N101 Nursing Informatics AY 2024-2025

Recently, a fellow student nurse drew flak after posting a video of a patient’s ECG monitor showing a flatline. This is not an isolated case, as immediately after, another intern became trending for posting a video of her performing CPR on an actual patient in the hospital. With that, one component that plays a critical role and is very evident  in the current healthcare system is the legislation, policy, and compliance in protecting patient health information. 

For instance, to ensure the utmost protection of the right to privacy of an individual and their health protection, the Department of Health (DOH) and all its stakeholders are guided by Republic Act 10173 or the Data Privacy Act of 2012. Stakeholders include DOH offices, bureaus, services, units and attached agencies, both government and private national and local health facilities, and healthcare providers. Chapter 8 of the act defines the penalties for noncompliance such as unauthorized processing of personal and sensitive information, unauthorized access or intentional breach, and malicious disclosure. 

While the mentioned incidents did not involve disclosure of actual health records, they still were not able to adhere to the standards protecting the patient’s privacy. This emphasizes the need for the strict enforcement of such laws and policies and monitoring of compliance by  all the members of the team.

References:

• Philippine eHealth Strategic Framework and Plan (PeHSFP) (2013, September 11). Retrieved from https://cdn.who.int/media/docs/default-source/digital-health-documents/global-observatory-on-digital-health/philippines_ehealth2013_2017.pdf?sfvrsn=327c0c01_3

• An Act Protecting Individual Personal Information in Information and Communications Systems in the Government and the Private Sector, Creating for this Purpose a National Privacy Commission, and for Other Purposes, Republic Act No. 10173  (2012, August 15)(Phil.),https://www.officialgazette.gov.ph/2012/08/15/republic-act-no-10173

One of the major problems in the healthcare system of the Philippines is the lack of necessary supplies, services, facilities, and professionals, which stems from the decrease in budget allocation for the health sector.

 The Philippine Daily Inquirer reported an 818 million peso cut on the four (4) significant facilities in the country (Lung Center of the Philippines (LCP), National Kidney and Transplant Institute (NKTI), Heart Center of the Philippines (HCP), and Philippine Children's Medical Center (PCMC)). Furthermore, there was also a decrease in budget allotment for the Department of Health (DOH), from 209 billion pesos to 199 billion pesos. Long before the execution of the budget cut, the Philippine healthcare delivery system was already experiencing limited capacity in handling the health concerns of the majority, therefore constraining the development of healthcare and limiting the care that our fellow Filipino patients deserve.

This is evident even in tertiary facilities like the Philippine General Hospital. As a student nurse, I have witnessed how doctors, nurses, and other healthcare workers limit the use of supplies, regardless of their necessity, due to the shortage that the institution is experiencing. Aside from that, patients also often endure their respective conditions as there is only a limited number of clients that hospitals can cater to daily since there are limited doctors, nurses, and even facilities. As a result, the necessary diagnoses, treatment, and/or management that one may immediately need are often delayed, delaying their recovery and probably aggravating their conditions. 

Thus, I am hopeful that someday, the officials will prioritize the community's needs, particularly concerning their health, focusing on disease prevention rather than treatment. Accordingly, "If the government wants health care to be truly accessible to every Filipino, it should put its money where its mouth is." (Philippine Daily Inquirer)

REFERENCES

Philippines eHealth Strategic Framework and Plan. 2013-2017. (n.d.). https://cdn.who.int/media/docs/default-source/digital-health-documents/global-observatory-on-digital-health/philippines_ehealth2013_2017.pdf?sfvrsn=327c0c01_3 

 Unkindest cuts on Health Budget. INQUIRER.net. (2023, September 10). https://opinion.inquirer.net/166192/unkindest-cuts-on-health-budget#ixzz8mufGGwVw

Leadership and governance are important components in ensuring the success of the eHealth Strategic Framework. Under this component, leaders and public servants are tasked to direct, coordinate, and manage eHealth agenda. In terms of operability, it is important that sufficient funding is provided to sustain the implementation of eHealth solutions. However, governance in the Philippines focuses more on political funding compared to health funding, which is reflected by a lack of discourse regarding budget cuts that affect tertiary hospitals like PGH. On this part, inadequacies in leadership and governance are very notable.

Human resources refer to the manpower or workforce available for the development and implementation of eHealth. The “manpower” may consist of people from varied health-related fields, such as health workers and health providers, information and communication technology workers, and others. In eHealth, the role of human resources is geared towards creating change and adoption – they focus on expanding the scale of eHealthy by encouraging relevant stakeholders to adopt eHealth solutions.

In the current healthcare system, there are programs aimed towards promoting capacity building, such as the eTURO program, which uses technology as a tool for eHealth education and health-related training programs.

However, there are challenges in solving the shortage of human health resources, especially those in remote or rural areas and in standardizing the health information that is relayed to different healthcare providers. In bridging these gaps, resources must be allocated towards further education and training of personnel, such as with the creation of training centers and eHealth communication programs.

References

eTURO - eHealthPH. (n.d.). eHealthPH. https://ehealth.ph/e-turo/

Philippine eHealth Strategic Framework and Plan (PeHSFP) (2013, September 11). https://cdn.who.int/media/docs/default-source/digital-health-documents/global-observatory-on-digital-health/philippines_ehealth2013_2017.pdf?sfvrsn=327c0c01_3

In the current healthcare system, the integration of eHealth is still evolving, with its components reflected to varying degrees, particularly in resource-limited settings like the Philippines. Globally, eHealth is seen through digital tools like EMRs, telemedicine, and health data management systems. These components aim to streamline healthcare delivery, enhance patient engagement, and improve overall outcomes. However, the extent of integration often depends on the health system’s infrastructure, training, and leadership, as outlined by the Donabedian SPO model.

In the Philippines, the government’s efforts to implement eHealth are visible in programs like the Philippine eHealth Strategic Framework and Plan, which sought to introduce telemedicine, EMRs, and other digital tools to address healthcare gaps. According to studies by Evio and Bonito (2024) and Marcelo et al. (2022), components of eHealth such as telemedicine (via devices like RxBox) and EMR adoption have been introduced in certain municipalities and primary care health centers. These efforts aim to improve access to healthcare, particularly in remote areas.

A strong example of effective eHealth implementation is the use of the RADISH platform at the Philippine General Hospital, which highlights the critical need for improving healthcare professionals' digital literacy and skills. Training staff to utilize systems like RADISH empowers them to efficiently monitor patient conditions, update records, and enhance communication between providers. This not only promotes the seamless integration of eHealth into everyday clinical workflows but also ensures that healthcare providers are equipped to meet the growing digital demands of modern healthcare. Additionally, it supports patient self-management by making health information more accessible and transparent.

References:

Remember at the peak of the COVID-19 pandemic in 2020, the country’s healthcare system was exposed to a critical vulnerability because of its lack of human resources such as physicians and nurses. This was evident in how prevalent the burnout among healthcare professionals during that time. I still remember hearing on the news and seeing on social media platforms how exhausted our healthcare teams were as they handled and treated the influx of not only the COVID-19 patients but also those with other illnesses. Some of those workers even fell ill and worse some died which further decreased the already limited manpower for health. Imagine the impact that has on the country’s healthcare system. Undoubtedly that shortage resulted to an increased burden on the remaining healthcare workers who were already shouldering a heavy workload thereby affecting the overall effectiveness of the healthcare system. Just like any system, it heavily relies on the people behind those work, as the eHealth framework describes, human resources are the ones who ‘develop, operate, and implement.’ When the health workforce/manpower is shortened, the health system is strained and burdened.

Reference

Philippine eHealth Strategic Framework and Plan (PeHSFP) (2013, September 11). https://cdn.who.int/media/docs/default-source/digital-health-documents/global-observatory-on-digital-health/philippines_ehealth2013_2017.pdf?sfvrsn=327c0c01_3

1. Our government takes on its role and responsibility to foster an “enabling environment for the use of IT in healthcare” through the use of the Philippine eHealth Strategic Framework and Plan (PeHSFP) solidified by increasing advocacies in electronic health application transition to digitize data storage in healthcare (DOH-DOST, 2016). However, their emphasis on a “widespread access to health care services and health information” lacks its ideal reality to thousands of rural health units lacking in resources to solidify this aim. Research by Ongkeko, et.al. (2016), finds challenges in implementing Community Health Information and Tracking System (CHITS) in topographically-challenged areas, especially in the provinces, where electricity outage tops the reason for implementation failure. Telemedicine, where delivery of health and education to disadvantaged communities are provided despite the distance, also had issues to power supplies and inaccessibility to digital infrastructures upon low financing for budget (Marcelo, et.al., 2022). These current issues at hand is what reflects in our current healthcare system- a lack of recognition and government body to advocate for these eHealth innovations despite their “goals” to achieve the target of PeHSFP. In this perspective, we see the significance of a policy making body to institutionalize these innovations upon the successes it can bring to our country’s healthcare delivery system. 

2. References: 

   1. DOH-DOST (2016). A Briefer on the Philippine eHealth Strategic Framework and Plan. https://www.pchrd.dost.gov.ph/wp-content/uploads/2022/03/plenary-philippine-ehealth-strategic-framework-and-plan.pdf 

   2. Marcelo, P. et al., (2022). Factors Affecting Adoption of a Telemedicine Device by Primary Care Health Workers in the Philippines. Acta Medica Philippina, 56(11). https://doi.org/10.47895/amp.vi0.3709

   3. Ongkeko, Jr., A. M., Fernandez, R. G., Sylim, P. G., Amoranto, A. J. P., Ronquillo-Sy, M.-I., Santos, A. D. F., Fabia, J. G., & Fernandez-Marcelo, P. H. (2016). Community Health Information and Tracking System (CHITS): Lessons from Eight Years Implementation of a Pioneer Electronic Medical Record System in the Philippines. Acta Medica Philippina, 50(4). https://doi.org/10.47895/amp.v50i4.769 

One essential component of the eHealth framework is Standards and Interoperability, which ensures seamless communication and data sharing between healthcare providers and institutions (Philippine eHealth Strategic Framework and Plan, 2013). This is reflected in the increasing use of electronic health records (EHRs) in the country, which are designed to improve healthcare delivery by making patient data more accessible and reducing errors in record-keeping. However, there are still challenges, such as the absence of a nationwide platform for both public and private institutions, which limit the full potential of interoperability (Lu & Marcelo, 2021).

The various eHealth solutions being created and put into action in the Philippines, such as the EHRs, indicate the possibility of enhancing healthcare delivery systems. Despite this, there are several challenges in the utilization and execution of eHealth, especially when it comes to the component of Standards and Interoperability. As discussed by Evio and Bonito (2024), there are many different factors that affect the incorporation of ICT in the current healthcare system. Contextual factors consist of individual traits, such as demographics, skills, and experience. Process-related factors include the ways in which implementation is done, both top-down and bottom-up strategies, and managing resources within health facilities. Additionally, content-specific factors refer to the nature of eHealth in sharing information with other systems, such as adaptability, accessibility, and sustainability. All of these factors play a significant role in determining the success of eHealth initiatives in the Philippines.

The Philippine eHealth Strategic Framework recognizes the need for continued development of eHealth systems, which should mainly focus on these different factors, to ensure that standards and interoperability goals are met across the healthcare sector.

References:

• Evio, B. D., & Bonito, S. R. (2024). Formative Evaluation of the Implementation of eHealth in the Philippines: A Qualitative Study. Acta Medica Philippina, 58(12), 35–47. https://doi.org/10.47895/amp.v58i12.9289
• Lu, J. L., & Marcelo, P. G. F. (2021). Assessment of the Context for eHealth Development in the Philippines: A Work in Progress from 1997 to 2020. Acta Medica Philippina, 55(6). https://doi.org/10.47895/amp.v55i6.3208
• Philippine eHealth Strategic Framework and Plan (PeHSFP). (2013). https://cdn.who.int/media/docs/default-source/digital-health-documents/global-observatory-on-digital-health/philippines_ehealth2013_2017.pdf?sfvrsn=327c0c01_3