Healthcare workers should always have quick and easy access to the most up-to-date medical information and technologies as they provide care and service to their patients. In this line, a well-planned data management system can allow healthcare personnel to make better informed decisions in the least possible time while delivering healthcare services.
This is the intention of the Universal Health Care Act, or Republic Act 11223, which was passed in 2019. However, more than three years since, many of the law’s provisions are still to be implemented or operationalized. The law’s main objective is to ensure that all Filipinos can access basic healthcare and ward accommodation, at the government’s cost. In this line, it also provides for the networking of all health information systems.
Ideally, anybody should be able to walk into the nearest clinic or hospital to get medical attention without having to worry about doctors’ fees, hospital cost, procedure cost, or even basic medicine. Moreover, one’s health information — including medical records and insurance information, if any — should also be accessible online to any of these medical facilities.
In fact, the Department of Health (DoH) book on RA 11223 specifically notes that the law “requires all health service providers and insurers to maintain a health information system consisting of enterprise resource planning, human resource information, electronic health records, and an electronic prescription log consistent with DoH standard.”
The DoH also notes the use “of integrated health information systems to reduce or eliminate overlaps, and ensure generation and reporting of quality and timely reports for operation and delivery of health services.” Systems should also allow “different health information systems and other e-health solutions of health care providers, insurers, and health-related entities to seamlessly communicate, share, exchange, process, and submit health and health-related data and reports.”
All health-related information will be shared with PhilHealth, which will maintain a “National Health Data Repository to ensure that quality health and health-related data and reports are readily available and made accessible to every stakeholder in the right way, and processed in a lawful, ethical, secure, consistent, and efficient manner at all levels of the healthcare system.”
Question is, three years into RA 11223’s implementation, where are we in terms of developing a National Health Data Repository (NHDR) and in instituting an Integrated Health Information System (IHIS)? To this date, I reckon, what we have is a fragmented system. At best, there are stand-alone systems that work in localized networks. I doubt very much if government hospitals, for instance, are all interconnected.
And this, to me, is the big challenge that should be addressed collectively by the government and the healthcare community. The initiative to maintain the NHDR, and to network all medical facilities, will require massive investment of resource, time, effort, and training. All stakeholders should be involved in the process.
The law actually requires the DoH and PhilHealth to develop and maintain the proposed IHIS and NHDR, as well as to institute a national health data standard for interoperability of all local health information systems. It is also their mandate to provide for a platform for the submission and processing of health and health-related data.
The law goes a step ahead by also requiring the government to produce an updated list of the mandatory national health data standards. These standards should be available in a standard health data catalogue as well as in the National Health Data Dictionary. The law envisions that connectivity to IHIS and the use of the NHDR will all be part of DoH and PhilHealth licensing and accreditation requirements in the future.
But other than providing for law three years ago, and additional regulations since then, it doesn’t seem like we are moving fast towards fully networking clinics and hospitals and integrating their information systems. At this point, many clinics and hospitals and healthcare facilities, particularly outside highly urbanized areas, do not even have stable internet or data connection. And, there is still no national data center for health information.
PhilHealth should urgently move on the creation of the NHDR, without which, integration won’t work. After all, PhilHealth is supposed to provide the platform for the safekeeping and exchange of information. The IHIS as well as NHDR are all integral parts of making universal healthcare a reality.
The law requires “all public and private, national and local health-related entities to submit health and health-related data to PhilHealth. These include administrative, public health, medical, pharmaceutical, and health financing data, which must be submitted through the [NHDR]. Such data will be made accessible to all stakeholders at all levels for healthcare utilization.”
The repository is supposed “to provide a single point of data submission and access to health evidence, and quality data and information. Up-to-date reports can be readily made available to support decision-making.” The NHDR also aims to improve access to public health and health-related data, and the management of patients’ medical records, and thus improve consultations and coordination of care as health information is easily exchanged between healthcare providers.
Imagine a situation where the NHDR gives the patient information on where to find specific medical assistance as well as physicians, with information on their experience, services, and fees. Patients can also search for health insurance institutions and the scope and cost of their packages. NHDR will also allow them access to information on DoH-licensed and PhilHealth-accredited healthcare facilities; accredited products and equipment; the cheapest drugs and laboratory examination services; and the location of nearest pharmacies and healthcare institutions.
Meantime, clinics and hospitals will gain access to patient records and medical history at the point of care. NHDR will also give them access to accurate and timely health data, as well as “evidence-based information to support clinical decision-making, and treatment design and assessment.”
All this aims to make the delivery of health services more efficient, and perhaps less costly, and mostly at government’s expense. This, after all, is the essence of universal healthcare. But the process starts with the collection of data and the effective sharing of information. The structure and system for this should already be put in place. In this day and age, data is health.
Marvin Tort is a former managing editor of BusinessWorld, and a former chairman of the Philippine Press Council