July - October 2015
The official publication of the Asia eHealth Information Network
The Asia eHealth Information Network: a Retrospective
I
n December 2011 in Bangkok, Thailand, the AeHIN core group met for the first time. Little did this group of seven people from six countries know that Asia eHealth Information Network would later grow into a network with over 600 members from 45 countries inside and outside Asia over the next 40 months. The Network, with its Working Council and active membership, has organized five international forums and general meetings, three certification trainings, five workshops, three online courses, 53 AeHIN Hours (and even expanded this to local country AeHIN Hours in five countries) and supported numerous in-country national eHealth/ HIS conferences.
These events reflect what is now the AeHIN eHealth Capacity-building Roadmap, which has so far defined the burgeoning demand for leaders, architects, and health informaticians in the region as countries progress with their national eHealth strategies. The Roadmap is a guide for member-countries in their journey towards more sound national eHealth strategies meant to meet key health and development goals. By the fourth general meeting in Bali October 2015, AeHIN can proudly present its 60 members who are trained, 12 of whom are fully certified on enterprise architecture, and 22, including a vice-minister for Health, fully
Looking Ahead of the Curve:
AeHIN in the Next Three Years F
rom zero to 12 architects and 22 IT governance managers for health, AeHIN is fortunate to be an active participant for eHealth development in Asia in the past three years. With the Post-2015 Development Agenda, Asian countries have to cull the lessons from MDG recounting and create solutions that will make Sustainable Development Goals reporting systems more standards-based, efficient, comparable, and seamless.
The Hexagon in AeHIN symbolizes “‘interoperability of systems” and when viewed in the context of the organization, it means “working together”. Though the hexagons are differently colored and sometimes overlapping, they still fit together. In AeHIN, like The Hexagons, there are many components to arrive at solutions in many eHealth problems in various countries in Asia. When AeHIN members work together, in every way, problems are solved and capacities are enriched.
certified on IT Governance, and 24 members who took an accredited online training program on health informatics standards. The groundwork for human capacity-building required to support the complex nature of national-scale health information systems are in place. Kudos to the AeHIN Working Council who, with the support of the WHO and development partners, continue to craft new programs for the shared benefit of our stakeholders in Asia. The AeHIN is assisted by its secretariat at the National Telehealth Center - University of the Philippines Manila and the Thai Health Information Standards Development Center in Bangkok.
What is in store for AeHIN in the next three years? We will leverage the AeHIN certified enterprise architects from Ministries of Health, MICTs, and the academe into the Regional Enterprise Architecture Council for Health (REACH). The REACH will become a shared resource for countries to support their enterprise architecture requests by providing architectural support and advice for their own national eHealth strategies. REACH will also maintain, on behalf of the Network, an enterprise architecture repository of artifacts from which countries can pull, adopt, and adapt for their own terms of references for national health information systems investments. Continued on page 2 1
AeHIN holds Interoperability Meeting in Manila MANILA, PHILIPPINES 24-26 AUGUST 2015-- The Asia eHealth Information Network (AeHIN) Interoperability Meeting was held at the Philippine International Convention Center participated in by 42 eHealth experts and country leaders representing 11 countries in Asia. The meeting initiated more focused discussions on solving challenges on national and regional eHealth interoperability. It helped the members learn from the challenges in health information systems faced by each country and the challenges in reporting and monitoring progress towards attaining the Millennium Development Goals (MDG), and lessons as the global community move towards Sustainable Development Goals (SDG). Workshops and discussions revolved around principles of interoperability, concerns on governance, enterprise architecture, standards and recommendations how to adopt these in concretizing the Network’s vision of better equity in health through eHealth-enabled systems. The need to satisfy the decision makers’ requirements
AeHIN Interoperability Meeting delegates at the Philippine International Convention Center, Manila, Philippines
for quality and standardized data was also tackled. Highlights of the discussions will be presented at the 4th AeHIN General Meeting to be held in Bali, Indonesia on October 2630. The Philippine Department of Health (DOH) Assistant Secretary Gerardo Bayugo opened AeHIN Interoperability Meeting and
depicted progressive efforts in eHealth in the country. The AeHIN Meeting coincided with the Global Forum on Health Research and Innovation 2015 organized by the Philippine Department of Science and Technology (DOST) and Council on Health Research for Development (COHRED). Both the DOH and DOST co-Chair the Philippine National eHealth Steering Committee.
JLN delegates attend Health Dashboards Panel Session Looking Ahead of the Curve:
AeHIN in the Next Three Years Continued from page 1
Joint Learning Network delegates attends Health Dashboards: Tools for Decision-Making Panel Discussion MANILA, PHILIPPINES 28 JULY 2015-Delegates from the Joint Learning Network (JLN) PPM-IT Collaborative Meeting attended the Health Dashboards: Tools for Decision-Making panel series co-organized by the Asia eHealth Information Network, held at the SMX Convention Center, Manila, Philippines. In line with the goals of Universal Health Coverage, with ICT as an enabler, the panel series gathered practitioners to share their best practices and lessons on factors that promote, and challenges in dashboard design/ data visualization and use in the health sector. Delegates are mainly representatives of various JLN member countries social health insurance programs and ministries of health in Africa and Asia: Ghana, Indonesia, Kenya, Malaysia, Moldova, Mongolia, Netherlands, Nigeria, the Philippines, and Vietnam. Panelists included the National Health Insurance-Moldova, National Health Insurance-Ghana, Health Information
Systems Programme-Vietnam, University of Oslo, Department of Health (DOH)Philippines and attached agencies Philippine Health Insurance Inc (PhilHealth), National Kidney Transplant Institute and Commission on Population, National Telehealth Center UP Manila, PATH, Asian Development Bank, and AeHIN. The event was made possible by the partner organizations of AeHIN and JLN: ACCESSHEALTH, and PhilHealth, the Philippine Department of Science and Technology, DOH, National Telehealth Center – University of the Philippines Manila, all of whom are members of the Philippine eHealth Steering Committee. Documentation of discussions are in aehin. org. JLN is a forum comprised of practitioners and policymakers from ministries of health, national health financing agencies, and other key government institutions in 22 Asian, African, Latin American and European countries as well as a diverse group of international, regional, and local partners.
AeHIN will encourage the creation of incountry interoperability labs. These labs will have unprecedented access to the REACH enterprise repository from where they can review and pull artifacts that they can use as guides as they build, acquire, and implement eHealth solutions. These labs will become the go-to places for various stakeholders in the countries for testing, tooling, training, and teaching for interoperability. In-country interoperability labs will be established, pulling the artifacts from the REACH repository. These interoperability labs intend to multiply capacity within countries to build, acquire, and implement those artifacts in HIS in operational – clinical, research and program management – environments. These labs will become the go-to places for various stakeholders in the countries for testing, tooling, training, and teaching for interoperability. In-country interoperability labs will be organized into the AeHIN Community of Interoperability Labs (COIL) -- learning from each other and disseminating new knowledge and research across borders. If the past three years was about governance and architecture, the next three will be about scale, deeper relevance and more rooted stakeholding. Founded on good governance, organized to manage the many stakeholder expectations, national eHealth steering committees can now evaluate better the opportunities presented to them and, through partnerships, produce practical, cost-effective eHealth solutions for their countrymen. 2
eHealth Asia 2015 forges partnerships and opens up opportunities - Sri Lanka
COLOMBO, SRI LANKA 13-14 October 2015-- More than a hundred local and
international delegates participated in eHealth Asia 2015 organized by the Health Informatics Society of Sri Lanka (HISSL) and the Information and Technology Association (ICTA). The opening ceremony was graced by Minister of Health Honorable Dr. Rajitha Senarathne and chairperson of ICTA Mrs. Chitrangani Mubarak.
The Health Informatics Society of Sri Lanka and the Information and Technology Association holds eHealth Asia 2015
The Asia eHealth Information Network (AeHIN), conference collaborator, provided international perspective to the conference. Major achievements of the conference are the showcase of successful eHealth applications in Sri Lanka and the opportunity for interoperability through a lab that will soon be built in the University of Colombo.
AeHIN hosts first eHealth Roundtable Series: Updates on Privacy MANILA, PHILIPPINES, 8 SEPTEMBER 2015 – The Asia eHealth Information Network (AeHIN) and the National eHealth Programme Management Office (PMO) in cooperation with the Philippine Heart Center held the first session of its eHealth Roundtable Series at the Philippine Heart Center. The three organizations invited stakeholders from different sectors to discuss the current state of privacy in healthcare. Various conveners and eHealth implementers presented proposed approaches in promoting, maintaining and securing health data and their perspectives on where the health sector should be headed next. Dr. Peter Sy from the University of the Philippines and chair of the Health Data Privacy Expert Group proposed privacy rules for healthcare facilities. He stressed that while there is already a Data Privacy Act of 2012, the country has still not organized the National Privacy Commission and lacks implementing rules and regulations (IRR). Coming up with a one-size-fits-all set of rules may not be sensitive to context; noting that “context is important in healthcare,” said Sy. “Solutions should be balanced—a balance between general applicability and context”. There should be a general set of rules serving as the IRR and a specific set of rules for each health facility. The chief information officers (CIO) have that responsibility to marshall and fashion such rules specific to their clinics or program offices. Areas of concern were also presented namely hiring, records management, and
training and orientation. In hiring, conflict of interest, relationship transparency, and privacy policy provisions should be introduced. On records management, persons accessing files by downloading, transmitting, and archiving should be identified well. On training and orientation, everyone involved in the organization— from those in the highest positions to staff — should be well informed of their roles and responsibilities in securing health data. Professionals from the Philippine health and IT sectors namely PhilHealth, the Philippine Heart Center, National Kidney and Transplant Institute, the Philippine Alliance of Patient Organizations, Microsoft Corporation, Foundation for Media Alternatives, and the Ateneo participated in the event as reactors. It was agreed that identification of roles and responsibilities in implementing health privacy should be done from the top-level cascading down to the base level. The culture of privacy (or lack thereof) was also raised, i.e. observations that doctors, as leaders in health care, should set an example by being more cautious. For instance, physicians should be more conscious of the practice of describing a patient’s case to a medical intern within hearing distance of other patients.
MyHIX 2.0 advances nationwide health IT interoperability initiatives in Malaysia PUTRAJAYA, MALAYSIA – The Malaysia Ministry of Health (MOH) is upgrading its existing nationwide health IT interoperability platform known as the Malaysia Health Information Exchange (MyHIX). Implementation of Phase 1 began in 2009 where MOH adopted standardsbased interoperable health IT solutions for effective and secure health data information exchange. Exchange of health information is achieved through electronic discharge summaries for the purpose of continuity of care and public health reporting. At present, a total of eight government hospitals and clinics are included in the network. The enhancement of MyHIX, which is named as MyHIX 2.0, includes developing additional Integration Profiles (IP): that is, e-referral, laboratory tests findings and radiological images. This shall enable patient referral to be done electronically as well as exchange of images and/or laboratory reports between health care providers in different health care facilities. MyHIX 2.0 is currently in the system development phase and scheduled to go-live in early 2017. Members of AeHIN, the Philippine National eHealth Programme Management Office (PMO), and the Philippine Heart Center meet for the first session of the AeHIN eHealth Roundtable Series at the Philippine Heart Center.
Privacy and security were also differentiated and recommendations were raised. According to Mr. Dondi Mapa from the private IT sector (Microsoft), “data should be treated like money—protect it against criminals and invest in security measures like standardized clouds.” Mr. Al Alegre (Foundation for Media Alternatives) talked about the complexities of health information ecosystems, defined privacy, confidentiality, security, and (cultural/political) sensitivities. While the Administrative Order (AO) on National eHealth Privacy Guidelines are welcome, Alegre commented that it should contain the processes, protocols, patient control, and access to data. Mr. Dennis Batangan of the Ateneo de Manila University raised that there should be programs for local government units (LGU) where they can anchor their mandate to the AO. Dr. Gerry Manzo of the Philippine Heart Center encouraged the conveners and stakeholders to continue their work even while waiting for their mandate; this way, things can move on while the AO is being processed. By the time it is processed, everything is already in place. 3
mChanneling transforms Sri Lanka’s Dompe Hospital
Medical students from the University of Kelaniya learning EHR and experience of its usage
A team from Police Hospital visits eDompe Hospital
Sri Lanka: Country Initiatives towards Interoperability There are many eHealth initiatives taking place in the preventive, curative and administrative aspects of healthcare in Sri Lanka. These initiatives bring many benefits to healthcare delivery. Issues on lack of interoperability and inability to exchange data between these initiatives, however, hinder the delivery of healthcare in certain healthcare institutions. These issues are yet to be resolved. Realizing the weight of the matter, the Ministry of Health, Nutrition and Indigenous Medicine (MoHNI) in Sri Lanka is currently drafting its National eHealth Guidelines and Standards. It is still at the draft level but the first version is soon to be released. While though the whole document has not been officially endorsed, sections of it are already being implemented by the means of Internal Health Ministry Circulars. For instance, the use of Personal Health Number is now being adopted by almost all eHealth solutions implemented in the country. A few months back, all these solutions were identifying their patients and clients using their own system. To standardize things, the MoHNI issued an internal Circular in standardizing the domain name structure of healthcare institutions under its purview. On the request of the Family Health Bureau, the arm of the MoHNI looking into Maternal and Child Health (MCH), a special working group has been set up under the Directorate of Health Information to look into interoperability issues with regard to software solutions implemented in the field of MCH. This group worked on ensuring backend integration between three major software solutions and preparing the common data elements in MCH.
Dompe District Hospital was unsystematic, unorganized, and overcrowded. But through eHospital Dompe Project and mChanneling it was transformed into a systematic, paperless environment. It is the most successful electronic transformation of a public hospital in Sri Lanka yet. During its paper-based time, waiting time in the Out-Patient Department (OPD) is 1 hour and 41 minutes. Today less time is spent for waiting because OPD processes and clinics like the Psychiatry Clinic and Dental Clinic are completely automated. The Queue Management Center also has the capacity to issue queue numbers for any clinic (One Stop Queue Management Centre). A patient is given a Patient Identification Number on his first visit. It is a card with printed barcode where important information such as medical history and prescriptions is checked and entered. Through the electronic queuing system and the cards, patients are led to the doctors they need to see. Each day, the system automatically generates backups. It also sends immediate notification of notifiable diseases via email.
There are 41 computers networked in the hospital; the system holds over 68,000 records at present. The Hospital Staff are well adjusted to the system; meetings and brainstorming sessions are held regularly to fine tune its implementation. The hospital has also began “PhysicianDriven EMR” for the in-patient ward section in April 2015 – the first in Sri Lanka. Recently, the Dompe District Hospital was selected by the University of Kelaniya as a resource center to train medical students on HER. Ready to be automated in the near future, a team from Police Hospital also visited the Dompe District Hospital. Future plans include interconnecting Dompe with a hospital with larger bed capacity to pilot test data-sharing, with an eye to eventually deploy it throughout the country. “We worked three years and six months with the system. Users are very familiar with the system. Patients have a good faith in it. They have realised the improvement of quality, efficiency, and patients’ safety by ICT.” - Dr. Sampath Kulathilaka, Medical Officer In-Charge of eHospital Dompe Project and mChanneling.
Myanmar holds HIS Strengthening Workshop
Speakers and Participants at Workshop on HIS Strengthening in Myanmar
NAY PYI TAW, MYANMAR, 19-20 AUGUST, 2015 – The Ministry of Health-Myanmar and the Asia eHealth Information Network (AeHIN), in collaboration with the World Health Organization (WHO), the Asian Development Bank (ADB), United Nations Children Fund (UNICEF), and other development partners held a workshop on Health Information System (HIS) Strengthening at the Horizon Lake View Resort Hotel. The workshop reviewed the current HIS status, priorities and barriers, and discussed steps towards developing and implementing a comprehensive country HIS. It engaged Myanmar government officials from Ministry of Health, University of Public Health, Central Statistical Organization, Ministry of Communication and Information Technology, and from organizations such as the United Nations Office for Project Services (UNOPS), Japan International Cooperation Agency (JICA), International Center for AIDS Care and Treatment Programs (ICAP), the Joint United Nations Programme on HIV/AIDS
(UNAIDS), and Marie Stopes International Myanmar. Approximately 60 participants participated in both plenary sessions and brainstorming sessions. Four separate working groups based on eHealth components from WHO-ITU National eHealth Strategy Toolkit such as I) Strategy and Investment, II) Services and applications, Standards and Interoperability, Infrastructure, III) Legislation, policy and compliance and IV) Workforce were formed. The groups identified the gaps and made several recommendations on the related topics during the workshop. Workshop outcomes look to a promising eHealth for development in Myanmar: country stakeholders recognized the significance the holistic development of country eHealth/HIS. The Ministry of Health high-level administrators acknowledge the importance and support the eHealth/HIS strengthening strategy. eHealth and HIS Blueprint, interoperability and health information standards are highlighted and recognized as the essential components of the country eHealth/HIS development.
To ensure compatibility among the three major Electronic Health Records (EHR) solutions implemented in healthcare institutions under the MoHNI, another working committee was set up also by the Directorate of Health Information. This working group is in the
process of identifying the characteristics of these EHR solutions. The initiatives have helped the MoHNI realize the importance of establishing interoperability between eHealth systems at an early stage where it can be adopted easily and feasibly. 4