Doctors, patients make digital shift

By Jennibeth B. Reforsado

Cora, a midwife employed in a rural health unit, receives patients on regular days.

But for three days every week, she does the opposite: she travels to far-flung villages to check on those who need medical attention.

Most of the time she has to deal with huge amounts of paperwork and occasionally gets frustrated by bureaucratic procedures involved in transferring patients to hospitals more equipped to treat them.

Cora’s story is a reenactment of a narrative featured in a promotional short film produced by a telecommunications company for its digital health product.

Based on real-life experiences, the film vividly depicts the regular challenges a rural health worker encounters in a traditional health care setting. However, with the country’s rapidly increasing development and adoption of digital technologies in the medical field, this, hopefully, may soon be a thing of the past.

More patients going digital

Multinational consulting firm McKinsey & Company, in its “Healthcare’s digital future” report published in July 2014, recognized that patients worldwide are even becoming more and more comfortable in using digital health care services. It advised that health care systems, payors, and providers should therefore go “all in” on their digital strategies.

Local key health players, both in public and private sectors, have been taking this suggestion to heart and have long deployed several technologies that are starting to make an impact.

“[There already are] databases like Watching Over Mothers and Babies, [which] curates maternal and neonatal morbidity and mortality data; RxBox, a portable telehealth device [that] allows health care professionals in remote areas access to specialists by measuring patient vital signs and transmitting them wirelessly; [and] e-Hatid, an android-run application [that] allows health care professionals in [local government units] to access health information,” Dr. Maria Minerva P. Calimag, immediate past president of the Philippine Medical Association, said in an e-mail.

She added that many patients, without citing specific figures, have been benefited by these digital health initiatives.

The government, through the Department of Health (DoH) and the Department of Science and Technology (DoST), has put in place the “Philippines eHealth Strategic Framework and Plan” to serve as the road map for the adoption in health care of these digital technologies. The two government agencies also inked a Joint National Governance on e-Health to achieve the set outcomes of the e-Health framework.

In implementing their goals, closer collaboration with private companies has been established.

Cloud-based medical records allow easy access

In 2010, DoH endorsed to the rural health units and municipal health offices in Iloilo and Cebu the cloud-based electronic medical record (EMR) system developed by Smart Communications, Inc.

Secured Health Information Network Exchange or SHINE, currently rebranded as SHINE OS+ to signify its open-source nature, is Smart Communications foray into digital health that can be used by health care providers. The company has recently partnered with the Ateneo Javascript Wireless Competency Center to further develop the software.

Offered for free and can be accessed in offline mode in case of weak mobile connections, the program has so far tallied 98,179 patient records and has benefited 518 end-users and 182 facilities in the provinces of Iloilo, Cebu, Bacolod, Rizal, and some parts of Metro Manila.

Jill M. Lava, manager of Community Partnerships, Public Affairs Group of Smart Communications, believes the initiative has thus far attained its goal based on the patronage it has attracted.

“In my opinion, it has made significant impact to the smaller communities that have shifted from manual record-keeping of patients to the said cloud-based EMR that allowed automatic storage of information of its community members for easy access in times of emergencies, calamities, or theft,” she said in a June interview. She added that it has also helped LGUs by providing them with speedier access to health data for the improvement of health conditions in their communities.

One SHINE program partner concurs.

Dr. Ianne Jireh Ramos-Cañizares, municipal health officer of Samboan, Cebu under the Doctors to the Barrios program of DoH, recognizes the many advantages that SHINE has been able to provide her, particularly in efficiently tracking and monitoring her patients.

“SHINE is indeed very useful. We’ve been telling our patients about it and they, too, are amazed by its potentials,” she said in a phone interview.

Challenges of digital health care

SHINE and the many other existing digital health innovations have made significant inroads in revolutionizing health care in the country but there’s no denying that roadblocks exist.

Dr. Cañizares, for one, referred to the Philippine Health Information Exchange (PHIE) not being implemented yet.

PHIE, according to Dr. Calimag of PMA, is intended to archive big data on health in the country and will be made available for viewing by authorized health care providers. The memorandum of agreement for PHIE was signed in March last year through collaboration between DoST, the Philippine Council for Health Research and Development, DoH, the Philippine Health Insurance Commission, and the Information Communications and Technology Office of DoST.

“The initiative hopes to provide accurate and reliable real-time data that eliminates duplication and allows for standardization, which will serve the purpose of research for health policy generation and budget allocation especially for diseases with the highest burden. With the PHIE in place, patients can transfer from one hospital to another without having to bring hard copies of his laboratory results with him. Information systems in laboratories and pharmacies will communicate with electronic medical records in hospitals to avoid duplication of patient records,” Dr. Calimag explained.

She also cited that the implementing rules and regulations of the signed Joint Administrative Order on the Implementation of the PHIE and the Joint Administrative Order on the Privacy Implementation Guidelines are still being drafted. The National Telehealth Bill, which has been revised many times, is also pending in Senate and Congress.

Smart Communications’ Ms. Lava also considered the lack of clear and solid government policies, guidelines, and protocols around e-Health as one of the challenges that hamper the mainstream use of digital technologies in health care.

Apart from that, she added that, with SHINE, they still have to cope with technical illiteracy as there are doctors, particularly of the older generation, who are quite hesitant to learn new technology. The limited hardware and software infrastructure, including network, also remains one of their problems.

The Philippines still has a long way to go toward achieving more efficient and effective health systems through digital health, but it is definitely off to a good start.

Jennibeth B. Reforsado worked as a proofreader for BusinessWorld for three years. She is now a writer-in-training for the Special Features Section.