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Reprint: Blueprint for National Health Information Systems

(Original PDF version can be downloaded from Scribd. Reposted with permission from Health Intel 2011 magazine of the Zuellig Foundation)

When a man decides to build a house, he does so with great apprehension. This is because the costs tend to be beyond his means and he probably will need to take a loan from the bank. Another reason is that the building process itself is complex, involving huge investments and commitment from many people ranging from the architect who designs the house to the plumber who lays down the pipes to the owner who will eventually live there. Adding to the anxiety is the fact that they do not know each other nor trust each other that much. It is therefore customary to prepare a blueprint prior to construction. The blueprint serves as a common reference point for every stakeholder involved in the project. Between the owner and the architect, they share the same vision of how the whole structure will appear and function. For the engineer and the contractors, the blueprint tells them what materials will be used. Once the structure is built, then it’s the interior designers’ turn to put in the appropriate furniture and fixtures in each room. At the end of it all, if the blueprint is followed faithfully, the owner is satisfied. It will be a coherent structure built by many hands pursuing a common goal of a comfortable home for a family. The blueprint serves as a contract of sorts.

This analogy works well for the ideal national health information system. If the country had this blueprint, various stakeholders from the public and private sectors can contribute to building their own specific systems that can fit the larger national health information system. Let’s then identify the counterparts of this analogy to the national health system. The owners of the national health information system are the Filipino people. They benefit the most from having an efficient, effective, and responsive system. As they are a diverse set of people, they are represented in this process by the Government of the Philippines, specifically, the Department of Health. It must be pointed out that a national health information system must involve the public and private sectors, the academe, non-government organizations and civil society groups. Internal informational need of the DOH is a mere component of the larger system. The department must practice openness to become a responsible and trustworthy representative of the people in the blueprinting

Architecture is a specialization that is both science and art. In effect, when it comes to selecting an architect for the national health information system, it is best to identify people and organizations that have done this before, and have failed and succeeded many times over. At the minimum, they should have documented everything, especially the failures so that the Philippine process can avoid the same pitfalls. Several countries have successfully crafted their Enterprise Architecture. Some of them are in Africa with direr situations than the Philippines. The Enterprise Architecture process is not cheap but it is also not impossible. Governance and leadership of DOH is a key component of the whole process. The resulting blueprint is called the “Health Sector Enterprise Architecture.” It will detail the major elements in the architecture, how they work within and with other elements in the larger health system. Once this sector-wide Enterprise Architecture is published, it can serve as a guide for organizations when they start building their own local health information systems from the large PhilHealth membership database to the rural health unit electronic medical records system. They can start confidently interacting with outside systems, knowing these systems are also compliant with the sector-wide
Enterprise Architecture.

So what’s next?

The DOH needs to carry this responsibility seriously and involve other stakeholders to make this happen. Health Secretary Enrique Ona has empowered Assistant Secretary Nemesio Gako to chair a multi-sectoral technical working group on information and communications technology for health (ICT4H). Collegially, they can come up with the sector-wide
Enterprise Architecture, which can then serve as a guide for all other stakeholders in the national health information system. DOH then shifts to technical assistance
and monitors if the blueprint is being implemented correctly. This may require re-orienting DOH into a regulatory and supervisory role (which is its primary mandate) rather than software development (which is not its core competency). More fundamentally, the more DOH creates the software, the less credible it becomes as a regulatory body on
information systems. To use another analogy, DOH should not be producing drugs because it may compromise its regulatory function
especially when its own drug fails the quality tests.

As a significant stakeholder in the larger health system, the private sector should be involved as soon as the organizational structure and processes for the sector-wide enterprise architecture efforts are clarified. This participation is crucial for the following reasons: first, the private sector has extensive experience with Enterprise
Architecture methodologies. Second, it recognizes the importance of the private sector in collecting and submitting data from their respective institutions. It is a well-accepted fact that a significant number of Filipinos access private healthcare facilities. Ignoring the data accrued from these facilities will result in epidemiologically
flawed analysis and we will not be able to see the complete picture of the country’s health situation. Lastly, they have the flexibility to implement the Enterprise Architecture and the accompanying standards in their local health systems. A true and sincere partnership with the private sector will result in faster deployments which can redound to more effective information systems on the ground.

In the end, if DOH does the right thing right now, Juan dela Cruz can enter any health facility and get the service he needs without worrying about whether it will be covered by PhilHealth or not. Repetitive lab tests are detected and avoided, and the health system is financed more viably because it is more efficient. Filipinos can now appreciate their health system, and begin to understand universal healthcare.

Any Juan will be happy to live in a home like this.

(Note that since this is an analogy, it is by no means perfect nor comprehensive. Its purpose is to pose a certain view of an abstract thing called the national health information system. Other views should be considered as well, but they should also be subjected to the same level of scrutiny that this will receive. The author’s contact details are Alvin Marcelo (alvin dot marcelo at gmail dot com).

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