Health Informatics in the Philippines – How Do We Move Forward?

It’s another week in our Health Informatics 201 class, ergo another blog post is due. For this week, we were tasked to answer the question…

How can we advance the field of health informatics in the Philippines?

Before we can move forward, a review of the current status of HI in the Philippines is imperative. Below is an infographic to help illustrate the rest of the contents of this blog.

HI 201 - W3 - Infographic

One of the earlier papers published that described the HI in the Philippines is by Dr. Marcelo in 2006. In his paper “Health Informatics in the Philippines”, he recounted the practice of biomedical informatics in the Philippines from the early 1980s and later on briefly told about how the Medical Informatics Unit of UP Manila was established. He then discussed infancy of health information system projects until the creation of this course. He considered the Masters of Science in Health Informatics as being at the center stage in HI in the Philippines. The paper was a decade old and gave the impression that while the field may be young, it held much promise in terms of healthcare in the years to come.

I remember thinking that the paper was written at the time when the first Nokia phones were gaining popularity both locally and globally. The same way that mobile phones have significantly evolved since then, the field of HI has had many milestones as well. In the following paragraphs are brief descriptions of some of those advances.

UP Manila is currently on its 11th batch of students for the MSHI program. Even though it is still the only program of its kind in the country (i.e. a masters degree), a similar course which offers certifications is now being offered by De La Salle University – Manila, in partnership with Electronic Health Records Philippines – Inc. They offer an online health informatics course that has two tracks – one for health professionals and another for IT professionals.

CHITS, which is short for Community Health Information Tracking System. It is a free and open source software electronic health record for the local government health centers in the Philippines. It is being managed by the UP Manila – National Telehealth Center and has been present since 2004. This software was integrated into RxBox, which is an ICT innovation designed to support DOH’s call for universal health care. The RxBox is a described as a telemedicine device capable of capturing medical signals, storing data in an electronic medical record or EMR, and transmitting health information via internet. The target areas for the this device were the rural health units/local health centers in geographically isolated and disadvantaged areas. Currently, the devices are deployed in 143 sites scattered throughout the Philippines.

On the other hand, eHealth Philippines is a community resource catering to health enthusiasts, experts, and researchers. They provide resources such as articles for their members, and conduct discussions and/or fora on various health-related topics. Meanwhile, HealthXPh is collaborative effort by healthcare stakeholders to discuss and use emerging technologies and social media to positively impact the Philippine health landscape. Like eHealth Philippines, they regularly conduct discussions through Twitter and Google Hangout Air that aim to educate all healthcare stakeholders and encourage collaboration and application of emerging technologies to improve the delivery of healthcare. In 2015, they pioneered the Healthcare Social Media Summit in Cebu and brought together different stakeholders to discuss the role of social media in healthcare.

Speaking of summits, another one is the eHealth Summit organized by the DOST-through PCHRD and DOH, the first of which was conducted in 2014. Similar to the aforementioned summit by HealthXPh, this is a venue for the different stakeholders to come together and discusses the many aspects and developments in terms of eHealth in the country.

Another advancement is in the field of HI is the presence of Health Research and Development Information Network (HERDIN). Gone are the days of manually looking through books, publications and whatnots for health-related data since HERDIN’s database provides access to both published and unpublished Philippine journals, conference proceedings, international databases, thesis and dissertations to name a few.

Finally, there’s the nationwide emergency hotline number – 911. This, to me, is one of the more impressive achievements of the Duterte administration, considering he has only been president for less than 2 months. Prior to the launch of 911, emergency services in the Philippines were decentralized. So far, I’ve read some feedback that the 911 system actually works and has helped not only address medical emergency but safety concerns as well.

Although no longer included in the infographic, “eHealth” has also been more used in private institutions in several ways. For example, St. Luke’s Medical Center in Quezon City and Bonifacio Global City offers a lot of online features for their clients. Patients can view their laboratory and diagnostic results online, as well as avail of other services like room booking and scheduling an appointment. They have also been electronically archiving their patient charts, and are moving towards the use of electronic medical records. Similar offerings can be found in other institutions such as Makati Medical Center (another private hospital), or Hi-Precision Diagnostics (a chain of private clinics). Even companies that are not healthcare facilities per se like Chevron Holdings, Inc., a private multinational company in the oil and energy industry, is employing the use electronic medical records as part of their clinic management system.

I’m sure that there were many other advances in the field of HI that I was not able to tackle, but I hope that what I’ve written above so far has given you more or less a better picture of how HI has progressed in the Philippines.

Going back to the driving question, how then can we advance the field of HI in the Philippines?

I have listed 9 different but interrelated aspects which I feel should be focused on.

First is the investment in the education of future stakeholders. We are currently in a digital age but the integration of healthcare seems to be lagging behind. The mere fact that there is only one masters program offering HI reflects a shortage in the opportunities for learning. As a physician in particular, I would love for health informatics to be incorporated in the doctor of medicine curriculum across all the medical schools, so that our future physicians will be more equipped not just with clinical knowledge or the digital savviness but also with at least an awareness of how they can contribute to the advancement of the field of HI. Nursing informatics is already being taught in nursing schools, and the medical schools definitely need to catch up. IT professionals should also be more given more opportunities to specialize in the field of or learn more about health informatics, as they will be key to the development of healthcare technologies.

Second is the training and enhancement of the knowledge and skills of the current workforce. Since health informatics is a relatively young field in the country, many healthcare professionals (HCPs) do not have a clear picture of what it is. In contrast to millennials and the younger generation who can easily navigate new technologies, the older population of HCPs (ex. doctors, nurses, barangay health workers in urban and rural areas) who are not as tech savvy may find it difficult to implement the new changes that are being introduced, such as the switch to electronic medical records from paper charts. This can lead to resistance to change or an impediment to the diffusion of an innovation, as discussed by Cain and Mittman in their iHealth Report entitled the Diffusion of Innovation in Health Care.

Third is the collaboration with key players. I’m using the term key players to loosely refer to anyone who has a say in the decision-making for any innovation that in the healthcare field. They can be the businessmen who will invest in the technology, researchers and developers, administrators of hospitals, legislators, etc. The field of healthcare in general has always been dynamic and technological advances are rapid. Communication channels should always be open so that there could be opportunities to collaborate and innovate.

Fourth, since a lot of the features of successful delivery of eHealth is done via the internet, our network infrastructure should also be improved. The Philippines is notorious for having one of the slowest and most expensive internet connectivities in the world. For HI to advance, our internet connection has to be significantly improved as well. Introduction of foreign telecommunication companies to increase local competition hopefully can drive our current providers to provide better and cheaper services.

As of 2016, 44.5M of the Philippine population uses the internet, translating to around 43.5% penetration rate. Globally, we account for 1.3% of the share of world internet users. In particular, Rappler reported that our mobile phone subscription has a 117% penetration rate. An average PH internet user spends 3.2 hours per day on his/her mobile phone and 5.2 hours on the desktop or tablet. The top online activity is engaging in social media (47%), followed by watching videos (19%) and playing online and mobile games (15%). HI should capitalize on these data. Mobile applications as means to deliver healthcare should further be explored. A strong social media presence would also be an advantage, because it has more potential to reach a wider audience. For example, health awareness initiatives may be best promoted via social media campaigns. Any type of information could easily be at the fingertips of the Filipinos as long as they own a mobile phone and have access to internet. We have to make sure that health-related information will be included in the list of those that they can easily have access to.

Next, creation and amendment of eHealth legislations should also be prioritized. Legislations play a significant role in the implementation of programs and in their funding. For example, if there was a law mandating all schools to incorporate health informatics in their curriculum, learning about HI will no longer be an elective or an option but something standard across all the schools offering that course. A law or bill mandating an initiative like RxBox would also affect the budget allocation of the government agency  responsible for said initiative.

Lastly is centralization. The proposed Philippine Health Information Exchange, for example, was planned to be rolled in late 2014 but has not been implemented until now. That would have allowed establishment of a centralized system for health registries and linkage systems. One of its planned features was the ability to store basic medical records of patient admitted in government health centers to ease the decision-making of professionals. Consequently, referral system would be improved as well as continuity of care. It is something that I feel would significantly benefit the public health sector in particular, but unfortunately it is still not being implemented. Meanwhile, at present, a number of private institutions already use electronic medical records or have in some way or form electronic databases. But since these were developed specifically for a particular company/institution, the systems they use are different from one another. It would be ideal if we can start with having a centralized healthcare system at least for the public sector first, and then we could explore linking it to the existing systems of private institutions. The idea seems grandiose and will probably be painstakingly hard, but ultimately the Filipinos will benefit from a more organized and efficient national healthcare system.

That is it for this week’s apple! To be honest, what I learned when I researched about the current health status of HI in the Philippines surprised me because I was so immersed in the private health sector that I did not know there were already a number of advances in the field led by the government agencies.

My questions for you this week are…

What are the some examples of health programs or campaigns that you were made aware of through social media?

Comments, suggestions and discussions are very much welcome on my blog. Leave a comment down below and let’s discuss and learn together.

XO,
Eve


References:

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Informatics, eHealth and Global Health – How Do You Connect The Dots?

Unlike any other class I’ve had before, Health Informatics 201 requires me to regularly blog. Contents of the posts are guided with a driving question that is different each week and is aimed at understanding the many different concepts in health informatics. Several references are also recommended to help answer the driving question.

This week, the driving question is…

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

Prior to reading any of the recommended literature, my initial thought was that eHealth is the use of informatics to deliver health on a global scale. And then I started reading and realized that there were several other concepts I needed to know and understand first before I could adequately answer this week’s driving question.

We were tasked to make a concept map to illustrate our answer and below is what I came up with. 

HI 201 - W2 Concept Map

Before we integrate and link the different concepts together, let me define some of the words and phrases above.

Health, according to the WHO, is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” On the other hand, the Indiana State University – School of Informatics defines informatics as a “rapidly developing field that is aimed towards the study and application of information technology to the arts, science and professions, and to its use in organizations and society at large.” When informatics is applied to health, it can be termed eHealth. Although there are a variety of definitions for eHealth, one of its simplest definitions is from the WHO, which is the “use of information and communication technologies for health.”

The American Medical Informatics Association defines biomedical informatics (BMI) as the “interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, motivated by efforts to improve human health.” It is more focused on researching and developing theories, methods and processes, and provides the link between research and its application to the practice of healthcare. It is a broad field with different disciplines cover from the tiniest molecule to the population in general.

Finally, global health is an “area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. It emphasises transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population-based prevention with individual-level clinical care (Koplan, et. al, 2009).”

Going back to the driving question, what, then, is the relevance of informatics to eHealth and global health? Based on the definitions provided above, I would say that informatics is a prerequisite of eHealth. It is the field that enables the use of technology to further advance the art and science of health.

Which now leads me to why I connected eHealth to biomedical informatics. These two go hand in hand since I believe that eHealth is at the core of BMI. It is also the reason why I connected eHealth to every level under it, since applications of BMI, whether it is focused the smallest of molecules or the biggest of populations, is facilitated and improved through eHealth. eHealth makes the continuous growth and evolvement of the fields possible.

What about global health? How is informatics related to it? Before diving into that, I’d like to give a brief overview of the concepts along the arrow above. The biomedical sciences are more focused on how the cells, tissues and organs work in the human body. They are not readily “visible” to the naked eye (although imaging does help us visualize some of these). Next is individual or clinical health, where the approach is towards patient as a singular entity. Meanwhile, public health focuses on health of the population of a particular community or country, and its main focus is the development of prevention programs. In contrast, international health is more focused on the health issues of countries other than one’s own, and it is geared towards both prevention and individual clinical care. Although the fields are independent of one another, they all form a continuum that ultimately leads to global health, and the aggregate knowledge from the different fields help drive the art and science of global health. While there are many factors that come into play when it comes to the delivery of health on a global scale, examples of which are funding and policy-making, informatics and eHealth provide all involved stakeholders (from consumers to health professionals to researchers to businessmen to politicians) with access to data. Decisions, whether big or small, are then made based on scientific evidence. Since global health is dynamic, methods can be refined and newer data can be regularly gathered, which would help stakeholders understand the different patterns within and among countries and/or populations.

As both a physician and a patient (at times), I feel that there is much to look forward to in terms of eHealth and biomedical informatics. With the rapidity with which new advances in the different fields of technology and medicine are made, it makes me hopeful for the future. More than being scared, I am excited for the many changes that are surely bound to happen. I envision that years from now, we will be more empowered as individuals and as a society, equipped with more scientific knowledge to take charge of our own health (as a patient or as consumers) and to take part in the delivery of health on a larger scale (as a physician).

That is it for this week’s apple! I definitely learned a lot of concepts and a number of my misconceptions were addressed. I hope that you were able to learn a thing or two, too.

Since I will be answering a question each week, I’d like to leave you a question as well as food for thought. This week, I’d like to know…

How has information and communication technologies influenced YOUR overall health?

Comments, suggestions and discussions are very much welcome on my blog. Leave a comment down below and let’s discuss and learn together.

By the way, aside from this little garden that I have, you can also find me on other social media accounts. Check the bottom left of your screen and click on those links.

XO,
Eve


References

New Chapter

“For I know the plans I have for you,” declares the Lord, “plans to prosper you and not to harm you. Plans to give you hope and a future.”

Jeremiah 29:11

I have always had a plan. I had timelines. Plans B and C. But this new chapter in my life is not something I planned nor prepared for.

As the first doctor in the family, the obvious track and expectation for me was to go into residency and fellowship. That was my plan even as early as first year of medical school. I already had a subspecialty in mind (neonatology) and had target institutions where I wanted to train and eventually practice. Never did I think that I would go into a different path, let alone take a course that is in its infancy in the Philippines.

Enrolling for UP Manila’s Masters in Health Informatics (Medical Informatics Track) program was a last minute decision. I went back and forth on this decision. To say that I was unsure is an understatement. It didn’t help that not many people, even doctors and fellow healthcare professionals, understood or knew this course. Discussing my plans with others often ended up with comments of disappointment and discouragement.

Despite everything, things kept falling into place. Every new experience I was introduced to pushed me to this new field. Over time, my interest only grew more. I saw the field’s relative newness not as a problem anymore but as an opportunity to be one of few doctors in this country specializing in this field. I saw its potential to greatly improve the delivery of healthcare in the Philippines. Instead of being scared, I became more and more excited to learn about it.

Now, I am finally here. I have finally started my journey on the road less traveled. I feel that this is where God wants me to be. While the end is not entirely clear yet, I have nothing but high hopes for this new adventure.