Power Distance

Earlier this week, I was fortunate to sit in a small group session at work with our Regional Director for a catch-up and discussion about a cross-cultural issue called Power Distance. In any organization across nations, it is not unusual to see authorities or top management to decide or provide directives to the lower level employees.

Shaping Health Informatics

When we started the semester last August, I still don’t have any idea what we will be doing for the graduate course. Way back college, I was used to taking class in the typical set-up of the professor teaching the lesson while the students just listen. I still vividly remember the first day of class when our professor, Dra Iris Isip-Tan, told us how we will be learning for HI 201

mHealth

According to a study conducted last March 2015 by the National Telehealth Center, it was said that the Philippines is the social media capital of the world. Out of the total population in the country, 115 million are mobile users (basing on the number of mobile subscriptions) and 32 million have access to internet. Most of them  use mobile internet to access social media sites such as Facebook, Twitter, Viber, Instagram, etc. With continuous increasing number of users, numerous innovative application are developed to assist Health Care Providers in providing health care by the use of handheld devices; most of the tasks include but not limited to: point of care health record maintenance and secured access by authorized users; information and time management; communications and consulting; reference and information gathering (CDSS); patient management and monitoring; clinical decision-making; and medical education and training (Ventola, 2014).

This week’s driving question, how can mobile applications be useful in primary care? I picked the project for my HI210 (System Analysis and Design) which focused on providing care during time of emergency.

Legal and Regulatory Issues in e-Health

The proposed Data Privacy Act of 2012 IRR has been around for two years during the Aquino’s term but it hasn’t implemented yet until last August. What does Data Privacy Act covers? It is a law that seeks to protect the all personal information (PI) collected by the Philippine government and private sectors in the country. The IRR contains the covered data privacy principles, how the personal data be handled and processed according to what is lawful, measures to secure and protect personal data and sensitive personal information in the government, rights of the data subjects, and the data breach notification.

This week’s driving question, is the Data Privacy Act adequate to protect confidential health information?

Telehealth in the Philippines

In today’s rise of technology, the healthcare is following suit in adapting different ways in automation, putting medical records and documentations in electronic format, and other application in delivering healthcare worldwide. To look at it in myopic view, it would be great to take advantage this adaptation since the Philippines is an archipelago that will strongly benefit the great number of remote rural areas that are in dire need of healthcare but do not have access due to the following factors:

Privacy, Confidentiality, Security and Trust

As previously mentioned before, one of the problems that are being faced in the use and implementation of health information systems is the privacy and security. It has been a stigma for a quite long time that sharing of confidential and personal health information can result to identity theft if the exchange of the information is not secured enough. However,  data subjects (a.k.a persons whose personal information is being processed) should be advised and informed that the use of their information should only be used as consented and under the protection of the law.

For this week’s topic, we are to discuss what are the policies in place to protect the Filipino patient’s privacy and confidentiality of health information? We have different laws implemented for different areas. However, we do not specifically have the one for medical information of the patients. See below for some of the Republic Acts in the Philippines:

1. Bill of Rights, Philippine Constitution 1987
2. Republic Act 386 – Civil Code of the Philippines
3. Republic Act 9344 – Juvenile Justice and Welfare Act
4. Republic Act 8505 – Rape Victim Assistance and Protection Act of 1998
5. Republic Act 8504 – Philippine AIDS Prevention and Control Act of 1998
6. Republic Act 9262 – The Anti-Violence Against Women and Children Act of 2004
7. Republic Act 9165 – Comprehensive Dangerous Drugs Act
8. Republic Act 7875 – National Health Insurance Act of 1995
9. Republic Act 3185 – The Revised Penal Code
10. Republic Act 10173 – Data Privacy Act of 2012
11. Republic Act 3573 – Law of Reporting of Communicable Diseases
12. Republic Act 2383 – The Medical Act of 1959
13. Hospital Code of Ethics
14. Department of Health Guidelines in the Planning and Design of a Hospital and other Health Facilities (2004)
15. Republic Act 8792 – Electronic Commerce Act of 2000; An Act Providing for the Recognition and Use of Electronic Commercial and Non-Commercial Transactions and Documents, Penalties for Unlawful Use Thereof and Other Purposes
16. Republic Act 5921 – An Act Regulating the Practice of Pharmacy and Setting Standards of Pharmaceutical Education in the Philippines and for Other Purposes
17. Republic Act 10175 – Cybercrime Prevention Act of 2012

As part of this week activity, we get to pick a hospital and review their privacy policy. However, on my end, most of the private hospital I visited for an interview are very much strict in releasing information. I will be providing insights basing on my observation during my stay in the area.

Patients that are currently confined in the ward, most of their medical information like the bar-coded doctor’s and nurse’s notes, consent forms, Operating procedure, medicine monitoring sheets, medical histories are compiled in the Patient’s Chart. The only group persons who can access to the information are the attending doctors and the nurses on duty on the ward. This medical information is confidential and only the authorized people can access it. It is privately stored in the nurse’s station during the patient’s confinement.

Once the patient is discharged, all of the medical documents from the ward are for safekeeping in the Medical Records department. Authorized persons who access them are MR officers and the attending doctors of the patients. If the patient would want to retrieve a copy of their records, it would only be released if there is a written consent of the patient accompanied with two valid IDs or if there would be a representative, written authorization letter, proof of degree of relationship (i.e., NSO Birth Certificate, Marriage Certificate) and representative’s valid IDs. Otherwise, no information will be released.

Since the provider has been using health information system, primary users of the systems have username and passwords for access. Although ideally there should be a limit or restrictions on up what extent they can access in the system based on their work responsibilities.

References:

1. Summary of the HIPAA Privacy Rule http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html
2. Summary of the HIPAA Security Rule http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html
3. Rodriguez L and Johnson MD. Patient Privacy: A Guide for Providers. http://www.medscape.org/viewarticle/781892_transcript
4. Rodriguez L and Pritts J. HIPAA and You: Building a Culture of Compliance. http://www.medscape.org/viewarticle/762170_transcript
5. Antonio, Marcelo. Health Information Privacy in the Philippines. http://aehin.hingx.org/Share/Details/2044

Knowledge Management and Information Retrieval

In the previous posts, Health Informatics is defined as a science that deals with information or data with the use of information and computer science/technology. However, data and information are building blocks and it might be a challenge for organizations when the obtained data and information are:

Clinical Decision Support System

As part of improving the delivery of health care system, there should be enough features that will provide the users, particularly the health care providers, enough details that will aid them in decisions when it comes to patient care. One of the key features a system would have is the Clinical Decision Support System. In literature, it is defined as a software or features that enables the patients or the clinicians with mapped clinical knowledge and patient-related information, appropriately organized, filtered and presented to generate data that would influence health decisions and choices to enhance patient care. To maximize the reliability of the system, there would be a need for the following:

Standards and Interoperability

On the previous weeks, we have discussed different ways on how to store medical records electronically. Either be stored through a Provider’s Health Information System or for personal use by the utilization of third-party PHR applications. To reiterate the goal of e-Health—be it on the local or worldwide level—is to have quality access to health care for all, and for that to be achieved, the convenience of timely access for patient’s information through Health Information Systems at any given point of care affects how different collaborating Health Care Providers (HCP) provide informed decisions and individualized care basing on accurate health information.

Due to increased number of different Health Information Systems being used by different health care facilities, it was identified that most of them are based on different data formats and structures, has incompatible operating systems, application servers, and databases. What does that mean? It means that the HIS are fragmented like isolated islands (like the Philippine archipelago, right?) and the information stored stays only within the vicinity of the facility because the system does not have the ability to share the information to another facility (for health care collaboration purposes). It lacks the functionality of interoperability.

For this week, we will be focusing on the aspect of Standards and Interoperability. Before we dive in the driving question, let us define what is interoperability?

Personal Health Record

Last week, we have discussed some details about Electronic Health Records (EHR) and some of the challenges encountered on the implementation in health care facilities. You may read it on the previous post if you haven’t.

As the concept of automation of the medical records, there has been an information system developed for the personal use of the patients. Personal Health Record, or PHR, is an electronic application—can be either web-based and/or mobile application—in which an individual can input their health information that can be easily accessed, managed; it can also be shared to others whom they authorized to view (i.e., health care providers, family members). Of course, this should be done a secure and private environment since the information within is confidential. In addition to that, PHR is separate and does not replace the legal record of any health care provider (HealthIT, 2013).

According to HealthIT.gov,