Of the blogs I have had to publish in the last 5 weeks, I think this is the one I was most excited to do because the task relates to something I experience on a regular basis.
The question were were asked was…
How can patients access their data from different health care providers as they transfer care?
We were assigned to also draw a flowchart that details the information collected at every step for a patient with diabetes with a non-healing wound who consults at outpatient patient but subsequently admitted in the hospital.
Currently, there are only very few institutions in the country using electronic medical records. Most hospitals, clinics and centers, even the most advanced, still rely heavily on paper charts. While some components are through eHealth (laboratory results can be checked online, etc.), the actual patient encounters are still documented through paper and pen. No national program has been implemented that allows for transfer of and/or access to data among institutions, especially those between the private and public sectors.
For a patient, then, who will seek consultation in an outpatient clinic for the first time, the process can be tedious. Aside from providing general data, he/she will have to relay his/her entire medical history to the attending health care professional. Although the prudent thing to do, especially for physicians seeing patients for the first time, is to do a comprehensive history and physical examination, the process can be complicated as well. More often than not, patients – especially the elderly – are unable to give an accurate past medical history. Unfortunately, they also tend to be the ones with several comorbidities. They may not remember all the illnesses they were diagnosed with, the medications they are taking (especially the dose), the exact operations they underwent and in what year, etc., and some of those data can significantly impact their care. Afterwards, if they need to be admitted to a hospital where a different physician will have to attend to them, the whole process of eliciting the biographic data and entire medical history (from diagnosis to procedures to medications) has to be repeated. Generally speaking, manual systems like the one described above are inaccurate, cause delay, non-standardized, and use different terms for the same meaning or have different meanings for the same terms (Herbosa, 2015).
But if there was a standardized system data from different institutions (whether private or public) that can be accessed by health care providers attending to a singular patient, then the process would look something like the one shown below.
Assuming the diabetic patient has not had any previous consults, or his previous consults were done when there was still no standardized interoperable system, upon initial consult at the the outpatient clinic, he/she will be asked to register. The biodata entered should be able to generate a unique identifier for the patient, which will be used for future reference. An alternative would be using the Unified Multipurpose ID, which is a government-issued card that can be used for different government agencies (SSS, PAG-IBIG, PhilHealth and GSIS). This will be associated with a singular electronic medical record (EMR) for the patient, where all information will be in a single view at the point of care. The physician’s evaluation and management will then be documented in the EMR, from his complete medical history, physical examination, assessment and management plan. Ideally, the EMR should also be equipped with decision support tools and knowledge based information to guide the health care provider in managing the patient. If the patient needs to be admitted, he will only have to indicate his unique identifier code or present his UMID, which should allow the health care team in the hospital to pull up his EMR. Instead of doing the entire process and trying to elicit the entire history, what the inhospital physician could do is verify what was already written in the EMR. Not only does this save time and effort on both ends, but more importantly it allows for more accurate “endorsement” of medical care, since the physician could review the notes of the previous physician. While in the hospital, the patient’s course will be documented in the same EMR. After discharge, it is common especially for patients who have chronic illnesses to follow-up. During this time, the use of a unique identifier or UMID will help facilitate pulling up of records and enable continuity of medical care.
As I mentioned earlier, there is still no national program that has been implemented that allows for transfer of and/or access to data among institutions. However, efforts towards this have been in the works for several years.
The Department of Health (DOH) and Department of Science and Technology (DOST) have signed a Joint National Governance on eHealth. These two departments are the leads in attaining the vision of the Philippine eHealth Strategic Framework and Plan (PeHSFP).
The main purpose of the PeHSFP is to describe how the eHealth vision will be achieved to guide national coordination and collaboration, as well as set a clear direction and guidance to the ongoing future eHealth activities in the country. And that vision is that …
By 2020, eHealth will enable widespread access to health care services, health information, and secure share and exchange patients’ information in support to a safer, quality health care, more equitable and responsive health system for all Filipino people by transforming the way information is used to plan, manage, deliver, and monitor health services.
In particular, one of the tools to achieve the vision will be through the Philippine Health Information Exchange (PHIE), which I already briefly discussed in this blog post. The key words here are standards and interoperability because the PHIE is a platform that allows authorized users to gain access to health information and share it across geographical and health sector boundaries. It is also a means for implementation of innovative ways to deliver health services and information. As long as the data are entered via a standardized format, they can be integrated into the system and later accessed. Examples of information which could be exchanged through the PHIE are demographics, health profiles, care plans, prescriptions, test orders and results, referrals, etc. Basically, it integrates all the different sources of health data (from the different EMRs – whether from private or public institutions, from urban or local areas – and different databases, etc.) into a national platform that is accessible to health consumers, health care providers, health care managers, policy makers, and researchers.
Health Information Exchange Diagram (DOH, 2014)
Specific to the health consumers, the idea is also for them (i.e. patients) to have controlled access to their individual health data, and for them to have the capacity to manage their health records. This step, I think, is crucial for empowering the Filipino people when it comes to taking charge of their health, since they will be more active players.
I sincerely hope that we achieve the eHealth vision by 2020. In particular, I’m very much interested in the full scale deployment of the PHIE because I think it would be a game changer in the way health care is delivered to the Filipino people.
That concludes this week’s blog post. It actually excites me to think that this is the direction we are headed. As a health consumer and a health care provider, I feel that the planned programs are promising.
As always, comments are welcome. Leave them down below and let’s discuss, yes?
- Overview of eHealth by the DOH
- Overview of the Philippine eHealth Strategic Framework and Plan by Ted Herbosa
- Philippine eHealth Strategic Framework and Plan 2014-2020 by the DOH