IT Governance: a simple solution to

the complex problem of building

Alvin B. Marcelo, MD
University of the Philippines Manila
 Abstract
• Information and communications technology has become pervasive
in many sectors, health included. Yet rather than streamlining
health processes, it seems ICT only serves to add to the
fragmentation with the creation of more information silos.
Improperly implemented, ICT can introduce new risks and
additional complexity to an already overworked sector. Emerging
from the chaos is IT Governance -- a discipline that encourages the
use of frameworks to guide stakeholders through the many
confusing elements of a health information system. With IT
Governance frameworks like COBIT5, board of directors who may
not have the language for technology receive assurance that
expensive IT investments are made in a cost-effective manner. The
presenter will share the journey of the Philippine National eHealth
Governance Structure and Technical Working Group in adopting
COBIT5 and the opportunities and challenges that come with it.
 Outline
• Brief background on the Philippine eHealth
Strategic Framework and Plan (PeHSFP)
• What is IT Governance and its contribution to
the PeHSFP
• The Philippine Health Information Exchange
(PHIE)
• Genomics, clinical informatics, public health
informatics in the context of the PHIE and
PeHSFP
 Disclosures
• Associate Professor of Surgery and Health Informatics,
University of the Philippines Manila
• Director, Technology Transfer and Business
Development Office, UP Manila
• Executive director, Asia eHealth Information Network
• Member, National eHealth Technical Working Group
(Philippines)
• Chair, eHealth Risk Management Expert Group
• Member, ISACA Manila Chapter
• No financial interests in the technologies discussed
 Disclaimers
• These are my personal perspective on how IT
governance has helped the Philippine eHealth
Strategic Framework and Plan.
• While facts are presented, the interpretations
of their rationale and motivations are mine. I
will highlight those instances in the
presentation. These should not be
misconstrued as policies.
 2011
• April Hoi An, Vietnam: Health Information
Systems Interoperability Workshop
– Agreement: there is no interoperability even
within Ministries of Health much more between
public and private sector
• June Manila: Asia-Pacific Health Information
Systems Leadership Forum
– A small group of participants agreed to form an
informal learning network -> Asia eHealth
Information Network (www.aehin.org)
 AeHIN Realizations
• Health is a very complex sector. It has many
stakeholders with competing agenda.
• ICT is also a complex sector. It has many
components that are interdependent on each
other.
• Health + ICT = eHealth can create even greater
complexity
• How do we manage eHealth? at national
scale?
 February 2012
• WHO and ITU invite country representatives
to Geneva
• Ground breaking message: to get eHealth
done right at national level and at scale,
health and ICT sector need to work together
 WHO-ITU National eHealth Strategy
Toolkit
Global launch of the
WHO-ITU National
eHealth Strategy
Toolkit
 August 2012
• Asia eHealth Information Network holds first
general meeting in Bangkok
• Regional launch of the WHO-ITU National
eHealth Strategy Toolkit
 July 2013
• DOH and DOST issue joint department memorandum
on the National eHealth Governance Structure and
Technical Working Group
• First presentation of the Philippines eHealth Strategic
Framework and Plan (PeHSFP)
Organizational Structure
WHO-ITU Toolkit PeHSFP
 Development Framework
WHO-ITU Toolkit PeHSFP
 October 2013
• National eHealth Steering Committee meets for
the first time
• Key decisions:
– add UP Manila and Commission on Higher Education
to Steering Committee (to cover Workforce)
– set initial priorities for eHealth: decrease maternal
deaths, increase PhilHealth coverage, complete health
facility enhancements, use IT in all public health
facilities
– approve the Philippine eHealth Strategic Framework
and Plan (PeHSFP)
 January 29, 2014
• Second Steering
Committee
Meeting
– Adopt IT
Governance
framework
(COBIT5) to
guide the
multisector
eHealth
initiatives (DBM
invests P154M)
 What is IT Governance?
• The discipline “to help enterprise leaders
understand why IT goals must align with those
of the business, how IT delivers value, how its
performance is measured, its resources
properly allocated and its risks mitigated”
 What is COBIT5?
• a business framework for the governance and
management of enterprise IT
• a set of tools and techniques to guide
enterprises with the design, development, and
maintenance of their information technology
COBIT5: Goals Cascade
COBIT5: Key Roles, Activities,
Relationships
COBIT5: Separation of Governance and
Management of IT
COBIT5 Processes
 May 27, 2014
• Third eHealth Steering Committee meeting
– approve the Philippine Health Information
Exchange as the key project for eHealth
interoperability
– directs TWG to start crafting the Data Sharing
Agreement for the PHIE
 July 23, 2014
• Fourth eHealth Steering Committee meeting
– direct TWG to comply with the Data Privacy Act of
2012 and release privacy guidelines to constrain
data sharing
 OpenHIE PHIE

TS – terminology service
CR – client registry
SHR – shared health record
HMIS – health management
information system
FR – facility registry
HWR – health worker registry
 Current Updates
• Public issuance of Administrative Order on the
Implementation of the Philippine Health
Information Exchange
 Current Updates
• Public issuance of the Administrative Order for
the Health Data Privacy Guidelines
Standards Catalog
v1
Standards Change Management
Manual v1.35
ehealth.doh.gov.ph
 What’s in it for genomics, clinical
informatics, public health informatics?
 Lessons Learned
• eHealth is complex. No single sector can do it alone. It
needs stakeholders to collaborate under the leadership
of the Department of Health.
• IT governance frameworks like COBIT5 help enterprises
navigate their IT. Without a framework, it is easy to get
lost in the complexity. With IT governance,
stakeholders can refer to a guide as they progress.
• Good governance is key to progress. Good governance
can be as simple as keeping meetings on schedule and
deciding together as a group.
• Consensus-building may take longer but is more
sustainable. Stakeholder ownership of eHealth will
ensure its adoption.
March 2, 12nn
Retinoblastoma

March 30, 12nn