Local eHealth implementation
GENE ALFRED S. MORALES
As PwC’s territory driver for the local healthcare industry, I’d like to share my realizations on the opportunities with eHealth as well as the challenges of implementing digital health in emerging markets like the Philippines.
Background
My initial exposure to eHealth was from doing desktop research on “m-health”, a subset of eHealth. As far back as 2012, the information and communication technology (ICT) sector in the Philippines had already started exploring the m-health opportunity. There were a couple of examples, such as one telco moving into this space.
First, they launched a web-based health solution to enable real-time, secure, and convenient access to health information. And second, they launched a 24/7 health hotline service manned by licensed Filipino doctors. Meanwhile, another telco collaborated with the government to launch a cloud-based electronic medical record and e-referral system in the Philippines. It’s readily deployable in any area with Internet coverage.
An exceptional information-enriching experience for me on the opportunities of eHealth was during the November 2014 joint session of the Asian Hospital Federation and the Philippine Hospital Association lecture session where PwC’s subject matter expert on Health Information Technology discussed telemedicine and new electronic gadgets using wireless communications and computer technology.
At that point, the critical role ICT plays in providing eHealth and m-health services became obvious to me. I also recognized the importance of collaborating or partnering with private companies, the government sector (including the DOH, the Department of Science and Technology, Philhealth, and local government units) and the NGOs in making healthcare more accessible, faster, better, and affordable, particularly for underserved communities.
Case Study: Project ECHO (Equitable Community Health Outreach)
Allied World Healthcare (AWH) is a non-profit social enterprise looking to provide free healthcare services to low- and middle-income countries through a radically different service model. It launched an eHealth-related project in December 2016 called ECHO (Equitable Community Health Outreach) in the Philippines. This involves designing a community-led healthcare model for areas that currently lack access to basic services while working with community resources (ranging from schools and shops to local healthcare workers) to give more comprehensive medical advice and support better access into the existing health systems.
In collaboration with business partners including the National University of Singapore, two digital platforms for eHealth were developed to support citizens and clinicians in accessing information, education, advice, and a host of other features to help them or others in their community have better health choices.
For those who can’t access digital services, locally embedded community partners are engaged (termed “Community Access Managers”, or CAMs) to train users in the two platforms so they can support their fellow citizens with basic advice and help individuals access local health providers and available finance mechanisms (e.g. payment of consultation fee and medications).
The aim is to generate jobs in the community so these CAMs could be anyone capable of handling basic community health technology. Training and equipment are provided as well. CAMs can be midwives, teachers, or anyone who is trusted in a local community and can be trained in using the system.
Most important, though, is the focus on Public-Private Partnership. The technology and community access services enable people in remote and underserved locations to connect to basic services. Then AWH works with non-profit organizations, governments, pharmaceutical companies, and insurers to help them address unmet community needs with free or affordable products and services. This is critical for sustainability. Collaboration is the driving force of their current success, funding, and growth.
Lessons learned
Based on the initial pilots in the Philippines, we can glean a number of lessons that new entrants to the eHealth space can learn from:
a. Apart from access to healthcare information, there’s dire need for financing (e.g., community-based) for the citizenry to avail themselves of required medications and/or specialized consultation.
b. The commitment of barangay leaders, the mayor, and the municipal health officer is critical to successful implementation. The local community gives high regard to messages and instructions given by their leaders.
c. Training and education of affected stakeholders are essential, particularly for remote areas where technological literacy is quite low.
d. Internet connectivity is a perennial problem that affects not just rural but also urban areas. Standalone electronic or manual spreadsheets as backup systems are essential for initial data gathering.
e. Each implementation site is likely to have unique concern, resulting in pressure to customize the application or platform.
f. Private organizations are interested and are willing to try out and participate in the model. They prefer having a well-defined role within the system to make sure their involvement is aligned with their company’s vision and sustainability targets.
Privacy compliance
Like any project that deals with sensitive personal information, an eHealth project like Project ECHO is subject to the Data Privacy Act (DPA) of 2012. The act states, “It is the policy of the State to protect the fundamental human right of privacy, of communication while ensuring free flow of information to promote innovation and growth. The State recognizes the vital role of information and communications technology in nation-building and its inherent obligation to ensure that personal information in information and communications systems in the government and in the private sector are secured and protected.”
Based on observations from the four test/soft implementation sites, majority of the citizenry are readily open to share personal information as part of user profiling. Although the Project ECHO platform already follows the privacy standards of the National Health Service of the United Kingdom, it needs to and is now in the process of aligning with Philippine DPA requirements.
Conclusion
A lot of work has yet to be done. Certain challenges, e.g., Internet connectivity, local regulations, and formal agreements with potential partners, remain but there’s a lot of hope that eHealth can deliver tangible benefits to communities around the country.
I look forward to a time where technology becomes a critical enabler for connecting various stakeholders within the health ecosystem to deliver the public health outcomes that our country so sorely needs.
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Gene Alfred S. Morales is a Director of PricewaterhouseCoopers Consulting Services Philippines Co. Ltd., a member firm of the PwC network. For more information on Project ECHO or Curis, you may contact Gene at gene.alfred.morales@ph.pwc.com or AWH’s CEO Edward Booty at edward@alliedworld.healthcare. This content is for general information purposes only, and should not be used as a substitute for consultation with professional advisors.
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