By Romulo F. Nieva Jr., RN, MHSS

PH’s health info system needs fixing


THE Covid-19 pandemic highlights the crucial role of the health information system (HIS). It has shown us the weakness of the entire HIS of the country and how the Department of Health (DOH) has been grappling with it. This problem is not new as advocates have been pointing this out over the past several years and even previous research studies have consistently emphasized the need to reform the HIS. I had previous experiences dealing with the DOH system and I know how complex and frustrating it is. And I’m sure it’s a lot more exhausting for DOH technical staff who have been working for the system, and the inadequacies are a product of structural gaps that are beyond their control.  

To efficiently manage a pandemic like this, the scope, timeliness, usability, and interoperability of HIS efforts are critical now more than ever. A 2011 Philippine Health Systems Review noted that the national and local HIS were poorly integrated and weakly governed. Thus, the present fragmented data ecosystem must be systematically changed to address the current pandemic and future outbreaks. Capturing and utilizing data that support timely decision-making is essential for any effective information system used in a public health setting. Such reliable and timely information, and not merely health data, is critical for effective management and implementation in an extraordinary time that would overburden the larger health systems.

Timely data for early decision making

One of the major implications of epidemics is straining the healthcare system. If it goes unmanaged, many Covid-19 patients will need hospitalization at the same time, draining the capacity of hospitals. This problem could be mitigated if harmonized HIS were widely adopted by all public and private health facilities including data collection units like airports and other local borders. These technologies would allow health workers to prioritize those who need immediate care and quarantine arrangements. Moreover, healthcare providers could connect with many more asymptomatic patients through telehealth technologies and reduce unnecessary trips to emergency rooms. This would significantly lessen redundant traffic and frequent contact among staff and patients.  

The major challenge of the current HIS is that multiple platforms and channels collecting data at different levels. This situation could impede the timeliness of data reporting and decision-making. This reminds me of my previous public health project with local government units (LGUs) and I observed that LGUs had used different platforms- some were using digital programs of DOH or in partnership with private organizations while others were still doing it manually. So, it’s not surprising to see reports about the discrepancy between raw data and aggregated data reported at different levels and delays in the submission of reports. The pandemic has somehow stretched the current health sector capacity including information systems.

Strengthening information governance  

The country’s health system is unarguably overdue for a real-time, technology-driven, surveillance, and reporting infrastructure to respond effectively to public health emergencies. A 2018 report on the Philippine health systems indicated that given DOH had faced with the critical challenge of integrating all existing HIS and data sources, and the inadequacy of a governance structure on information and communication technology (ICT) for the health sector, the agency issued standard policies, procedures and guidelines governing all ICT-related work in 2005. But despite these enormous efforts, data interoperability, even among healthcare facilities, remains a significant problem. Data sharing across platforms and with patients is essential. For instance, data on locations of confirmed cases, diagnostic tests, the denominator of total tests administered, and many other streams of information must flow as freely as possible without compromising privacy or other essential elements of ethical care.

The DOH attempted to solve this fragmentation by developing the Philippine Integrated Disease Surveillance and Response Project that aims to enable early detection, reporting, investigation, assessment, and prompt response to emerging diseases, epidemics, and other public health threats. However, the experience of vertical information systems at the DOH provides a concrete example of the challenges associated with the lack of harmonized HIS.  Another weak spot is the lack of integrated systems with private sector information, which forms a huge amount of transactions with health providers. This is partly due to weak enforcement of information-sharing regulations and a preference for proprietary software in private facilities, which restricts the ability of the DOH to obtain assistance from other IT specialists in other sectors, based on the 2018 Philippine Health Systems Review.

A call to action

Apart from the needed infrastructure for robust information collection and exchange, many structural and social barriers must be overcome before the country can realize the full potential of the system. The success of the programs hinges on real-time collection and analysis of data as well as instant decision-making and communication to LGUs. A nationwide health information exchange could prove to be vital for early identification and even prediction of the centers of the epidemics. Communication and exchange of data among the national government, private facilities, and the local health authorities are never more important than during public health disasters like epidemics.


About the Columnist

Image of Romulo F. Nieva Jr., RN, MHSS

Romulo Nieva Jr. is a public health professional and currently a doctoral research scholar at the University of Otago in New Zealand.