Blogs posted for Asian Development Bank (ADB)

Without incentives, health data sharing systems don’t work for patients

Published July 1 2016

In the multi-payer systems that characterize primary health care in Asia and the Pacific, both developed and developing countries suffer a way of delivering care that works against data sharing.

Even in Hong Kong, China—which has one of the highest standards of health care in the region—services are rendered without a sharable electronic medical records system, as I witnessed in a recent encounter with the medical profession that gave me first-hand insight into the matter.

Like 70% of Hong Kong’s population, I get my primary health care in the private sector. After a recent well-woman check-up with my family doctor, she sent me to a specialist, with a printed letter and photocopies of my test results. The specialist subsequently typed up and posted back his reply, explaining his diagnosis and course of action. Now both doctors had the same sheets of paper in my medical records. Meanwhile, the specialist my doctor recommended was not the same one who had provided my obstetric care, as well as periodic check-ups, over the past 17 years.

Now there were three doctors, with consulting rooms within walking distance of each other, all of who know me, and had important information about my reproductive health (and illness)… and no formal way to share the data with each other.

So I shared the data myself – I delivered the referral specialist’s handwritten notes to my longstanding gynecological care provider so he could put them in his paper records. This is what happens in Hong Kong’s private medical sector, which delivers the most expensive—and arguably the most patient-centric—primary care in the territory. The only reason all three of these doctors are now up to speed on my health is because I took it upon myself to make that happen. This is not a typical way that patients in Hong Kong deal with their health records, if they even see them at all. Usually this data is simply not shared with them or anyone else because there is no mechanism for that to happen.

Had I been part of the minority who access primary care at a Hospital Authority (HA) outpatient facility, every encounter with any health worker would have been logged in the HA’s excellent electronic medical records system. My health data would be available for easy retrieval at any point in the future. What the HA’s system can’t do, though, is tap into private sector medical records, where the vast majority of primary care happens in Hong Kong.

In March 2016 the Hong Kong, China government launched its Electronic Health Record Sharing System. It didn’t seem to create much of a splash, so I was intrigued. There is a system for data sharing after all. But leaving aside the baffling instructions for patient registration, there is another major constraint – I can register as a patient, but there is no mechanism for me to check whether or not any of my private providers have signed up, and even participating providers may not be able to share all the data they have due to “technical constraints and readiness.”

When I asked my providers, one specialist supported the idea of patient data sharing and praised the HA system, but complained the registration process was onerous and the perceived benefit to him and his patients was minimal.

Hong Kong, China is a multi-provider, multi-payer health care environment where public hospitals compete with private primary and specialist care providers. There is thus a strong disincentive for the sectors to share patient data they consider to be their proprietary information. This lack of data sharing is one key reason why Hong Kong’s primary care financing model is poor value for money.

Patients are not in a position to drive the creation of a central medical records database. Public trust in the Hong Kong government, currently at its lowest level since the 2003 SARS outbreak, also undermines efforts to reassure patients that their data will be kept safe and confidential. Moreover, the government’s data sharing system only offers a (somewhat clunky) mechanism for sharing data, but does nothing to address the disincentives to sharing it.

A robust, genuinely population-wide medical data sharing system with strong and transparent governance helps identify patients uniquely and confidentially whenever and wherever they access health care. Providers can access the information they need–and only that information–to provide continuity of care. This has enormous positive implications for public health, and other Asian countries should be aware of this.

The problem can only be effectively addressed by government intervention that compels all public and private health service providers to share their data, promote continuity of care, and put their patients’ wellbeing first.

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Blogs posted for Asian Development Bank (ADB)

The art of interactive conference for knowledge sharing

 

Published on ADB website on Thursday, 12 November 2015

Written by Susann Roth and Jane Parry

Conferences are a great way to bring like-minded people together in one venue to learn from each other and share ideas. But they can also be deadly dull if they don’t break away sufficiently from the traditional plenary format. Fortunately, the recentConference on Measurement and Accountability for Universal Health Coverage in Asia-Pacific gave participants a multitude of innovative ways to engage with their peers.

ADB jointly organized the event, held in Bali in late October, together with the Government of Indonesia, BPJS Kesehatan (Indonesia’s largest social health insurance provider), the World Health Organization, UNICEF, the Asia eHealth Information Network (AeHIN) and other development partners such as NORAD, the Joint Learning Network, and PATH. During the conference, participants reviewed the current evidence on cost, benefit and impact of ICT-enabled solutions in the health sector, and then set about developing their own set of concrete priority actions to work on in the coming year at the country and regional levels.

A number of plenary sessions brought together high-profile speakers from around the region and beyond. The sessions became interactive with the help of the forum app Pigeonhole, through which the audience posted questions as they arose, and others could then vote on them. As questions bubbled up to the top of the list, the speakers were able to address the issues that most concerned their audience.

There were the usual breakout sessions, with feedback presented to the whole conference, and each group was tasked with a practical goal to achieve. In these smaller groups, national peers decided on the next steps appropriate to their unique circumstances that will help their country use ICT-enabled solutions to reach the goal of universal health coverage and transition their countries health sector M&E frameworks from the Millennium Development Goals (MDGs) to the new Sustainable Development Goals (SDGs).

By using a marketplace format—which is our personal favorite—the conference was able to present 22 different digital health architecture tools and solutions, with participants choosing the ones that interested them the most. Presenters engaged with smaller and strongly interested audiences, showcasing a wide range of innovations, including those for electronic health records, civil registration and vital statistics, geographical information systems, and open-source software solutions for health information systems.

Hearing about how ICT can be harnessed to make health systems interconnected and serve patients better is interesting, but the conference went a big step further.

A live demonstration showed in real time how even fairly basic computers and mobile phones can support existing open-source digital health solutions to deliver better care. Using a scenario of maternal/child health and malaria to illustrate the role for interoperable HIS in continuity of care, the live demo showed how a barcode-based unique health identifier can be created at any point of care. Information can then be shared not only with national databases, but also with other points of care in different locations and over time. Check out this video to learn more about digital health infrastructure.

The conference also got participants out of the meeting rooms with four site visits to a BPJS regional division office; a district hospital that had deployed integrated HIS and BPJS information systems, and two primary care clinics at different stages of implementing ICT-enabled HIS.

As the week drew to a close, it was clear that the transition from the MDGs to the SDGs was an over-arching theme. Whereas the MDGs fostered a silo-ed approach to specific health issues, the health-related SDGs have a clear focus on equity and they demand measurement and accountability for achieving specific targets. Both these factors put the role of ICT at the forefront.

This event was an excellent forum to build a regional response to the global call to action made at the Measurement and Accountability for Results in Health Conference held in Washington, DC earlier this year. Participants left Bali knowing that there was a thriving community of practice that they could draw on for advice and support, and ADB is proudly part of that.

 

 

 

 

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Blogs posted for Asian Development Bank (ADB)

Move away from HIV and AIDS? Not quite yet!

Published on ABD website, Monday, 01 December 2014
By Susann Roth, Patricia Moser and Jane Parry
The AIDS response in our region has undoubtedly made impressive gains in the past 15 years. But as we mark today World AIDS Day, we can reflect that there is so much more that remains to be done.
New infections have fallen since 2001, but in 2013 there were 4.8 million people living with HIV in the region, including 350,000 newly infected that year. Worryingly, the number of new infections has flatlined for 5 years. Treatment access has been massively expanded, and 1.56 million people living with HIV were receiving life-saving antiretroviral therapy by 2013. But at that rate only half of those eligible will be on treatment by 2015.
Resources dedicated to the AIDS response in our region come from both domestic and international sources, and ADB has been supporting HIV prevention projects since the early 1990s. From 2005 onwards, much of ADB’s contribution has been through the ADB Cooperation Fund for Fighting HIV/AIDS in Asia and the Pacific, established with a $19.2 million grant from the Government of Sweden.
HIV specialists from ADB and its partner organizations gathered recently to discuss what the fund had achieved as it draws to a close at the end of this year.
The 120 participants from governments, UN agencies, and civil society organizations had a lot of good news to discuss. The fund has supported 17 projects in 12 countries, and had its most notable successes when it focused on ADB’s unique advantages: its key role in the development of the region’s new transport and economic corridors, its convening power and knowledge broker status, and its established relationships with national decision-makers at the most senior level.
The Cooperation Fund’s success stories included projects that capitalized on ADB-supported infrastructure projects to mitigate HIV risk along economic and transport corridors. Projects in Cambodia, the People’s Republic of China, the Lao People’s Democratic Republic, Mongolia, Myanmar, Papua New Guinea, and Viet Nam all used this route to bring HIV prevention interventions to otherwise hard-to-reach vulnerable groups such as migrant workers, mobile populations and people living in border areas; and key populations at higher risk of HIV including sex workers, and people who inject drugs.
The knowledge base on HIV in Asia and the Pacific has been greatly improved thanks to a grant from the Cooperation Fund to set up and manage the HIV and AIDS Data Hub. The Data Hub’s website is now the go-to resource for data on the epidemic and response in the region. Other projects under the fund contributed more than 20 publications and other knowledge products, many of which are routinely used by ADB staff in HIV prevention work as part of infrastructure projects.
Partnerships with specialist HIV agencies, in particular UNAIDS, and grassroots organizations that have strong connections to marginalized groups and target populations, have greatly extended ADB’s reach. They have also enabled resources from the fund to strengthen civil society and nongovernment organizations and build their capacity, notably in the Greater Mekong Subregion.
HIV prevention is not a static target and as the epidemic in this region has evolved, the Cooperation Fund has been able to target resources to areas where there are newly emerging vulnerabilities, e.g., in cities such as Manila, Bangkok, and Chennai; and in border areas throughout the Greater Mekong Subregion.
And thanks to ADB’s established relationships with governments and the private sector in Asia and the Pacific, the fund has been uniquely positioned to convene key players from the private and public sectors, build on their experiences, and foster cross-border collaboration. Some of the most innovative projects are those that have brought on board the private sector, such as the Asian Football Confederation, which was able to use its massive region-wide reach to disseminate HIV prevention messages through the Protect the Goal campaign.
Hearing about the successes of the Cooperation Fund—as well as the lessons learned from those projects that were less successful—was heartening. Based on all this good news, it might be tempting to think that it’s time for HIV to move over and make way for other health and development priorities. What a wrong move this would be.
One only has to look again at the data, and the newly emerging epidemics in hotspots around the region, to see how much more work remains to be done.
HIV/AIDS continues to be a significant threat to economic prosperity and health security in the region. Slowing down efforts now runs the grave risk of unraveling the gains made so far, and missing the opportunity to stop the epidemic in its tracks, reverse its course and get on target for zero AIDS by 2030.
In his opening remarks at the meeting in Bangkok, Myo Thant, an ADB Principal Economist in the Office of Regional Economic Integration, said that we need more resources, but we also need to understand how best to utilize these resources. Specifically, there is a need to increase the knowledge base, not just about the epidemic landscape in the region, but also about what works, and how best to invest previous resources in future interventions.
HIV does not exist in isolation, nor does it respect national boundaries. The strengthening of health systems is crucial to improve access to HIV/AIDS testing, prevention, treatment, care and support, including harmonization of services across the porous national boundaries in border areas. All sectors must be brought onside including, public, private and nongovernment agencies. Moreover, greater domestic responsibility for HIV/AIDS investments notwithstanding, support from regional and international funding sources is still essential.
For its part, ADB must continue to be innovative in its contribution to the HIV/AIDS response, strengthen its partnerships and tirelessly use its influence to ensure that this region does not drop the ball on HIV/AIDS.

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