Information Technology

and Community Health

 eHealth in the Community Setting
Digital health
In the advent of Information Communication Technology (ICT), the curr
ent health care industry is undertaking a significant transformation. Since the goal
of the health system is to provide quality, affordable, accessible, equitable, and effi
cient health for all, majority of the health systems are challenged to improve the qu
ality of care while decreasing cost and establish an administrative and medical pro
cess with the use of ICT such as digital health.
Digital health, also known as information and communication technolog
y (ICT) in the health system, is the field of theory and practice associated with any
03 digital technologies to improve health from its conceptualization
aspect of adopting
to application or operation (WHO, 2019; Ghebreyesus, 2017). Digital health involv
es the use of different health care services to improve patient’s health and well bei
ng (Mellodge and Vendetti, 2011; Kostkova, 2015; Baumann, 2015; Sonnier, 2016)
. 04
Digital Health versus eHealth
 Often digital health is used interchangeably with eHealth. But digital health is broader
and focuses also on smart devices, huge data storage and big data analytics (WHO, 2019).
Moreover, since the face of digital health is dynamic, terms – eHealth, medical informatics,
health informatics, telemedicine, telehealth, and mHealth – have been used over the last
decades, depending on the available advancements of technologies and their respective
local environments (WHO, 2019; Wootton et al., 2009). All these terms were attempts to
describe the application of ICT to health sectors, healthy systems, and well – being (WHO,
2019). However, digital health goes beyond its simple meaning as it reflects the integration
of concepts while allowing flexibility for diverse purposes to understand various categories,
functions and policy needs (WHO, 2019). The terms digital health and eHealth will be used
interchangeably depending on the context within which particular term is being discussed.
 Uses of digital health interventions
The ultimate objective of digital health is to enable a health system to use ICT to improve achievement of health and wellness, in line
with the national strategies and plans as well as with the global objectives such as Universal Health Coverage (UHC) and
Sustainable Development Goals (SDGs) (Marcelo et al., 2018; WHO, 2018)

Gaps in the Health system that

needs to be improved

Digital disease surveillance system. Social health insurance payment

01 (Mellodge and Vendetti, 2011) 03 processes (Marcelo et al., 2018)

Health education and interventions

Electronic and medical records
02 (Blumenthal and Tavenner, 2010; 04 (Kostkova, 2015; Asi and Williams
2018)
Campanella et al., 2015
 Nature and scope of digital health in the Philippines

1960 1998
Use of telephones is increasingly becoming The National Telehealth Center (NTHC) in the
more prevalent and at the same era, using University of the Philippines Manila was established.
telephones, resident physicians in the country As a primary research unit of UP Manila for ICT, they
sought consultations and medical advice from initiated the design and development of ICT cost –
senior clinicians regarding the management of effective tools especially for the remote, rural and
hospitalized patients (Fernandez – Marcelo et understood communities in the Philippines.
al., 2012)
2009
2004-2008 The WHO conducted a global survey on eHealth with
The NTHC had its first breakthrough when it self-reports from a selected group of digital health
conducted a telemedicine research and service in expert informants as the basis. It revealed that in the
remote and undeserved areas in the Philippines country. ICT training both formal and non-degree
through a partnership with the Commission on courses for students and health professionals alike
Information and Communications Technology. can be used to build the digital health capacity of the
workforce
Cont…

2011-2016
With goals to develop user friendly ICT solutions
VISION
in order to accelerate the gathering and By 2020 eHealth will enable wide
processing of health and related information for sepread access to health care ser
policy making, and to deliver quality healthcare vices, health information, and sec
services, the National Unified Health Research
Agenda (NUHRA) recognized ICT in the health urely share and exchange patient
sector as a priority research focus (Fernandez- s’ information in support to a safer
Marcelo et al., 2012) , quality health care, more equita
ble and responsive to health syst
ems for all the Filipino people by t
ransforming the way information i
s used to plan, manage, deliver a
nd monitor health services
Vision, Components, Strategic Phases
 eHealth Components of the PeHSFP 2014-2020
eHealth Components Description

Directs and coordinates eHealth activities at all levels of the health system. Criti
Governance cal areas of governance include agenda setting, stakeholder engagement, over
all architecture, clinical safety, monitoring and evaluation and policy oversight

Legislation, Policy and Com

Involves creation of the required legislation, policies and compliance to suppor
pliance
t the attainment of the eHealth vision.

Promotes and enables the exchange of health information across geogr

Standards and Interoperability aphical and health sector boundaries through the use of common stand
Add Contents Title ards and terminologies.

Strategy and Investment This refers to the funding support and guidance needed to execute the
strategic plan.
 eHealth Components of the PeHSFP 2014-2020
eHealth Components Description

Establishment of necessary physical technology, software platforms, services a

Infrastructure
nd applications to support health information exchange.

Refers to the workforce needed to develop, operate and maintain the national
Human Resource
eHealth plan.

The required services and applications to enable widespread access to

Add Contents
health care services, information, Title
and securely share and exchange pat
eHealth Solutions
ent’s information in support of health system goals.
 3 phases on the implementation strategies to roll out the National eHealth program

1. Standardize and connect 2. Transform

– the key focus is on the establishm – involves continuing innovations
ent of governance and foundations and provid to develop and implement defined national
e basic connections to start information sharin eHealth solutions. This phase is started in
g across the health sector. This phase started 2016 and is expected to conclude in 2019
in 2014 and was concluded in 2016 and beyond

3. Maintain and measure

-eHealth is expected to be established at this poi
nt and there is a need to maintain, sustain, continuously m
easure in terms of performance, and ongoing innovations
and updates need to be managed This phase is set to com
mence in 2020.
 The Philippine health information exchange

Health information exchange (HIE)

- a process of sharing patient – level electronic health information across different health
facilities, practitioners, and organizations (Adler – Milstein, and Dixon 2016; Khumalo, 2017; Vest
and Gamm, 2010)
- Not only addresses the portability of the patient data information to health care
providers and government agencies such as health insurance providers, but the integration of
different health information systems (HIS) address the need for better information for decision
making (Bates and Bittion, 2010)

Through this, the gaps in management of health care delivery networks, health care delivery, and
social determinants on health can be analyzed and eventually addressed. This leads to a soun e
videnced – based health policy which is catered by different government agencies that support p
ublic health.
NURSES are knowledge managers.
They constantly process raw patient data
into valuable information to deliver
evidence – based and individualized care.
DATA are the fundamental elements of
cognition (Gudea, 2005), and are defined
as unanalyzed raw facts that do not imply
meaning. The power of
data and
When meaning is attributed to
information
data and when data are
processed and analyzed, then
data become INFORMATION.
 Problems that may emerge in using paper –
based methods

1. Continuity and interoperability of care stops in the unlikely event that a record gets misplaced.

2. Illegible handwriting results to misinterpretation of data.

3. Patient privacy is compromised.

4. Data are difficult to aggregate.

5. Actual time for patient care gets limited.

6. The ability to manipulate large amounts of data

7. The ability to relate data to cohorts or people who share similar health problems

8. The ability to link to genomic data

Benefits of having a well – managed patient
information system:

1.Data are readily mapped, enabling more targeted interventions and

feedback
2.Data can be easily retrieved and recovered
3.Redundancy of data is minimized
4.Data for clinical research becomes more available
5.Resources are used efficiently.
Characteristics of good quality data

1. Accuracy
2. Accessibility
3. Comprehensiveness
4. Consistency/Reliabilit
y
5. Currency
6. Operational Definition
 Electronic Medical Record Systems

EMRs – automated systems that stores patient demographic, clinical and administrative
data.

Advantages of EMR use are:

1. Easily retrieve patient data especially on their follow – up visits
2. Track patient progress over time
3. Monitor and improve overall quality of care.

CHITS (Community Health Information Tracking System)

– pioneer community based EMR in the country
- developed in 2004 by Dr. Herman Tolentino of UP Manila and MIU
(Medical Informatics Unit)
iClinicSys (Integrated Clinic Information System)
- homegrown of EMR of the DOH
- developed in 2013
- widely used community – based EMR
 Universal Health Care and EMR use

The Universal Healthcare Law of 2019 or Republic Act 11223 calls for the full adoption of
information systems which “include but are not limited to enterprise resource planning,
human resource information system, electronic medical record and electronic
prescription logs.”
The law also mandates regular uploading of data through interoperable systems (RA 112
23, 2019)
PhilHealth is mandated to ensure financial risk protection to all Filipinos by developing
service packages. Most common service packages available in community health center
s, lying – in, clinics and primary hospitals are the primary care benefit (PCB) packages,
maternal and newborn care packages, outpatient TB-DOTS benefit package and HIV an
d AIDS benefit packages among others.
Challenges to EMR Implementation

1. Double charting
2. Interference with face – to – face patient care
3. The perception that EMR is just a simple replacement of the paper
record
4. Managing data privacy and confidentiality