Complexity of Information Systems

If a hospital information system in one facility is a complex process by itself, how much more complex will a national health information system be? How can government manage this complexity?

sys·tem

ˈsistəm/

noun

1.    a set of connected things or parts forming a complex whole, in particular.

2.    a set of principles or procedures according to which something is done; an organized scheme or method.

An Information system is indeed complex, like the hospital information system – it is most likely composed of different systems itself. A hospital information system may be composed of an administrative information system and clinical information system, both consist of systems. The clinical information system may have a pharmacy information system, electronic medical record that may be an electronic health record that can go through different departments of the hospital. A hospital information system is really complex system of interrelated systems.

According to Philippine eHealth Strategic Framework and Plan speech of USec. Ted Herbosa, Information technology has become affordable and pervasive.  Yet, despite this, IT has not been effectively used in the health sector.  There will be tremendous benefits if key healthcare processes can be computerized.

Computerizing the processes like health data gathering cannot only lifting the burden of pen and paper work of the health workers during their daily services, but their most dreaded reports generation. Having an electronic medical record with the capability of generating reports can be really beneficial for the health workers, giving them more time to cater more health services than manually doing reports that they submit regularly.  That does not only end on generation of reports, but the submission of reports can be really tacky depending on which part of the country are you. Some health workers need to travel by land or sea just to submit a report because of the poor IT infrastructure in some areas in the country.

According to the WHO’s eHealth Strategy Toolkit It all starts with a vision. Vision is a mental image of the future.  On planning, the organization must have a clear vision of what they want, not only on what would be multi stakeholders’ best interest of the governing bodies but multi stakeholders, following the framework in the toolkit. (Figure 3)

Setting the context would be first step, according to the The Philippine eHealth Strategic Framework and Plan: the Story of its Evolution, the rationale “effective use of information technology in healthcare”. On the vision, the desired outcome must be set and lastly setting the foundations for change.

The next step would be developing a National eHealth Action Plan, hence the “Philippine eHealth Strategic Framework and Plan 2014 to 2020.

And lastly Monitoring and evaluation.

According to the toolkit, monitoring and evaluation is his is a sequential process that begins with determining the indicators to be monitored and outcomes to be evaluated. Baseline and target measures are set for each indicator. Targets serve as the basis for tracking actual progress against planned progress, and determining whether corrective action is required.

Anything done in haste is waste. With the national information system slowly taking its place, comparing it to an hospital information system, it would be more complex.  However, amat victoria curam, victory loves preparation.  There’s no better way to prepare in implementing a very complex solution than preparation.

Free Market Philippines

In the Philippines, are free market forces, unfettered by government intervention or regulation, adequate for providing appropriate deployment of the national information infrastructure in support of health and health care?

According the Department of Finance of the Philippines, the Philippine Government is committed to a free market economy. There is, however, significant direct government involvement in the countrys economic activity through both economic planning and the state-ownership of numerous corporations involved in certain strategic sectors, such as banking, power-generation, oil production and transportation.

However throughout the years, we’ve seen and experienced how people from the business abused the free market economy of the Philippines, especially on basic needs like food.  The National Information Infrastructure both free market and the government is not adequate in supporting the need for health and health care. Even if the free market or private business can cater to the need, there is a need for standards and regulations on implementation.  It does not only protect the public but also the stakeholders who might pay too much.

The National Information infrastructure of the Philippines is an act to promote and to govern the development of the telecommunications in the Philippines.  The promises it gives, will pave way to better communication.  However, even if NIIP is in place, there are still areas around the Philippines that have no poor to no access to telecommunications, because lets face it – what’s in it for the telecommunication companies serving an area of so little population and the market for their services is not as big as areas with bigger population.

My take on this, is to have a public private partnership.  According to Department of Finance of the Philippines PPP is a key strategy of the Philippine development plan. With the end view of fostering an environment conducive for private sector entrepreneurial initiatives, the government has developed a policy environment that strongly supports private sector participation in its development activities.  Since the telecommunications in the Philippines are all private business, they hold the key on having ICT infrastructure in areas where there is still poor or no access to telecommunications in partnership with the government.  Through the NIIP, the regulations will protect masses, prevents abuse and provide security.

According to the WHO eHealth Strategy Toolkit, collaboration between the health and ICT sectors, both public and private, is central to this effort. The major United Nations agencies for health and telecommunications respectively, the World Health Organization (WHO) and the International Telecommunication Union (ITU) have recognized the importance of collaboration for eHealth in their governing body resolutions, which encourage countries to develop national eHealth strategies.   . Experience shows that this requires strategic and integrated action at the national level, to make the best use of existing capacity while providing a solid foundation for investment and innovation. Establishing the main directions as well as planning the detailed steps that are needed is crucial to achieving longer-term goals such as universal access to care, health sector efficiency, reform or more fundamental transformation.

On the statement, NIIP and the National eHealth Strategy will stand to strategize, plan and protect the interest of the public and private sector for the use of ICT for health.

Health Information Systems and Sustainability

Citation:

Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries D.A. Ludwick, John Doucette

Building Leadership  FOR DATA DEMAND AND USEData Demand and Use of USAID

What are the factors affecting the advancement of the field of health informatics in the Philippines?

We could name a lot of factors affecting the advancement of health informatics in the Philippines, true to its archipelagic geography, reaching all the communities in all the 7,107 is a true feat. However, with this age of technology and modernisation, 4720 geographically isolated and disadvantaged areas, which comprises of more than have of all the 1494 municipalities have communities that are hard to reach and some are still unserved or underserved in terms of health care, according to the GIDA profiles of 2010 from the DOH.This factor alone affects the advancement of technology to these areas. These areas are lacking the proper or even the minimum infrastructure for information and communication technologies. According to the latest sitio electrification report, there are still 15974 sitios that have no electricity. Electric nowadays is no longer just a luxury, it is a need. Not only that GIDAs are difficult to travel to, because of difficulties of reaching them physically, it is also difficult to reach the even over cellphone. There is a problem of connecting the islands even wirelessly, internet signals are poor to none and most often than GIDAs are also mobile phone signal unreachable.

There a lot of good solutions for our health care situation now a days, doctorless communities can do Telemedicine, Rooms of paper health files can be managed through Electronic Medical Records, poor health compliance can be managed by information services, however these solutions still would not fit in all communities in the Philippines. The infrastructures like roads, safe transportation, electricity and communication technologies are needed. Infrastructure require so much investment to make systems work in our areas considering that we are typhoon-prone and with geographically isolated islands and technologies such as cellphone and internet connectivity are from the private sector, which means it's business. Governance and leadership to spearhead and sustain these changes are also issues.

Another factor that I think that will ultimately affect the advancement is the capacity of the users to technology, based on the 2005 Information and Communications Technology (ICT) indices, Philippine Ranked poorly on eReadiness 51/65. A lot may have happened in 9 years, with all the advancement that happened. The ICT Development Index (IDI) for the years 2011 and 2012. for 157 countries. The IDI is a composite index which combines 11 indicators into one measure that serves to monitor and compare developments in ICT across countries.  In 2012, the Philippines global rank in IDI was 98. This is the same rank it achieved in 2011. Despite the increase in its IDI from 3.14 in 2011 to 3.34 in 2012, the Philippines did not improve its ranking. (NSCB) IDI also measures capability or skills on using ICT, our rank may be a manifestation of our readiness to ICT.

Citation:


June 30, 2014 Sitio Electrification Program Status from the National Electrification CouncilGIDA Profiles from the DOH 2010http://www.nscb.gov.ph/factsheet/pdf06/fs11_06.asp – National Statistics Coordination Boardhttp://www.nscb.gov.ph/sexystats/2014/SS20140207_ict.asp#sthash.bWrxbSRI.dpuf