This blog is the first in a series where we examine the state of HIS use among Philippine hospitals.
Information systems in healthcare have evolved tremendously over the years. The use of some level of information management has become virtually indispensable among care providers, facilities, and health systems. Around the world, the current pandemic has placed a spotlight on healthcare. It also set a level of scrutiny on how care is safely and efficiently provided. In this era, it generally involves the use of tools and IT systems.
WHO states that what constitutes its importance is that, “such information systems serve multiple users and a wide array of purposes that can be summarized as the generation of information to enable decision-makers at all levels of the health system to identify problems and needs, make evidence-based decisions on health policy and allocate scarce resources optimally.”
Health information systems are called upon to enable tracking along the continuum of inputs to the health system, from processes, outputs, as well as outcomes and impact.
Yet, owing to prohibitive costs and competing priorities, few developing countries have hospital and care facilities that have sufficiently strong and effective health information systems to meet all these diverse and important information needs.
Like a growing enterprise, achieving a level of care system requires carefully thought out strategies. These involve starting with organizational objectives before even thinking about core features. It also means assessing and building up support capabilities while considering the tools that will help lead the team towards its goal.
Leading healthcare analytics company Health Catalyst, has brilliantly laid out a historical table that helps hospitals figure out which stage they are in their healthcare systems.
The main healthcare drivers in this era were Medicare and Medicaid. The IT drivers were expensive mainframes and storage. Because computers and storage were so large and expensive, hospitals typically shared a mainframe. Shared hospital accounting systems were the principal applications emerging in this environment.
One of the main healthcare drivers in this era was the need to do a better job communicating between departments (ADT, order communications, and results review) and the need for discrete departmental systems (e.g., clinical lab, pharmacy). The reduction of hardware size allowed the installation of computers in a single department without environmental controls. As a result, departmental systems proliferated. Unfortunately, these transactional systems, embedded in individual departments, were typically islands unto themselves.
Healthcare drivers were heavily tied to DRGs and reimbursement. For the first time, hospitals needed to pull significant information from both clinical and financial systems to be reimbursed. At the same time, personal computers, widespread, non-traditional software applications, and networking solutions entered the market. As a result, hospitals began integrating applications so financial and clinical systems could interact in a limited way.
In this decade, competition and consolidation drove healthcare, along with the need to integrate hospitals, providers, and managed care. From an IT perspective, hospitals now had access to broad, distributed computing systems and robust networks. Therefore, we created an integrated delivery network (IDN)-like integration, including the impetus to integrate data and reporting.
The main healthcare drivers were increased integration and the beginnings of outcomes-based reimbursement. We now had enough technology and bedside clinical applications installed to make a serious run at commercial, real-time clinical decision support.
The information above gives us a concrete way to frame where most Philippine hospitals are in their hospital information systems journey — which more or less cuts and jumps through the different periods while also dependent on the level of and type of hospital organization (primary, secondary, tertiary and teaching) to which they belong.
It is also good to point out that several factors mainly influence part of the adoption of these systems in local settings (approximating the following in order of importance):
Availability of innovation
For the most part, Philippine hospitals were mostly using systems primarily supporting ADT and other operational requirements. While leading hospitals have blazed a trail of their own by benchmarking their systems globally, most had systems that were mostly siloed or islands among themselves. Using paper, these hospitals barely even touch and encode clinical data. Such practice leaves doctors and care professionals to depend solely on their own competencies, sorting through paper medical records, and delivering successful outcomes against the growing complexities of providing care.
But lately, things have been accelerating towards the adoption of better systems that require substantial clinical data because of government mandates related to DOH EMR compliance and Philhealth financial reimbursements.
Modern requirements subtly push Philippine hospitals to make use of electronic medical records for reporting statistics. Some of these include the renewal of licenses as well as providing correct clinical data to support claims reimbursements. The outcome is multi-fold as this forces Philippine healthcare to shift from paper to electronic. It also promotes increased use of data in providing care and upgrade to systems that make better use of IT. Implementing these technologies will reduce manual errors and manage care complexities. Thus, leading to more team collaboration.
So, can we say that the use of better hospital systems in the country is making progress? Tell us what you think!
In another article, we will discuss the available options for hospitals that aspire to step up in their healthcare proposition. As well as differentiate themselves against the competition using IT innovation.
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