20informatics.pdf

[3] Koplan J, et al. Towards a common definition of global health. Lancet 2009;373:1993-1995.

[4] Oh H et al. What is eHealth(3): A systematic review of published definitions. J Med Internet Res 2005 Jan-Mar;7(1):e1 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550636/

[5] https://en.wikipedia.org/wiki/Informatics#History

[6] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550636/

[7] Ibid

[8] http://www.healthcareitnews.com/news/ibm-watson-pinpoints-rare-form-leukemia-after-doctors-misdiagnosed-patient

back to school v3.0

even with the bit of rain here and there, class will push thru.

even the declaration from the school and city class will push thru.

surprisingly it also stopped raining, so i guess class will really push thru.
very curious what this new semester will bring about. but first time to grab some breakfast as the tummy is already complaining.

#MI216 #MSHI

Allons-y!

tardis & tech support

to help out non whovians out there. i will occasionally give definitions on Doctor Who terminology. but for starters, we will start with the blog title, tardistechsupport.

what is a tardis / time and relative dimension in space?

according to Wikipedia

A TARDIS is a product of the advanced technology of the Time Lords, an extraterrestrial civilisation to which the programme’s central character, the Doctor, belongs. A properly maintained and piloted TARDIS can transport its occupants to any point in time and space. The interior of a TARDIS is much larger than its exterior. It can blend in with its surroundings using the ship’s “chameleon circuit”. TARDISes also possess a degree of sapience (which has been expressed in a variety of ways ranging from implied machine personality and free will through to the use of a conversant avatar) and provide their users with additional tools and abilities including a universal translation system based on telepathy.

what is a tech support?

according to Wikipedia again… (this is how diligent this tardis tech support can be)

Technical support (often shortened to tech support) refers to a plethora of services by which enterprises provide assistance to users of technology products such as mobile phones, televisions, computers, software products or other informatic, electronic or mechanical goods. In general, technical support services address specific problems with a product or service rather than the provision of training, customization, or other support services. Most companies offer technical support for the products they sell, either freely available or for a fee. Technical support may be delivered over by e-mail, live support software on a website, or a tool where users can log a call or incident. Larger organizations frequently have internal technical support available to their staff for computer-related problems. The Internet can also be a good source for freely available tech support, where experienced users help users find solutions to their problems.[not verified in body] In addition, some fee-based service companies charge for premium technical support services.

now you just combine the two and you get the meaning of tardis tech support.

Allonsy!