HI 201 Journey – A Look Back

It has been a rollercoaster of a semester for me. I entered this course not fully understanding what I was getting myself into, but at the same time I was very hopeful that I would find my niche. And after 16 weeks of blogging and learning about the basics of this course, I can honestly say that I feel I belong here. I’m still struggling and I know there is still much to learn; however, I can now also see that there are so many opportunities for me in this field, opportunities which I am excited to explore.

Before moving on to the next semester, l’d like to look back at what has transpired over the last few months. Below are the highlights of each blog:

Week 2: Informatics, Global Health and eHealth
HI 201 - W2 Concept Map
Driving Question:
What is the relevance of informatics to global health and eHealth?

Highlights: Introduction to the very basic concepts which I had previously confused with. These concepts served as the foundation for this course.


Week 3: Health Informatics in the Philippines
HI 201 - W3 - Infographic
Driving Question:
How can we advance the field of health informatics in the Philippines?

Highlights:  I was honestly surprised when I discovered all the progress our country has had in terms of eHealth. It was my first introduction to RxBox, CHITS, and other local initiatives. Prior to this I was somehow pessimistic about the state of healthcare in the Philippines.



Week 4: Health Information Systems in Developing Countries
HI 201 - W4 - Mind Map Ver. 2
Driving Question:

How can health information systems be sustainable in developing countries?

Highlights: I was introduced to the concept of hybrids and learned about the ITPOSMO dimensions of health information system design-reality gap.


Week 5: Governance and Management in Health Informatics
Driving Question: 
Why are governance and management important in health informatics?

Highlights: I learned about the COBIT 5 business framework and how it relates to governance and management.



Week 6: Establishing the Philippine Health Information Exchange 
Driving Question: 
How can patients access their data from different healthcare providers as they transfer care?

Highlights: I learned more about the Philippine Health Information Exchange, which I thought was a very promising initiative and something which I hope I can actively get to be part of when I graduate this course.

Week 7: Enterprise Architecture in Healthcare
Driving Question: 
In a multistakeholder, multicomponent health information system, how can you ensure that all the players are doing their part?

Highlights: This assignment was a struggle for me and I had a difficult time understand what EA was, but I eventually got there! *happy dance*

Week 8: Electronic Health Records: Issues and Challenges
Driving Question: 
What are the issues and challenges in implementing electronic health records in primary care?

Highlights: This, for me, helped reinforced what I already knew about EMRs (not EHRs yet) since we are using one in the company I am working for.


Week 9: Personal Health Records
Driving Question: 
What features are considered critical or most useful by users of Personal Health Records?

Highlights: I was able to develop a scoring system for a PHR and use it to evaluate an app I bought from iTunes.


Week 10: Standards and Interoperability
Driving Question: 
How can healthcare institutions adopt standards to ensure interoperability?

Highlights: I learned about significance of standards and interoperability, and the role they will play in the successful implementation of the PHIE.


Week 11: Clinical Decision Support
chitsDriving Question: How can Clinical Decision Support Systems (CDSS) improve the quality of healthcare?

Highlights: Learning about the 10 commandments for CDSS was interesting for me. It was also fun trying to come up with a CDSS that can incorporated into CHITS, although it was challenging at the same time since I’m not really familiar with it.

Week 12: Knowledge Management and Information Retrieval
screen-shot-2016-11-28-at-12-12-25-amDriving Question: How can knowledge management improve access to healthcare research?
Highlights: I liked how the concepts above was explained. I used to mix up the concepts of data, information and knowledge. Answering this assignment also led me to the dengue vector eradication efforts in Pangasinan, which I thought was really interesting.

Week 13: Privacy, Confidentiality, Security and Trust
data-privacyDriving Question: What policies are in place to protect the Filipino patient’s privacy and confidentiality of health information?

Highlights: This assignment helped me educate myself further on the policies that were in place that protected the privacy rights of the Filipino patient. It was the perfect jumping board for the next blog, which had to do with the Data Privacy Act of 2012.

Week 14: Legal and Regulatory Issues in eHealth
Driving Question: 
Is the Data Privacy Act adequate to protect confidential health information?

Highlights: I have a couple of cousins who are lawyers, and it was enlightening discussing this Act with them. After reviewing this Act and its IRR, I have a couple of reservations as to how effectively this can be implemented. But I think it’s good that something like this exists, considering we are in the age where information and communication technologies are integral to the processes of many businesses, including healthcare.

Week 15: Telehealth
Driving Question: 
How can telehealth support healthcare delivery in the Philippines?

Highlights: I reviewed House Bill 4199 or the Telehealth Act of 2014 for this assignment. After reading the very comprehensive Data Privacy Act of 2012, I felt that this fell short in terms of comprehensiveness. I think this Act needs a lot of improvement before it can be implemented.

Week 16: mHealth

barriers_to_mobile_healthDriving Question: How can mobile applications be useful in primary care?

Highlights: I think that by the time I did this assignment, I was more or less convinced that my niche in health informatics is more of helping out the private sector, particularly the corporate world. While the general public, especially the underserved and the underprivileged need to be attended to, a population that also needs attention are the workers, especially those in the BPO or in similar industries. They present with unique health challenges, and this is what I would like to explore more in the future.

It was an incredible journey, indeed. I hope my blogs were informative enough. If you are medical student or an allied medical professional and you’re reading this, I hope I convinced you enough to give this field a shot. We need more like us!

As always, comments and questions are very much welcome. Leave them in the box below.



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.