UPM SILAB: Achieving UHC through Digital Health Capacity Building in the Philippines
August 03, 2024
UPM SILAB: Achieving UHC through Digital Health Capacity Building in the Philippines
By Jose Alfonso C. Madroño, UPCM Class of 2026
A patient seeking healthcare for their illness would find themselves getting a check-up in a local health clinic and even possibly, in a primary, secondary, or tertiary hospital if referral is needed. Each visit has its own story, but repetitive history taking, physical examination, and ordering laboratory tests tend to be a commonality. Oftentimes, laboratory tests need to be repeated to aid in diagnosis or treatment monitoring, especially when transferring healthcare providers, and factors like these lay a series of problems for both the patient and the physician. For the sake of continued patient care, how can the data from one institution be accessed by another? In seeking proper health care, how can the patient safely and securely access their own data to present to their physicians? This challenge therefore tracks into the realm of Universal Health Care and Digital Health.
UPM SILab Logo
Each of these institutions, from the local clinic to the different hospitals, has its own centralized health information system that records and keeps the data of each of their patients. It is very common to encounter a records system which is largely physical: hard copies of history taking data, lab results, imaging findings, and the like. Other institutions have already begun transitioning to an electronic medical records system, though still supplemented by the tried-and-tested physical copies. With the different modalities, this poses a glaring problem in accessing data from one institution to another. There becomes an apparent break (at least in digital health) in continued patient care. The lack of a standardized information dissemination system results in the fragmentation of data and the inability of patients to access their data from all these different systems. This apparent disconnect is what UP Manila Standards and Interoperability Lab (UP Manila SILab) hopes to bridge.
UP Manila SILab Lead, Dr. Alvin Marcelo
The UP Manila SILab, led by chairperson Dr. Alvin Marcelo, understands the role digital interventions play in the Universal Health Coverage Act. At present, the Philippines still operates on incompatible information systems holding non-standardized data. This limits the opportunities for research, and remains a challenge in utilizing the data for key decision-making. The UPM SILab, therefore, is working to provide quality health — accessible to patients and physicians, at any time and any place, for the right purposes.
The creation of UPM SILab took inspiration from the work of Dr. Janus Ong, a gastroenterologist, transplant hepatologist, and hepatitis advocate. Dr. Ong, with ongoing research, received a grant to establish a standardized system for hepatitis data. It was from this point that the team decided for UPM SILab to replicate Dr. Ong’s work to other priority programs of the Department of Health (DOH), PhilHealth, and other organizations.
The UPM SILab and the UPCM Hepainformatics Team hosted a two-day in-person HepaCon workshop last February 27 - 28, 2023 at the UPM Medical Science Henry Sy Sr. Building
As Dr. Ong and the core group of UPM SILab were all affiliated with UP Manila, it was only natural that the UPM SILab team emanated from within, but other key institutions that are in partnership with UPM SILab all hold key roles in its development and future. DOH sponsors the needed training in developing the technology and system, and in turn, it becomes a key recipient of the knowledge products generated by UPM SILab. Recognizing the vital work of UPM SILab, DOH has aided UPM SILab in gaining traction and showcasing its importance to the health informatics community. Moreover, PhilHealth utilizes the highly specialized work of standardization and interoperability for its system in bridging together the data among hospitals, physicians, and patients. Lastly, the UPM SILab team partnered with the UP Surgical Innovation and Biotechnology Laboratory (UP SIBOL), a group whose goal is to provide accessible, locally designed and manufactured medical tools for Filipinos. In this partnership, UP SIBOL aims to embed the tools created by UPM SILab into its own devices.
In realizing its goals, UPM SILab focuses on its 4Ts: teaming, tooling, training, and testing. Teaming is about facilitating the consensus of its stakeholders on national policies, while tooling involves converting these policies into computable representations. Training sessions include webinars, workshops, and ongoing projects, such as the Viral Hepatitis project. The Community of Interoperability Labs Knowledge Sharing Session (COIL-KSS) is an example of a webinar series that integrates and discusses digital health landscapes of countries from Taiwan, Sri Lanka, Laos, India, and Thailand, to name a few. These sessions focus on the bigger picture of how SILabs play a crucial role in its collaboration with the government, local health insurance office, electronic medical record vendors, and other stakeholders. After which, testing is crucial to monitor the tools’ compliance to set regulations. These four components are guided by the World Health Organization’s (WHO) Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable (SMART) Guidelines. This approach directs countries to adopt optimal clinical and data practices for quality digital health.
UPM SILab conducted a 5-day hybrid Interoperability Training Course, for the IT specialists of the Philippine Health Insurance Corporation, Inc. (PhilHealth).
UPM SILab also works to ease the transition from paper systems to smart digital systems through the use of Fast Healthcare Interoperability Resources (FHIR), a standard developed and maintained by Health Level Seven International (HL7), a not-for-profit organization that supports clinical practice and effective health service management by establishing standards for exchanging electronic health information. FHIR is a standard for exchanging health-related information electronically. The focal point of the team’s tooling and training programs is FHIR — particularly what it is, how to use it, set it up, and implement it. The team regularly hosts webinars, announced through its website and Facebook page, to educate the general public, health informatic enthusiasts, and health-tech workers.
UPM SILab paved the way for Philippine healthcare interoperability with its year-end event, “Interoperability Demo and Convergence Workshop Planning” last December 11-12, 2023 at Sequoia Hotel.
At present, UPM SILab has created the FHIR Profile and Implementation Guide for Viral Hepatitis, utilizing the National Viral Hepatitis Initiative. Moreover, to stay up-to-date with the latest advancements and trends in digital health, the team maintains a close relationship with similar SILabs in other countries such as Indonesia, where they were able to garner insight on how they were able to use FHIR during the Hajj. They have also developed a training program on basic and advanced interoperability.
Dr. Marcelo’s ultimate vision is for UPM SILab to become the master reference node in the country and from there, to spring forth other Standards and Interoperativity Labs in various state universities and colleges. As medical students, we can take part in this vision by taking a role in the laboratories and begin building standardized tools. As future clinicians, we are slowly being exposed about the information gap in fragmented digital healthcare, allowing us to raise awareness. Dr. Marcelo believes we can create SMART-on-FHIR apps by employing simple softwares that can attach to any electronic medical record that immediately improves functionality. Through multidisciplinary efforts, engaged local partnerships, and strong international relations, the UPM SILab is poised to ensure the readiness of standardization and interoperability of health data in the country.