Healthcare IT Governance and Enterprise Architecture: Philippine Experiences Laying the Foundations for the National eHealth Program

1. Healthcare IT Governance and
Enterprise Architecture:
Philippine Experiences
Laying the Foundations for the National
eHealth Program
Alvin B. Marcelo, MD

2. Disclosures
• Member (academe), Philippine National eHealth Technical Working
Group
• Associate professor of Surgery and Health Informatics, University of
the Philippines Manila
• Manager, Standards and Interoperability Lab for Asia powered by
AeHIN (SIL-Asia)
• Chief Medical Information Officer, St Luke’s Medical Center

3. slide 3

4. Governance Structure for Philippine eHealth
Strategic Framework and Plan

5. Outline
• About Philippines
• eHealth in the Philippines
• IT Governance
• Enterprise Architecture
• State-of-the-Art

6. Philippines
• Population: 102,624,209 (July 2016 est.)
• Median age total: 23.4 years
male: 22.9 years
female: 23.8 years (2016 est.)
Population growth rate:
1.59% (2016 est.)
country comparison to the world: 73
Birth rate:
24 births/1,000 population (2016 est.)
country comparison to the world: 61
Death rate:
6.1 deaths/1,000 population (2016 est.)

7. THE PHILIPPINE HEALTH AGENDA
• The Philippine Health Agenda(PHA) seeks to
fulfill the global call for Universal Health
Coverage, adopting "All for Health towards
Health for All" as the rallying point to realize the
vision of a Healthy Philippines by 2022.
• The PHA aims to:
(1) Ensure the best health outcomes for all,
without socio-economic, ethnic, gender, and
geographic disparities;
(2) Promote health and deliver healthcare
through means that respect, value, and
empower clients and patients as they
interact with the health system; and
(3) Protect all families especially the poor,
mar:ginalized, and vulnerable against the
high costs of healthcare.

8. THE PHILIPPINE HEALTH AGENDA
One of the strategies identified to fulfill the guarantees of PHA is:

9. Philippine Development Plan
Philippine Health Agenda 2016-2022
National Objectives for Health
Health Enterprise Architecture
DOH Information System Strategic Plan
(DOH ISSP 2015-2017; 2018-2020)
Philippine eHealth Strategic
Plan (2017 – 2022)
Philippine Strategic Framework for ICT
Sector, Philippine eGovernment Master
Plan 2013-2016.; 2017-2022
Philippine Digital Strategy 2011-2016
SDGs
Health Policy Services Health Regulation Technical SupportHospital Services Support to Operations
World Health Assembly
58th & 62nd WHA eHealth Resolutions
9
CONTEXT
SETTING
Philippine Health Information System

10. 10
Ensuring Universal
Access to ICT
Developing Human
Capital for Sustainable
Human Development Using ICT to promote
efficiency and
transparency in
government
Strategic
Themes for the
Philippine
Strategic ICT
Roadmap
Strategic Themes of the Philippine
Strategic Roadmap for the ICT Sector
(2006-2010)

11. BACKGROUND AND RATIONALE
• 2010-2011: ICT (eGovernment) Competency Maturity Model Assessment
(Strategy Alignment, IT Governance and Processes, Organizational Change Management,
Business Transformation Readiness) through the Asian Development Bank
• 2011: Creation of the Interagency Consultative ICT4Health Group (NGAs,
private sector & academe), which recommended the following:
• Architecture: Governing ICT use and investments
• Standards & Interoperability: Member ID, Provider ID, Facility ID, Drug codes; ATC/DDD, ICD,
CPT, LOINC, Data & Time, WGS, PSGC, SSL, HL7 etc.
• Standards compliance body for various application systems
• Capacity building of HHR
• Cross cutting issues: interoperability with others, information security policy, support privacy
legislation, ICT-enabled education & awareness
• 2011 – Formulation of the DOH Enterprise Architecture (1st)
11

12. GOVERNMENT INFORMATION SYSTEMS PLAN
• Issued through EO 265 on July, 2000
• Framework and guide for computerization of
key frontline and common services and
operations of the government
E-GOVERNMENT MASTER PLAN
• Singular authoritative strategic blueprint
for Philippine E-Governance.
MEDIUM-TERM INFORMATION AND COMMUNICATIONS
TECHNOLOGY (ICT) HARMONIZATION INITIATIVE
• The process and governance structure to implement the eGovernment
Master Plan (EGMP) with a bottom-up perspective of ICT needs, to be
"harmonized" for inclusion into the EGMP.
•(Joint Memo Circular NEDA-DBM-DOST 2012-001)
MITHI
BACKGROUND AND RATIONALE
12

13. EGOV MASTER PLAN FRAMEWORK

14. 14
MEDIUM TERM INFORMATION TECHNOLOGY HARMONIZATION
INITIATIVE (MITHI)
Governance Structure for Implementing the
eGovernment Master Plan (DBM, NEDA, DOST)
MITHI Health Cluster
Governance Structure :
National eHealth Steering
Committee and Technical
Working Group
( DOH, DOST, PhilHealth,
UPM Joint DM 2013-
0200)
MITHI Higher
Education Cluster
MITHI Justice, Peace
& Order cluster
MITHI Public
Financial
Management Cluster
Other Clusters

15. GOVERNMENT’S MOVE TO eHEALTH
Health System Challenges trying to help address:
 Access to health care services
 Access to real-time information for decision-making
• Delayed availability of health data and statistics
• Many health data or information coming from disparate
systems and locations with different formats, and lacking in
harmonization
• Data quality problems in terms of reliability, timeliness,
accuracy and completeness
• Poor and slow recording and data processing
• Very long reporting process from the RHU/HCs to the
M/CHO, PHO, RO then to the DOH CO.
Philippine
eHealth
Strategic Plan
2017-2022

16. Different Data Formats
mm/dd/yyyy
yyyy/mm/dd
Many data or
health information
coming from
disparate systems
(EMRs) and
locations…
Different Data Codes
‘F’ Female | ‘M’ Male
1 Female | 2 Male
Lack of Standard
Terminologies &
Meanings
Sex, Gender, Lab results..
Lack of Harmonization in Processes
Department of Health collects data
Philhealth collects the same data
Poor Data Quality
Eq. Available Data
are outdated, 3
yrs/ late
Current State
TECHNICAL PROBLEMS

17. Philippine eHealth Framework
Basis: WHO-ITU eHealth
ToolKit

18. 18
PHIE Implementation
EHR Systems Certification
IT in All Public Health Facilities
IT-Enabled Health Services
VISION
By 2020, an ICT-enabled
Philippine Health System
towards better and
equitable access to quality
health care services, and
easier access to secure
real time and quality
health data and
information for
evidenced-based decision
making.
Hospital
Management
Information
Systems
Health Data Standards Use
EMR Implementation

19. STRATEGIC GOALS
Strategic Goal 1: Provide a rational and accountable eHealth agenda, and legal and
normative framework and structures to implement eHealth.
Strategic Goal 2:
Increase efficiency of processes and systems in health care delivery
and administration and create new processes and better forms of
doing things.
Strategic Goal 3:
Establish a unified and coherent health & management information
systems relevant to individuals, managers, and other stakeholders.
Strategic Goal 4:
Institutionalize knowledge management systems to promote data,
information and knowledge exchange and utilization especially at
sub-national levels.
Strategic Goal 5:
Capitalize on ICT to reach & provide better health services to GIDA,
support MDG/SDGs’ attainment, and dissemination of information
to citizens and health providers in a variety of technology
platforms.
slide 19

20. Governance of eHealth in Philippines
Steering Committee:
Chair: DOH minister
Co-chair: DICT minister
Members: PhilHealth, DOST minister,
DSWD minister, UP chancellor
Meets quarterly
TWG:
Chair: Dir Valdez
Co-chair: DOST
Members:
PhilHealth,
UP (Drs Marcelo),
FDA, Vital statistics,
Social welfare
Meets monthly

21. Adoption of IT Governance Framework (COBIT5)

22. Enterprise Architecture

23. Program Management
5 new staff were hired to support the Philippine eHealth
Strategic Framework and Plan

24. Standards and Interoperability
1) Standards Catalog
2) Standards Change
Management
Manual
1) Standards Catalog
2) Standards Change
Management
Manual

25. Summary
• Philippine eHealth and telehealth evolving very fast
• Many stakeholders
• Many components
• Poorly defined relationships
• There is a clear governance structure to provide directions
• The Philippine Health Agenda specifically mentions eHealth and
telemedicine
• Opportunities are possible for application of telehealth in the country