Republic of the Philippines

Department of Health
KNOWLEDGE MANAGEMENT AND
INFORMATION TECHNOLOGY SERVICE

INFORMATION MANAGEMENT SYSTEM ASSESSMENT TOOL

The Information Management System Assessment Tool is a rapid assessment tool which aims to establish regional
baseline data on information system and knowledge management domain based on the Local Health System
Maturity Level (LHS ML) key results area (KRA) on Information Management, analyze gaps and identify
corresponding needs.

NAME OF REGION /
HEALTH FACILITY
ADDRESS
HOSPITAL LEVEL SECTOR __Government __Private
(if applicable) if Government:
__DOH-Retained __LGU-
Managed
NAME OF RESPONDENT POSITION
CONTACT NUMBER(s) EMAIL
DATE OF ASSESSMENT

I. PREPARATORY LEVEL
A. POLICIES
CRITERIA RESPONSE/ RATING REMARKS
1. Presence of ICT 1-NO ICT Strategic Plan
Strategic Plan 2-Drafted/ informal ICT Strategic Plan present but not formalized
3-With Approved ICT Strategic Plan but NOT implemented
4-With Approved ICT Strategic Plan and being implemented
5-With Approved ICT Strategic Plan being implemented and regularly
reviewed and updated as necessary
2. Presence of ICT 1-NO ICT Investment Plan
Investment Plan 2-Drafted/ informal ICT Investment Plan present but not formalized
3-With Approved ICT Investment Plan but NOT implemented
4-With Approved ICT Investment Plan and being implemented
5-With Approved ICT Investment Plan being implemented and regularly
reviewed and updated as necessary

B. STATUS OF EMR IMPLEMENTATION

CRITERIA RESPONSE/ RATING REMARKS
EMR Implementation 1-NO EMR implemented (paper-based, spreadsheet-based, or online (name of the EMR if
encoding tool - i.e. Google Sheets) applicable)
2-EMR implemented but incomplete or partially available, used and
irregularly maintained
3-EMR is implemented and actively used by <50% of the target
facilities
4-EMR is implemented and actively used by>50% of the target facilities
5-EMR is implemented and actively used by >75% of the target
facilities AND Data generated may be accessed, used and processed
as prescribed by organizational policies and national guidelines (data
submission)
 C. INVENTORY
C.1. ONGOING/CURRENTLY IMPLEMENTED SYSTEMS/APPLICATIONS
SOFTWARE/ RESPONSE/ RATING REMARKS
INFORMATION SYSTEM (name of software or IS)
HR
Finance
Administration
(General)
Procurement
Logistics and
Warehousing
(Other system/software)
Response Options:
1-NO software or information system (IS) implemented (paper-based, spreadsheet-based, or online encoding tool -
i.e. Google Sheets)
2-Software or IS implemented but incomplete or partially available, used and irregularly maintained
3-Software or IS is implemented and actively used by <50% of the target population.
4-Software or IS is implemented and actively used by >50% of the target population.
5-Software or IS is implemented and actively used by >75% of the target population AND data generated may be
accessed, used and processed as prescribed by organizational policies and national guidelines (if applicable)

C.2. HARDWARE (Desktop or Laptop with required specifications to run the software or
IS, including peripherals- mouse, keyboard...)
SOFTWARE/ RESPONSE/ RATING REMARKS
INFORMATION SYSTEM
HR
Finance
Administration (General)
Procurement
Logistics and Warehousing
(Other system/software)
Response Options:
1-NO ICT equipment allocated (paper-based, manual)
2-With at least one (1) ICT equipment allocated but specifications DOES NOT meet software minimum requirement
to function properly
3-With at least one (1) ICT equipment allocated with specifications compliant to software minimum requirement to
function properly
4-ICT equipment allocated with quantity is proportional to ICT staff deployed and specifications compliant to
software minimum requirement to function properly
5-ICT equipment allocated with quantity is proportional to ICT staff deployed; specifications compliant to software
minimum requirement to function properly and regularly maintained or upgraded.

C.3. INFRASTRUCTURE AND CONNECTIVITY

CONNECTIVITY RESPONSE/ RATING REMARKS
Electricity 1-NO electricity present
2-With electricity in <50% of target areas and unreliable.
3-With electricity in ALL target areas with <50% reliability.

Internet Connectivity
*SLOW- experiencing frequent data lag, delay in loading a website or online platform
4-With electricity on ALL target areas with 50-75% reliability.
5-With electricity on ALL target areas with >75% reliability.
1-NO internet present
2-With internet in <50% of target areas, slow and highly
unreliable.
3-With internet in >75% of target areas, slow with <75%
reliability.
4-With internet on ALL target areas, occasional slow
connectivity with over 75-99% reliability.
5-With high speed internet (leased line, dedicated internet
connection or broadband) with >99% reliability

C.4. HUMAN RESOURCE

DESIGNATION RESPONSE/ RATING REMARKS
Health Information System
Staff (Senior IO position
with program management
and ICT planning and
monitoring function)
Knowledge Management
Staff (IO position)
eHealth Systems staff
Data Protection Officer
Database Administrator
Network Administrator
Software/Application
Developer
Cybersecurity Officer
Cybersecurity Staff
Information Technology
Staff
Response Options:
1-NO Staff designated
2-Ad hoc/ informally assigned with no Personnel Order
3-Designated staff (Job Order or Plantilla) with Personnel Order but with different primary role/ function
4-Designated staff (Job Order or Plantilla) with Personnel Order primarily functioning on this role
5-Designated Plantilla staff primarily functioning on this role with regular capacity building activities and Learning and
Development plan

C.5. STANDARDS COMPLIANCE/DATA PRIVACY

CRITERIA RATING REMARKS
ManOps/ SOPs
- Citizen’s Charter
- Complaints
Mechanism
DPA Compliance
- ie. 5 Pillars
 Cybersecurity
Compliance
Response Options:
1-NO policy drafted
2-Drafted/ informal policy present but not formalized
3-With Approved policy/ies but NOT implemented
4-With Approved policy/ies and is being implemented
5-With Approved policy/ies being implemented and regularly reviewed and updated as necessary

II. ORGANIZATIONAL LEVEL

“Promotion” to the Organizational Level requires a rating of at least “3” on ALL criteria under
the Preparatory Level.
CRITERIA RATING REMARKS
Signed MOA 1-NO MOA drafted
2-Drafted/ informal MOA present but not formalized
3-With Approved, Signed and Notarized MOA but NOT implemented
4-With Approved, Signed and Notarized MOA and is being
implemented
5-With Approved, Signed and Notarized MOA being implemented and
regularly reviewed and updated as necessary
Dedicated ICT Personnel 1-NO Staff designated
2-Ad hoc/ informally assigned with no Personnel Order
3-Designated staff (Job Order or Plantilla) with Personnel Order but
with different primary role/ function
4-Designated staff (Job Order or Plantilla) with Personnel Order
primarily functioning on this role
5-Designated Plantilla staff primarily functioning on this role with
regular capacity building activities and Learning and Development
plan

III. FUNCTIONAL
CRITERIA RATING REMARKS
1. Referral through
EMR from PCPN to
secondary/ tertiary
facilities
2. Referral through
EMR from
secondary/ tertiary
facilities to Apex
hospital
a. Referral facilities
or Apex hospital/s
to PCPN
3. Referral through
EMR from referral
facilities or Apex
 hospital/s to PCPN
4. Referral through
Telemedicine Service
Response Options:
1-NONE Present
2-Drafted/ informal protocol/s or module/s but not formalized
3-With Approved protocols or module/s but NOT implemented
4-With Approved protocols or module/s and being implemented
5-With Approved protocols or module/s being implemented and regularly reviewed and updated as necessary
--------------------------- End of Assessment--------------------------------------
 Republic of the Philippines
Department of Health
KNOWLEDGE MANAGEMENT AND
INFORMATION TECHNOLOGY SERVICE

INFORMATION MANAGEMENT SYSTEM ASSESSMENT TOOL

The objective of this assessment tool is to establish baseline data of the current Information Management
System utilized by health facilities, analyze gaps and identify corresponding ICT-related investments.

NAME OF HOSPITAL/HEALTH FACILITY

ADDRESS
HOSPITAL LEVEL (if applicable)
SECTOR Government DOH-Retained LGU-Managed
Private
CONTACT NUMBER(s) FAX NUMBER
CONTACT PERSON(s) POSITION
EMAIL ADDRESS DATE OF ASSESSMENT

I. PREPARATORY LEVEL
a. POLICIES
CRITERIA REMARKS
1. ICT Strategic Plan 1- NO ICT Strategic
Plan
2- Informal/Draft
ICT Strategic Plan
present but not
formalized
3- With Approved
ICT Strategic Plan
but NOT
implemented
4- With ICT
Strategic Plan being
implemented
5-With ICT Strategic
Plan being
implemented and
regularly reviewed
and updated
2. Do you have an existing ICT Investment Plan?

b. STATUS OF EMR IMPLEMENTATION

CRITERIA REMARKS
1. Do you have a Health Information System (HIS)?
(Indicate the name of the HIS provider on the remarks
column)
HIS Classification In-House Third-party service provider
Non-Government Medical Society
 Organization
Health Professional Donor/Funding Agencies
Associations

Type of HIS In-House Third-party service provider

Non-Government Organization Medical Society
Health Professional Associations Donor/Funding Agencies
HIS Investment and Initial HIS Investment (in PHP)
Maintenance Cost
(Pleace N/A if not
applicable)
Maintenance Cost of HIS if subscription-based
or requiring manpower maintenance cost (in
PHP)

c. INVENTORY
i. ONGOING/CURRENTLY IMPLEMENTED SYSTEMS/APPLICATIONS
NAME OF FEATURES/MODULES TYPE OF DATE
SOFTWARE/ AVAILABLE DEVELOPMENT ACQUIRED
INFORMATION (Outsourced/In-house/
SYSTEM DOH-developed)
ii. HARDWARE
Instruction: Fill- out the table below by identifying existing ICT equipment in your hospital/health
facility. For the description, if the computer unit is a clone, kindly indicate the specifications including the
Processor, Memory, Hard Disk Capacity.

EXISTING HARDWARE RESOURCES

ITEM TYPE QUANTITY DESCRIPTIO LOCATION/USER DATE CONDITION
N ACQUIRED (OPERATIONAL/
DEFECTIVE)
Laptop 2 Asus Information Desk October Operational
UX305LA- 2019
FB049T
Laptop
Desktop
Computer
Printer
Scanner
Modem
UPS/AVR
Others:

iii. NETWORK
Instruction: Fill- out the table below by identifying the network system in the hospital/health facility.
 1. Is there any existing LAN?  YES  NO
2. If YES, fill- out the table below:
SERVER Brand
SPECIFICATION Name/Model:
Processor:
RAM:
Hard Disk Capacity:
NETWORK OPERATING Name:
SYSTEM Version:
SWITCH/HUBS Quantity:
Brand:
Condition:
STRUCTURED CABLING Existing?  Yes  No
Cable Setup
INTERNET CONNECTION Type
Speed

iv. HUMAN RESOURCE

Instruction: Fill- out the table below based on the existing ICT personnel or assigned ICT personnel in
the hospital/health facility

DESIGNATION Number of Permanent Staff Number of Contractual Staff

Data Protection Officer

Database Administrator
Network Administrator
Cybersecurity Officer
Cybersecurity Staff
Information Technology Staff

v. STANDARDS COMPLIANCE/DATA PRIVACY

Instruction: Fill- out the table below by checking the corresponding response and provide remarks if
necessary.

CRITERIA YES NO REMARKS

1. With registered/designated Data
Protection Officer?
2. All Data Processing Systems are
registered to the National Privacy
Commission?
3. Conducted Privacy Impact Assessment?
4. Has Data Protection and Privacy
Management Program (i.e. privacy
manual)?
5. Complaints Mechanism
6. Has Privacy Notice and Patient Consent
 (including electronic repository of signed
consent forms)
7. Has organizational Security (policies
and procedures in place)
8. Has Physical Security (physical access
and security, design and infrastructure)
9. Technical Security:
a. Firewalls
b. Encryption
c. Access Control Policy
d. Security of Data Storage
e. Other Information Security Tools
10. Has Breach Management, Incident
Response Procedures, and Breach
Reporting/ Notification Protocols?
11. For Third Parties: Has Data Sharing
Agreements/ Memorandum of
Agreement/ Outsourcing Agreement/
Service Level Agreement/ Terms and
Condition/ Non-Disclosure Agreements?

II. ORGANIZATIONAL LEVEL

CRITERIA YES NO REMARKS
1. Do you have an existing ICT
Development Plan for the whole
P/CWHS?
2. Do you have a functional Electronic
Medical Record System? (Please
indicate the EMR Provider and the
date of engagement)
3. Do you have existing Memorandum of
Agreement (MOA), Service Level
Agreement (SLA) on engagements
with Telemedicine Providers? (Please
indicate the EMR Provider and the
date of engagement)
4. Do you have dedicated ICT personnel
to implement the ICT Development
Plan?
III. FUNCTIONAL
CRITERIA YES NO REMARKS
1. Do you have a validated EMR
deployed to the P/CWHN capable of
referring patients:
a. PCPN to referral facilities
(secondary/tertiary)
b. Referralfacilities
(secondary/tertiary) to Apex
hospital)
 c. Referral facilities or Apex
hospital/s to PCPN
2. Do you have security incidents and
personal data breaches detected and
responded to in a timely manner?
3. Do your health facilities provide
telemedicine services