What are the current challenges to health informatics in developing countries?
This isn’t Physics — you can’t just neglect air resistance.
One thing I remember during my undergraduate Computer Science is the No Free Lunch Principle. Picking a fast algorithm may look like the best option until you see how inefficient it is in the aspect of memory management.
What am I pointing out? It means that everything has a price. The implementation of different programs in Health Informatics requires certain resources. This isn’t alarming if we’re just born filthy rich, but for a p̶o̶o̶r̶e̶r̶ ̶t̶h̶a̶n̶ ̶m̶y̶ ̶e̶y̶e̶s̶i̶g̶h̶t̶ developing country, the needs of this field aren’t easy.
But why are we limiting this post to developing countries only?
I’m not sure whether you were sleeping in Economics class or you were born yesterday, but the Philippine economy isn’t as affluent as you think.
… a nation with a lower living standard, underdeveloped industrial base, and low Human Development Index (HDI) relative to other countries. (What is Developing Countries, 2019)
It still falls below the criteria set to be called a developed country. This is the reason why we contextualized the hurdles of Health Informatics to just the developing countries only.
Uhmm. What is Health Informatics again?
Good question but you can just read it here. Come back here once you’re done reading.
I get it. So, what are the challenges?
Improving health care is the driving force for the establishment of Health Informatics. The progress of the healthcare industry in developing countries is being hindered by “poor economics, political uncertainty, and the lack of cutting edge infrastructure”. (Luna et al, 2014) Now, if the industry of healthcare isn’t perfect after all, what’s more with this budding field of health?
The authors of the study listed a set of problems that Health Informatics is facing in most developing countries. In light of this, I’ll try to put these problems within the bounds of the Philippines.
I. Resource and Infrastructure Limitation
Philippines maybe wealthy with natural resources but that doesn’t automatically translate to financial resources. Therefore, with so little money, the government focuses more on allotting these funds to the basic needs that will support its people to live sound; and IT infrastructure isn’t one of them. Building proper, long-lasting, and sustainable network infrastructure needs a huge amount of money.
If an IT advancement exists, it is most likely seen in highly urbanized area, e.g. NCR, metropolitan areas of Region III, IV-A, and VII. Looking at the map of urban areas of the Philippines, it’s just a small dot on a big plane.
The said areas also have a better health care system than their rural counterparts. What’s the problem in here, you ask? Health Informatics doesn’t just target a specific group of persons; it should cater to the entire population to see its benefits.
Fortunately, the Department of Information and Communication Technology (DICT) addresses this issue through their GovNet and National Broadband Plan. Offices like the Department of Education (DepEd) — albeit primarily used for learning — gives computer sets and IT devices to the public schools to mend the gap in the digital divide.
To fix some of the gaps in the reach of healthcare, a new industry sprouts out: Telehealth.
Telehealth is defined as the delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies. (What is Telehealth?, 2018)
Globe introduced their own Telehealth service, KonsultaMD, to address the health needs of their subscribers. A similar initiative was also made by some insurance companies like Maxicare.
Hopeline, the suicide hotline for Philippines, was also introduced last 2017. First Aid PH, a telehealth service for emergency response, exists even before the former were made available to the public.
This is an innovative way of making health care portable and budget-friendly. However, it has its downsides: no medical record per patient and vague diagnosis and prognosis.
In a smaller setting, like in clinics, hospitals, local community health institutions, etc. , Health Informatics shows a better improvement in achieving its goal. Deploying it to a wider range sounds promising, but it really needs a Health IT Agenda, first.
II. Development of Health IT Agenda
Like when building a family, implementing an eHealth service needs plan, too; you can’t just do whatever you want without assessing different factors and analyzing its future repercussions.
The World Health Organization (WHO) emphasized “the need for health IT application frameworks to better develop and sustain IT projects”. (Luna et. al., 2014) It was observed in the study that most developing countries have a lack of support or direction.
In the case of the Philippines' Department of Health (DOH), an eHealth Strategic Framework and Plan have been put in place since 2014 and it will last 'till 2020. No words of it publicly except for some of the project updates.
Hopefully, despite the current administration’s “do it now, scrap it later”-type of planning, this project comes to fruition.
III. Overcoming Uncertainty, Ethics, and Legal Considerations
As a new field, the legalities and ethical considerations of Health Informatics is still in its juvenile phase. At this level of legal uncertainty, anybody could do things without legal implication or it could delay implementations of such programs.
The result of this mishap is people not trusting to any innovations presented. And trust, like in a relationship, makes or breaks anything. Hence, medical practitioners or anybody in the field of Health Informatics needs to be knowledgeable on the legal frameworks and medical ethics of the country they are in.
The existence of the Data Privacy Act and Cybercrime Prevention Act of the Philippines gives a breather to the data subjects of Health Informatics programs while also giving a tough control to anybody who will misuse such confidential information.
IV. Lack of Use of Common Interoperability Standards
Remember the downsides of Telehealth? Here’s where it happens.
As a subscriber of KonsultaMD, I was elated to find answers to questions about my health. I’ve called them for five times since then; and for those five times, I have to tell them who I am and my medical history. I wish I had an autobiography and have them read it over and over again.
My health record only confides within the doctor I’m currently talking to — and I don’t think they even have a record for patients. If the call suddenly cut out and you call again, there is no way to continue what was left unsaid; we have to start over again. Like in a relationship.
The goal of interoperability, in the context of software engineering, is to make a software that can communicate its data with other systems that need it. It sets a mutual understanding between parties.
Now, if interoperability standards were set in place, my offline and online record are now in sync. Whenever I avail the Telehealth service, they are updated with my current health status. Same goes, if I go to my GP.
V. Lack of Trained Workforce
Introducing Health Informatics in UP Manila is a great leap forward in the Philippines’ medical field. The poblem is that the graduates of such field are scarce and they may or may not be practicing it after graduation.
Another thing is that graduating from the Health Informatics doesn’t automatically mean that they are prepared to face the real world. Certain expertise may still need to be honed.
VI. Regional Integration
Communication is crucial in the implementation of Health Informatics. An implementer must share their knowledge of the field, their success stories, and the obstacles they’ve met during implementation to other interested parties.
This information sharing strengthens the bond between industries and it also improves the system.
Currently, a repository of journals for Health Informatics is presently running online.
Challenges are a vital part in any development. However, when unmitigated, it can cause a downfall. But like any challenges, studying them and planning carefully on how to address these issues, this field will bloom to its full potential.
IGI Global. (2019). What Is Developing Countries. [online] Available at: https://www.igi-global.com/dictionary/developing-countries/7401 [Accessed 22 Aug. 2019].
NEJM Catalyst. (2018). What is Telehealth? – NEJM Catalyst. [online] Available at: https://catalyst.nejm.org/what-is-telehealth/ [Accessed 25 Aug. 2019].
Luna D et al. Health informatics in developing countries: going beyond pilot practices to sustainable implementations: a review of the current challenges. Healthc Inform Res. 2014 Jan; 20(1): 3–10.