eHATID LGU Monograph 2

Title: Creating Digital Spaces for Citizens’ Health Access: The eHATID LGU Project Technical Reports
Published by: Institute of Philippine Culture – Ateneo de Manila University
Date Published: 2019
ISBN: 978-971-8610-70-1

Full Publication: eHATID LGU Monograph 2 – Creating Digital Spaces for Citizens’ Health Access: The eHATID LGU Project Technical Reports

 

From eHealth TABLET to eHaMBinGG: The Development of eHATID LGU as a Techno-Governance eHealth System Model

Vincent Christopher A. Santiago

The eHealth TABLET for Informed Decision-making of Local Government Units (eHATID LGU), a project initiated by the Institute of Philippine Culture of Ateneo de Manila University (IPC-ADMU), in partnership with the Philippine Council for Health Research and Development of the Department of Science and Technology (PCHRD-DOST), situates itself within two major health programs of the Philippines. The 2010-2016 Universal Health Care (Kalusugang Pangkalatahan) Program and the Philippine Health Agenda for 2016 2022, with the battle cry “All for Health towards Health for All,” recognize the importance of information and communications technology (ICT) to health services, especially in facilitating various processes and improving outcomes. In a decentralized health system like that of the Philippines, governance at the national and local levels largely influences the use of ICT in the health delivery system.

Over the last four years, eHATID LGU has greatly evolved since it began as eHealth TABLET in 2013, enhancing its capability as a health information system supporting the local governments, the Department of Health (DOH), and the Philippine Health Insurance Corporation (PhilHealth). The following sections provide an overview of the development of this techno-governance eHealth system model.

Conceived as eHealth TABLET

The prototype of eHATID LGU, the eHealth Technology Assisted Boards for LGU Efficiency and Transparency, or eHealth TABLET, was launched in 2013, with the aim of addressing fundamental issues related to the acceptance and adoption of health information systems in the country’s geographically isolated and disadvantaged areas (GIDAs). By identifying the local government unit (LGU) as the primary site of engagement, the project adopted a bottom-up or devolved approach in developing the application, as opposed to the “top-down” approach commonly employed for health information systems in the past.

Moreover, the project introduced the smart tablet as platform for the application, in place of the more common desktop personal computers. This allowed for the mobility of health records, as these were stored in a portable device, and the accessibility of data, since the tablet relied on the Internet for connectivity, unlike the desktop computer, which used often unreliable wired connection.

The project was deployed in ten pilot sites:
1. Lal-lo, Cagayan 6. San Jose de Buenavista, Antique
2. Guimba, Nueva Ecija 7. Anilao, Iloilo
3. Santa Rita, Pampanga 8. Isulan, Sultan Kudarat
4. Paombong, Bulacan 9. Dumalinao, Zamboanga del Sur
5. Alcoy, Cebu 10. Bacuag, Surigao del Norte

Expanded to become eHATID LGU

With the signing of a Memorandum of Agreement (MOA) between DOST-PCHRD and Ateneo de Manila University on 17 June 2014, the next phase of eHealth TABLET implementation was formalized. Renamed eHealth TABLET for Informed Decision-making of Local Government Units (eHATID LGU), the project was intended to be deployed in 450 cities and municipalities in 42 provinces of the country.

The eHealth TABLET’s important innovations, including the smart tablet platform and overall devolved approach to health service delivery and implementation, were carried over to eHATID LGU, which is now part of the National Unified Health Research Agenda (NUHRA). The system was designed to have three key functionalities: electronic medical records (EMR), mayor-doctor communication, and alerts/ notification.

Evaluated based on the Program Components

In August 2014, the eHATID LGU team saw the need to assess project implementation and technologies, in anticipation of further developments to the system, such as the integration of the Primary Care Benefit 1 (PCB1) electronic information system into the eHATID LGU system. The project team thus devised a project evaluation plan to articulate several short-, medium-, and long-term goals and account for recent outcomes in the following program components:

1. Institutional development and partnership
2. Integration of eHealth TABLET and eHATID LGU in eHealth.ph
3. Capacity building
4. Integration of the eHATID LGU system into provincial and regional health information exchanges (HIEs)
5. Systems integration
6. Sustainability

Following these program components, the evaluation plan was divided into three main sections: Process Evaluation Plan, Outcomes, and Measurement Plan. These are discussed further in chapter 3.

The Process Evaluation Plan sought to account for institutional linkages both at the high level, i.e., compliance with PhilHealth technical requirements, and at the operational level, i.e., deploying the eHealth TABLET to LGUs. The Outcomes component identified the key stakeholders and target groups, as well as their main program activities. These institutions and agencies were highlighted based on specific objectives of the eHealth TABLET. Finally, the Measurement Plan is intended as a set of evaluation tools outlining the purpose, target, and data associated with each of the program components.

The project team approved the fifth and final version of the evaluation plan in October 2014.

Integrated the eHATID LGU Morbidity Boards in Geospatial Graphs

In 2015, in response to the need for a data analytics component in eHATID LGU, the eHATID LGU Morbidity Boards in Geospatial Graphs (eHaMBinGG) was developed. It serves as a visualization module for health morbidity data stored in the Government Cloud (GovCloud) facility of the Department of Science and Technology-Advanced Science and Technology Institute (DOST-ASTI). Important trends and patterns in the eHATID data could be easily represented on digital maps of the deployment sites.

Culminating in Studies of eHATID LGU and the Production of This Monograph

In September 2016, the project team initiated the first cycle of studies of eHATID LGU to fulfill the following objectives:

1. Contextualization of the development of the eHATID LGU system and in-depth description of all its components.

2. Documentation and evaluation of:

a. regional technical assistance providers (RTAP) training and its outcomes,
b. LGU end-users training and its outcomes,
c. software development and cloud-based solutions,
d. system acceptance and utilization by end-users, namely, the local government/rural health unit staff, and
e. utilization of the communication tools and alert system.

3. Monitoring of status of stated project goals and their attainment.

Twelve resource persons were convened to form the Technical Advisory Reference Group (TARG) and carry out the studies, focusing on various aspects of eHATID LGU, its place in eHealth in the Philippines, dynamics of the project’s interaction with local government officials, and local health facilities, and potential for analytics of the health data generated through the system. Their written output went through a feedback process involving the authors themselves and members of the eHATID LGU project
team. Some of these manuscripts comprise this monograph, which consists of two parts.

Part One presents the various aspects of eHATID LGU and its precursor projects. The first article is a comprehensive mapping of the project’s history and development as a techno-governance intervention in the field of eHealth in the Philippines. eHATID LGU, although situated in a terrain with other electronic medical records of various groups and institutions, introduces crucial innovation that has proven to be helpful toward efficient health-service delivery to end users. The second evaluates the actual deployment and implementation of eHATID LGU. As a member of the project team that visited all of the sites to conduct training in the use of the application, the author details specific objectives, best practices, and challenges that were reported throughout these activities. The third and last details the eHATID LGU evaluation plan, highlighting the principles of evaluative research that were applied to eHATID LGU.

Part Two focuses on the analytics and knowledge management side of eHATID LGU. The first article describes the components and features of eHaMBinGG and its place within the overall eHATID LGU framework. eHaMBinGG is deemed a data-driven contribution to the field of eHealth in the Philippines, not just at the national level but also, and perhaps more importantly, at the local or grassroots level. The second discusses eHaMBinGG and its application to specific localities. The third and last is a case study of one project deployment site, San Jose de Buenavista in the province of Antique. It tackles how data that have been generated and stored in the eHATID LGU and eHaMBinGG systems can be analyzed to identify patterns and trends in the spread of noncommunicable diseases.