Information Technology moves the Philippines toward universal health coverage May 28, 2013

An interview with Dr. Alvin Marcelo, senior vice president and chief information officer of Philhealth

An essential element of health information management is the information technology (IT) behind it. Both in the U.S. and around the world, policymakers are working to define the regulations and standards for health IT.

Alvin Marcelo, MD, senior vice president and chief information officer of the Philippine Health Insurance Corporation (PhilHealth) and member of the JLN Information Technology track, discusses the advantages and challenges to overseeing health information management for a nation.

Jennifer Masters: One of the core IT working group activities was geared towards interoperability. Could you speak to the importance of interoperability and whether there are any efforts being made to standardize operations?

Alvin Marcelo: I think standardization is an important and necessary prerequisite for interoperability. There is no one system that can actually meet the needs of every type of stakeholder. When people start realizing that the monolithic model doesn’t work, then every stakeholder begins building their own specific system and they exchange information ineffectively and inefficiently with each other until interoperability comes into play. You want to make your health software very useful for stakeholders, but then you also have a very diverse set of stakeholders and a very diverse set of software applications, so the real challenge to interoperability is in getting these diverse systems to communicate with each other in a consistent manner. Standards are what you need so that these different diverse software applications can be guided on how to talk to each other.

JM: Are you taking any specific efforts to create standards or is there an existing standards set you are trying to follow?

AM: We’re working to establish the building blocks for the Open Health Information Exchange (OHIE) that’s making news today in Rwanda. It would have four standard registries—clients, providers, facilities, and terminology. That is the model of what we’re building right now. It’s not for facility-to-facility interactions but more for compliance reports from facilities to PhilHealth or facilities to the Ministry of Health. We’re just trying to get the essential components of OHIE working together for the very simple but important task of submitting regular reports to the Ministry and to PhilHealth. Once we do that, since we’ve selected the standards and the framework of OHIE, then we can start adding compliance into the system. We will use the same platform for other purposes, like tracking prescriptions or electronic medical records exchange, or electronic laboratory results exchange. The goal for 2013 is build OHIE according to Rwandan specifications and use it for the very simple business case of submitting routine reports.

JM: In building a system like this, is data security something that’s taken into consideration?

AM: Yes, data security must be built into the system by default because we’re talking about personal health information. There must be security, but at the same time, it might not be the same level of security that you have right now in the U.S. or in Europe. It might be a security mechanism that is good enough to ensure individuals that these records are well managed and to allow communication to happen, but without overburdening the engineers and the health professionals. You really need to find the sweet spot, so to speak, where we have enough security to assure patients that our data are not being thrown around left and right to whoever has access to the technology but also enabling the facilities to exchange data without having to repeat all the efforts that have been done in the other facilities.

How are you collecting data on fraud? Join the Member Portal to share your insights with Dr. Marcelo and other JLN members.

JM: Do you find that the Philippines are equipped with the human resource capacities to manage these systems?

AM: What’s ironic is that a lot of U.S. facilities actually outsource their health information management to IT companies that are operating inside the Philippines. We have the local knowledge to manage these systems, but I think if we start tapping into these human resources we will need to take on the international compliance strictness of the American system. The IT vendors that are operating locally on behalf of American facilities are saying there must be an easier way for us to do this here for the Philippines, so that is what we need to work on. We have adequate engineering resources but what we lack right now is policy. What we really need are human resources for health policy formulation.

JM: What additional topics would you like to see addressed at JLN meetings?

AM: One of the things I would like to be shared is collecting data on fraud. I think that’s one of the areas we want information technology to address and one very clear area where cost benefit can be realized. Investing in IT is much cheaper than the cost of the fraud, so the money that you’re losing from fraud helps build the case for investing in IT. Another thing I would to like see shared is information on IT governance in general, and specifically on outsourcing. How do you actually outsource specific services that you know aren’t within your competencies but are crucial to the basic operations of your company? At our insurance corporation, we make policies and regulate health insurance in our country but we’re not an IT company. We don’t have enough resources to actually run a high-tech IT capable information system. So can we outsource that? Server administration, network administration, application development and support, help desk—these things could be outsourced but we don’t quite know how to do that. The third thing I’d like to see would be analytics, or business intelligence. Once you have these data companies, whether outsourced or in-house, how do you use that information to learn and to build a better performing health insurance corporation?

JM: What tends to be the greatest implementation challenge surrounding health IT systems?

AM: Getting people out of the old way of doing things and bringing them into the new way—change management. When you have systems already in place, whether it’s paper or technology, getting a whole enterprise consisting of 5,000 users into the new system is not an easy feat. Getting from making the policy change to executing it with the new technology platform is a gargantuan task. It’s not enough to just decide that IT reform needs to happen, there must also be political support behind the reform or else you just tend to slide back to the old way of doing things. That’s the greatest challenge right now.