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Law that impact the practice of medical informatics

The Section 36 of the Universal Health Care Act or Republic Act (RA) 11223 and its Implementing Rules and Regulations (IRR) mandates all health service providers and insurers to maintain a health information system consistent with DOH standards. Its components are required to be electronically uploaded on a regular basis through interoperable systems.

Aside from mandate, having the RA and IRR provided a strong foundation to further develop the health information system of the country. This law also identified various key agencies to oversee and implement the needed changes and form the necessary collaboration or partnership for the delivery of expected services. It has secured funds and resources to operationalize the needed developments. Moreover, has mechanized incentive programs for its use.

Since the Law’s enactment, the Department of Health and its partner agencies initially issued supporting policies which are the following:  

1.     DOH-PhilHealth Joint Administrative Order 2021-0001: Guidelines on the Implementation and Maintenance of an Integrated Health Information System

2.     DOH-PhilHealth Joint Administrative Order 2021-0002: The Mandatory Adoption of National Health Data Standards for Interoperability

3.     DOH-PhilHealth-DICT Joint Administrative Order 2021-0001: Guidelines on the Implementation of the Standards and Conformance and Interoperability Validation

4.     DOH-PhilHealth-Joint Administrative Order 2021-0001: Implementing Guidelines of Section 31 of the Republic Act 11223, otherwise known as the “Universal Health Care Act”, on the Processing and Submission of Health, and Health-related Data

5.     DOH-DILG-PhilHealth Joint Administrative Order 2021-0001: Guidelines on the Implementation of Telemedicine in the Delivery of Individual-based Health Services

Even before the Covid-19 Pandemic, this Act has really pushed forward the institution of health informatics for Health Sector’s compliance.  Having responded to Covid-19, made many realize how these systems are vital and necessary as we address massive hospital surges, exhaustive hospital operations, activation of our business continuity plans, implementation of alternative working arrangements and facilitation of remote mobilization of health services. This Pandemic experience is really an eye opener for the quick implementation of the Act, its IRR and supporting policies.    

Now that we are coping in the New Normal, the Acts implementation and regulation of Sec. 36 is expected to be more evident and must encourage advancement in consideration of the new practices and innovations we were able to recently adopt like use of big data analytics, telehealth, mobile health, etc. As we move forward, I can only hope for this developments not to stall rather to be pursued inspired by its significant contribution to healthcare in our recent battle against the Covid-19 Pandemic. 

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Reaction to the Article: When Medical Informatics Clashes With Medical Culture

Reading the Article titled: When Medical Informatics Clashes with Medical Culture brings back a lot of frustrating hospital stories. Those memories combined with my “What if I was in that situation?” is worrisome. But now, given the opportunities and experiences I have, I am becoming more hopeful. Hopeful, that someday we could facilitate to live our lives free from the struggles experienced in healthcare. Some part of me knows that it is something that I have to do before I could focus on my own personal aspirations. That was the direction. That is the reason why I bothered serving the government. Why I bothered to study in UP. Why I bothered entering this course. It is a life path fulfilling this purpose. And I know, with all the advancement in technology, just maybe, I might be riding on a tide that could really change the future of medicine and health care. Soon, we will eventually know.  

Each week we try to cope. We usually spend to maintain our daily activities,. Like in the household. We cover the payment for a lot of things just to keep life comfortable (e.g. rent, food, electric, water, and internet bills). These do not include other misc. expenses like your own allowance, gas, insurance, and merely a lot more to mention. Others have more essential expenditure especially when they have kids or a lot are dependent on them. For some few, they needed to save more in order to spend for health maintenance or other necessary medications for themselves or even for their family members. Usually based on experience, we spend PHP 12,000 plus for treatment/ maintenance medications a month. Less of this if, we bought generic meds or we reduce the frequency of taking it, due to less or lack funds. But, how will these be enough if you are only earning a minimum wage? How will this be enough if two or more of your family members needed also to spend for their health? How hard it is to be the bread winner of that family? Just recently,  I overheard a conversation in a pharmacy. One lola said “Kalahati lang ng sa reseta” then continue to converse with another lola, “Minsan ganun talaga, mas kailangan kumain, pero minsan hindi mo na mainda ang sakit, pwede na ito kesa wala.” Another in a diagnostic laboratory, I again overheard, “Pangatlong beses ko na ito e. Kailangan daw kuhanan ako ulit ng dugo kasi paso na yung ibang labs, natagalan akong makaipon ulit para sa susunod na check up.” For me, mahirap, napaka mahirap talaga makarinig ng ganito.

As healthcare professionals it is inculcated in us to provide the best possible care and sometimes yes, regardless of the cost. However, we are in difficult times. We are in the middle of the Pandemic. This is the time where healthcare professionals are needed or expected to be more creative and to think outside the box. And if we can help our people by being efficient and well informed through health informatics and other technological advancement already available, then maybe it is best we exploit this development now in order to alleviate the health spending costs.  In a study published in 2016 regarding financial protection from health spending in the Philippines, it highlights that out-of-pocket health spending in the country increased by 150% from 2000-2012. The percentage of people incurring catastrophic payment has tripled and pushed more than 1.5M  people into poverty. If through health informatics, we can provide the best possible option for our patients considering their financial limitations, maybe they would become more optimistic and more likely to survive or seek medical care that is affordable to them. Maybe it is the much needed help they are expecting. To aid them through these decisions without compromising or totally disregarding their other priorities over what we intend to give or advise as the “best possible care.”

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mHealth apps

As published by Imaginovation Insider, people generally look for the most basic functionalities in a Mobile Healthcare App. These are the following: ability to schedule/cancel appointments, ability to request prescriptions and easy access to medical records. When able to avail/download and access such apps, the following characteristics makes or breaks the appreciation of the application. The features should exhibit the following: ease of access; detail and actionable information; communication with health professional; a platform where patient community is being facilitated; amazing digital experience; and integration to wearable devices.

A study conducted in China about the use of mobile health application concluded that its use could improve patient experience, especially when able to access health information, when there is physician-patient communication and when the app facilitates the most convenient way of reaching out to physicians, ensures transparency in medical charges and improve short-outcomes.

While, some evidence say that the use of mHealth app is usually based on personal level factors and its perceived helpfulness. One example is the study of Bhuyan et al. in 2016 on the use of mobile health applications for health-seaking behavior among US adults. The study revealed that respondents were more likely to have mHealth apps if they had more education, health insurance, were confident in their ability to take good care of themselves, or had commodities. Others are less likely to have them if they were older, had higher income, or lived in rural areas. Moreover,  in terms of use, those who were older and with higher income were less likely to report its usefulness in achieving behavioral goals. While those that were older, African American, and had confidence in taking care of their health, were more likely to respond that mHealth apps were helpful in making medical care decisions and in facilitating communication with Physicians or even when asking for second opinion.

If I were to use an mhealth app, I would always consider the convenience it brings when it comes to facilitating with ease my health transactions. As a patient, I am most likely to use it if it is being prescribed by my physician, or if the use of the mhealth app is in aid of emergency services, monitoring my vital signs or facilitates a control or regulation of use of mechanical implants such as heart pacemaker or LVAD, or in a futuristic view of things, an adjustment or configuration to artificial eye lenses, etc. Who knows what future mHealth app could further bring. I still believe that with the right idea, it can change a whole lot in healthcare or its delivery as we know it. Then maybe a huge uptake on the sustainability of its use.

Reference:

Georgiou, M. (2022, February 9). Developing a Healthcare App in 2022: What Do Patients Really Want? Retrieved from Imaginovation Insider: https://imaginovation.net/blog/developing-a-mobile-health-app-what-patients-really-want/

Lu, C., Hu, Y., Xie, J., Fu, Q., Leigh, I., Governor, S., & Wang, G. (2018). The Use of Mobile Health Applications to Improve Patient Experience: Cross-Sectional Study in Chinese Public Hospitals. JMIR Mhealth Uhealth 2018, vol. 6, iss. 5.

Bhuyan, S. S., Lu, N., Chandak, A., Kim, H., Wyant, D., Bhatt, J., . . . Chang, C. F. (2016). Use of Mobile Health Applications for Health-Seeking Behavior Among US Adults. Springer Science and Business Media: Mobile System .

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National Patient ID

In 2021, the US Senate has progressed on its initiatives on national patient ID. It has encouraged innovation by removing the "antiquated" legislative barriers blocking research into new strategies for unique patient identification from its most recent appropriations bill. It is said, in the long run, having a national patient identification (ID) number will contribute greatly in the provision of quality healthcare services. The implementation of national patient ID is also anticipated to resolve the following: misidentification; duplication, incomplete and inaccurate health records; unnecessary cost from patients; slow turnaround time in medical transactions. All for the provision of best care and to further facilitate continuity of care.  

But no matter how much good it will bring, arguments have been also raised regarding: Patient privacy where when the national patient identification number is compromised, the patient’s entire health record would be easily accessible in one location; serious medical issues or mistakes that could arise from erroneous or duplicate number being assigned to patient with a different medical history-- may it be in the form of providing the wrong medications, testing procedures or other medical intervention; huge cost requirements for implementing the system (developing or modifying an existing system is said to be cost-prohibitive); significant amount of time and effort required in building the national system that will carry out such function; level of centralization and efficiency in the process being aspired for since a lot may still lack internet access in the far flung areas or may experience slow system connectivity due to limited signals between the government and health care providers in some remote areas. Simply put it that any information system will not thrive on poor technology settings. There will be huge implication and adjustment on policies and systems (public or private health information systems in place) also when once implemented.

The Philippines approved and issued in 2018, the Republic Act (RA) No. 11055 or “An Act Establishing the Philippines Identification System.” In the declaration of policies, it provides for the promotion of seamless delivery of service by establishing the national identification system. This is to improve the efficiency, transparency, and targeted delivery of public and social services. Likewise, it shall aim to enhance administrative governance, to reduce corruption, curtail bureaucratic red tape, and avert fraudulent transactions and misrepresentation. Moreover, it shall strengthen financial inclusion and promote the ease of doing business which is one of President Duterte’s primary directive.  According also to the National Economic and Development Authority, the lead agency on implementing the System, as a foundational digital ID system, it will accelerate our transition to digital economy that enables a presenceless, paperless and cashless transactions.  

In the Philippine Identification System (PhilSys), the person shall declare his or her name according to his or her birth certificate and other personal information. It will issue a unique serial number, which will be called the PhilSys Number or PSN that shall be issued by the Philippine Statistics Authority. The PSA takes seriously the privacy, security and integrity of the registered persons data. Thus, safeguards are to be set in place in compliance to Data Protection Laws of the country.

In relation to this development, PSN can be one of our best choices to be a national patient identification number in supplementation from the PhilHealth number vice versa, so as to ensure validation and authentication of electronic health or medical records. Moreover, since the National Telecommunication Commission has released the guidelines on RA No. 11202 or the Mobile Number Portability Act, we can also link this records to an individual’s permanent personal mobile numbers to allow authority to access strictly confidential health records whenever necessary or as needed. This gives the Owner of records a heads up for the security of files. Whenever a user is accessing personal files, it will allow immediate feedback/action when unauthorized access is encountered. Although, this may only aid in resolving privacy issues and may only apply to routine or usual daily transactions. Application of this method will differ most likely in emergency situations. To add, that privacy issues is only one concern compared to a lot cited here. I hope, with the COVID Pandemic, people are able to realize its benefit/advantages consequently outweighing its disadvantages. Soon, we would be able to figure out how to best implement this initiative tailor fit to the needs of our citizen and the healthcare delivery system of our country.  

References:

Adrian, M. (2022, March 1). Here’s Everything That You Need To Know About The National ID! Retrieved from imoney Learning Centre: https://www.imoney.ph/articles/national-id-system/

Miliard, M. (2021, October 20). Healthcare groups cheer Senate progress on national patient ID. Retrieved from https://www.healthcareitnews.com/: https://www.healthcareitnews.com/news/healthcare-groups-cheer-senate-progress-national-patient-id

NPI Lookup. (2021, May 11). Should We Implement A National Patient Identifier (NPI) System? Retrieved from NPI Lookup: https://npi-lookup.org/insights/should-we-implement-a-national-patient-identifier-npi-system/#Pros_of_using_NPIs

National Economic Development Authority. (2021, March). Philippine Identification System Act (PhilSys). Retrieved from National Economic Development Authority: https://neda.gov.ph/philsys/

Jason, C. (2020, June 16). What is a National Patient Identifier and Why is It Important? Retrieved from xtelligent HEALTHCARE MEDIA: https://ehrintelligence.com/news/what-is-a-national-patient-identifier-and-why-is-it-important

CNN Philippines Staff. (2019, June 17). NTC issues guidelines on permanent cellphone number. Retrieved from CNN Philippines: https://www.cnnphilippines.com/news/2019/6/17/ntc-implementing-rules-regulation-mobile-number-portability-act-permanent-cellphone-number.html

Republic of the Philippines, 17th Congress. (2018, August 06). An Act Establishing the Philippien Identification System. Philippine Identification System Act. Metro Manila, Philippines.

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About Philippines’ Healthcare Information Security

Way back year 2016, a study on Health Information Privacy in the Philippines: Trends and Challenges in Policy and Practice was published. It reviewed the legal, professional and ethical landscape of health information privacy in the Philippines (Antonio, Patdu, & Marcelo, 2016).  

It found out that:

1. There is no existing policy framework that addresses issues relating to:

a. access to health information for non-health professionals,

b. use of health information for non-health purposes, and

c. rules relating to collection, storage and utilization of electronically-driven or –stored information.

2. Lacking was a privacy culture, on either the provider’s or client’s side.

The study also concluded that technological developments outpaced policy and practice and that it is necessary to:

a. unify the patchwork of regulations governing the privacy of health information;

b. advocate for a privacy culture among professionals and patients alike;

c. fortify the evidence based on patient and provider perceptions of privacy; and

d. develop and improve standards and systems to promote health information privacy at the individual and institutional levels.    

Fast forward to year 2021, I searched on other developments and stumbled on the following references:

The Philippine Health Systems Review where in Section 2.9.3 on Patient Rights, provides that Patient rights to privacy, confidentiality of communication and correspondence, data security, privileged information and informed consent are already contained in specific laws such as the Cybercrime Prevention Act of 2012 (Republic Act No. 10175), Data Privacy Act of 2012 (Republic Act No. 10173), or in specific guidelines such as the PhilHealth’s Benchbook, Philippine Medical Association’s Code of Ethics, and other several bills which have been filed in both houses of Congress supporting the passage of a Magna Carta of Patient’s Rights and Obligations.

 During the Covid-19 Pandemic, the law on Mandatory Reporting of Notifiable Disease and Health Events of Public Health Concern Act of 2018 (Republic Act 11332) was popularized due its provision on mandatory reporting which is the obligatory reporting of a condition to local or state health authorities as required for notifiable disease, epidemics or public health events of public health concern. This became an issue due rising violations committed by stubborn citizens hiding their comromised health condition status amidst the pandemic. Also some firms and organizations turning a blind eye regarding the conditions of employees just to resume operations. As viewed in news, there were discussions among local chief executives whether Covid-19 patients’ data are better disclosed to the public just to control citizens on committing the said violations. But of course this gained little traction since one problem seen with this idea aside from violation on data privacy was also public discrimination and stigmatization.

Also another is a proposed bill on Big Data Center to Hasten Response in Disaster, Disease Breakouts. Although this was proposed back in the year 2014 which called for the establishment of a big data center where large volume of datasets used for research and development and other important purposes are said, will be facilitated and protected (big data analytics). Imagine if this bill was passed into law, and its implication to our Electronic Health Records. It can potentially transform healthcare by gaining insights to clinical records and other data repositories to facilitate informed decisions. It will also be a big undertaking to maintain the security of records. Just like what the Department of Health is doing on health facility reports on COVID-19, Data Drop, it is somewhat an application of this idea. To add, also the collection of big personal data from contact tracing application. I can’t imagine how our authorities are trying to monitor its implementation or the manner how they can catch persons exploiting this initiative, those that compromises the people’s data/information security and intruding privacy by possible tracking and activity logging, even how paranoid it seems, is still possible.

 But more than the citing of these laws and guidelines, is the assessment whether if everyone is aware, respects its enforcement or participates in the effective implementation of cyber/information security policies. Similar to what was cited in the study of Antonio, Patdu, & Marcelo, 2016, privacy culture and its advocacy is still a big step towards improvement among others mentioned and will aid healthcare information security in the process of development.

Reference:

Moaje, M. (2021, September 14). Construction firm faces charges for not reporting Covid-19 cases. Retrieved from Philippine News Agency: https://www.pna.gov.ph/articles/1153476

Rosete, F. D. (2021, June 9). Oro LGU warns raps vs. 'stubborn' Covid patients, contacts. Retrieved from Philippine News Agency: https://www.pna.gov.ph/articles/1143166

Seventeenth Congress, Republic of the Philippines. (2019, April 26). Mandatory Reporting of Notifiable Disease and Health Events of Public Health Concern Act. An Act Providing Policies and Prescribing Procedures on Surveillance and Response to Notifiable Diseases, Epidemics, and Health Events of Public Health Concern, and Appropriating Funds Therefor, Repealing for the Purpose Act No. 3573. Manila, National Capital Region, Philippines.

Dayrit, M. M., Lagrada, L. P., Picazo, O. F., Pons, M. C., & Villaverde, M. C. (2018). The Philippines Health System Review. India: World Health Organization, Regional Office for South-East Asia on behalf of the Asia Pacific Observatory on Health Systems and Policies.

Antonio, C. A., Patdu, I. D., & Marcelo, A. B. (2016). Health Information Privacy in the Philippines: Trends and Challenges in Policy and Practice. Acta Medica Philippina Vol. 50 No. 4, 223-236.

Aquino, P. B. (2014, June 25). Big Data Center to Hasten Response in Disaster, Disease Breakouts. Retrieved from Senate of the Philippines: http://legacy.senate.gov.ph/press_release/2014/0625_aquino1.asp

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Health Data Standards,  its adoption and the Healthcare IT  in the Philippines

In a study I read a couple of days ago written by Alkraiji, et al., in 2015, it was mentioned that “the level of adoption of health data standards in healthcare organisations remains frustratingly low worldwide although health data standards have been perceived to be an essential tool for interoperability barriers within health information systems.” Their study conducted in Western Asia (Saudi Arabia), provided a list of key factors from different aspects as to what affects the adoption of data standards in tertiary hospitals,  such as: 1. technological factors - which is about complexity and compatibility of health data standards, IT infrastructure, switching costs, market uncertainties, systems integration and enhancing the use of advanced systems; 2. Organisational factors - which is about the lack of adequate policies and procedures and information management plan, resistance to change, data analysis and accreditation; and 3. Environmental factors - which is about the lack of national regulator and data exchange plan, national healthcare system and the shortage of professionals (Alkraiji, Jackson, & Murray, 2015). Given the list, along with other considerations, it shall aid in recommending what data standards can benefit the local healthcare IT setting especially here in the Philippines.

In Administrative Order No. 2013-0025 dated September 10, 2013 on the National Implementation of Health Data Standards for eHealth Standardization and Interoperability (eHSI Release 001), the  Department of Health asserts its mandated as the over-all technical authority on health that provides national policy direction and development on national plans, technical standards and guidelines on healh. The Department also acknowledges that one of the key components to achieve a responsive health system in the country is the widespread adoption of health data standards and that to be able to share and use data from different sources like healthcare providers, data must be interoperable or built upon common definition, terminologies, elements, structures  and organization.

Provided that there is already an initial government mandate through an Administrative Order way back 2013, the chosing of health data standards must be aligned to the Department’s objectives to facilitate its fast adoption and implementation by healthcare providers. Likewise to the study of Alkraiji et al. environmental and organisational factors could really affect the adoption of such standards since it is mandatory for all organizations to adhere to policies and its implementing rules and regulations. If it is for a nationwide adoption and implementation, it is the way to go, to considerably have the approval of the national government agencies for full cooperation of its stakeholders.

Now strengthened by the Universal Health Care Act enacted in 2019, under Section 31 and 36, two of the key strategies identified are to strengthen evidence-based sectoral policy and planning and improvement of the country’s health information system. To aid in operationalizing these strategies the use of common standards are once again recognized not just by a Department issuance but now by Law. This was further supported by other Joint Administrative issuances released by the Department of Health and the Philippine Health Insurance Corporation on mandatory adoption and use of identified national health data standards for interoperability. One of the Order’s objective was to guide the market on development of eHealth services, product systems, applications, network and technologies. Personally, this for me is really one big leverage for adoption of such recommended standards. Another was to define the implementation governance to direct and coordinate the adoption and use, which can now address the factor of resistance to change.

Given all these data, these can really direct the adoption of health data standards, especially in a situation that it is being recommended by the Health Government for Health Sector’s use. As a Government support on implementation, it also guarantees guidance for administration, investment and triggers standard conformance and interoperability validation of health information systems and/or other eHealth services for local and national health and health-related data reporting (to DOH and PhilHealth) within the province/city-wide network.

Furthermore these health standards will be part of licensing and accreditation requirements for health facilities and its cost for adoption, use and continuous compliance were provided with guidelines to be accommodated under the their administrative funds (for government health facilities other than their income it is also subsidized by the national government) and/or the Special Health Funds in the public sector, once operational (this is also a fund source that can be supported by the national government).

But if to chose only one health data standard, I would recommend for further implementation (also one of the recommendated health data standard of DOH) the use of the Digital Imaging and Communications Medicine (DICOM) by the National Electrical Manufacturers Association (to include its future enhancements). Since it is a standard for handling, storing, printing and transmitting information in medical imaging. It includes a file format definition and a network communication protocol. It also enables the integration of scanners, servers, workstation, printers, and network hardware from multiple manufacturers into a picture archiving and communication system. Since, we are now transitioning to new normal arrangements of working remotely, a fix to have a unified standards for storing and transmitting medical images could aid our health professionals diagnose better, work effectively and efficiently in this new era of digitization. Just imagine also its potential in supporting big data management for big data analytics. This shall also create an opportunity for enhanced commercial interest in investing in solutions needed in health management and the delivery of healthcare services. Back to the study of Alkraiji et al. on technological factors that affects adoption decision with the massive reliance to IT infrastructure in this digital age, not only does the health professionals adjust but also the market, all towards supporting systems integration and enhancing the use of advanced systems.

Reference:

Department of Health. (2021, April 21). Mandatory Adoption and Use of National Health Data Standards for Interoperability or Joint Administrative Order No. 2021-0002. Manila, National Capital Region, Philippines.

Department of Health. (2015, September 2). National Implementation of Health Data Standards for eHealth Standardization and Information Interoperability (Administrative Order No. 2015-0037). Manila, National Capital Region, Philippines.

Alkraiji, A. I., Jackson, T., & Murray, I. (2015). Factors impacting the adoption decision of health data standards in tertiary healthcare organisations in Saudi Arabia. Emerald Insight Vol. 29 No. 5, 650-676.

Department of Health. (2013, September 13). National Implementation of Health Data Standards for eHealth Standardization and Interoperability (eHSI Release 001) or Administrative Order No. 2013-0025. Manila, National Capital Region, Philippines.

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Digital Health: Adoption of Telehealth/Telemedicine and Other Similar Systems

The paper on the role of eHealth, telehealth, and telemedicine for chronic disease patients during COVID-19 pandemic is about a rapid review of studies to summarize the role of mHealth, telehealth, and/or telemedicine solutions in the delivery of healthcare to chronic disease patients during the COVID-19 pandemic. It confirmed that researchers from various specialties across the world have made a huge effort to improve healthcare services for chronic disease patients and that in all the materials published and reviewed in this study, indicated were the promising potential of eHealth, telehealth, and/or telemedicine solutions in delivering healthcare services like its use in the conduct of follow-ups, medium for communication, consultation, training, prescription, and other caregiver support to patients living with chronic diseases/conditions during the pandemic. Some of the studies also mentioned the support to the continued use of such technological solutions in the future even when the COVID-19 crisis is over. The paper also cited top recommendations for eHealth, telemedicine, and/or telehealth solutions for improvement.

 While in the Philippines, personally observed and also supported by studies/articles and news published, was the notable increase also on the use of teleconsultations months after the advent of COVID-19 Pandemic. This was said to have aided reducing health center occupancy and preventing spread of COVID-19 to populations. That, while in public health emergency of global concern and despite the travel and movement restrictions, through increased capacities and built partnerships, it has allowed the provision of healthcare solution to people. Disease prevention, diagnosis, treatment and management were carried out even with the outbreak.

 It is in our best interest that our government now recognizes these advancements in technology or the continued development of such. With the promise of Universal Health Care on improving integrated health systems, this COVID-19 pandemic and its impact became the test of time. But more to that, an Opportunity. This situation made us realize that what we currently have for the delivery of health services are not enough and that our health system is frail and vulnerable, deemed at the brink of collapse every time COVID-19 cases rises or can you imagine, if another new unanticipated emergency/disaster struck the country. It aided us to lobby for the much needed technological change. Truly eHealth, telehealth, and/or telemedicine solutions has really become our New Normal and yes, our Future.

 Bitar, H., & Alismail, S. (2021). The role of eHealth, telehealth, and telemedicine for chronic disease patients during COVID-19 pandemic: A rapid systematic review. Digital Health, Volume 7: 1-19.

Gunasegaran, T. (2021, May 26). Telemedicine provider reports high teleconsultation uptake in the Philippines. Retrieved from Healthcare IT News: https://www.healthcareitnews.com/news/asia/telemedicine-provider-reports-high-teleconsultation-uptake-philippines

Hani, A. (2021, September 29). Rapid Development of Telehealth Services in the Philippines. Retrieved from OpenGov Asia: https://opengovasia.com/rapid-development-of-telehealth-services-in-the-philippines/

Hartigan-Go, K. (2020, October 28). A Reflection About Telehealth in the Philippines. Retrieved from ISPOR News Across: Asia-Pacific: https://press.ispor.org/asia/index.php/2020/10/28/a-reflection-about-telehealth-in-the-philippines/

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Comparing the Needs of the Philippine Government vs. the Needs of Physicians related to Electronic Health Records Use

I would like to think that the needs of our Physicians in terms of Electronic Health Records (HER) use is based on personal preferences (depending on specialization/department they are attending) for example, as cited in one article, an Emergency Department Physician who works in a fast-paced and demanding environment would prefer an intuitive and responsive EHR allowing less energy on inputting data so they can focus more on improving patient outcomes. Where, drag-and-drop features (less time on typing) and real-time patient work flows are accessible to every staff (allowing users to track immediately their patient’s progress in the ER) are available. Thus, aiding on safely treating everyone without wasting valuable time. More so, an EHR that does not compromise expediting patient care, able to simplify documentation, track patient status and more to enhance the delivery of emergency medicine.

 Other physicians would put their money on using an EHR that is flexible, with customizable virtual workspace, workflows that closely mimic the paper-based processes and communications of clinicians. An EHR that has easy-to-use interfaces and functionality. Something anyone could pick-up, figure out, and start using with little/no training or even help. Some physicians would prefer that EHRs are with mobile capabilities to support an “on the go” work style and must be accessible through their tablets, laptops, and desktops and has a feature on immediate access to clinical practice guidelines whenever necessary or it could be so much more depending on how they operate and prefer to deliver a certain task.

 While the needs of the Philippine government in terms of EHR use is more broad (due scope that covers national and sub national stakeholders) complex (since it shall apply to all levels of care and specialty) and shall support achieving integration of healthcare services through an interoperable system that is seamless, responsive, efficient, cost-effective and realtime.

 In its development, there are principles, various policies and well consulted framework that should be considered. All together a lot shall be discussed on the information needed to be captured (there is already an issuance on mandatory adoption and use of national health data standards for interoperability), services, infrastructure and applications it offers (since it depends on the setting the EHRs will be used).

 Features shall allow secured and authorized data sharing, a single unified view of client’s health records across hospitals/facilities in the country. An EHR that can facilitate aggregation of health data and generate reports for monitoring in support to policy, planning, service delivery, financing, regulation and the overall health systems development.  In its implementation on a national scale, the government’s goal is to foster good governance, strengthened accountability, increased transparency, and advancement on operational efficiency of various stakeholders in the health sector to deliver quality services and make information available to various service providers and its people for the ultimate realization of Universal Health Care.

 Sources:

 Butterfield, B. (2012). What Physicians Want in an EHR: Physician Practices have been Ignored by Health IT Vendors—Until Now. AHIMA, 44-46.

Department of Health, PhilHealth, Department of Science and Technology, Department of Information and Communication Technology. (2017, August 1). Joint DOH-PhilHealth-DOST-DICT Administrative Order No. 2017-0001. Implementation of the National eHealth Electronic Health Record System Validation (NEHEHRV). Manila, Philippines: Department of Health.

Department of Health . (2021, April 23). Memorandum Circular No. 2021-0020 . DOH-PHIC Joint Administrative Order (JAO) No. 2021-0002 titled "Mandatory Adoption and Use of National Health Data Standards for Interoperability". Manila, Philippines : Department of Health.

Marcelo, A., Medeiros, D., Ramesh, K., Roth, S., & Wyatt, a. P. (2018). Transforming Health Systems through Good Digital Health Governance, ADB Sustainable Development Working Paper Series No. 51. Mandaluyong : Asian Development Bank.

What Emergency Department Physicians Need from Their Software. (2013, October 21). Retrieved from CareCloud: https://www.carecloud.com/continuum/emergency-department-physicians-ehr-software/