The Tardis Technician, aka MS Health Informatics Student.

A person can choose to never stop learning and this is the philosophy that I have adopted. I graduated from college more than ten years ago but since then, education, whether formal or informal, has and will always be a part of my life. My career can be said to be quite a curious one – I have an industrial economics degree, which I’ve applied in two industries, namely the automotive and hotel industries, and I also have a bachelor’s degree in nursing and I’ve worked in hospitals and aged care facilities. While these fields, at first glance, appear dissonant, I’ve learned that the skills in one can also be applied to the other. In particular, in my operations experience in the automotive and hotel industries, I have seen the advantage of the use of technology and believe that this can be used to an advantage in providing greater benefit in providing better patient care. It is this intersect — that of medicine and technology — that I would like to focus on and develop myself professionally. It is a direction where I can harmonize and apply what I have learned in my current and past roles. It is a field that is of extreme interest to me, not only because of its potential but also because I believe it is where I will develop my strengths. I have a natural inclination to the use of technology as I recognize, and have availed of, its benefits. At the same time, I feel fulfilled when I work in the medical field. It is challenging and rewarding to be directly responsible for the care and happiness of each patient that I have assisted.

Self-directed learning as a method of instruction is ideal for post-graduate studies. A more mature student can be trusted on to take initiative in seeking out answers and not merely relying on others to provide them. Education is as much the process as it is about the outcome. Self-directed learning promotes resourcefulness and discipline. It also makes the student accountable for his education. Because the student has actively chosen the path of his studies, he places a greater value on what is learned. In the modern world, it also creates an opportunity for a student to explore and develop his own interests and to adapt his studies to real world scenarios and experiences.

I lived in Australia for an extended period, during which, I took the opportunity to observe how hospitals and health care facilities used facilities to the benefit of patients. The use of technology helped in minimizing waiting time, assisted nurses and doctors in their tasks, improved efficiency and accuracy. This use of technology was not exercised not only in the high-end facilities but also in public hospitals. In stark contrast, I also worked in a Philippine local government hospital where I witnessed that there was a lack of resources, leading to problems such as not having a standard method of information data-gathering and patients experiencing delays in receiving medical attention. I would like to explore whether the prevalent use of technology, such as in Australia, can be replicated to some extent by our public hospital and facilities.  With this in mind, I’ve considered the following as possible areas of research: (A) because I’ve seen how long it can take to verify and re-verify the patient coming from one hospital to another, whether there can be a standardized system of patient information gathering and sharing among and between government and private hospitals – i.e. whether it would be possible for the hospital industry in to share a secured database for all the patients in the country, which would minimize the time it takes for patients to be admitted from a one hospital to another, may it be private or government; (B) maximizing mobile technology in improving patient care. Mobile technology such as tablets and smartphones have become affordable thus increasing accessibility.  This would be of particular help to low budget hospitals and health centers that would not have the capacity to purchase computers. I would like to know if there is a way to use this kind of mobile technology as a tool in improving the much needed improved data gathering of patient information and data access to help minimize the waiting time of each patient from the time they arrive in the medical institution until they are diagnosed and treated by the doctors; (C) whether mobile technology can be used by a barangay health center in monitoring data of its constituents, which would enable local government officials to: (i) ensure that it has the proper resources for the needs of its people such as medicines and equipment, and (ii) to promote the appropriate education/awareness campaigns and programs. I am hoping that in the course of my studies, I can get advice on which of the foregoing would be the most worthwhile pursuing or if these preliminary ideas can be further developed and formed into clearer research topics.

image: https://en.wikipedia.org/wiki/University_of_the_Philippines_Manila

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Allons-y!

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Electronic Health Record: Issues and Challenges

This is already the 8th week blog for the subject HI201 Health Informatics. The driving question for this week is: “What are the issues and challenges in implementing electronic health records in primary care?”

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Before we proceed to answer the driving question, we need to qualify and narrow down our focus on the electronic health records in primary care for developing countries. One main reason is that most developed countries have already tackled and surpassed issues and challenges in implementing their electronic health records in primary care. We need to focus on developing countries such as the Philippines to help tackle the pending issues and challenges in implementing electronic health records in primary care.

What are Electronic Health Records (EHR)? Other names of EHRs are Automated Health Records (AHR), Electronic Medical Records (EMR) and Computer-based Patient Record (CPR).

Electronic Health Record includes all information contained in a traditional health record including a patients health profile, behavioral and environmental information. As well as content, the EHR also includes the dimension of time, which allows for the inclusion of information across multiple episodes and providers, which will ultimately evolve into a lifetime record. (Mon, 2004, Amatayakul, 2004)”

Automated Health Records (AHR) – this term has been used to describe a collection of computer-stored images of traditional health record documents. These documents are typically scanned into a computer and the images are stored on optical disks. ( Electronic Health Records: A Manual for Developing Countries. World Health Organization, 2006 )

Electronic Medical Records (EMR) – similar with Automated Health Records, this has been used to describe automated systems based on document imaging or systems which have been developed within a medical practice or community health center. These include patient identification details, medications and prescription generation, laboratory results and in some cases recorded by doctors during patient consultation. EMRs are normally used within a hospital setting as their means of recording data of all their patients.  (Electronic Health Records: A Manual for Developing Countries. World Health Organization, 2006)

Computer-based Patient Record (CPR) – this was defined as a collection of health information for one patient linked by a patient identifier. The CPR could include as little as a single episode of care for a patient or healthcare information over an extended period of time. (Amatayakul, 2004)

Whether the term EHR,, AHR, EMR or CPR is used, it is important to recognize that the records must be organized primarily to support continuing, efficient and quality health care. The system must also continue to meet legal, confidentiality and retention requirements of the patient, the attending health professional and the healthcare institution.

There are a number of advantages in the move from a paper-based system to an electronic system. For one, there will be an improvement in the accuracy and quality of data recorded in a health record. Healthcare practitioners shall have enhanced access to a patient’s healthcare information enabling such information to be shared by relevant healthcare practitioners for the present and continuing care of the patient. Quality of care is expected to improve as a result of having health information immediately available at all times. There will be an improvement in the efficiency of the health care record service. There will also be lower healthcare costs for the patient as duplication of tests and procedures will be avoided.

What are the issues and challenges?

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The following issues and challenges are listed by the World Health Organization:

  1. Unique patient identifier must be addressed before moving forward to automation
  2. Clinical data entry issues and lack of standard of terminology
  3. Resistance to computer technology and lack of computer literacy
  4. Strong resistance to change by many healthcare providers
  5. High cost of computers and computer systems and funding limitations
  6. Concern by providers as to whether information will be available on request
  7. Concerns raised by healthcare professionals, patients and the general community about privacy, confidentiality and the quality and accuracy of electronically generated information
  8. Quality of electronic healthcare information and accuracy of data entries
  9. Lack of staff with adequate knowledge of disease classification systems
  10. Manpower issues – lack of staff with adequate skills
  11. Environmental issues – electrical wiring and supply of electricity, amount and quality of space needed for computers, etc.
  12. Involvement of clinicians and hospital administrators

 

How to address these issues and challenges? Some recommendations below.

  1. Use of a unique patient identifier that will give accurate results in data collection. Double counting will be minimized in the collection of data for the use of the hospital or the government in assessing the needed health programs to improve healthcare of the patients. The government must assist in ensuring that a single patient identifier will be created for the citizens to guide in proper data collection in the healthcare system. Herein, we see the value of the implementation of a national ID system.
  2. The biggest error in clinical data entry is the absence of a common data dictionary that will be used in the implementation of the EMR. This will give different meanings and definitions on each entry that can cause confusion and disarray in the analysis of the healthcare record of the patient. An agreed data dictionary that will be common for every user of the EHR will address one of the biggest errors in clinical data entry.
  3. Resistance to computer technology and lack of computer literacy are issues that go hand in hand in preventing the use of computer technology in the healthcare environment. There are 2 sets of people involved here, one set is composed of those who are computer literate but knowingly choose not to make use of computers in the implementation of EHRs. The other group is composed of those who totally do not have computer literacy, preventing them the use of EHRs even if they want to. With the continuous evolution of computer technology and the internet, proper education and guidance will remove the apprehension of users and educate new users in the use of EHRs in the healthcare environment.
  4. Any change in a system will have automatic resistance and the same can be said for healthcare providers. Resistance to change usually comes from not being aware of the new system and the uncertainty of future that it might bring to them. The best way to answer this is the involvement of the healthcare providers from the outset of preparations for the implementation of EHRs. This way, there will be familiarity with the upcoming healthcare information system and it will not be a shock to the healthcare providers.
  5. The high cost of hardware and software has a significant effect on the implementation of EHRs. Without the hardware, then there is no medium for the software to run and implement EHRs in the healthcare environment. With the current trend of computers becoming less expensive, the administrators and implementers of the EHRs should focus more on prioritizing the hardware and software needed to fully implement the EHRs. This means that the purchase of multiple medium specs computers must be prioritized over the purchase of high spec computers. Medium specs computers are likely to perform as well as high spec computers in the implementation of the EHRs
  6. The establishment of an EHR will address the concern of the providers regarding access to healthcare information of the patients. Such information is generated or stored in the database for future access.
  7. Data privacy is a big issue not only in the health sector but also in relation to other uses of computer technology. At a minimum, existing laws and regulations that address data privacy in the general sphere of technology should, at a minimum, apply to the health sector. Because of the sensitive nature of medical information, greater fines and penalties should be imposed on those who violate data privacy in EHRs.
  8. As with paper based recording, the accuracy of data collection is a big factor in the use of EHRs. One may have the EHR implemented, but with wrong data input on the files of the patient, the EHR will be more of a burden than benefit to the healthcare providers. Some factors of data quality are the accuracy and validity of the original source data. Data should be reliable, complete and legible. The data must also be recorded at point of care and available to authorized persons when and where needed for patient care.
  9. The coding of the disease classification system is still continually growing. This means that continuous training and education must be provided in proper coding for this sector of the healthcare information system.
  10. A well-oiled machine will work more efficiently than one lacking in oil. The same can be said for a well trained workforce in the healthcare environment. It is vital to have a well trained staff in the implementation of the EHR as this will make or break the successful use of the EHRs. Without proper staff manning the system, the EHR will just be another software inside the hard drive of the computer.
  11. Environmental issues include the electricity and space requirements in the implementation of EHRs. As most EHRs will be implemented within an existing healthcare environment, the additional impact on electrical use should be minimal. If an EHR will be implemented alongside the construction of a new healthcare provider, then the issues of electricity and space availability must also be addressed. In any event, electricity and space requirements or restrictions should be considered in the design of the system.
  12. As mentioned earlier, the involvement of the providers at the outset of the planning of EHR is vital. Clinicians and hospital administrators should likewise be involved as they will have the authority to ensure that there is a smooth transition in the implementation of the EHRs in the healthcare environment.

 

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Sources:

 

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Allons-y!

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Enterprise Architecture in Healthcare

The driving question for this week is: “In a multistakeholder, multicomponent health information system, how can you ensure that all the players are doing their part?” A  question that follows is: “What enterprise architecture frameworks are available and which one is the best for the health sector?”

To answer the driving question, to ensure that all players are doing their part, there should be accountability. A good leader can act as the captain of the ship to ensure that everyone is doing his or her part. There should be a road map to follow to guide, not only the leader but also all participants as regards what direction to take and what their respective roles are.

With regard to information systems, this road map is, essentially captured in the concept of enterprise architecture (“EA”).  Gorton (2006) defines architecture as a system’s structure, its components and their respective functions, and how these components communicate. Gorton also states that architecture must address non-functional requirement issues like quality, and technical and business constraints. Architecture can refer to a wide range of contexts in IT, from a macroscopic framework — the blueprint for the IT system as a whole organization — to a design for one particular application.

According to Stansfield, et al., “The enterprise architecture provides the missing link to guide development and implementation of national health information systems.” EA places software development against a larger context enterprise — the whole business organization and how each individual part works with others. When defining software features and requirements, EA always refers back to the needs of the whole enterprise, in the context of the core processes and key customers. Essentially, EA is the interplay between a business and the information system that supports the business.

In the paper entitled “Alignment in Enterprises Architecture: A comparative analysis of Four Architectural Approaches by Magoulas, Hadzic, Saarikko and Pessi“, the four enterprises architecture provided are the Zachman Framework, The Open Group Architecture Framework (TOGAF), the Extended Enterprise Architecture Framework (E2AF) and the Generalised Enterprise Reference Architecture and Methodology (GERAM). These are described generally below:

The Zachman Framework was originally developed by John Zachman and extended to its current scope with the aid of John Sowa. In its inception, tThe purpose of the framework was to steer organizations away from the widespread practice of viewing the enterprise through static and disconnected models.

The Open Group Architecture Framework (The Open Group, 2009) was originally released in 1995. At the time, it was based upon TAFIM, a framework for information management developed by the United States Department of Defense. Currently in its ninth revision, TOGAF has gradually expanded its scope from strict management of IT towards a broader business orientation.

The Generalised Enterprise Reference Architecture and Methodology is a product of the IFAC/IFIP Task Force on Architectures for Enterprise Integration, founded in 1990. GERAM is designed so that the practitioner is able to combine different frameworks or methodologies in order to customs design a new architecture. Consequently, it is an extensive standard that includes meticulous descriptions of reference architectures, modeling languages, techniques and tools.

The Extended Enterprises Architecture Framework was created by Jasper Schekkerman in 2001. Rather than any unified documentation, E2AF is documented in several separate documents that are incremented in a piecemeal fashion. E2AF assumes a holistic approach to architecture, stating that an enterprise that is to function as a whole must be designed as a whole. Strong emphasis is also placed on contextual awareness and stresses constant awareness of threats and opportunities in the environment.

The “broader business orientation” of TOGAF reflects that widespread applications of this enterprise architecture. It can be applied not only within the IT sector but can expand to other sectors as well including the health sector. In the website, The Open Group.Org describes TOGAF as a framework that “enables organizations to effectively address critical business needs by:

  • Ensuring that everyone speaks the same language
  • Avoiding lock-in to proprietary solutions by standardizing on open methods for Enterprise Architecture
  • Saving time and money, and utilize resources more effectively
  • Achieving demonstrable ROI” (http://www.opengroup.org/subjectareas/enterprise/togaf/)

Magoulas, et al reflects on the strengths of TOGAF vis-à-vis functional alignment, structural alignment and contextual alignment. TOGAF, as an EA, ensures functional alignment “by operational contracts between customers and provides.” This can be transposed to the health sector space wherein we can put into place operational contracts between patients (i.e. customers) and health practitioners (i.e. providers). The other EAs do not appear to offer this advantage of functional alignment.

Structural alignment is promoted in TOGAF, which is “based on governance contracts, IT responsibility, data trustees and ownership of common applications.” These concepts are key in the health sector. Notably, none of the other three EAs appear to put much emphasis on these concepts. Lastly, contextual alignment, which provides for “harmony between the external and internal environments of the enterprise” is supported by TOGAF, which ensures alignment through “operational and governance contracts.” The TOFAF framework requires that enterprises comply with laws and regulations. The TOGAF framework is broad enough to apply to many sectors and industries, including health.

It is to be noted however that, while TOGAF is, among the four EAs discussed, the best EA for the health sector, a specific framework for the Philippine Health Information System can be developed and may find even better suitability. In the paper, PHIS: The Philippine Health Information System by Canlas RD Jr., the following were given as guidelines as based on a combination of principles from service-oriented architecture, software development methodology, public health and change management and intended to improve the success rate of PHIS implementation. Canlas, appears to have built on the general principles under popular EAs (including TOGAF) to set out a framework specific to the Philippine health information sector.

  1. Appoint an architect, convene a Governance Committee and define the master plan. The architect shall draft the master plan in close consultation with the Governance Committee which represents the policy and decision making body of the PHIS project.
  2. Train project staff and key stakeholders to give an overview of enterprise architecture and service oriented architecture, and how these will be used to design and develop PHIS.
  3. Develop with end-use in mind. Develop applications in the context of serving these needs. Gather only data that is relevant to end-use. It is better to focus resources on gathering data and creating applications that will be used immediately or in the near future.
  4. Treat users as co-developers. Developers need to include non-technical end-users even during the conceptualization and design stages and all throughout the development phase. This allows for a system that is more responsive to the needs of users. Engage users/ stakeholders from the start. It is important for PHIS to involve everyone who will be contributing to and using the system.
  5. Establish a legal foundation for privacy and confidentiality policies. This includes creating policies and laws not just to protect privacy but also to allow informed use of health information for activities.
  6. Applications as service; separate service delivery from implementation. Identify core business processes, then find applications that could provide services to support these processes. Think of data-gathering by different users as a process that could be served by a standard data service.
  7. Use open standards. This encourages flexibility, interoperability and minimize being locked into vendor-specific solutions.
  8. Take small steps. Tackle small projects with high chances of success. Starting small has the benefits of achieving early success which in turn builds more confidence and buy-in from everyone.
  9. Evolve gracefully. Instead of radically changing everything to a service-oriented infrastructure, start by transforming existing applications into services. Since service requesters do not need to know how a service is executed, developers can start by rewriting a few service providers, without impact on the requesters.

These recommended guidelines are significant because they frame the discussion beyond the popular EA principles and sets out a practical and relevant road map — one that is within the Philippine context.

Sources:
Canlas RD Jr. PHIS: The Philippines Health Information System – Critical Challenges and Solutions.
Sessions R. A Comparison of the Top Four Enterprise-Architecture Methodologies http://msdn.microsoft.com/en-us/library/bb466232.aspx

 

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Establishing the Philippine Health Information Exchange

How can patients access their data from different healthcare providers as they transfer care?

Establishing the Philippine Health Information Exchange

The partnership between the Department of Science and Technology (DOST), Philippine Health Insurance Corporation (PHIC) and Department of Health (DOH) created the Philippine Health Information Exchange (PHIE). The PHIE is a health informatics system that will allow the operation and accurate use of data from various institutions and health facilities around the country. This will provide access to accurate health information from barangay health centers up to the national level, to improve the health care delivery system of the country. The data gathered by the PHIE will not only be used by these 3 agencies, but can be used by other organizations as well for the improvement of their services.

In the HIMSS AsiaPac15 Conference & Exhibition held on September 2015 during the Digital Healthcare Week, an update on the PHIC for Improved Healthcare Outcomes was given. Among the national objectives for health is to provide guidance in attaining the strategic goals of the DOH for the health sector namely, ensuring financial risk protection, access to quality health facilities and attainment of the health-related Millennium Development Goals. According to the update: “The Health Support Systems will establish harmonized, quality, relevant and responsive e-health services, to provide the necessary tools, data, information and knowledge for evidence-based policy and program development towards the provision of accessible, quality, affordable, efficient and safe health services and attainment of better health outcomes for all Filipinos.”

The use of PHIE is not as simple as it may sound. Theoretically, the sharing of health information will be easy if you are pertaining to a single hospital setting, wherein all the departments are housed in one roof. The reality is that the full implementation of PHIE, which will span the entire country, will face certain hurdles along the way. The Philippines is an island country and not all of its citizens have easy accessibility to basic health centers within the archipelago. Even with the onset of good technology,  internet access still does not reach 100% of the citizens needing access to health information. Issues about data security and data privacy in gathering health data are present. Some health care professionals are also hesitant in using eHealth as this is outside their norm and comfort zone. The limited human health resource knowledgeable in health informatics will hinder the training and education of other health professionals to fully implement the PHIE. These problems must be properly tackled first, so as the ensure the smooth use and operation of the PHIE in the country.

The collaboration between the private and public sectors as well as local and international health agencies will support the establishment of the PHIE. The sharing of information among and between agencies and experts sharing the same interests will promote a more efficient implementation of the PHIE. The problems faced by other countries that have already implemented their own respective Health Information Exchanges may be avoided and may be used as a learning tool to further improve the implementation of PHIE. Along with the sharing of information and technical advice, funding from local and international agencies will ensure that the PHIE will have the backbone to stand on its own. Without a proper budget to implement the PHIE, all the sharing of knowledge, training and education of users of PHIE will be wasted if there will be no fund to purchase the basic equipment needed for the implementation of PHIE.

A significant aspect of the PHIE is the improvement of the Electronic Medical Records (EMRs) system that will assist in the mobility of patients. The current setup in hospital settings is the referral system wherein a patient will be carrying a paper referring him or her to another hospital. This paper does not always contain the complete history of the patient for proper care. There is a chance that the patient might lose the referral form along the way. This is where EMRs come into play. With the use of EMRs, the history and data of the patient from one hospital will now be stored in a secured cloud database. This means that the patient will have access to his or her records just by accessing the database even if there is a transfer of care to another health provider.

Conceptually, the idea of having universal access to EMRs is straightforward. However, in reality, it may not be so. The EMRs being used by each hospital use different setups or formats and are simply not interchangeable or inter-operable. Thus, one set of EMRs from one hospital would not automatically work with the existing EMRs of another hospital. The PHIE seeks to address the problem. By having a central database for all EMRs in the country with a uniform setup or format, the patient will be assured that he or she will be able to avail of health services in any hospital using his or her history and data stored by the PHIE and that such information can be easily accessed by the chosen health care provider by the patient. This will ensure that there will be no gaps or oversight in healthcare due to lack of patient information.

Below is a flowchart on how PHIE will handle the shared health information among and between different health providers.

PHIE Flowchart.jpgSource: ehealth.gov.ph

Part of the assignment for the week is to draw a flowchart that details information collected at every step for a patient with diabetes with a non-healing wound consulting at the outpatient clinic. He is subsequently admitted in the hospital. Below is the attached flowchart showing the path the patient will take until he is subsequently admitted in the hospital.

week6-flowchart

 

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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.