The Role of IT Governance in Supporting the National

eHealth Strategy

Teodoro Herbosa, MD, FPCS, COBIT5 (F)

Outline

• eHealth before IT governance

• Key events triggering IT governance

• eHealth with IT governance

History of HMIS

• Philippine HMIS go as far back as the 1980's

• Because of unreliability of manual recording systems, data was not trusted as much

• In 1990, data collection systems went from bad to worse because of the devolution of healthcare to local governments

Data/health information comes from disparate systems and locations. Problems are:

Different Data Formats Lack Data Harmonization Data Quality Problems in terms of reliability, timeliness, accuracy, and

completeness

New Patient - Recording of Patient’s Master/Demographic Data - Recording of Past Medical Histories - Taking of Vital Signs - Doctor’s Orders - Observations, Assessment - Findings / Diagnosis

Patient

Health Facility 1

Health Facility 2

Recording of Patient’s Master/Demographic Data and Recording of Past Medical Histories are repeated.

Challenges with Manual Systems

• Inaccurate

• Delayed

• Non-standardized

• Differing meanings for the same terms

• Different terms for the same meaning

Key Events• Aquino Health Agenda pushes for universal health

coverage

• Minister of Health mandates the use of ICT to deliver the promises of UHC

• Department of Budget and Management restricts IT budget (will only fund shared services, integration of multiple agencies)

• PhilHealth requires submission of electronic data for reimbursement.

Improved Health especially for the

Poor and Vulnerable

Secure access to quality care at

facilities

Achieve the public health MDGs

Provide financial risk protection

INTERVENTIONS OF CARE

Primar

y Pre

vent

ion

and H

ealth

Promoti

on Curative Health

Care

Secondary Prevention and Primary Care

IMPROVED HEALTH GOVERNANCE

IMPROVED HEALTH GOVERNANCE

What Happened Next?

• DOH and DOST update national eHealth strategy vis-a-vis WHO-ITU toolkit

What Happened Next?• DOH and DOST update national eHealth strategy vis-

a-vis WHO-ITU toolkit

• DOH invites PhilHealth and DOST to craft an integrated services project (Philippine Health Information Exchange)

• DOH and PhilHealth co-define the minimum dataset

• DOH convenes EMR implementers to discuss minimum data set and reporting requirements

Adoption of IT Governance

• Decision made October 9, 2013

• COBIT5 (Control Objectives for Information and related Technologies) www.isaca.org

eHealth with IT Governance

• Clear organizational structure

• Clear rules for making decisions

• All issues get resolved, even if it means an emergency meeting by Ministers is needed

National eHealth Steering Committee

Technical Working Group

Health Data Standards

Experts Group

Health Data Security and Privacy Experts

Group

DOH-PhilHealth-DOST

eHealth Stakeholders (On-call Resource

Persons)

Steering Committee• Adopts an IT governance framework (COBIT5)

• Role is to Evaluate, Direct, and Monitor

• Define the expected benefits, acceptable risks, and ensure available resources

• Assigns the Technical Working Group serves as the workhorse for the ministers

• Assigns the Program Management office to perform day-to-day operations.

Technical Working Group• Aligns, plans, and organizes the activities in

support of the benefits, risks, and resources

• Build, acquire, implement solutions

• Deliver, service, and support

• Reports to Steering Committee

• Supervises Program Management Office

Program Management Office

• Implement the instructions of TWG

• Prepare for meetings

• Maintain documentation

• Other activities set by TWG

Status: Philippine eHealth Strategic Framework and Plan (May 15, 2014)

LEGEND:

DOH/PhilHealth

DOST

TWG / PMO

TWG / PMO TWG / PMO

SC / TWG

TWG / PMO

MITHI, Standards,

Privacy ExpertsPHIEMITHI

iGovPhil

Warehouse NCD registry HCI Portal

Green – task is in control

Yellow – task is experiencing delay but in control by TWG

Red – task is delayed and requires Steering Committee intervention

Capacity-building,

competency standards

Advantages of IT Governance

• Makes it simpler for ministers and officers to understand the whole eHealth program

• Designates specific roles and responsibilities to different stakeholders and monitors them

• Creates a feedback mechanism that shows ministers how IT is delivering value to the ministry

Philippines eHealth Components 2014-2020

Philippine Health Sector Roadmap 2014 to 2016

Revised May 13, 2014

Summary• For national eHealth strategies, IT governance

frameworks like COBIT5, are important because they simplify and clarify the roles of different stakeholders

• The first key decision by the ministers is to adopt an IT governance framework

• Once adopted, there will now be a mechanism to plan and implement the national eHealth strategy