Alvin Marcelo | University of the Philippines Manila (original) (raw)

Videos by Alvin Marcelo

A snippet of a lecture on M&E for digital health interventions

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a lecture to FERCAP

1 views

Papers by Alvin Marcelo

eHealth is defined by the World Health Organization as the use of information and communications ... more eHealth is defined by the World Health Organization as the use of information and communications technology for health. Countries are beginning to realise its importance and are starting to make key investments. Yet the complexity involved with building and maintaining national-scale health information systems overwhelms most governments. The Philippines is adopting the AeHIN National eHealth Capacity Roadmap which recommends a proper sequence of structural reforms starting from strategy (WHO-ITU National eHealth Strategy Toolkit) to governance (COBIT5) to architecture (TOGAF) and to program management. These interventions were designed to build capacity in the public and private health sectors for cooperation and collaboration around better information systems in support of patient care and public health.

JMIR public health and surveillance, Apr 26, 2022

Background: COVID-19 is an ongoing global pandemic caused by SARS-CoV-2. As of June 2021, 5 emerg... more Background: COVID-19 is an ongoing global pandemic caused by SARS-CoV-2. As of June 2021, 5 emergency vaccines were available for COVID-19 prevention, and with the improvement of vaccination rates and the resumption of activities in each country, verification of vaccination has become an important issue. Currently, in most areas, vaccination and reverse transcription polymerase chain reaction (RT-PCR) test results are certified and validated on paper. This leads to the problem of counterfeit documents. Therefore, a global vaccination record is needed. Objective: The main objective of this study is to design a vaccine passport (VP) validation system based on a general blockchain architecture for international use in a simulated environment. With decentralized characteristics, the system is expected to have the advantages of low cost, high interoperability, effectiveness, security, and verifiability through blockchain architecture. Methods: The blockchain decentralized mechanism was used to build an open and anticounterfeiting information platform for VPs. The contents of a vaccination card are recorded according to international Fast Healthcare Interoperability Resource (FHIR) standards, and blockchain smart contracts (SCs) are used for authorization and authentication to achieve hierarchical management of various international hospitals and people receiving injections. The blockchain stores an encrypted vaccination path managed by the user who manages the private key. The blockchain uses the proof-of-authority (PoA) public chain and can access all information through the specified chain. This will achieve the goal of keeping development costs low and streamlining vaccine transit management so that countries in different economies can use them. Results: The openness of the blockchain helps to create transparency and data accuracy. This blockchain architecture contains a total of 3 entities. All approvals are published on Open Ledger. Smart certificates enable authorization and authentication, and encryption and decryption mechanisms guarantee data protection. This proof of concept demonstrates the design of blockchain architecture, which can achieve accurate global VP verification at an affordable price. In this study, an actual VP case was established and demonstrated. An open blockchain, an individually approved certification mechanism, and an international standard vaccination record were introduced.

Background: Drug counterfeiting is a global problem with significant risks to consumers and the g... more Background: Drug counterfeiting is a global problem with significant risks to consumers and the general public. In the Philippines, 30% of inspected drug stores in 2003 were found with substandard/spurious/falsely-labeled/falsified/counterfeit drugs. The economic burden on the population drug expenditures and on governments is high. The Philippine Food and Drug Administration (FDA) encourages the public to check the certificates of product registration and report any instances of counterfeiting. The National Police of Philippines responds to such reports through a special task force. However, no literature on its impact on the distribution of such drugs were found. Blockchain technology is a cryptographic ledger that is allegedly immutable through repeated sequential hashing and fault-tolerant through a consensus algorithm. This project will develop and test a pharmacosurveillance blockchain system that will support information sharing along the official drug distribution network. Objective: This study aims to develop a pharmacosurveillance blockchain system and test its functions in a simulated network. Methods: We are developing a Distributed Application (DApp) that will run on smart contracts, employing Swarm as the Distributed File System (DFS). Two instances will be developed: one for Ethereum and another for Hyperledger Fabric. The proof-of-work (PoW) consensus algorithm of Ethereum will be modified into a delegated proof-of-stake (DPoS) or practical Byzantine fault tolerance (PBFT) consensus algorithm as it is scalable and fits the drug supply chain environment. The system will adopt the GS1 pedigree standard and will satisfy the data points in the data standardization guidelines from the US FDA. Simulations will use the following 5 nodes: for FDA, manufacturer, wholesaler, retailer, and the consumer portal. Results: Development is underway. The design of the system will place FDA in a supervisory data verification role, with each pedigree type-specific data source serving a primary data verification role. The supply chain process will be initiated by the manufacturer, with recursive verification for every transaction. It will allow consumers to scan a code printed on the receipt of their purchases to review the drug distribution history. Conclusions: Development and testing will be conducted in a simulated network, and thus, results may differ from actual practice. The project being proposed is disruptive; once tested, the team intends to engage the Philippine FDA to discuss implementation plans and formulate policies to facilitate adoption and sustainability.

Journal of Medical Internet Research, Jun 9, 2020

Background: Personal health record (PHR) security, correctness, and protection are essential for ... more Background: Personal health record (PHR) security, correctness, and protection are essential for health and medical services. Blockchain architecture can provide efficient data retrieval and security requirements. Exchangeable PHRs and the self-management of patient health can offer many benefits to traditional medical services by allowing people to manage their own health records for disease prevention, prediction, and control while reducing resource burdens on the health care infrastructure and improving population health and quality of life. Objective: This study aimed to build a blockchain-based architecture for an international health record exchange platform to ensure health record confidentiality, integrity, and availability for health management and used Health Level 7 Fast Healthcare Interoperability Resource international standards as the data format that could allow international, cross-institutional, and patient/doctor exchanges of PHRs. Methods: The PHR architecture in this study comprised 2 main components. The first component was the PHR management platform, on which users could upload PHRs, view their record content, authorize PHR exchanges with doctors or other medical health care providers, and check their block information. When a PHR was uploaded, the hash value of the PHR would be calculated by the SHA-256 algorithm and the PHR would be encrypted by the Rivest-Shamir-Adleman encryption mechanism before being transferred to a secure database. The second component was the blockchain exchange architecture, which was based on Ethereum to create a private chain. Proof of authority, which delivers transactions through a consensus mechanism based on identity, was used for consensus. The hash value was calculated based on the previous hash value, block content, and timestamp by a hash function. Results: The PHR blockchain architecture constructed in this study is an effective method for the management and utilization of PHRs. The platform has been deployed in Southeast Asian countries via the Asia eHealth Information Network (AeHIN) and has become the first PHR management platform for cross-region medical data exchange.

American Medical Informatics Association Annual Symposium, 2000

The latter half of 1999 saw a surge in electronic This paper aims to compare existing open source... more The latter half of 1999 saw a surge in electronic This paper aims to compare existing open source medical record system (EMR) development applications to determine their similarities and using open source software. Although the open differences. Parameters observed were choice of source method is a welcome respite from the operating system, required components, network restrictive licensing system of commercial architecture, installation, configuration, companies, it also has its negative effects. The documentation, and ability to accommodate new openness of development creates the potential developers and changes in the code tree. A for creating an atmosphere of data model matrix summarizing these parameters will be anarchy and this could severely hamper shown. development of open source software for healthcare.

Yearbook of medical informatics, Apr 22, 2018

The Asia eHealth Information Network (AeHIN) was created by the World Health Organization to prom... more The Asia eHealth Information Network (AeHIN) was created by the World Health Organization to promote knowledge exchange and resource sharing on health information systems and eHealth among countries in Asia. AeHIN maintains that better health can be achieved by strengthening evidence-based policies and health systems through better quality and timely health information systems and civil registration and vital statistics. AeHIN further asserts the role of ICT for health as an enabler to improve the flow of information, through electronic means, to support the delivery of quality and equitable healthcare services and management of health systems. The JTMI Special Issue on AeHIN invites researchers and practitioners to share their experiences with their national-scale eHealth strategies and implementations. The goal is to consolidate the knowledge base and enable the discourse necessary for effective regional health systems. The topics of interest for the special issue include (but are not limited to): eHealth Governance, eHealth Architecture, Standards & Interoperability for Health, eHealth Policies and Strategies, Health Systems & eHealth, Ethical, Legal, and Social Aspects of eHealth, eHealth Workforce, and Experience & Lessons Learned from National eHealth Projects. This special issue on Asia eHealth Information Network (AeHIN) contains five papers that show how ICT for health has been developed and implemented. The AeHIN position paper by Alvin Marcelo and Boonchai Kijsanayotin, Chair and Co-Chair of AeHIN presents the Asia eHealth Information Network’s (AeHIN) response to the MA4Health 5-point call-to-action. The call was released in Washington DC June 8 and the response was circulated for comments in Manila, Colombo, and Yogyakarta until finalized in Bali last October 29, 2015. The paper by Jayawardena and Rathnayake presents a cross sectional descriptive study on Computer literacy among health care workers in District Base Hospitals in Kalutara District. This study shows that more than two third of MOs, Paramedics and Nurses were computer literate. Less than one third of Attendants were computer literate. Majority of them have a positive attitude towards use of computers at their work place. However, the use of ICT was low. This emphasizes the need for computer knowledge development among healthcare staff in order to have a well-functioning e-hospital. Rajesh Kumar Sinha and RenuElza Varghese survey and report on Perception of Health Care Professionals towards mHealth Application. This study concludes that many professionals are using smart phones and perceived that mHealth applications can support them in patient care, research, education and promoting the best practices in the healthcare industry. The paper by Maruf Haque Khan et al. presents User’s acceptance to the adoption of Health Information Technology (HIT) in Bangabandhu Sheikh Mujib Medical University: Premier Medical University in Bangladesh. Bangabandhu Sheikh Mujib Medical University (BSMMU) is the prime medical university

Springer eBooks, 2020

Most healthcare organizations, at the local, national, and international levels aspire to commenc... more Most healthcare organizations, at the local, national, and international levels aspire to commence their digital transformation but are at a loss on how to start the process. This chapter presents a practical approach that begins with laying down the foundations for strong governance to guide institutions towards this complex process. The approach begins with Governance (G)-setting clear decision-making structures and strategic directives to the whole enterprise. This is followed by adoption of Frameworks (F) that provide a common reference for all stakeholders as they undergo their respective changes. Because almost all healthcare data are sensitive and should be kept confidential, Ethical (E) processes must be in place to ensure that patients are safe and that their welfare is of the utmost priority. Data governance (D) then comes into play providing clear guidelines, systems, and structures in the management of data. Once these aforementioned fundamentals are in place, cloud and compliance (C) capabilities should be available to ensure that a secure infrastructure is in place to store, process, and protect large volumes of information. This elastic infrastructure enables the accumulation of big data (B) at a rate faster than what most analytical tools can manage in real-time opening up opportunities for visualizing information. With this tremendous amounts of data, the prerequisits are laid out for Artificial Intelligence (A) and new insights, previously unknown, can be discovered and used for creating new products and services for the enterprise and as input for decision-making for improved governance. Keywords Digital health • Governance • Compliance • Ethics Learning objectives By the end of this chapter, you will be able to • understand a practical framework for introducing technology-based changes in health institutions in low-to-medium income countries (LMICs) • present an incremental approach to implementing business transformation through a sequence of interventions designed to gradually introduce these changes

Yearbook of medical informatics, Jun 2, 2022

background of literature identified through the rapid review. Results: To illustrate the concept ... more background of literature identified through the rapid review. Results: To illustrate the concept of resilience, we present case studies from the adoption of District Health Information Software version 2 (DHIS2) for managing the Covid pandemic in Rwanda, and the adoption of the OpenEHR open Health IT standard. To illustrate accessibility, we show how open source design systems for user interface design have been used by governments to ensure accessibility of digital health services for patients and healthy individuals, and by the OpenMRS community to standardise their user interface design. Finally, to illustrate the concept of equity, we describe the OpenWHO framework and two open source digital health projects, GNU Health and openIMIS, that both aim to reduce health inequi-ties through the use of open source digital health software. Conclusion: This review has demonstrated that open source software addresses many of the challenges involved in making healthcare more accessible, equitable and resilient in high and low income settings.

Yearbook of medical informatics, Aug 1, 2011

To analyze the contribution of Free/Libre Open Source Software in health care (FLOSS-HC) and to g... more To analyze the contribution of Free/Libre Open Source Software in health care (FLOSS-HC) and to give perspectives for future developments. Methods: The paper summarizes FLOSS-related trends in health care as anticipated by members of the IMIA Open Source Working Group. Data were obtained through literature review and personal experience and observations of the authors in the last two decades. A status quo is given by a frequency analysis of the database of Medfloss.org, one of the world's largest platforms dedicated to FLOSS-HC. The authors discuss current problems in the field of health care and finally give a prospective roadmap, a projection of the potential influences of FLOSS in health care. Results: FLOSS-HC already exists for more than 2 decades. Several projects have shown that FLOSS may produce highly competitive alternatives to proprietary solutions that are at least equivalent in usability and have a better total cost of ownership ratio. The Medfloss.org database currently lists 221 projects of diverse application types. Conclusions: FLOSS principles hold a great potential for addressing several of the most critical problems in health care IT. The authors argue that an ecosystem perspective is relevant and that FLOSS principles are best suited to create health IT systems that are able to evolve over time as medical knowledge, technologies, insights, workflows etc. continuously change. All these factors that inherently influence the development of health IT systems are changing at an ever growing pace. Traditional models of software engineering are not able to follow these changes and provide up-to-date systems for an acceptable cost/value ratio. To allow FLOSS to positively influence Health IT in the future a "FLOSS-friendly" environment has to be provided. Policy makers should resolve uncertainties in the legal framework that disfavor FLOSS. Certification procedures should be specified in a way that they do not raise additional barriers for FLOSS.

PLOS Digital Health

Executive summary of open health data Openness and sharing of discovery lie at the heart of the s... more Executive summary of open health data Openness and sharing of discovery lie at the heart of the scientific method. Yet historically, the data and reports upon which they are based have not been easily accessible and often require onerous efforts to obtain. From this was borne the open data movement, which has advanced research and transformed public health policy-making in countries that have embraced this change. Open health data refers to unrestricted, free-of-charge access to health data [1]. By making health data available to all without any limitations to its reuse, it leverages national transparency, accountability, participation, innovation, and research through a multitude of data sources in large volumes-as well as paving the way for the creation of novel citizen-centric services [1,2]. The ability to access and combine diverse health data enriches analytical capacity and evaluation that can inform national policy development and improve healthcare delivery [3,4]. Open health data is therefore a public resource and should be delivered purposefully and proactively, in line with user needs and its potential contribution to value creation [2]. However, the open data movement comes with the need to balance its benefits with the security and privacy challenges that come with it, such as the risk of re-identification [4]. The issue of selling medical data to commercial organizations such as pharmaceutical companies, insurance companies, and other private companies has also stirred much controversy and raised concerns about ethicality, reproducibility, and generalizability [5]. Undeniably, challenges to the implementation of open health data remain, including the lack of awareness of its potential benefits, unsteady leadership and accountability, and weak legal and ethical oversight. Additionally, addressing the enormous gap in resources and knowledge on tools and techniques is acutely needed to make the technological shift to open and interoperable databases with unified protocols, frameworks, and terminology [3]. Despite the challenges in open health data, numerous countries and institutions have proven its feasibility with the proper legislation and implementation. By incorporating formal requirements in national open data strategies, laws, and regulations, the majority of Organisation for Economic Cooperation and Development (OECD) member countries have successfully adopted and scaled up "open by default" and "government as platform" approaches to data [2]. This has resulted in stronger governance frameworks and an increase in data availability, paving the way for the publication and use of open government data in various sectors geared towards social, government, and business innovation, with potentially important implications for public sector integrity, sustainable development, and gender equality [2]. With the passage of its e-government law, Germany has catapulted its data accessibility in recent years

PLOS Digital Health

The availability of large, deidentified health datasets has enabled significant innovation in usi... more The availability of large, deidentified health datasets has enabled significant innovation in using machine learning (ML) to better understand patients and their diseases. However, questions remain regarding the true privacy of this data, patient control over their data, and how we regulate data sharing in a way that that does not encumber progress or further potentiate biases for underrepresented populations. After reviewing the literature on potential reidentifications of patients in publicly available datasets, we argue that the cost—measured in terms of access to future medical innovations and clinical software—of slowing ML progress is too great to limit sharing data through large publicly available databases for concerns of imperfect data anonymization. This cost is especially great for developing countries where the barriers preventing inclusion in such databases will continue to rise, further excluding these populations and increasing existing biases that favor high-income c...

Yearbook of Medical Informatics

Studies in health technology and informatics, 2011

Optimal use of limited human, technical and financial resources is a major concern for tuberculos... more Optimal use of limited human, technical and financial resources is a major concern for tuberculosis (TB) control in developing nations. Further impediments include a lack of trained physicians, and logistical difficulties in arranging face-to-face (f-2-f) TB Diagnostic Committee (TBDC) consultations. Use of e-Health for virtual TBDCs (Internet and "iPath"), to address such issues is being studied in the Philippines and Pakistan. In Pakistan, radiological diagnosis of 88 sputum smear negative but suspected TB patients has been compared with the 'gold standards' (TB culture, and 2-month clinical follow up). Of 88 diagnostic decisions made by primary physicians at the spoke site and electronic TBDC (e-TBDC) at hub site, there was agreement in 71 cases and disagreement on 17 cases. The turn-around time (TAT; patient registration at spoke site for f-2-f diagnosis to receiving the electronic diagnosis), averaged 34.6 hours; ranging 9 minutes to 289.2 hours. Average TAT a...

In recent years, Smart Homes have become a solution to benefit impaired individuals and elderly i... more In recent years, Smart Homes have become a solution to benefit impaired individuals and elderly in their daily life settings. In healthcare applications, pervasive technologies have enabled the practicality of personal monitoring using Indoor positioning technologies. Radio-Frequency Identification (RFID) is a promising technology, which is useful for non-invasive tracking of activities of daily living. Many implementations have focused on using batteryenabled tags like in RFID active tags, which require frequent maintenance and they are costly. Other systems can use wearable sensors requiring individuals to wear tags which may be inappropriate for elders. Successful implementations of a tracking system are dependent on multiple considerations beyond the physical performance of the solution, such as affordability and human acceptance. This paper presents a localisation framework using passive RFID sensors. It aims to provide a low cost solution for subject location in Smart Homes he...

Studies in health technology and informatics, 2017

This paper draws on the vision, mission and experience with the WHO Collaborating Centre on eHeal... more This paper draws on the vision, mission and experience with the WHO Collaborating Centre on eHealth (WHOCC-eHealth) and Yunus Social Business Health Hub (YSBHH) based at UNSW Australia, and the Asia electronic Health Information Network (AeHIN). Global eHealth aims to provide equitable access to ICT and health care, particularly to the poor, vulnerable and disadvantaged. Social business aims to solve social and economic problem. Its best known product is microcredit financial services for the poor which are small loans that enable them to "produce something, sell something, earn something to develop self-reliance and a life of dignity". Citizen engagement and community participation is integral to both constructs within the context of global partnerships for Integrated People-Centred Health Services (IPCHS) and Sustainable Development Goals (SDGs). The eHealth dimension is consumer heath informatics, social media, mHealth and the Internet of Things. The convergence is mult...

Studies in health technology and informatics, 2017

A major hurdle in eHealth implementation is that it is difficult to put into practice. In this st... more A major hurdle in eHealth implementation is that it is difficult to put into practice. In this study, the primary aim was to identify the main barrier associated with implementing eHealth. This study surveyed IMIA members from May to November 2015. From the results, it is clear that medical professionals were recording most of their data by hand. This paper culture is a paradigm that is difficult to break. Cultural factors are the primary barrier in eHealth implementation.

A snippet of a lecture on M&E for digital health interventions

2 views

a lecture to FERCAP

1 views

eHealth is defined by the World Health Organization as the use of information and communications ... more eHealth is defined by the World Health Organization as the use of information and communications technology for health. Countries are beginning to realise its importance and are starting to make key investments. Yet the complexity involved with building and maintaining national-scale health information systems overwhelms most governments. The Philippines is adopting the AeHIN National eHealth Capacity Roadmap which recommends a proper sequence of structural reforms starting from strategy (WHO-ITU National eHealth Strategy Toolkit) to governance (COBIT5) to architecture (TOGAF) and to program management. These interventions were designed to build capacity in the public and private health sectors for cooperation and collaboration around better information systems in support of patient care and public health.

JMIR public health and surveillance, Apr 26, 2022

Background: COVID-19 is an ongoing global pandemic caused by SARS-CoV-2. As of June 2021, 5 emerg... more Background: COVID-19 is an ongoing global pandemic caused by SARS-CoV-2. As of June 2021, 5 emergency vaccines were available for COVID-19 prevention, and with the improvement of vaccination rates and the resumption of activities in each country, verification of vaccination has become an important issue. Currently, in most areas, vaccination and reverse transcription polymerase chain reaction (RT-PCR) test results are certified and validated on paper. This leads to the problem of counterfeit documents. Therefore, a global vaccination record is needed. Objective: The main objective of this study is to design a vaccine passport (VP) validation system based on a general blockchain architecture for international use in a simulated environment. With decentralized characteristics, the system is expected to have the advantages of low cost, high interoperability, effectiveness, security, and verifiability through blockchain architecture. Methods: The blockchain decentralized mechanism was used to build an open and anticounterfeiting information platform for VPs. The contents of a vaccination card are recorded according to international Fast Healthcare Interoperability Resource (FHIR) standards, and blockchain smart contracts (SCs) are used for authorization and authentication to achieve hierarchical management of various international hospitals and people receiving injections. The blockchain stores an encrypted vaccination path managed by the user who manages the private key. The blockchain uses the proof-of-authority (PoA) public chain and can access all information through the specified chain. This will achieve the goal of keeping development costs low and streamlining vaccine transit management so that countries in different economies can use them. Results: The openness of the blockchain helps to create transparency and data accuracy. This blockchain architecture contains a total of 3 entities. All approvals are published on Open Ledger. Smart certificates enable authorization and authentication, and encryption and decryption mechanisms guarantee data protection. This proof of concept demonstrates the design of blockchain architecture, which can achieve accurate global VP verification at an affordable price. In this study, an actual VP case was established and demonstrated. An open blockchain, an individually approved certification mechanism, and an international standard vaccination record were introduced.

Background: Drug counterfeiting is a global problem with significant risks to consumers and the g... more Background: Drug counterfeiting is a global problem with significant risks to consumers and the general public. In the Philippines, 30% of inspected drug stores in 2003 were found with substandard/spurious/falsely-labeled/falsified/counterfeit drugs. The economic burden on the population drug expenditures and on governments is high. The Philippine Food and Drug Administration (FDA) encourages the public to check the certificates of product registration and report any instances of counterfeiting. The National Police of Philippines responds to such reports through a special task force. However, no literature on its impact on the distribution of such drugs were found. Blockchain technology is a cryptographic ledger that is allegedly immutable through repeated sequential hashing and fault-tolerant through a consensus algorithm. This project will develop and test a pharmacosurveillance blockchain system that will support information sharing along the official drug distribution network. Objective: This study aims to develop a pharmacosurveillance blockchain system and test its functions in a simulated network. Methods: We are developing a Distributed Application (DApp) that will run on smart contracts, employing Swarm as the Distributed File System (DFS). Two instances will be developed: one for Ethereum and another for Hyperledger Fabric. The proof-of-work (PoW) consensus algorithm of Ethereum will be modified into a delegated proof-of-stake (DPoS) or practical Byzantine fault tolerance (PBFT) consensus algorithm as it is scalable and fits the drug supply chain environment. The system will adopt the GS1 pedigree standard and will satisfy the data points in the data standardization guidelines from the US FDA. Simulations will use the following 5 nodes: for FDA, manufacturer, wholesaler, retailer, and the consumer portal. Results: Development is underway. The design of the system will place FDA in a supervisory data verification role, with each pedigree type-specific data source serving a primary data verification role. The supply chain process will be initiated by the manufacturer, with recursive verification for every transaction. It will allow consumers to scan a code printed on the receipt of their purchases to review the drug distribution history. Conclusions: Development and testing will be conducted in a simulated network, and thus, results may differ from actual practice. The project being proposed is disruptive; once tested, the team intends to engage the Philippine FDA to discuss implementation plans and formulate policies to facilitate adoption and sustainability.

Journal of Medical Internet Research, Jun 9, 2020

Background: Personal health record (PHR) security, correctness, and protection are essential for ... more Background: Personal health record (PHR) security, correctness, and protection are essential for health and medical services. Blockchain architecture can provide efficient data retrieval and security requirements. Exchangeable PHRs and the self-management of patient health can offer many benefits to traditional medical services by allowing people to manage their own health records for disease prevention, prediction, and control while reducing resource burdens on the health care infrastructure and improving population health and quality of life. Objective: This study aimed to build a blockchain-based architecture for an international health record exchange platform to ensure health record confidentiality, integrity, and availability for health management and used Health Level 7 Fast Healthcare Interoperability Resource international standards as the data format that could allow international, cross-institutional, and patient/doctor exchanges of PHRs. Methods: The PHR architecture in this study comprised 2 main components. The first component was the PHR management platform, on which users could upload PHRs, view their record content, authorize PHR exchanges with doctors or other medical health care providers, and check their block information. When a PHR was uploaded, the hash value of the PHR would be calculated by the SHA-256 algorithm and the PHR would be encrypted by the Rivest-Shamir-Adleman encryption mechanism before being transferred to a secure database. The second component was the blockchain exchange architecture, which was based on Ethereum to create a private chain. Proof of authority, which delivers transactions through a consensus mechanism based on identity, was used for consensus. The hash value was calculated based on the previous hash value, block content, and timestamp by a hash function. Results: The PHR blockchain architecture constructed in this study is an effective method for the management and utilization of PHRs. The platform has been deployed in Southeast Asian countries via the Asia eHealth Information Network (AeHIN) and has become the first PHR management platform for cross-region medical data exchange.

American Medical Informatics Association Annual Symposium, 2000

The latter half of 1999 saw a surge in electronic This paper aims to compare existing open source... more The latter half of 1999 saw a surge in electronic This paper aims to compare existing open source medical record system (EMR) development applications to determine their similarities and using open source software. Although the open differences. Parameters observed were choice of source method is a welcome respite from the operating system, required components, network restrictive licensing system of commercial architecture, installation, configuration, companies, it also has its negative effects. The documentation, and ability to accommodate new openness of development creates the potential developers and changes in the code tree. A for creating an atmosphere of data model matrix summarizing these parameters will be anarchy and this could severely hamper shown. development of open source software for healthcare.

Yearbook of medical informatics, Apr 22, 2018

The Asia eHealth Information Network (AeHIN) was created by the World Health Organization to prom... more The Asia eHealth Information Network (AeHIN) was created by the World Health Organization to promote knowledge exchange and resource sharing on health information systems and eHealth among countries in Asia. AeHIN maintains that better health can be achieved by strengthening evidence-based policies and health systems through better quality and timely health information systems and civil registration and vital statistics. AeHIN further asserts the role of ICT for health as an enabler to improve the flow of information, through electronic means, to support the delivery of quality and equitable healthcare services and management of health systems. The JTMI Special Issue on AeHIN invites researchers and practitioners to share their experiences with their national-scale eHealth strategies and implementations. The goal is to consolidate the knowledge base and enable the discourse necessary for effective regional health systems. The topics of interest for the special issue include (but are not limited to): eHealth Governance, eHealth Architecture, Standards & Interoperability for Health, eHealth Policies and Strategies, Health Systems & eHealth, Ethical, Legal, and Social Aspects of eHealth, eHealth Workforce, and Experience & Lessons Learned from National eHealth Projects. This special issue on Asia eHealth Information Network (AeHIN) contains five papers that show how ICT for health has been developed and implemented. The AeHIN position paper by Alvin Marcelo and Boonchai Kijsanayotin, Chair and Co-Chair of AeHIN presents the Asia eHealth Information Network’s (AeHIN) response to the MA4Health 5-point call-to-action. The call was released in Washington DC June 8 and the response was circulated for comments in Manila, Colombo, and Yogyakarta until finalized in Bali last October 29, 2015. The paper by Jayawardena and Rathnayake presents a cross sectional descriptive study on Computer literacy among health care workers in District Base Hospitals in Kalutara District. This study shows that more than two third of MOs, Paramedics and Nurses were computer literate. Less than one third of Attendants were computer literate. Majority of them have a positive attitude towards use of computers at their work place. However, the use of ICT was low. This emphasizes the need for computer knowledge development among healthcare staff in order to have a well-functioning e-hospital. Rajesh Kumar Sinha and RenuElza Varghese survey and report on Perception of Health Care Professionals towards mHealth Application. This study concludes that many professionals are using smart phones and perceived that mHealth applications can support them in patient care, research, education and promoting the best practices in the healthcare industry. The paper by Maruf Haque Khan et al. presents User’s acceptance to the adoption of Health Information Technology (HIT) in Bangabandhu Sheikh Mujib Medical University: Premier Medical University in Bangladesh. Bangabandhu Sheikh Mujib Medical University (BSMMU) is the prime medical university

Springer eBooks, 2020

Most healthcare organizations, at the local, national, and international levels aspire to commenc... more Most healthcare organizations, at the local, national, and international levels aspire to commence their digital transformation but are at a loss on how to start the process. This chapter presents a practical approach that begins with laying down the foundations for strong governance to guide institutions towards this complex process. The approach begins with Governance (G)-setting clear decision-making structures and strategic directives to the whole enterprise. This is followed by adoption of Frameworks (F) that provide a common reference for all stakeholders as they undergo their respective changes. Because almost all healthcare data are sensitive and should be kept confidential, Ethical (E) processes must be in place to ensure that patients are safe and that their welfare is of the utmost priority. Data governance (D) then comes into play providing clear guidelines, systems, and structures in the management of data. Once these aforementioned fundamentals are in place, cloud and compliance (C) capabilities should be available to ensure that a secure infrastructure is in place to store, process, and protect large volumes of information. This elastic infrastructure enables the accumulation of big data (B) at a rate faster than what most analytical tools can manage in real-time opening up opportunities for visualizing information. With this tremendous amounts of data, the prerequisits are laid out for Artificial Intelligence (A) and new insights, previously unknown, can be discovered and used for creating new products and services for the enterprise and as input for decision-making for improved governance. Keywords Digital health • Governance • Compliance • Ethics Learning objectives By the end of this chapter, you will be able to • understand a practical framework for introducing technology-based changes in health institutions in low-to-medium income countries (LMICs) • present an incremental approach to implementing business transformation through a sequence of interventions designed to gradually introduce these changes

Yearbook of medical informatics, Jun 2, 2022

background of literature identified through the rapid review. Results: To illustrate the concept ... more background of literature identified through the rapid review. Results: To illustrate the concept of resilience, we present case studies from the adoption of District Health Information Software version 2 (DHIS2) for managing the Covid pandemic in Rwanda, and the adoption of the OpenEHR open Health IT standard. To illustrate accessibility, we show how open source design systems for user interface design have been used by governments to ensure accessibility of digital health services for patients and healthy individuals, and by the OpenMRS community to standardise their user interface design. Finally, to illustrate the concept of equity, we describe the OpenWHO framework and two open source digital health projects, GNU Health and openIMIS, that both aim to reduce health inequi-ties through the use of open source digital health software. Conclusion: This review has demonstrated that open source software addresses many of the challenges involved in making healthcare more accessible, equitable and resilient in high and low income settings.

Yearbook of medical informatics, Aug 1, 2011

To analyze the contribution of Free/Libre Open Source Software in health care (FLOSS-HC) and to g... more To analyze the contribution of Free/Libre Open Source Software in health care (FLOSS-HC) and to give perspectives for future developments. Methods: The paper summarizes FLOSS-related trends in health care as anticipated by members of the IMIA Open Source Working Group. Data were obtained through literature review and personal experience and observations of the authors in the last two decades. A status quo is given by a frequency analysis of the database of Medfloss.org, one of the world's largest platforms dedicated to FLOSS-HC. The authors discuss current problems in the field of health care and finally give a prospective roadmap, a projection of the potential influences of FLOSS in health care. Results: FLOSS-HC already exists for more than 2 decades. Several projects have shown that FLOSS may produce highly competitive alternatives to proprietary solutions that are at least equivalent in usability and have a better total cost of ownership ratio. The Medfloss.org database currently lists 221 projects of diverse application types. Conclusions: FLOSS principles hold a great potential for addressing several of the most critical problems in health care IT. The authors argue that an ecosystem perspective is relevant and that FLOSS principles are best suited to create health IT systems that are able to evolve over time as medical knowledge, technologies, insights, workflows etc. continuously change. All these factors that inherently influence the development of health IT systems are changing at an ever growing pace. Traditional models of software engineering are not able to follow these changes and provide up-to-date systems for an acceptable cost/value ratio. To allow FLOSS to positively influence Health IT in the future a "FLOSS-friendly" environment has to be provided. Policy makers should resolve uncertainties in the legal framework that disfavor FLOSS. Certification procedures should be specified in a way that they do not raise additional barriers for FLOSS.

PLOS Digital Health

Executive summary of open health data Openness and sharing of discovery lie at the heart of the s... more Executive summary of open health data Openness and sharing of discovery lie at the heart of the scientific method. Yet historically, the data and reports upon which they are based have not been easily accessible and often require onerous efforts to obtain. From this was borne the open data movement, which has advanced research and transformed public health policy-making in countries that have embraced this change. Open health data refers to unrestricted, free-of-charge access to health data [1]. By making health data available to all without any limitations to its reuse, it leverages national transparency, accountability, participation, innovation, and research through a multitude of data sources in large volumes-as well as paving the way for the creation of novel citizen-centric services [1,2]. The ability to access and combine diverse health data enriches analytical capacity and evaluation that can inform national policy development and improve healthcare delivery [3,4]. Open health data is therefore a public resource and should be delivered purposefully and proactively, in line with user needs and its potential contribution to value creation [2]. However, the open data movement comes with the need to balance its benefits with the security and privacy challenges that come with it, such as the risk of re-identification [4]. The issue of selling medical data to commercial organizations such as pharmaceutical companies, insurance companies, and other private companies has also stirred much controversy and raised concerns about ethicality, reproducibility, and generalizability [5]. Undeniably, challenges to the implementation of open health data remain, including the lack of awareness of its potential benefits, unsteady leadership and accountability, and weak legal and ethical oversight. Additionally, addressing the enormous gap in resources and knowledge on tools and techniques is acutely needed to make the technological shift to open and interoperable databases with unified protocols, frameworks, and terminology [3]. Despite the challenges in open health data, numerous countries and institutions have proven its feasibility with the proper legislation and implementation. By incorporating formal requirements in national open data strategies, laws, and regulations, the majority of Organisation for Economic Cooperation and Development (OECD) member countries have successfully adopted and scaled up "open by default" and "government as platform" approaches to data [2]. This has resulted in stronger governance frameworks and an increase in data availability, paving the way for the publication and use of open government data in various sectors geared towards social, government, and business innovation, with potentially important implications for public sector integrity, sustainable development, and gender equality [2]. With the passage of its e-government law, Germany has catapulted its data accessibility in recent years

PLOS Digital Health

The availability of large, deidentified health datasets has enabled significant innovation in usi... more The availability of large, deidentified health datasets has enabled significant innovation in using machine learning (ML) to better understand patients and their diseases. However, questions remain regarding the true privacy of this data, patient control over their data, and how we regulate data sharing in a way that that does not encumber progress or further potentiate biases for underrepresented populations. After reviewing the literature on potential reidentifications of patients in publicly available datasets, we argue that the cost—measured in terms of access to future medical innovations and clinical software—of slowing ML progress is too great to limit sharing data through large publicly available databases for concerns of imperfect data anonymization. This cost is especially great for developing countries where the barriers preventing inclusion in such databases will continue to rise, further excluding these populations and increasing existing biases that favor high-income c...

Yearbook of Medical Informatics

Studies in health technology and informatics, 2011

Optimal use of limited human, technical and financial resources is a major concern for tuberculos... more Optimal use of limited human, technical and financial resources is a major concern for tuberculosis (TB) control in developing nations. Further impediments include a lack of trained physicians, and logistical difficulties in arranging face-to-face (f-2-f) TB Diagnostic Committee (TBDC) consultations. Use of e-Health for virtual TBDCs (Internet and "iPath"), to address such issues is being studied in the Philippines and Pakistan. In Pakistan, radiological diagnosis of 88 sputum smear negative but suspected TB patients has been compared with the 'gold standards' (TB culture, and 2-month clinical follow up). Of 88 diagnostic decisions made by primary physicians at the spoke site and electronic TBDC (e-TBDC) at hub site, there was agreement in 71 cases and disagreement on 17 cases. The turn-around time (TAT; patient registration at spoke site for f-2-f diagnosis to receiving the electronic diagnosis), averaged 34.6 hours; ranging 9 minutes to 289.2 hours. Average TAT a...

In recent years, Smart Homes have become a solution to benefit impaired individuals and elderly i... more In recent years, Smart Homes have become a solution to benefit impaired individuals and elderly in their daily life settings. In healthcare applications, pervasive technologies have enabled the practicality of personal monitoring using Indoor positioning technologies. Radio-Frequency Identification (RFID) is a promising technology, which is useful for non-invasive tracking of activities of daily living. Many implementations have focused on using batteryenabled tags like in RFID active tags, which require frequent maintenance and they are costly. Other systems can use wearable sensors requiring individuals to wear tags which may be inappropriate for elders. Successful implementations of a tracking system are dependent on multiple considerations beyond the physical performance of the solution, such as affordability and human acceptance. This paper presents a localisation framework using passive RFID sensors. It aims to provide a low cost solution for subject location in Smart Homes he...

Studies in health technology and informatics, 2017

This paper draws on the vision, mission and experience with the WHO Collaborating Centre on eHeal... more This paper draws on the vision, mission and experience with the WHO Collaborating Centre on eHealth (WHOCC-eHealth) and Yunus Social Business Health Hub (YSBHH) based at UNSW Australia, and the Asia electronic Health Information Network (AeHIN). Global eHealth aims to provide equitable access to ICT and health care, particularly to the poor, vulnerable and disadvantaged. Social business aims to solve social and economic problem. Its best known product is microcredit financial services for the poor which are small loans that enable them to "produce something, sell something, earn something to develop self-reliance and a life of dignity". Citizen engagement and community participation is integral to both constructs within the context of global partnerships for Integrated People-Centred Health Services (IPCHS) and Sustainable Development Goals (SDGs). The eHealth dimension is consumer heath informatics, social media, mHealth and the Internet of Things. The convergence is mult...

Studies in health technology and informatics, 2017

A major hurdle in eHealth implementation is that it is difficult to put into practice. In this st... more A major hurdle in eHealth implementation is that it is difficult to put into practice. In this study, the primary aim was to identify the main barrier associated with implementing eHealth. This study surveyed IMIA members from May to November 2015. From the results, it is clear that medical professionals were recording most of their data by hand. This paper culture is a paradigm that is difficult to break. Cultural factors are the primary barrier in eHealth implementation.

Journal of the International Society for Telemedicine and eHealth, 2017

Background: Technological advances increase the feasibility of mobile-phone teledermatology (mder... more Background: Technological advances increase the feasibility of mobile-phone teledermatology (mdermatology). By saving time and costs, underserved areas lacking dermatologists may benefit greatly. Objectives: To assess the clinical efficacy of mobile-phone store-and-forward mdermatology compared to face-to-face consultation. Methods: Patients from a rural health centre in Batangas were randomised to either mdermatology or face-to-face group. In the mdermatology group, a general practitioner (GP) assessed patients, took photographs using a cell phone camera and sent these via e-mail accessed via the GP’s mobile phone to the mdermatologist’s mobile phone. In the face-to-face group, the GP assessed patients and then referred them to the face-to-face dermatologist. Both the mdermatologist and face-to-face dermatologist provided assessments and plans for patients in their respective groups. Clinical outcomes were assessed after two and four weeks. Results: A total of 123 patients were i...

Medinfo, 2001

The increasing popularity of open source (OS) software has made it a viable alternative to propri... more The increasing popularity of open source (OS) software has made it a viable alternative to proprietary technologies presently used in numerous healthcare facilities. Despite easy availability however, open source applications have not been adopted enthusiastically by the health industry. The key issues are reliability and stability. This paper enumerates the different OS medical information managers currently available and discusses the various techniques they used for their implementations. A standard set of technical criteria was created. and the results of ratings were used as basis for comparison.

Health data collection is challenging in most developing countries. This is due to reliance on in... more Health data collection is challenging in most developing countries. This is due to reliance on inefficient manual collection systems and to the lack of human resource capacity. This study analyzes the existing maternal and child care programs of local government health units in the Philippines and identifies a strategic data point for both programs. A strategic data point is a single-capture data point that is predictive of local action items. An example of a strategic data point is the report of pregnancy (or last normal menstrual period or LNMP). A related action item to the LNMP is the need for a BCG dose for the baby ten months later. The investigators posit that quality reporting (accurate and timely) of strategic data points can result in better health systems performance measurement by providing checkpoints that can feed back to local health workers (and the larger health system) actions to take at specific points in time. A simple short messaging system-based (SMS) conceptual model is presented to demonstrate this potential.

The national health information system is an important resource of any country. It is the basis f... more The national health information system is an important resource of any country. It is the basis for many decisions and interventions by ministries of health often amounting to millions of dollars and affecting a wide sector of society most especially the poor and the vulnerable. Like many developing countries still on manual paper-based systems, the Philippine national health information system suffers from accuracy, timeliness, and credibility issues. It is also plagued by huge volumes of unused data collected from various vertical programs of the government. This paper proposes the promulgation of a strategic data point (SDP) in the national health system that is easy to collect yet is powerful enough to influence several programs. The report of pregnancy is one such SDP. It is a single data point that can inform several programs: maternal care, child health, the expanded program on immunization (EPI), the local civil registry, and the Department of Education to name a few. This paper describes how a single data point such as a pregnancy report submitted by short messaging system (SMS) can be leveraged cost-effectively by the national government to support informed decision making nationally and locally.

Medical records are the backbone of the health care service sector. Automating medical records ha... more Medical records are the backbone of the health care service sector. Automating medical records has been one of the challenges in the IT industry and has been shown to bring numerous benefits for patients, health providers, and facilities. Globally however, stakeholders in developing countries have been slow in adopting information and communications technology into their health careflow because of the significant investment in hardware and software. The Philippines is the texting capital of the world with more than 25 million people with access to a cellphone. This study demonstrates a prototype electronic medical record that is accessible with WAP-enabled cellphones (wireless application protocol). Technical, economic and clinical considerations attendant with such portable wireless medical records are discussed as well as strategic directions for future development in the Philippines.

The national health information system is an important resource of any country. It is the basis f... more The national health information system is an important resource of any country. It is the basis for many decisions and interventions by ministries of health often amounting to millions of dollars and affecting a wide sector of society most especially the poor and the vulnerable. Like many developing countries still on manual paper-based systems, the Philippine national health information system suffers from accuracy, timeliness, and credibility issues. It is also plagued by huge volumes of unused data collected from various vertical programs of the government. This paper proposes the promulgation of a strategic data point (SDP) in the national health system that is easy to collect yet is powerful enough to influence several programs. The report of pregnancy is one such SDP. It is a single data point that can inform several programs: maternal care, child health, the expanded program on immunization (EPI), the local civil registry, and the Department of Education to name a few. This paper describes how a single data point such as a pregnancy report submitted by short messaging system (SMS) can be leveraged cost-effectively by the national government to support informed decision making nationally and locally.

Since the first presentation on Open Source at the 1999 American Medical Informatics Association,... more Since the first presentation on Open Source at the 1999 American Medical Informatics Association, much interest has been noted about this method of software development. Although mainstream information technology industries have been employing it for more than a decade, the health information management industry is only beginning to pay more attention to this phenomenon. This newly acquired attention is presumably an effect of the rising popularity of open source software like the Linux operating system and the Apache webserver. In addition to the economic freedom provided by open source applications, there is also the intellectual liberty that is most appealing to developers. Despite these obvious advantages, however, the open source initiative is failing to take the health industry by storm. Stakeholders are at best viewing the phenomenon at a distance. Issues like reliability, portability, and interoperability are those most often raised in discussions. This paper aims to propose a two-pronged approach to health application development using open source methodology that will address most of the issues. The first method proposes the pooling of common objects used in healthcare-Common Open Source Medical Objects (COSMOS). The second method proposes local in-house application development using these common objects. Building software with COSMOS would provide the guarantee that interoperability will be maintained at the application layer. Open source application development is a relatively new technology to enter the health information management field. Since health is a mission-critical industry, open source software will necessarily have to undergo numerous validation studies in order to gain recognition of the domain experts. A united open source developer community would be a critical requisite to this success.

In October 2010, Secretary Enrique T. Ona presented the Aquino Health Agenda (Kalusugang Pangkala... more In October 2010, Secretary Enrique T. Ona presented the Aquino Health Agenda (Kalusugang Pangkalahatan or Universal Health Coverage) and specifically mentioned the important role of information and communications technology (IT) in making health care more efficient. One month later, Sec Ona releases a department personnel order (DPO) creating the ICT for Health technical working group (ICT4H TWG), a multi-sectoral group of stakeholders interested in the use of ICT in health. The ICT4H TWG was chaired by DOH Asst Secretary Nemesio Gako with Director Crispinita Valdez as co-chair. The members were: Roy Consulta (ICTO), Alvin Marcelo (UP Manila), Ramon Duremdes (PLDT), Samuel Matunog (Segworks), Esther Go (Medilink), Kenneth Hartigan-Go (AIM), Mario Matanguihan (PhilHealth), Dondi Mapa (ITAP), and Angelo Ramos (Molave Foundation).

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