LESSON 12

Materials Management System

Materials Management System

The management function of hospital material that is to ensure that services are rendered successfully
from one source to an end user-covers several areas of the hospital and could drastically affect the expenses of
the medical institution. Executing this function in a manner that lessens expenses and ensures adequate cash
flow requires effective management of a large amount of information from several sources
To successfully manage such information, many hospitals implement a form of materials management
information system (MMIS). The aforementioned system can be used to manage functions like purchasing,
accounting, inventory management, and patient supply charges ("Materials management information systems,
1996).

Purchasing

Purchasing RequestPurchase OrderReceiving Delivery

Purchasing process

In HIS by BizBox, a purchase request marks the beginning of the procurement process. Using this form,
the user notifies the purchasing department regarding the needed items and services. It contains the quantity, as
well as a timeframe for the items requested. It has the authorization information needed to proceed with the
purchase. The requested items are then confirmed using the purchase order and a supplier is nominated. Once
completed the order is sent to the supplier for processing.

Finally, the items are checked during receipt of the delivery. The receiver, which is usually the Central Supplies
department, uses the purchase order as basis for accepting the delivered items that should be checked for dents
and damages. Afterwards the said items are then released to the requesting department.

Inventory Control
Inventory is one of the biggest expenses for most medical institutions (Johnston, 2014). Inventory
control plays an important part in refining the quality of health care services since lives of people are on the line
and medical costs are increasing

Strategies in improving inventory control in the health care facility:

1. Ensuring Shipment Accuracy

Checking shipments for accuracy means ensuring that the received items are the ones ordered and the
supplies are free from possible damages during transit.
2. Aligning with Sales Projections
Coming up with an inventory tracking report in comparison with actual sales proves to be a challenge in
the field of medicine. However, it is necessary to prevent wastage, identify trends, and ensure that there is no
excess inventory.
3. Complying with Regulations
The health institution should be responsive to the current trends and needs of the highly regulated health
care industry. The regulators monitor health institutions and determine the success or failure of companies to
serve the best interest of the patients.
4. Establishing Buying Cycles
Buying cycles should be determined and understood by inventory personnel based on the previous
cycles, so that inventory ordering becomes manageable through the elimination of shortages and overages. The
said cycles determine the trends and adjustments that can be made accordingly.

Item Master Maintenance

Since the importance of inventory control has been recognized, the usage of a materials management
system brings an advantage. In this system, the Inventory Item Maintenance screen has many sections. The
upper portion contains master information. Additional options appear after the selection of an existing item.
"Item Tab" is used for maintenance of the attributes of an inventory item, such as product type, item class, item
type, and others. If the balance and order activity is zero (O), items can be deleted using this option. Users may
set the product type to group similar items for sales analysis and inventory reporting, most of the inventory
reports are based on a certain product type. The "Item Availability" form specifies inventory levels across all
warehouses.

Item Indents and Issues

There are some instances when items are damaged either upon receipt from the supplier or during the
move from the source to another location. Some suppliers allow return of goods that have indents or the like,
with a guarantee of replacement without any additional payments. This applies to distribution and retail
industries where the goods for sale are fast-moving. Normally, damaged items are moved to another warehouse
for them to be monitored.

Reorder Level and Minimum and Maximum Inventory Ordering

In a typical materials management system, reorder level is the minimum quantity of an item that a
company has in stock, so when the stock reaches the stated minimum quantity, the item must then be te ordered
(purchase order/production order).
A basic reordering method implemented in many ERPs and other inventory management softwares is
the Min/Max inventory ordering method. The "Min" value is representative of a stock level that prompts a
reorder, and the "Max" value is representative of a new targeted stock level that follows the reorder. The main
difference of these two-Max and Minis often interpreted as the economic order quantity (EOQ)- Although the
Min/Max method is an unpolished method for inventory ordering, its settings could be adjusted to provide
better inventory performance (Vermorel, 2014).

Enquiries and Quotations for Drugs, Consumables, Assets, and General Items
According to Webrino (2018), the following documents are required in the materials management
process:

1. Enquiries - The enquiries mark the beginning of the purchasing process. These establish the relationship
between the entity and the right supplier. The supplier provides information on the availability and price of the
required items.
2. Quotations - Quotations contain vital information regarding the requirements which include price, delivery
details, payment terms, and etc. Companies usually review two to three quotations before selecting the supplier.
3. Orders - The buyer shows the intention to purchase the required item by issuing a purchase order. A
purchase order is placed to signify intention to engage in commercial operations for a specific product or
service. Upon agreement, the order becomes a contract between the health care institution and the supplier
4. Invoices - An invoice is also called a bill. It is a commercial document that indicates the product, the ordered
quantity, and the agreed price. The supplier issues this to the buyer to show the products and services that were
sold or provided to the buyer.
5. Documents - Documents are statutory requirements used during purchase and sales transactions. These
ensure smooth transition and completion of the process.

Comparison of Quotations and Preferred Vendors

Purchase Quotations
A purchase quotation is a document for requesting prices and delivery information from a vendor before
the purchase order. It dan be created then sent to vendor. When a response from a vendors erected with a list of
prices and delivery dates, the information can be entered in the purchase quotation, In this way, the complete
history of the sourcing process can already be stored in the system. From the quotation, the right vendor for the
purchase can be chosen based on the tracked information It helps in lessening expenses, improving the quality
of the product or service, and increasing on-time delivery. A purchase quotation report allows the comparison of
offers in order to pick the appropriate vendor for the purchase scenario, Afterwards the purchase order can
already be created from the selected quotation.

Preferred Vendors
Companies typically maintain a list of preferred vendors from whom inventory items are usually
purchased. They look for a vendor who has on-time performance, offers reasonable costs, provides high quality
products and services offers fully licensed, bonded, and insured products and services, and has good business
practices.

Purchase Requests, Orders, and Approval

Purchase Request
A purchase request or purchase requisition is a document that notifies the purchasing department that
certain items or services need to be replenished. The document stipulates a timeframe and required quantities
for the requested items. In certain instances, it also contains authorization to acquire assets. For enhanced
accountability and for documentation purposes, some companies require a purchase requisition for all
purchases, but others only require then for specific kinds of purchases, such as those that would require greater
capital outlay (SAP 2012).

Purchase Orders
A purchase order is a legally binding contract which shows that the seller has already accepted the order
issued by the buyer (SAT, 2012). It should contain: information about the buyer and seller (name, address,
contact details, and etc.); order number and order date; item description (quantity, unit, and total price):
shipping information (shipping date and address); billing address; and the authorized signature.

Approval Process
The person who creates the document, either a purchase request or order, is the originator. When the
said originator adds document/s to the materials management system, the system checks for any approval
requirements. If the document fails to meet the approval requisites, the originator is notified that the document
needs approval. The document is temporarily saved as a draft
When the approval process is launched an internal request is immediately sent to the first approval stage.
This request is received in the Messages/Alerts Overview window, and the approver can access the document.
Approval can be done through a mobile phone if the devices are integrated. And internal notification goes back
to the originator with link to the rejected document when the approver rejects the document. The originator can
amend the document, and the approval procedure will continue until the conditions are adequately satisfied
(SAP 2012).
Receiving and Tracking Items
The following policies should be followed for the proper receipt and inspection of goods (The York
College, 2017):

1. Signing for Deliveries - The person who receives the delivery should inspect the delivered items before
signing the receiving document and the packing list. Then the document should be submitted to the appropriate
department for reconciliation
2. Refusing Delivery - The receiving department should refuse to accept any shipment if the packaging appears
to be damaged or if there is any item that does not have a corresponding purchase order
3. Record Retention - The packing list should be provided to the receiving department during delivery to
ensure that there is proper documentation since it is are taking possession and legal ownership of the delivered
items Tf no list was provided the department should request the copy from the supplier. All files should be kept
according to the guidelines of the entity. This helps track partial and staggered deliveries.
4. Inspecting a Shipment - The personnel receiving the items should inspect the goods to ensure that the
following minimum conditions are met:

a. The received items match the requirements stated in the purchase order (type, description color and etc.)
b. The quantity is correct.
c. The item has no damage, discoloration, and issues.
d. The quantity per unit of measurement is accurate (e.g. one dozen = 12 pieces).
e. Packing list, certifications, and other delivery documentation are completely provided.
f. Perishable items should be in good condition and have not reached the expiration dates
g. The items are functioning properly

5. Partial Deliveries - When items are delivered partially without proper notification from the supplier, the
receiving personnel should advise the Purchasing department for approval and further instructions. This should
also be typically noted in the packing list or the receiving document
6. Tracking of Goods - Goods can be easily tracked/traced when they are managed by serial number or batch.
Through that, aging of products can also be monitored based on how long they have been in the warehouse

Purchase Returns along with Returnable/Non-Returnable Gate Pass

Defective or substandard quality goods, incorrect order delivery, and deteriorated purchased and sold
items are usually common in business. These lead to purchase or sales returns. When purchased goods are
returned the materials management system updates inventory levels to reflect the decrease in quantity.
Movement of inventory is not limited to purchase returns Supplies and equipment are also sometimes
required to be taken out of the department for repairs or consignment. For temporary movement, a returnable
gate pass is issued, whereas for permanent movement, a non-returnable gate pass is given. The system can be
configured to track returnable and non-returnable items or equipment. It can also be set to monitor due dates for
returnable items and to provide detailed reports about the status of different inventory items.

Consignment Stock Receipt, Consumption, and Regularization

In the process of consignment, the vendor or consignor issues materials to the receiver or consignee and
these materials are stored in the consignee's premises. The vendor maintains legal ownership until such
materials are removed from consignment stores. The invoice is due at predetermined intervals. In addition,
customers can also arrange to take over ownership of the remaining consignment material after a certain period
(SAP, 2011)
Expired Stock and Quarantine

Expired Stock/Inventory
Upon reaching their expiration dates, some goods, such as food and medicine, can no longer be utilized.
In rare instances, they may be sold to other parties at lower costs. Expiration dates and decrease in values of
items must be reflected in the financial records so discrepancies in financial statements will be prevented. The
amount that reduces inventory in the records is recognized as a loss which equals to a reduction in profit
(Keythman. 2017).

Quarantine Stock/Inventory
When undecided about how to handle defective goods whether to be sold as scrap reworked them until
returned, or used as it is a quarantine location or warehouse can be used to temporarily house them a final
decision is reached.
Inventory is put into quarantine if it is initially rejected during Infor IN Warehousing 2018)
 Production, upon completion of an operation, when specified and "Move Rejected End tem w
Quarantine,
 Inbound inspection upon receipt of:
 Manufactured end items
 Purchased items
 Sold items on sales return orders
 Enterprise planning distribution orders
 Outbound inspection upon issue of materials to production

Drugs and Consumable Issues and Returns to Patients

Nagarajan (2017) affirms that 30 to 50 percent of hospital charges are actually attributable to
diagnostics, drugs, and consumables; and doctors get only between 10 to 20 percent. For both hospitals and
patients, drugs and consumables take up the bulk of expenditure. This is why materials management is critical
for hospitals to optimize the investment in these kinds of consumable assets.
While some hospitals have functional inventory databases, the lack of integration does not give them
holistic information, and this affects decision-making, both on a managerial level and during day-to-day
operations. For instance, some drugs are misplaced or misappropriated, or shortages and surpluses may occur as
a result of improper inventory controls in a traditional system (Infor LN Warehousing. 2018). This is where
materials management system become advantageous. It provides an overview of the entire institution's
purchasing and inventory control processes. As a result, decision-makers can have mare reliable information
and can monitor the bigger picture.

Issue Methods
Inventory management is a crucial function for any product-oriented business. Common inventory
handling methods include:

a. First In, First Out (FIFO) - Inventory items are sold based on the order they are purchased. This is the most
common technique.
b. Last In, First Out (LIFO) - Last items to enter the system are sold first. This is common among non
perishable items like petroleum, minerals, and metals.
c. First Expired, First Out (FEFO) Materials are sold based on the dates they should be consumed, regardless
of when they were purchased.
Generic Tax Formula Configurations
Materials management systems usually allow tax rates to be defined internally via tax codes, or imported
from an external source. Tax configurations are usually accounted on a per country basis. The following taxes
that can usually be processed while posting documents are
 tax on sales and purchases,
 additional taxes like VAT
 sales and use tax in USA, and
 withholding tax like income tax in India.
The automatic calculation of the tax dues during the purchasing process makes the process less susceptible to
clerical errors.

Periodic Physical Stock Taking and Adjustments with Tracking

An inventory count is a process where a business physically counts its entire inventory. A physical
inventory may be mandated by financial accounting rules or tax regulations to place an accurate value on the
inventory, or the business may need to count inventory so component parts or raw materials can be restocked.
Businesses may use the following tactics to minimize the disruption caused by physical inventory (CTT
Reviews, 2016):
 Inventory services provide labor and automation to quickly count inventory and minimize shutdown
time.
 Inventory control system software can speed up the physical inventory process.
 A perpetual inventory system tracks the receipt and use of inventory and calculates the quantity on hand.
 Cycle counting, an alternative to physical inventory, may be less disruptive.

The materials management systems offer all of these in addition to the barcode and RFID capability which
are supplementary technologies placed to give the institution more accurate and less burdensome inventory
counts.
 LESSON 13
CLINICAL DATA REPOSITORIES

CLINICAL DATA REPOSITORIES

Nowadays, most institutions have existing clinical data repositories (CDR) in electronic or written
format, to represent an aggregated database of clinical information. The repositories usually house a multitude
of laboratory results, diagnostic reports, and various clinical documentations. These data are readily searchable
and exportable, often because the information is gathered from standard clinical care procedures (Robertson and
Williams, 2016). The repositories integrate physician-entered data with data form different existing information
systems including laboratory, radiology, admission, and pharmacy. They are places where nboth clinical data
and other data of interest, such as external data sources and financial data, are assimilated (Carter, 2001).
A clinical data repository can successfully depict the same sample across different points in time, from
varying sources both within and outside the health institution. Common kinds of available information in the
CDR are listed below:
 Patient demographics
 Patient's primary care provider
 Medication list
 Allergies
 Hospital in-patient visits
 Immunizations
 Diagnoses
 Procedures
 Laboratory results
 Social history
 Emergency department encounters
 Outpatient practice visits
 Vitals

Maintaining them poses a lot of advantages since the longitudinal view of a patient's medical record can
assist in improving patient experience, and having information about prior test results and procedures leads to
more informed patient care decisions and helps avoid redundant treatment.
CDR INTEGRATION WITH HIS
Bergeron (2013) describes a clinical data repository as a systematically structured and gathered
"storehouse" of patient-specific data, which is usually mirrored from a clinical application, or supplemented
with data from other clinical systems. Since it is maintained as a separate database particularly created in aiding
decision analysis, the main application avoids computational loading, and response time to a query is improved.
Moreover, because almost all simple, customized, or complex patient records are mirrored in it, queries are
possible without sacrificing the performance of the source applications. Furthermore, since the data typically
originated from one source with little to no manipulation, near real-time retrieval of clinical data is possible.
There are different levels of integration in the said repository. These levels depend on locations, indices,
catalogues, semantic translations or equivalences, syntactic structures, and links to external information. They
influence functionality by setting constraints on how easily someone can make queries for any of the contents.
The integration structure from the CDR to the laboratory information system, for example, may any be different
for radiology or pharmacy. These differences might mean that a user may only access certain types of
information, and use particular types of queries from a given information system depending on the restrictions
which were set during the integration process. The aforementioned restrictions vary in terms of the user's
access. While some CDRs are fairly open, others are restricted either to employees of an institution or to
members of some research network. Access control to the CDR functions as a safeguard to uphold data security
and integrity.
Wade (2014) emphasizes that the longitudinal nature of the CDR requires a way of linking various
observations of the same identified subject. Most repositories usually contain personally-identified data;
however, due to privacy issues, they only release de-identified data which can lead to the omission of some data
in a dataset. The lack of identifiers could also prevent the linking of data for some patients. Presented below
(Table 13.1) are the different types of clinical data repositories that Wade classified according to factors
described above.
Table 13.1 Types of clinical data repositories
REPOSITORY TYPE DEFINITION
Study A database that collects observations for a specific clinical research study.
Electronic health record A database of observations made as a result of direct health care
Registry Observations collected and organized for the purpose of studying or guiding
particular outcomes on a defined population; associated studies are either
multiple or long-term and evolving over time
Warehouse A repository that adds level of integration of quality to the primary (research or
clinical) data of a single institution to support flexible queries for multiple users,
is boarder in application that a registry
Collection A library of heterogeneous datasets from more organizations than a warehouse or
more sources that an registry; organized to help users find a particular data set,
but not to query for data combined across datasets
Federation A repository distributed across multiple locations, where each location retains
control over access to its own data, and is responsible for making the data
comparable with the data of other locations.
These repositories are beneficial in consolidating patient information, a disadvantage is that most CDRs
are only integrated with clinical data. Laboratory results, diagnoses, and demographics might be available in
one platform, but overall patient satisfaction, the amount of time a patient had to wait before being treated, and
other information not directly related to patient care might be unavailable.
Multiple Views for Patient Medical Record
Information on patients is typically scattered across multiple subsystems. A clinical data repository standardized
data from disparate sources into a cohesive format. It comprises numerous tables which offer a partial view of
patient information (Gensinger, 2014). Its structure allows data to be extracted along dimensions such as time
(by year, month, week, or day), location, or diagnosis. These data can often be accessed in smaller units within
the same dimension. For instance, a user can view the number of patients with a certain type of diagnosis,
laboratory result, or prescription within a year, then a month in that year, and further into a day in that month.
One can also access how many times a particular procedure has been performed at all locations within a health
system, and then see the aggregate amount per region or per facility. It helps organizations to transform large
amounts of information from distinct transactional files into a unitary decision-support database (Wager, Lee, &
Glaser, 2013).
Ball and Douglas (2013) elaborate that a well-deployed clinical repository has multiple advantages. First
advantage is the CDR function to provide longitudinal views of patient information. It is often organized
primarily around patients and secondly around visits or encounters, a method that easily accommodates views
that span multiple visits. This allows clinicians to trend and chart results independent of the visits and test panel
organization. For example, a clinician could study the trend of a patient's blood sodium levels over the past six
months independent of other factors.
Another advantage is its capability to provide access to information when needed. Since it receives
information from a multitude of feeder systems, it can create a "one-stop shopping environment. This is done by
allowing the clinical staff to access a variety of patient-focused information through a consistent and easy-to-
use graphical interface (GUI). The GUI access can be deployed through hand-held devices, bedside computing
devices, computers in physician's offices, or computing devices in nursing stations. In any case, this wide
variety of information access moves far closer to deployment of information at the point of care.
Finally, CDR provides a cross-continuum view of information since it allows information to be gathered
and viewed from sources other than an acute setting. This type of ambulatory-focused information combines
with the acute information to give clinicians a new level of insight into the wellness of their patients.
Data Visualization of Laboratory Results and Vitals
Data collected through an electronic health record system may be retrieved at the request of an
authorized user, whether a physician, medical technologist, nurse, or radiologist. The electronic health record
may present patient care information as text, tables, graphs, sounds, images, full-motion video, or signals on an
electronic screen, phone, pager, or paper (Bronzino & Peterson, 2014).
Unfortunately, analyzing trends and patterns from large data sets can be a challenging process. This is
where data visualization, the art of representing data in a pictorial or graphical format, becomes useful. It helps
in simplifying a wide array of information, and it allows decision-makers to derive analytical results from the
information presented visually. Through this, correlations, patterns, and trends which might be undetected from
text-based clinical data can be revealed and recognized with more ease.
For example, the physician can easily review the results of multiple chest x-rays obtained over the
course of months or years when deciding if a nodule has grown. This information would not have been
accessible when basing on textual clinical data alone. Moreover, patients suffering from specific diseases that
require careful charting or monitoring of laboratory values, including anticoagulation or blood sugar values, can
understand what is expected in their care because of better means of data presentation (Figure 13.1).

FIGURE 13.1 SAMPLE BLOOD SUGAR LEEL CHART

 Visualization of clinical data is increasingly becoming an important tool in decision-making. The
graphical representation feature of most clinical data repositories enables scenario analysis, which helps users
use different kinds of filters in order to change the level of information that may be seen. Common filters
include age and gender, in order to assess outcomes of certain interventions based on isolating certain factors.
This kind of analysis is a good opportunity in empowering the frontline staff by giving them straightforward
data which will efficiently and effectively facilitate the performance of their tasks (Rains & McCuistion, 2018).
KEY POINTS TO REMEMBER:
 Clinical data repositories (CDR) integrate physician-entered data with data from different existing
information systems including laboratory, radiology, admission, and pharmacy.
 A CDR is a systematically structured and gathered "storehouse" of patient-specific data, which is usually
mirrored from a clinical application, or supplemented with data from other clinical systems.
 Repository types include study, electronic health record, registry, warehouse, collection, and federation.
 CDRS offer a cross-continuum view of information since they allow information to be gathered and
viewed from sources other than an acute setting.
 Data visualization helps in simplifying a wide array of information, and it allows decision-makers to
derive analytical results from information presented visually.
 LESSON 14
ETHICS, PRIVACY AND SECURITY

ETHICS IN HEALTH INFORMATICS

Technology helped in the modernization of the health care industry; however, this made practitioners to
be dependent on the use of mechanical aids in providing patient treatment. Conversely, human values should
continue to govern research and the actual practice in health care.
Health care informatics covers issues on honorable actions and proper and improper behaviors in the
health care. However, most health practitioners are not familiar with ethical issues even if some issues have
been controversial.
Nowadays, privacy and confidentiality are among the popular sources of debate. However, more
important issues such as the use of appropriate informatics tools in clinical settings, determination of users,
system evaluation, system development, and many others need attention. These and other questions on the
various legal and regulatory requirements need to be addressed (Goodman, 2106)
Listed below is a set of ethical principles for appropriate use of decision-support systems, particularly in
informatics, as described by Shortlife and Cimino (2013).
1. A program should undergo appropriate evaluation prior to use in clinical practice. It should perform
efficiently at an acceptable financial and timeframe cost.
2. Adequate training and instruction should be completed before proceeding to the implementation.
3. A qualified health professional should be assigned to handle concerns regarding uses, licenses, and other
concerns. The software systems' applications should not replace functions such as decision-making.

Information systems store patient's records that can be retrieved when needed. These records assist in the
dispensation of health care or other supplementary services which are part of health informatics. Health
informatics is guided by health information ethics defined as the application of the principles of ethics in the
domain of health informatics. The three main aspects of information ethics are general, informatics, and
software ethics (Samuel & Zaiane, 2014).
GENERAL ETHICS
In public health, general ethics guide the reasoning and decision-making of all people and organization
involved in health care. Two of the ethical principles a health professional must uphold are autonomy and
beneficence and non-maleficence.
1. Autonomy
Autonomy is defined as the idea of either allowing individuals to make their own decisions in
response to a particular societal context, or being free from external influence or control. Electronic
health records (EHR) must maintain respect for patient autonomy, and this entails certain restrictions
about the access, content, and ownership of records. A compromise must be reached between levels of
patient autonomy and quality of patient records. When patients are given too much control over their
EHRS, this could defeat the purpose of the use of such document because critical information might be
modified or deleted without the knowledge of the health professionals. Limiting patient access and
control over patient records improves document quality because patients can also verify their own
records (Mercuri, 2010).
 2. Beneficence and Non-maleficence
These two principles are respectively defined as do good and do no harm. In health informatics,
beneficence relates most significantly with the usage of stored data in the EHR system, and non-
maleficence with how the stored data is protected.
Deeply integrated EHR systems will contain substantial amounts of raw data, and great potential
exists for the conduct of groundbreaking biomedical and public health researches. These kinds of
research will be beneficial to both the individual patient and the society. With this in mind, new EHR
systems should be developed with the capacity to allow patients to release information from their EHRs
which can be valuable to researchers and scientists. Similarly, the available consolidated data from
clinical data repositories will allow health care professionals to provide the best possible treatment for
their patients, further upholding the principle of beneficence.
However, the integrated data storage in health informatics is also a breeding ground for varying
threats. Temporary outages, at a minimum, might prevent health care professionals from performing
necessary procedures. At worst, it could even result in significant patient mortality. Total system
failures, however, may cause even greater damage. In order to avoid these instances, all data must have
multiple back-ups for fast and easy recovery. Since medical records contain very sensitive information
about an individual, the highest level of data security possible should also be upheld. Vulnerabilities in
security put patients at a risky position, and might ultimately lead to the violation of the principle of
non-maleficence (Mercuri, 2010).
INFORMATICS ETHICS
Informatics ethics is about the ethical behavior expected from an individual assigned to handle
information, as prescribed by the International Medical Informatics Association (2016). It follows seven
principles:
1. Principle of Information-Privacy and Disposition
Everyone has the fundamental right to privacy. Every individual should ensure that he or she has control
over the collection, access, use, communication, manipulation, storage, linkage, and disposition of data
about himself or herself.
2. Principle of Openness
The control measures of particular data should be disclosed to the concerned individual in an appropriate
and timely fashion.
3. Principle of Security
Legitimately collected data should be protected through all appropriate measures against access, use,
modification or communication, manipulation, linkage, loss, degradation, and unauthorized destruction.
4. Principle of Access
Authorized individuals should be given access to electronic health records and the right to correct the
data with respect to their completeness, accuracy, and relevance.
5. Principle of Legitimate Infringement
The right to privacy and control over personal data should be conditioned by the appropriate, legitimate,
and relevant data-requirement of a democratic society and by the equal rights of others.
6. Principle of the Least Intrusive Alternative
Any infringement of privacy rights should occur in the least intrusive manner and with the les amount of
interference with the rights of the affected parties.
7. Principle of Accountability
Any infringement must be justified to the concerned individuals in a timely and appropriate fashion.
SOFTWARE ETHICS
 Health informatics ethics relies on the use of the software to store and process information. It follows the
activities carried out by the developers might affect the end-users. Therefore, software ethics is the ethical
duties and responsibilities of software developers to the stakeholders and employees, and the profession). They
should execute all system activities with the best interest of the society in mind. They should disclose any
threats or known defects in the software. They should ensure that completed activities serve the best interests of
the institution and its employees. They should be straightforward about their personal limitations and
qualifications. Finally, they must build products that meet the professional standards through testing and
detailing unresolved issues. In support of the mentioned responsibilities of software developers, the
management should require ethical approaches in software development (Samuel & Zaïane, 2014).
PRIVACY, CONFIDENTIALITY, AND SECURITY
Privacy and confidentiality are often used interchangeably, but they are not synonymous. Privacy
generally applies to individuals and their aversion to eavesdropping, whereas confidentiality is more closely
related to unintended disclosure of information. For example, someone who is spying on a certain person to find
out about his or her visit to an acquired immunodeficiency syndrome (AIDS) clinic is a violation of that
person's privacy. On the other hand, if someone breaks into the clinic to view an individual's patient record, that
act is in violation of confidentiality.
There are numerous significant reasons to protect privacy and confidentiality. First, privacy and
confidentiality are widely regarded as rights of all people which merit respect without the need to be earned,
argued, or defended. Second, protection of these rights is ultimately advantageous for both individuals and
society. Patients are more likely to be comfortable to share sensitive health care data when they believe this
information would not be shared inappropriately. This kind of trust essentially establishes a successful
physician-patient or nurse-patient relationship and enables the practitioners to perform their jobs better.
Furthermore, the protection of privacy and confidentiality benefits public health. When people are not afraid to
disclose personal information, they are more inclined to seek out professional assistance which helps in
diminishing the risk of increasing untreated illnesses and spreading infectious diseases (Goodman, 2016).
When patients trust medical professionals and health information technology enough to disclose their
health information, the latter will have a more holistic view of patients' overall health and both health care
professional and patient can formulate more informed decisions. In circumstances in which breaches of and
confidentiality occur, serious consequences for the organization await, such as reputational and financial harm,
or vulnerability personal harm to patients. Poor privacy and security practices heighten the TIGA Department of
patient information and increase the risk of successful cyber-attacks (USA Department of Health and Human
Services, 2015).
In summary, the idea that physicians should hold health care information in confidence should be
applicable no matter what the circumstances. The obligation to protect privacy and to keep health information
confidential fall on system designers, maintenance personnel, administrators, and, ultimately to the physicians,
nurses, and other frontline users of the information. The protection of privacy and confidentiality is non-
negotiable because it is a duty that does not fluctuate (Goodman, 2016).
LEVELS OF SECURITY IN HOSPITAL INFORMATION
System Safeguards are the solutions and tools which may be utilized to implement security policies at
different levels of health organization. At the administrative level, they may be implemented by the
management as organization-wide policies and procedures. Mechanisms can be put in place to protect
equipment, systems, and locations at the physical level, while automated processes to protect the software and
database access and control can be implemented at the technical levels. Examples are enumerated in Table 14.1
below, as discussed by the US Department of Health and Human Services.
 It is important to note that the types of safeguards may be prescribed or restricted by law. Another
important consideration is the cost-benefit principle. If it is not cost effective for an institution to avail of an
expensive technology to mitigate a risk to electronic health information, an alternative is to require the staff to
follow a new administrative procedure that equally reduces the risk. Conversely, if an institution cannot afford
to place additional burden on the staff due to possibilities of human error, it may choose to purchase a
technology that automates the procedure in order to minimize the risk.
Regardless of the type of safeguard (Table 14.1) chosen to be implemented, it is important to monitor its
effectiveness and regularly assess the health IT environment to determine if new risks are present.
TABLE 14.1 ADMINISTRATIVE, PHYSICAL, AND TECHNIAL SAFEGUARD FOR HIS
Administrative • Regular risk assessment of the health IT environment
Safeguards • Continuous assessment of the effectiveness of safeguards for electronic health
information
• Detailed processes and procedures for viewing and administering electronic health
information
• Training for the users of health IT to appropriately protect electronic health
information
• Reporting of security breaches (e.g., to those entities required by law or contract) and
continued health IT operations
Physical • Placing office alarm systems Locking offices and areas that contain computing
Safeguards equipment that stores electronic health information
• Having security guards that make regular rounds in the vicinity
Technical • Configuration of computing equipment to ensure security (e.g. Virus checking,
Safeguards firewall
• Using certified applications and technologies that store or exchange electronic health
information
• Setting up access controls to health IT and electronic health information (e.g.,
authorized computer accounts)
• Encryption of electronic health information
• Regular audit of the health IT operations
• Having backup capabilities (e.g., regular backups of electronic health information to
another computer file server)
Source: Reassessing your security practices in a Health IT environment: A guide to small health care practices
(Office of the National Coordinator for Health Information Technology, n.d.)
The National Research Council (1997) emphasizes that technological security tools are essential
components of modern distributed health care information systems, and that they serve five key functions:
1. Availability - ensuring that accurate and up-to-date information is available when needed at appropriate
places
2. Accountability - helping to ensure that health care providers are responsible for their access to and use
of information, based on a legitimate need and right to know
3. Perimeter Identification - knowing and controlling the boundaries of trusted access to the information
system, both physically and logically
4. Controlling Access - enabling access for health care providers only to information essential to the
performance of their jobs and limiting the real or perceived temptation to access information beyond a
legitimate need
5. Comprehensibility and Control - ensuring that record owners, data stewards, and patients understand
and have effective control over appropriate aspects of information privacy and access.
LEVELS OF SECURITY IN THE LABORATORY INFORMATION SYSTEM
McPherson and Pincus (2017) narrate the following flow of information, described in Table 14.2. in a
specific portion of the hospital information system, that is, the laboratory information system.
TABLE 14.2 KEY STEPS IN LABORATORY INFORMATION FLOW FOR A HOSPITAL PATIENT
STEP DESCRIPTION
Register patient The patient record (e.g., ID Number, name, sex, age, and location) must be created in the
LIS prior to the test(s). The LIS usually receives these data automatically from the hospital
registration system when a patient is admitted.
Order tests The attending physician orders the tests for the patient and the procedure is requested as
part of the laboratory's morning blood collection rounds. These orders are entered into the
CIS and they are sent to the LIS electronically.
Collect sample The LIS prints a list of all patients who have to be drawn which also includes the
appropriate number of sample barcode labels for each patient order. Each barcode contains
the patient ID, sample contained, and laboratory workstation which is used to sort the tube
once it reaches the laboratory. An increasingly popular approach is for caregivers or nurses
to collect the blood sample. Sample barcode labels can be printed (on demand) at the
nursing station on an LIS printer or portable bedside printer prior to collection.
Receive sample Once the sample arrives in the laboratory, the status is updated in the LIS from "collected"
to "received." This is done by scanning each sample ID into the LIS. Once the status
becomes "received" the LIS then transmits the test order to the analyzer that will perform
the required test.
Run sample The sample is loaded to the analyzer, and the barcode is then read. No work list is se the
analyzer knows what test to perform from the order provided by the LIS. However, when
tests are performed manually, the technologist prints work list from the LIS. The work list
should contain the names of the patients and the tests ordered on each and next to each test
is a space to record the result.
Review results The analyzer then produces the results and sends the same to the LIS. The result is only
viewable to the assigned technologists until it is released for general viewing The LIS can
also be programmed to flag certain results-for example, critical values-so the technologist
can easily identify what needs to be repeated or further evaluated.
Release results The technologist is responsible for the release of the results. Unflagged results are
reviewed and released at the same time. The LIS can be programmed to automatically
review and release normal results or results that fall within a certain range. This approach
reduces the number of tests that a technologist has to review. The results are automatically
transmitted to the CIS upon release.
Report results The physician can now view the results on the CIS screen. Reports can be printed when
needed.
The aforementioned principles regarding administrative, technological, and physical safeguards can be
applied similarly to the laboratory information system in order to improve its security. Examples are listed in
Table 14.3.
TABLE 14.3 ADMINISTRATIVE, PHYSICAL, AND TECHNICAL SAFEGUARDS FOR LIS
Administrative • Continuous training for the users of the LIS
safeguards • Periodic review of standards used to identify results that should be flagged
• Review of the authorization and supervision policies
 • Strict implementation of the rules and regulations for the testing procedures
• Release and dissemination of guidelines on the proper disposal of laboratory
specimen
• Enforcement of strict policies on the proper use of laboratory workstations
• Requiring appropriate disciplinary measures as needed

Physical safeguards • Ensuring the periodic maintenance of laboratory equipment

• Having biometrics or other security measures for laboratory access
• Maintenance of controlled temperature both for equipment and specimen •
• Presence of contingency operations plan
• Use of appropriate personal laboratory safety equipment
Technical • Presence of automated identity confirmation procedures for users requesting access
safeguards • Regular updating of passwords
• Requiring different authorizations based on user level
• Capacity of the unit to automatically log-off after a specified period of inactivity

PHILIPPINE DATA PRIVACY ACT OF 2012

Business process management, particularly involving health information technology, is an increasingly
growing industry within the Philippine economy. With total IT expenditure reaching $4.4 billion in 2016, the
industry is forecasted to go beyond doubling itself by 2020. In addition, Filipinos utilize social media heavily,
with a whopping 3.5 million users on LinkedIn, 13 million on Twitter, and 42.1 million on Facebook (Wall,
2017).
Given the rapid evolution of the digital economy and heightened international data trading, the
Philippines has decided to strengthen its privacy and security protection by passing the Data Privacy Act of
2012, with an aim "to protect the fundamental human right of privacy of communication while ensuring free
flow of information to promote innovation and growth” (Republic Act No. 10173, Ch. 1, Sec. 2).
The Act applies to individuals and legal entities that are in the business of processing personal
information. The law applies extraterritorially, applying both to companies with offices in the Philippines and
even those located outside that use equipment based in the Philippines. It covers personal information of
Filipino citizens regardless of the place of residence. The main principles that govern the approach for this Act
include transparency, legitimacy of purpose, and proportionality.
Furthermore, in the Data Privacy Act of 2012, consent is one of the major elements highly valued. The
Act provides that consent must be documented and given prior to the collection of all forms of personal data;
and the collection must be declared, specified, and used for a legitimate purpose. In addition, the subject must
be notified about the purpose and extent of data processing, with details specifying the need for automated
processing, profiling, direct marketing, or sharing. These factors ensure that consent is freely given, specific,
and informed. However, an exception to the requirement of consent is allowed in cases of contractual
agreements where processing is essential to pursue the legitimate interests of the parties, except when
overridden by fundamental rights and freedom. Such is also the case in responding to national emergencies.
Processing of sensitive and personal information is also forbidden, except in particular circumstances
enumerated below. The Data Privacy Act of 2012 describes sensitive personal information as those being
• about an individual's race, ethnic origin, marital status, age, color, and religious, philosophical political
affiliations,
• about an individual's health, education, genetic or sexual life of a person, or to any proceeding or any
offense committed or allegedly committed,
 • issued by government agencies "peculiar" (unique) to an individual, such as social security number,
and
• marked as classified by an executive order or act of Congress.

The exceptions are

• consent of the data subject,
• pursuant to law that does not require consent,
• necessity to protect life and health of a person,
• necessity for medical treatment, and
• necessity to protect the lawful rights of data subjects in court proceedings, legal proceedings, or
regulation

The provisions of the law necessitate covered entities to create privacy and security program to improve
the collection of data, limit processing to legitimate purposes, manage access, and implement data retention
procedures.
The Act provides for different penalties for varying violations, majority of which include imprisonment.
These violations include:
• unauthorized processing,
• processing for unauthorized purposes.
• negligent access, improper disposal,
• unauthorized access or intentional breach,
• concealment of breach involving sensitive personal information,
• unauthorized disclosure, and
• malicious disclosure.

Any combination or series of acts enumerated above shall make the person subject to imprisonment
ranging from three (3) years to six (6) years, and a fine of not less than one million pesos (P 100000000 but not
more than five million pesos (P 500000000 Republic Act No. 10173, Ch. 8, Sec. 33).
KEY POINTS TO REMEMBER:
 Health informatics ethics is the application of the principles of ethics to the domain of health
informatics. There are three main aspects of health informatics ethics: general ethics, informatics ethics,
and software ethics.
 General ethics covers autonomy beneficence, and non-maleficence.
 Informatics ethics refers to privacy, openness, security, access, infringement, least intrusion and
accountability.
 Software developers should consider the best interest of the society in general, the institution and its
employees, and the profession
 Administrative, physical, and technical safeguards are placed to regularly monitor effectiveness and
assess the health IT environment.
 LESSON 15
CHANGE MANAGEMENT IN HEALTH INFORMATICS

CHANGE MANAGEMENT
Generally, there are four kinds of changes that all kinds of organizations might encounter, with the
likelihood of overlap among the conceivable outcomes.
a. Operational changes can influence the way dynamic business tasks are led, including the
computerization of a particular business segment.
b. Strategic changes occur when the business direction, in relation to its vision, mission, and philosophy,
is altered. For instance, changing the business technique from business growth to increasing market
share in the overall industry is a case of strategic change.
c. Cultural changes influence the internal organizational culture, for example, the way the business is
conducted, such as actualizing a CQI (continuous quality improvement) framework.
d. Political changes in human resources occur primarily due to political reasons of varying types,
commonly, changes that happen on top patronage levels in the government agencies.
Different sorts of changes typically have dissimilar impacts on different organizational levels. For instance,
operational changes tend to have the highest impact on the lower organizational levels, and mostly affect
frontline employees. Employees working at the upper levels might be indifferent to the changes, which may
cause significant distress to those attempting the implementation of change.
Conversely, the effect of political changes is more strongly felt on the higher levels of the organization.
When changes occur relatively in a bureaucratic organization, those working on the bottom level often notice
the change at the top (Lorenzi & Riley, 2000).
There is no denying that organizational changes have varying degrees of impact on both the organization,
and in effect, its clientele. This lesson discusses change management contextualized in health informatics,
which is increasingly becoming a course of action that health institutions avail in order to improve their
services.
Changes are inevitable especially in organizations because they need to evolve to meet the demands of the
stakeholders which include global competition, changes in customer demand, technological advances, and new
legislation.
Organizations may even change the way they operate in order to cope with the demands. Redefining roles,
eliminating ineffective processes, or initiating new ways of working are considered minor adjustments.
Conversely, there are times when pressures necessitate major disruptions which transform the culture; re-
organize people, processes and systems; and change the organization's strategy radically.
For more than 100 years, change management has been evolving with its beginnings rooted in health and
job-related grief studies. Currently, most change management processes which are designed to drive business
transformations draw their inspiration from behavioral and social sciences and IT and business solutions.
 A survey on change management conducted in 2007 involving over 400 senior HR managers in the US
revealed the following reasons behind the percentages of organizations implementing or planning change over
the previous two years:
 New performance management process (58%)
 Relocation or facility closure (57%)
 Organizational culture changes (54%)
 New IT system (51%)
 Change of strategy (45%)
 New financial/accounting systems (41%)
 Downsizing, layoffs (40%)
 Operational changes resulting from new legislation, economic conditions, or national/international
events (30%)
 Product rebranding (26%)
 Acquisition (25%)
 Off shorting or outsourcing (16%)
 Merger (10%)
 Corporate ownership change (8%)
Meanwhile, in the health care industry, the following are factors that contribute to the changes:
1. Regulatory adjustments
2. Shifts in consumer behavior patterns
3. Accelerated pace of IT development
Health care consumers want a more customized experience and greater opportunity to participate in their
health care decisions. This means that health care institutions need to adapt a more innovative technology,
implement an informed patient engagement strategy, and adjust their organizational structures to drive better
patient experiences which may result in numerous and rapid changes (Quinn, 2017). However, technology alone
is not enough. The truth of the matter is that no technology can be successfully implemented without the human
factor which intensifies the work processes and gives the appropriate guidance. The need to find the right
balance between technology and human factor is necessary in the roadmap for organizational changes.
Another vital element in change management initiatives is communication. Information should be shared so
the stakeholders would be advised about the timing, nature, and importance of changes in the business.
Participation from management is crucial to the successful implementation of the planned changes. Any change
can only be successful when the employees are motivated towards the change and are willing to accept the
vision presented by the organization's leadership (Aljohani, 2016).
Those organizations which are able to manage change well will definitely survive and thrive. This is
basically the concept of change management. The managers need to direct, control, and monitor the changes to
ensure that the objectives are met. They must ensure that the employees adapt the changes without disrupting
the regular operations (Downey, 2008).
Change management process has a wide range of models with each model having its own strategic
approaches. The more common change practice examples include:
1. Kurt Lewin's Unfreeze-Change-Refreeze model
This three-step model was proposed by Kurt Lewin, founder of social psychology, in the 1950s. This is
still widely used as the basis for many change management strategies.
2. Proski's ADKAR' model
 This acronym means "Awareness of the business reasons for change; Desire to engage and participate in
the change; Knowledge about how to change; Ability to implement change; and Reinforcement to
ensure change sticks" (ADKAR).
3. Kotter's Change model
This eight-step model was developed by John Kotter of Harvard Business School. Building a strong
collaborative team by using a solid strategy, creating effective communication channels, supporting staff
empowerment, using a phased and steady approach, and securing the change within an organization's
culture are the core concepts of this method (QuickBase, 2017).
APPLICATION OF CHANGE MANAGEMENT
Change management is defined as a series of tools, techniques, and processes aimed at successfully
effecting change. These tools support the application of other initiatives such as Six Sigma, Customer
Relationship Management (CRM). Total Quality Management (TQM), or Enterprise Resource Planning (ERP),
but can be implemented in a variety of contexts.
Downey (2008) enumerates the common tools and techniques that can be used during a change
initiative:
• Gathering information about the 'as is' and 'to be status of the current process
• Mapping of the process for both 'as is' and to be status
• Gap analysis
• Business case development
• Project management
• Problem solving
• Requirements elicitation techniques
• Negotiation skills

In addition, the progress of the change initiative can be measured against the objectives set by the
organizations (Downey, 2008). The said objectives will be measured by the key performance indicators (KPIs)
which include reducing rework by x%, improving in stakeholder satisfaction, for example, customer/employer
surveys, reducing time to market, enhanced speed of delivery, and having good return on investment (ROI)
which is the total cost to implement the initiative versus total savings gained from the initiatives per period
In the world health care, some hospitals are reluctant and indignant towards the idea of change; and they
find it difficult to adjust. Thus, health informatics hopes to change the way health care conduct their business on
a daily basis. Health care providers need to welcome change and approach information technology with an open
mind. Aziz (2007) emphasizes that a mechanism for the transformation of business and clinical processes
should be in place. By encouraging the adoption of innovation in health care information technology by
clinicians, therapists, nurses, and physicians, health care providers can achieve key success factors (Table 15.1).
TABLE 15.1 KEY SUCCESS FACTORS
Key success factors at the leadership level in health Key success factors at the program level
care organizations
1. Setting the vision and strategy roadmap for the 1. Clear and timely dissemination of information
organization 2. Building a strong project leadership team and other
2. Forming a governing body to set direction and functional teams
priorities, and to allocate resources 3. Providing proper training on the new changes
3. Designating of the organization's executive especially on the workflow and technology
sponsor, departmental champions, and program 4. Forming integrated teams to address and resolve
manager critical and complex issues
 4. Defining reporting requirements for the project
5. Setting and managing the users' expectations
5. Empowering staff and end-users to improve the
process by removing barriers and obstacles
6. Maintaining changes through by positive
reinforcement
7. Frequent celebration of success by acknowledging
contributors thus keeping the motivation and
momentum
8. Monitoring and constant measurement of key
indicators (e.g., using a dashboard to report progress
and benchmarks)
9. Involving those who are affected by the change in
decision making (a., choice of computer carts, COW)
10. Other creative actions and incentives e.g.,
monthly prizes for high performing teams, providing
snacks and drinks

WORKING WITH PHYSICIANS

Most physicians have patients in multiple hospitals since they are non-hospital employees. Systems of
health institutions may differ from each other which complicates the situation. Thus, they should have de
adoption methods to avoid any issues. Aziz (2007) lists some ideas for the success of the transformation
1. Communicate patiently the benefits of the changes in terms of patient care and safety.
2. Nominate physician leaders at the start of the program.
3. Use web, CBT, and other multi-channel learning and training opportunities.
4. Be ready and available to answer questions and clarifications.
5. Make sure that there is a process in place in handling enhancement requests and developments.

TRAINING AND EDUCATION IN HEALTH INFORMATICS

Below is a list of practices that emphasize life-long learning in support of the change management that
must be initiated by the leaders of the organization (Aziz, 2007).
1. Provide instructor-led training classes to cover different shifts.
2. Present contemporary models of training.
3. Make computer laboratories available for practice (24/7).
4. Roll out accompanied by on-the-job/real-time training.
5. Summarize the steps and make cheat sheets handy.
6. Print easy to carry colorful booklets in a pocket.
7. Provide a short manual with key facts and how-to-tips.
8. Have well equipped training rooms,
9. Schedule train-the-trainer program to give enough time to practice.
10. Assign a super-user to keep people involved.
11. Provide the business process maps and process workflows.
12. Prepare a day-in-the-life scenario for the simulation.
13. Walk them through the flow several times until they are able to adapt.
14. Entertain and answer questions clearly and provide details.
15. Prepare the users by discussing some of the challenges and frustrations they might encounter in the
early stages of the rollout.
 Enumerated are the fundamental practices that management needs to embrace as its well-rounded strategy
(Aziz, 2007).
1. Align business leaders with clinical leaders by creating a governance structure.
2. Focus on the process design and map the workflow clearly.
3. Have due diligence to ensure a thorough organizational and business impact analysis.
4. Encourage the involvement of clinicians at various levels at the start of the project.
5. Show commitment by staying on the course and communicating the objectives clearly.
6. Have a strong program customized to address different needs.
7. Get feedback into the loop and work on it.
8. Have a 24 x7 help desk to ensure that the program is well-structured and has ample support
9. Select a couple of measurement criteria for benchmarking and system evaluation.

HEALTH INFORMATION PROFESSION

Role of Health Information Management Professionals
Health information management (HIM) professionals have a special skill set that qualifies them to
assume the role of privacy and security officers who take care of the storage, protection, and maintenance
formation in the health care institution. This is coupled with their academic preparations, aces in the health
sector, and commitment to the advocacy of patient care and professional code of ethics (May, 2014)
HIM professionals should be committed to the timely and accurate collection and management of data
which cover the aggregation, analysis, and dissemination of patient health information. They manage the said
information and medical records, administer the computer information systems, and standardize the coding
systems for the diagnoses and procedures of the services provided to patients. Such information is kept secure
and private in accordance with state laws.
A career in health information management and health information technology is not limited to data
capture, documentation, and maintenance of clinical information but also includes data analytics and
interpretation, and management of the health information technology systems.
HIM professionals may fall into various job categories with varied titles, including
1. Health information management department director
2. Health information management system manager
3. Information security officer
4. Chief privacy officer
5. Health data analyst
6. Health record technician specialist
7. Clinical coding specialist
8. Patient information coordinator
9. Physician practice manager
10. Health information administrator
11. Revenue cycle specialist
12. Director of quality management
13. Health information manager
14. Health information technologist/technician

These professionals also ensure that a patient is billed accurately and assure that the accumulated health
care information is compiled and analyzed to assist in making recommendations that can improve the health
services. They are also expected to devise policies that address concerns on the delivery of high quality health
care and the availability of quality information for decision-making (May, 2014).
PHILIPPINE HEALTH INFORMATION PROFESSION
Advancements in ICT (information and communication technology) are upsetting not only for
traditional businesses, but even those not immediately thought of as probable beneficiaries-such as the health
care sector. From electronic patient records to the wireless transmittal of patient files for remote diagnosis,
improvements in communication and technology will lead to better delivery of health care services.
Telemedicine, or the use of electronic communications to transmit and exchange medical information and data
to provide patient treatment, is quickly gaining momentum within the country and the rest of the ASEAN
region.
With the increasing popularity of smart phones, wireless tools, and other comparable technology,
primary care and specialist referral services, as well as remote patient monitoring and patient medical health
information, are undeniably improved with the help of telemedicine. Thailand, Singapore, and Malaysia have
started adopting health care IT solutions to bring the sector to the next level. In 2009, Singapore developed its
National Electronic Health Record initiative, which permitted health care practitioners in the country to access
patients records across the health care continuum. Malaysia initiated a Hospital Implementation System in 1993,
with its first telemedicine project in 1996, and Thailand created its National Health Information Committee in
2010.
Likewise, the Philippines has developed an e-Health Strategic Framework and Plan for 2014 to 2020,
whose objective is to utilize information and communication technologies in the health sector. This will assist in
the delivery of health services and manage health systems for greater efficacy, with the ultimate goal of
providing universal health care for the Filipinos. One of the strategic goals of this framework is to establish
unified and coherent health and management information systems, to take advantage of ICT to reach and
provide better health services, and support the attainment of the UN's Sustainable Development Goals. In line
with this, the Department of Health (DOH) in Region IV-B has launched the first interactive telemedicine
system in Marinduque, and seemingly the entire country, at the Dr. Damian J. Reyes Provincial Hospital. The
system currently provides medical consultations and diagnostics through video calls (De Dios, 2016)
TELEMEDICINE IN THE PHILIPPINES
For an archipelago such as the Philippines, the delivery of health care services might be proven to be
challenging. Fortunately, the rise of telemedicine within the region has been a beneficial turn of events for the
Philippine health care sector.
Multiple players in the telemedicine scene currently exist, ranging from mobile apps to call center
services. Some providers of over-the-phone telemedicine services are Medgate and Lifeline. Common features
include 24/7 call centers, diagnosis using images sent via email, medical certificates, and treatment plan
summaries. Telemedicine centers usually have a corresponding mobile app to facilitate easier access, Unique to
Lifeline, however, is video consultation with doctors, patient education, free doctor or nurse home visits, and
delivery of medication and prescriptions in exchange for a fixed monthly subscription fee.
Mobile app-based telemedicine centers, on the other hand, include MyPocketDoctor and MyDocNow.
These providers are usually in partnership with other international telemedicine centers. Medway Healthcare
Inc. offers the most comprehensive telemedicine services by using telefollow-up and teleconsultation
procedures. These applications are accessible online. It is the first medical clinic in the Philippines which
mobilized the pre-employment medical examination (PEME).
 Telefollow-up is a specialized application which notifies patients of the medical evaluations results via
text messages. Patients will know the status if they are fit to work or still have pending workups within 24 hours
of PEME. On the other hand, follow-up teleconsultation takes care of the online communication between the
patient and the physician regarding the follow-up of medical results when the patient is unavailable to get the
results personally. The physician gives the necessary advice and schedules the follow up visit.
The specialist teleconsultation is also available which gives way to consultation despite distance barrier.
This application enables real-time consultation with a physician with the assistance of a nurse and utilization of
the appropriate telemedicine equipment. If the specialist needs to listen to the patient's breathing, the nurse
would place the telephonic stethoscope on the appropriate areas of the patient's body and the sound would then
be transmitted back to the specialist. The equipment uses high-definition cameras to focus on lesions or specific
body parts. As for the test results, they are transmitted by using a store-and-forward technology if real time
option is not available. (Medway Health Inc., 2012).
The government pioneered nationwide telemedicine efforts, through research and service work of the
National Telehealth Center (UP-NTHC) of the University of the Philippines Manila and funding from the
Commission on Information and Communications Technology (CICT). It implemented the Buddyworks
Telehealth project from 2004 to 2007. This uses a web-based and SMS-based telehealth platform. Subsequently,
the Department of Health (DOH, funding from 2011 to 2013) and Department of Science and Technology
(DOST, 2007 to present) supported the UP-NTHC's continuing telehealth program expanding its geographic
scope and telehealth innovations. From an initial 10 isolated and disadvantaged sites, it grew to link over a
thousand young doctors with clinical specialists based in the UP-Philippine General Hospital and regional
hospitals of the Cordillera Administrative Region and Eastern Visayas to support them in their clinical decision
making. Other DOH regional hospitals are being prepared by the UP-NTHC to become telehealth hubs in the
locale.
The RxBox diagnostic telemedicine device was incorporated in the government telehealth program
through DOST's support. The first version was developed in 2007 by Dr. Alvin Marcelo and Dr. Luis Sison of
UP-NTHC and UP Engineering in Diliman, respectively. The RxBox device included sensors that can measure
blood pressure, pulse rate, temperature, and even an electrocardiogram. Dr. Marcelo, a patient's clinical trauma
surgeon, envisioned that the RxBox would be used in ambulances transmitting a patient's clinical parameters via
telehealth to prepare better the emergency room clinicians to receive these critical patient Dr. Sison continued to
develop the second version beginning 2012, this time with Dr. Portia Fernandez- Marcelo*. They added sensors
that will detect fetal heart beats and the pregnant woman's n se centers contractions, and envisioned its use in
rural health units. The objective was to equip these rural centers with lifesaving diagnostic tools and better
manage health information. Clinical data gathered by the RxBox is exchanged with the community health
information tracking system (CHITS) electronic medical record system; in the event of clinical dilemma, data
can be pulled from CHITS and transmitted to specialist for teleconsultation. In the latter part of 2018, the
seamlessly linked systems of RxBox, CHITS, and telehealth will be implemented in 1,000 rural municipalities
and with medical specialists in all regions nationwide.
KEY POINTS TO REMEMBER
 Change is inevitable and pervasive. Organizations are driven to change in order to respond to the many
pressures they encounter from their environment. These pressures include global competition, changes
in customer demand, technological advances, and new legislation.
 Change management is a series of tools, techniques, and processes aimed at successfully effecting
change.
 Health information management (HIM) professionals, credentialed with their academic preparations,
work experiences, and commitment to patient advocacy and professional code of ethics, have a
 specialized skillset that uniquely qualifies them to assume the role of both privacy officials and/or
security officials who store, protect, and transmit information in all media and formats.
 One of the strategic goals of the e-Health Strategic Framework and Plan for 20142020 is to establish
unified and coherent health and management information systems to take advantage of ICT to reach and
provide better health services, and support the attainment of the UN's Sustainable Development Goals.
 Telemedicine efforts from the government and other non-profit organizations have also ensued. The
National Telehealth Center is the leading research unit in the University of the Philippines responsible
for developing cost effective tools and innovations in the realm of information and communications
technology (ICT) for improving health care.