National health-informatics system set up
By Grace Roxas, Contributing writer
After nearly a decade of dogged learning by doing, the country's prime mover for promoting information and communications technology (ICT) in health is now nailing down the brass tacks, in terms of establishing a viable community of practice.
"There's a place for the concepts and the theories, but at some point, we have to bring together stakeholders-those who have solutions and those who are looking for solutions-and let them interact," said Dr. Alvin Marcelo, director of the University of the Philippines Manila National Telehealth Center (NTHC).
The center held a conference in December on the latest trends and state-of-the-art solutions in electronic health-records (EHR) management.
On top of being kept abreast of what's possible with today's technology, participants also learn from the profiles and case studies of existing and upcoming local projects-government and private sector-and from expert viewpoints on key EHR issues such as standards, infrastructure, and security.
These conferences also serve notice that NTHC has hit its stride as a catalyst for the responsible and innovative use of ICT in improving access to health information and services in the country since its founding in 1998.
Marcelo admitted there was some rough going during the center's first few years of existence although in hindsight, he thinks the learning curve was just right.
"The center started because the three of us came home from training abroad," he recalled. "But pagtapos ng training, you're not an expert. You need time to test your concepts into reality and it took us three years. We took projects, squandered other people's money, and failed, but we learned a lot from the failure. After that, alam na namin."
The boom in the local medical-transcription business for the US market also pulled up the quality benchmark for medical informatics geared for local consumption. Marcelo noted that while digitizing health information already has a 50-year history in the US and Europe and was already in local practice as early as the 1980s, questions over security, privacy, and confidentiality were secondary issues.
"Medical transcription provided a backdoor for security issues to become a concern in the Philippines," he observed. "As we gain experience in that business for an overseas market, the next question is why not have the same level of security for EHR here?"
With its roots in academia, NTHC's first successful major undertaking was creating a graduate program, Masters of Science in Health Informatics, in UP Manila. After another three years of setting up the curriculum and passing the gauntlet of reviews and approvals, the program is now training its second batch of would-be health informatics experts-mostly licensed health practitioners and biochemistry or computer-science graduates.
By properly equipping people for the automation of the health-care workflow through the master's program, NTHC is also laying the ground for another key initiative, this time in terms of establishing a common platform for a seamless national health-information system.
National community of practice
The Philippine National Health Information Infrastructure (PNHII) is an interagency consortium seeking to forge a single community of medical-informatics practice at the national level by making authorized data traffic possible among all kinds and levels of health facilities in the country. These can range from rural health units and private clinics to tertiary hospitals and national medical services and research institutions, regardless of differences in systems and technologies.
PNHII will run on open-source (i.e., free) software so that any facility can directly download the source codes and study and modify them to fit its own purpose. The use of the platform-independent XML (extensible markup language) schema will enable different systems to talk to each other through a basic data exchange configuration.
In October 2005, a formal agreement was drawn up to form the consortium among the Department of Health (DOH), Department of Science and Technology, Philippine Health Insurance Corporation, UP Manila, and the Philippine Medical Informatics Society. NTHC also hopes to bring in the private sector as a partner in the consortium.
Marcelo said the building blocks for this pivotal project are already on the table and a pilot in a major medical institution, most likely the Philippine General Hospital (PGH), is possible in a year's time.
For one, they have already identified standards in terminology that can be best used across health facilities once agreements have been reached among parties represented in PNHII. These standards are international naming codes for diseases (ICD-10), clinical and laboratory test and results (LOINC), radiology studies (DICOM), and data exchange (HL7).
PNHII also concerns itself with agreements on standards for data architecture or the categories of data that will be processed and exchanged, and on required identifiers for the patients, facilities, providers, health and administrative information.
On the technology side, secure data-exchange protocol is the key deliverable across the different wired and wireless web-based media, which include 3G cellphones and wi-fi. The PNHII web site will also be used as the reference site where the standards agreed upon will posted.
There already exists a number of EHR applications in the government and private sector that can lend themselves to interope-rability within PNHII. DOH has developed, among others, a hospital-management-information system for its retained hospitals.
NTHC itself has developed a few pilot EHR systems in different settings, including a health-center-based community-health tracking system now under trial in some areas of Pasay and Marikina, an integrated surgical-information system, and a blood-bank information-management package for PGH.
The ultimate solution?
Marcelo dreams of a time when up to a decade's schedule of personal health-care needs and related services can be anticipated for any individual who walks into any wired health facility for consultation.
"Once you digitize health information and do it correctly, a patient becomes a real human being in the health system," he said. "You put him on the radar screen of the system, as opposed to just being an information on a piece of paper that might get lost in the manual file system of a [rural health unit] or a clinic."
It will also fill in glaring and life-threatening efficiency gaps in the health system. "Today, we have warehouses with drugs expiring worth PhP40 million while 10 kilometers away in another city, children are dying from vaccine-preventable diseases. That's a gap in the information system. All you need to do is connect the supply with the demand," Marcelo added.
If there are clouds marring this utopian vision at the moment, it's the usual suspect. "What is lacking is funding. You need to get two to three people to just sit down and implement these standards for a reference implementation," Marcelo lamented.
NTHC and other stakeholders in nationalizing medical informatics are also dependent on the national government's pace for setting up the physical networking infrastructure to support the content created through PNHII and the specialized EHR applications. Going by the timetable set by the Commission on Information and Communications Technology, it will take at least four more years for the information superhighway to reach even half of the neediest segments, namely, the rural barangays.
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Participation urged in policy development
Emphasizing the importance of a "participatory process" among stakeholders in health, the Asian Institute of Management (AIM) gathered various members of the health sector from here and abroad in a recent health-policy symposium, Determinants of Health: A Public Policy Perspective. Prof. Emmanuel Leyco, director of the AIM Health-Care Management Program, led the symposium.
The symposium aimed to mobilize key stakeholders, especially the private sector, in the formulation and implementation of health policies. Health-related issues such as access and availability of health care, budget considerations, and health-service delivery were also tackled.
"Health buys wealth"
Philip Stevens, director for health program of the International Policy Network, discussed the "real determinants of health." He pointed out that health-care services have become a commodity that only the wealthy have access to, straying from its being a basic right that a government is responsible for providing its citizens. This is evidenced by the fact that the economic growth of a country was noted to be directly proportional to the people's life expectancy. Said Stevens: "The higher the economic growth, the more lives that can be saved. Health buys wealth."
He also discussed the social determinants of health, focusing on the influence of inequality on health-care services. Lack of appropriate governance and policies that do not address the issues involving health care are the main hindrances to the accessibility of health-care services to the majority of a country's population. Public-health systems established have many weaknesses-from poor coverage to outdated technologies, rationing treatments to politicization of health-care decisions.
Barun Mitra, founder and director of India's Liberty Institute, gave an overview of India's health-care system as a lesson for the Philippines to learn from. India has been used several times as a role model in terms of accessibility and affordability of medicines.
He discussed the Indian pharmaceutical sector, highlighting its successes, making it a "standard" for comparison. He showed that 90 percent of the medicines consumed in the country was produced locally. India supplies eight percent of the world's medicine consumption. India ranks among the top five pharmaceutical producers, exporting to more than 175 countries.
The delivery system
Still, amidst these impressive numbers, India faces a health crisis. Its health-care situation is no better than that of other countries. Also, only 30 percent of the people have access to medications and the allotment for health care is only 0.9 percent of the gross domestic product (GDP). He also said that patent has little influence on the accessibility of health-care and medicines-it still boils down to the delivery system.
Lastly, Dr. Eduardo Banzon, senior vice president of the Philippine Health Insurance Corporation (PHILHEALTH), spoke on the PHILHEALTH's role in making health-care services more accessible. He tackled the four areas that define the access to health care-universal participation, adequate protection, health-care providers, and health facilities.
M Cherrie Cruz
End lymphatic filariasis now, experts urge
Unknown to many, lymphatic filariasis (LF) is the second-leading cause of permanent disability in the country, next to diabetes. This tropical disease is one of six potentially eradicable diseases; unfortunately, it affects more than 645,000 Filipinos. Endemic in 39 provinces, LF puts as many as 23 million Filipinos at risk of contracting it, if no preventive measures would be taken.
Treating LF is safe, effective, and affordable. Treatment consists of a single dose of diethylcarbamazine (DEC) in one year, at about PhP5 per person. Mass treatment would then cost roughly PhP3.2 million, not counting diagnosis which costs PhP156 per test.
Aware of the limited resources of the government, the Department of Health (DOH), together with the World Health Organization (WHO) and the Global Alliance to Eliminate Lymphatic Filariasis (GAELF), reached out to the "deeper-pocketed" business community through a forum entitled Changing Lives: Best Business and Social Practices that Make Remarkable Changes in Filipinos. Present at the forum held on March 20 at the Manila Polo Club were Health undersecretary Ethelyn Nieto, WHO representative to the Philippines Jean-Marc Olivé, and GAELF executive secretary David Molyneux.
Said Molyneux: "Today is focused on highlighting the collective action from the key pillars in society: business, government, and civil society, as well as non-governmental organizations, each doing their share to reduce the health burden of the cost by concerted action against the disease lymphatic filariasis with the expectation that we will be able to eliminate this awful condition."
Also present were Dr. Antonio Villalon, past president of the Philippine College of Physicians, several business executives from top corporations (Ayala Foundation, Microsoft Philippines, Pilipinas Shell Petroleum Corporation, Metrobank Foundation, Sun Microsystems Philippines), and former president Fidel V. Ramos.
Nieto stressed the importance of making "public-private partnerships work for the betterment and health of our people," to ultimately achieve the goal of elimination of LF by 2010.
"The poorest of our poor largely bear the brunt of the disease," she added. "Currently, most of the cases-around 71 percent-are found in fourth to sixth class municipalities countrywide.... This sets off a ceaseless and vicious cycle of poverty and disease," Nieto said.
Individuals and organizations who wish to get in touch with the National Filariasis Elimination Program may call the group (+63-2-7116808 or +63-2-7438301 local 2350 or 2352). The program is based at the Infectious Disease Office of the National Center for Center for Disease Prevention and Control, 3F Building 13, DOH Compound, Santa Cruz, Manila.
M Carisa Paraz, MD
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