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:
- That e-health be part of the official curriculum of medical students.
- Formal training be given to medical staff.
- Identification and adoption of best practices.
- 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:
- Directs and coordinate eHealth activities at all levels like hospitals and health care providers
- Legislation, Policy and Compliance
- Formulation of the required legislations, polices and compliance to support the attainment of eHealth vision.
- 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
- Strategy and Investment
- Develops, operates and sustains the national eHealth vision.
- 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.
- 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.
- 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.
Information Governance: Principles for Healthcare (IGPHC)