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.

Advertisements
Standard
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.

 

 

 

 

Standard
Blogs posted for Asian Development Bank (ADB)

ICT helping countries move toward universal health coverage

 

Published on ADB website on Friday, 12 December 2014

Written by Susann Roth and Jane Parry

When the Conference on Measuring and Achieving Universal Health Coverage with ICT in Asia Pacific wrapped up earlier this month, the 290 participants could head home knowing that it had been time well spent. Not only did they share their experiences as health systems administrators and managers, they also left with a bigger network, and a commitment to taking concrete steps to use information and communications technology (ICT) to help their countries move closer to universal health coverage

It was gratifying, as one of the co-organizers together with colleagues from World Health Organization and the Asian e-Health Information Network to see this process unfold. The conference was designed to get people talking in small groups, actively learning from each other, consulting together to hammer out what needs to happen for health systems to fully harness the benefits of ICT, and it culminated in a vote on what the 10 most important next steps are.

ADB is committed to increasing health investments in the coming five years and those investments have to go where the organization can have the biggest impact. One of ADB’s key strengths is its ability to convene disparate organizations and foster partnerships.

This conference was a prime example of effective collaboration among partners to capitalize on each other’s strengths. The knowledge that was gained in the conference room will not just travel back home with the participants. ADB’s health team learns from this process too.

The 10 next steps agreed to at the meeting will also inform a forthcoming joint ADB/WHO policy brief on using ICT to promote and measure progress towards universal health coverage.

ICT can bridge the gap between existing health systems and universal health coverage, but it’s a complex process and every country has its own challenges. We need to know from the people who are closest to the respective health systems to ensure that ADB’s commitment to supporting the goal of universal health insurance continues to hit the mark.

Standard