Lecture Notes: Health Information System PDF

LECTURE NOTES Sources: Nuevo. (2019). Health Information System for Medical Laboratory Science VISION, MISSION, CORE VALUES AND records (i.e. all personal health information of an OBJECTIVES OF THE INSTITUTION individual). If patien...

LECTURE NOTES Sources: Nuevo. (2019). Health Information System for Medical Laboratory Science VISION, MISSION, CORE VALUES AND records (i.e. all personal health information of an OBJECTIVES OF THE INSTITUTION individual). If patients are given too much control over their EHRs, critical information might be An educational institution is a place where modified or deleted without the knowledge of learners of different ages gain education. the health professionals. Thus, patient access This education may either be formal or informal. and control over such records must be limited to Formal education refers to a structured method improve the quality and accuracy of EHRs. of learning (e.g. follows a curriculum). Another issue concerns patient use of online Informal education refers to independent health information. Sites that provide health learning outside of a classroom information should be constantly updated and Vision Statement Mission statement monitored for accuracy and reliability. A What the institution What the institution compromise should be met between respecting expects to become does and why is that the autonomy of patients in accessing such important websites and preventing possible patient harm Average of 14 words Average of 5-20 words from inaccurate information and unnecessary Inspires individuals to Defines key measure of prescription of medicines. be at their best the Institution’s success Autonomy: In order for a patient to make a fully Talks about the future Talks about the present informed decision, he/she must understand all leading to the future risks and benefits of the procedure and the Where do we aim to What makes us likelihood of success. be? different? The principles of beneficence and non- Where do we want to How will we get to maleficence are respectively defined as to do be? where we want to be? good and to do no harm. In health informatics, beneficence relates with how data is used in Core values, or sometimes referred to as a value improving health care while non-maleficence statement, guides or directs the educational governs how data is protected against varying institution in decision-making. threats. Core values shall be distinct to the institution. Beneficence: The procedure must be provided Educational objectives are short statements that with the intent of doing good for the patient learners should achieve within or at the end of a involved and not for other reasons (e.g. research course or lesson. purposes). Educational objectives shall be SMART – Non-maleficence: The procedure should not ETHICS, PRIVACY, specific, measurable,CONFIDENTIALITY AND attainable, realistic, time- harm the patient involved or others in society. bound SECURITY ART specialists should operate under the assumption that they are doing no harm or at The three main aspects of health information least minimizing harm by pursuing the greater ethics are general, informatics, and software good. ethics. General ethics guide the reasoning and decision- Informatics ethics is concerned with ethical making of all people and organizations involved behavior expected from an individual assigned to in health care. Three of the ethical principles that HCPs must uphold are autonomy, beneficence handle information. It follows seven principles. and non-maleficence. Principle of Information-Privacy and Disposition: Everyone has the fundamental right Autonomy is defined as the idea of allowing individuals, such as HCPs and patients, to make to privacy. HCPs and patients should ensure that their own decisions and to be free from external he/she has control over the collection, access, influence or control. An issue arises on patient use, communication, manipulation, storage, autonomy over EHRs or electronic health linkage, and disposition of his/her personal data. 1  Principle of Openness: The control measures of Before identifying the security measures in a particular data should be disclosed to the laboratory information system, an concerned individual in appropriate and timely understanding of the information flow in a fashion. laboratory must be satisfied first. According to Principle of Security: Legitimately collected data McPherson and Pincus (2017), the key steps of should be protected through all appropriate information in a laboratory information system measures against access, use, modification, are as follows: manipulation, loss, degradation, and unauthorized destruction. Principle of Access: Authorized individuals should be given access to EHRs and the right to correct the data with respect to their completeness, accuracy, and relevance. Principle of Legitimate Infringement: The right to privacy and control over personal data should be conditioned by the appropriate, legitimate, Patient Registration: The patient record and relevant data-requirement of a democratic (including ID number, name, sex, age, location) society and by the equal rights of others. must be created in the laboratory information Principle of the Least Intrusive Alternative: Any system (LIS). infringement of privacy rights should occur in the Test Requisition: The attending physician orders least intrusive manner and with the least amount the tests for the patient and the procedure is of interference with the rights of the affected requested as part of the laboratory's blood parties. collection rounds. Principle of Accountability: Any infringement Specimen Collection: In sample collection, a must be justified to the concerned individuals. barcode corresponding to each patient order, is generated by the LIS. These barcode labels Software ethics refers to the ethical duties and contain the patient ID, sample contained, and responsibilities of software developers to the laboratory workstation to which the sample is stakeholders (i.e. society, institution and sent (e.g. whole blood intended for CBC testing is employees, and the profession. Health sent to the hematology workstation). informatics relies on the use of a software to Specimen Reception: Once the sample arrives in store and process information. Activities carried the laboratory, each barcode is scanned to allow out by the developers may affect the end-users. the LIS to update the status of the sample from Software developers should disclose any threats "collected" to "received". The test orders for or known defects in the software and should each sample are then sent to corresponding execute all system activities with the best laboratory analyzers or machines. interest of the society in mind. Sample Processing: The sample is loaded onto the analyzer and the barcode is read. The Privacy and confidentiality are often used analyzer then automatically detects which test/s interchangeably, but they are not synonymous. to perform (from step number 4). Privacy generally applies to individuals and their Review of Results: The analyzer produces results avoidance to eavesdropping and sends these to the LIS. The result is viewable Confidentiality is more closely related to by authorized laboratory technologists. unintended disclosure of information. Releasing of Results: The lab technologist is For example, spying on a certain person to find mainly responsible for this step. All results must out about this person's visit to an AIDS clinic is a have been counter-checked for accuracy and violation of privacy. Contrastingly, breaking into reliability. a clinic to view an individual's patient record is a Reporting of Results: The attending physician violation of confidentiality. can now view the patient's results. Results can be 2  printed when needed. An electronic health record (EHR) collects Safeguards are solutions and tools which may be observations made as a result of health care. utilized to implement security policies at Examples of EHRs are laboratory results and different levels of health organization. They may records of medications given to patients. either be administrative, physical, or technical in A registry collects observations made for the nature. purpose of studying or guiding particular Administrative safeguards: outcomes on a defined population. ▪ Continuous training for users of the LIS A warehouse adds levels of integration and ▪ Periodic review of standards used to quality to the primary data of a single institution. identify results that should be flagged A collection is a library of heterogeneous data ▪ Review of laboratory policies sets from organizations. ▪ Strict implementation of rules and regulations for testing procedures Multiple Views for Patient Medical Record: CDRs ▪ Release and dissemination of guidelines allow data extraction along dimensions such as on proper disposal of laboratory time, location, or diagnosis. Data extraction specimen makes data visualization possible. ▪ Enforcement of strict policies on the Data visualization refers to the use of proper use of laboratory workstations illustrations such as tables and graphs to simplify ▪ Requiring appropriate disciplinary a wide array of information. This supports measures as needed decision-making in health care. Physical safeguards: ▪ Periodic maintenance of laboratory ELECTRONIC HEALTH (eHealth) equipment Electronic health (eHealth) refers to a broad ▪ Having biometrics and other security group of activities that use electronic means to protocol for laboratory access deliver health-related information, resources, ▪ Maintenance of controlled temperature and services. for both equipment and specimen eHealth also refers to the use of ICT for health. ▪ Contingency planning Note: ICT: Information & Communications ▪ Use of appropriate PPE Technology Technical safeguards: The concept of eHealth is guided by the ▪ Automated identity confirmation statement, the right information must be procedures for users’ access to the LIS provided to the right person at the right place and time. ▪ Regular updating of passwords ▪ Requiring different authorizations eHealth covers activities such as mobile health, ▪ Capability of the unit to automatically telemedicine, and electronic health records. log-off after long periods of inactivity Mobile health (mHealth) refers to the use of CLINICAL DATA REPOSITORIES mobile communication devices in health care. Clinical data repositories (CDR) are storehouses mHealth includes the use of health applications of patient-specific data. that may be downloaded through a person’s These data include patient demographics, gadget. information from a primary health provider such Telemedicine, or telehealth, refers to the use of as a diagnosis of patients, medical / laboratory telecommunications technology in health – such procedures performed on a patient, results of as to address or remove any distance barriers in these procedures, and/or immunization records. the provision of health services. There are five types of CDR: study, EHR, warehouse, registry, and collection. Electronic records shall strictly follow the manual A study collects observations made for specific medical record information flow. clinical research. Different terms have been used to describe the transition from manual to electronic records. These terms are AHRs, EMRs, CPRs, and EHRs. 3  transition from manual to electronic records. HEALTH INFORMATION SYSTEMS These terms are AHRs, EMRs, CPRs, and EHRs. The term, health information systems (HIS), refers to systems that capture, store, manage, Automated health records (AHRs) are and transmit health-related information that can collections of computer-stored images of be sourced from individuals or activities of a traditional health record documents. However, health institution. these did not address data input/output at a Through the use of health information systems, patient care level. health care personnel will have easier access, Electronic medical records (EMRs) are easier updating, and better control of health automated systems based on document imaging information as compared to the manual process or systems. This is the start of actual entering of of health information flow. patient information into an electronic system. Such systems also allow improved Computer-based patient records (CPRs) are communications between health care facilities collections of health information linked by a (e.g. in coordinating health information of unique identifier for each patient. However, patients). access and usage are only limited to inpatient facilities. A health information system is made up of six Electronic health records (EHRs) serve as components, namely: resources, indicators, data lifetime records of patients. All health sources, data management, information information of a patient is included in an EHR. products, and dissemination and use. HIS Resources are classified as inputs; Indicators, Advantages of eHealth: efficient use of health- data sources, and data management are related resources, increased speed of delivery, included under processes; and information prevention of overuse of medications, and products, and dissemination and use are removal of need for physical space in treating classified as outputs. patients Applications of EHRs: administrative (i.e. patient HIS Resources: include frameworks required to registration), computerized physician order ensure a fully-functioning HIS and the resources entry or CPOE, information systems, clinical that are prerequisites for a system to be documentation, pharmacy systems (i.e. e- functional. HIS resources include information prescribing) policies, infrastructure, financial, and human resources Issues and challenges of EHRs: clinical data entry Examples of human resources are: issues, resistance of staff to technology, lack of epidemiologists, statisticians, demographers, computer literacy, strong resistance to change and other HIS staff responsible for data by healthcare providers, financial implications collection, processing, reporting, and quality. (i.e. Is the government willing to allocate its funds Improvements to HIS require attention on the to developing such system? How assured are we training, development, remuneration & career that implementation of such system will be development of human resources successful and that our funds will not go to Infrastructure includes means of storage, filing, waste?), privacy and confidentiality concerns, and retrieval of records manpower issues, and environmental issues (i.e. Indicators - are the basis for HIS plan and calamities and disasters). strategy; needs to encompass the determinants Safeguards against the issues and challenges of of health (e.g. socioeconomic and demographic EHRs: data back-up, contingency plans for factors, environmental and behavioral risk disaster recovery, securing workstations, factors), health system inputs, outputs and requirement of passwords, limiting access to processes, and health status. information This includes core indicators such as mortality, morbidity, fertility, prevalence, and incidence rates. 4  Indicators should be linked and harmonized with key indicators in major international and global initiatives such as the SDGs, GFATM, and GAVI. Data Sources - are divided into population-based approaches (e.g. censuses and civil registration) and institution-based data (e.g. service records). Censuses: primary sources of information for determining the size, geographical distribution An HMIS needs to be complete, clear, simple, and characteristics of a population; ideally held cost-effective, accessible, and confidential every 10 years (Janneh, 2002). It should be complete with all Civil Registration: continuous, permanent, information but avoiding duplication and compulsory and universal recording of the consistent in assigning definitions to similar occurrence and characteristics of vital events information from various sources. It should also such as live births, deaths, and changes in marital be simple to use and clear as to what is status measured by the elements. The eligible users must have access and should be able to use the Service Records: cover records of health service system with ease. The confidentiality of patient providers and records of events with important information and data privacy should always be a health consequences from other sectors (ex: top priority. While providing all these benefits, records on unintentional injuries, homicides, the system must prove its cost-effectiveness suicides, road traffic accidents, environmental through its operations. incidents, food and product safety) HMIS is built upon the conceptualization of three information-processing phases: data input Data Management: includes all aspects of data (acquisition and verification), data management handling from collection, storage and quality- (storage, classification, computation, and assurance and flow, to processing, compilation update), and data output (retrieval and and analysis. presentation). Each phases comes with elements that are listed below. Information Products, sometimes referred to as data transformation, are the basis for evidence Data Acquisition refers to the generation and and knowledge to shape health action collection of data through the input of standard Dissemination and Use: Health information is coded formats to assist in the faster mechanical made to be readily accessible to decision-makers reading and capturing of data. Data Verification involves data authentication HEALTH MANAGEMENT INFORMATION and validation. This helps ensure the quality of SYSTEM gathered data. A Health Management Information System (HMIS) is specially designed to assist in the Data storage includes preservation and archiving management and planning of health programs, of data. It is advisable that data which are no as opposed to delivery of care. longer actively used should be archived. The health component of HMIS refers to clinical Data classification or data organization sets the studies to understand medical terminologies, efficiency of the HMIS. Key parameters or clinical procedures, and database processes; categories should be used for easier data search. management refers to the principles that help Data computation requires various forms of data administer the health care enterprise; and manipulation and data transformation, including information system refers to the ability to mathematical models, statistical and analyze and implement applications for efficient probabilistic approaches, and other data analytic and effective transfer of patient information. processes. Data update facilitates new and changing 5  information and requires constant monitoring. Financial data Information relating to the Data retrieval pertains to the process of data performance of the entity transfer and data distribution. The transfer collected for administering considers the transmittal of required data from a purposes. source to an appropriate end user. Data presentation is the reporting of the interpretation of the information produced by the system. Summary tables, statistical reports, and the use of visuals is encouraged especially for high-level managerial decision-making. The Performance of the Routine Information System Mangement (PRISM) Framework is a conceptual framework that broadens the analysis of HMIS or RHIS by including the three determinants of HMIS performance namely HMIS FUNCTION BRIEF DEFINITION behavioral, organizational, and technical determinants. Client data elates to all information of the client related to his/her Behavioral determinants involve the knowledge, transactions, reports and skills, attitudes, values, and motivation of the others people who collect and use data. Next, organizational or environmental determinants Scheduling Observed to distribute covers the culture, structure, resources, roles, resources to areas that need and responsibilities of the health system and key them contributors. Lastly, technical determinants Authorization Focuses on monitoring of the involve data collection processes, systems, Tracking authorized personnel and their forms, and methods use of authorized units Billing Refers to the notification of charges for the patient and other related documents Accounts Ensures that customers are Receivable (A/R) properly notified about their Management bill and will settle it accordingly Reporting Refers to reports issued by the health organization or facility Medical Record Also known as “Electronic Health Record”, is a collection The HMIS Monitoring and Evaluation (M&E) is a of digital information about a core component of current efforts to scale up for patient better health. Global partners and countries Compliance Procedure that should be have developed a general framework for M&E of followed for the improvement health system strengthening (HSS). The purpose of the condition of the patient of the M&E Framework is to assess the effect of or the service provided. an integrated service delivery. 6  The HMIS Monitoring and Evaluation (M&E) is Total cost of package: The information system a core component of current efforts to scale up must fit the budget of the hospital or for better health. Global partners and countries institution. have developed a general framework for M&E Web-based system: The information system of health system strengthening (HSS). The must be readily connected to the Internet to purpose of the M&E Framework is to assess the allow exchange of information within and effect of an integrated service delivery. between hospitals. Monitoring refers to the collection, analysis and Implementation and support: The provider or use of information from programs for the vendor of the information system must also purpose of learning from the acquired provide appropriate training and assistance on experiences, accounting the resources used how to use the system. both internal and external, and obtaining results The top 3 hospital information system and making decisions. providers in the Philippines are: Bizbox, Evaluation is the systematic assessment of MedSys KCCI, and COMLOGIK. completed programs or policies. Data quality refers to the overall utility of a The functions of a hospital information system dataset as a function of its ability to be are helping desk, scheduling, patient processed easily and analyzed for a database, registration, admission, discharge, transfer, data warehouse, or data analytics system. billing, contract management, and package deal Data quality signifies the data’s appropriateness designer. to serve its purpose in a given context. Having A help desk is used in answering frequently quality data means that the data is useful and asked questions (FAQs) such as how to use the consistent. information system. The aspects of data quality include its accuracy, Patient registration allows entry of patient- completeness, update status, relevance, related information into the system. consistency, reliability, appropriate presentation, and accessibility. Discharge refers to any information acquired when a patient is moved from “hospital to HOSPITAL INFORMATION SYSTEM home”. Transfer refers to any information acquired A hospital information system is a computer when a patient is moved from “hospital to system structured to manage all records of another health care facility”. The term may not health care providers to make information and be used to describe a patient who has been reports available to other health care personnels declared lifeless; or a patient who has left the – ultimately leading to increased efficiency in facility without any authorized permission. doing their tasks and responsibilities. Billing allows a user to view a patient’s record of Such system has benefitted different hospital transactions and outstanding balances. departments of the hospital such as in nursing stations, physician clinics, radiology, and pharmacy departments. A hospital information system may also be Nursing station: easier construction of patient used to generate medical reports such as charts; Physicians: may access patient records laboratory, radiology, and cardiology reports. anytimes; Radiology: the information system Laboratory report: displays elements with may serve as a database storage of radiologic administrative or clerical information (i.e. test results; Pharmacy: monitoring utilization of patient information and demographics), in medications addition to the information about the specimen and tests. In selecting or purchasing a hospital information Radiology report: provides details of the system, three parameters must be considered: requested radiology examination or procedure total cost of package, web-based system, and Cardiology report: contains important medical implementation and support. vascular information based on test results 7  LABORATORY INFORMATION handling, to final disposal of chemicals used in a MANAGEMENT SYSTEM laboratory. A laboratory information management system Worklist and workflow: LIMS assists laboratories (LIMS) is designed to help process information in in setting priorities of current workloads based health care to improve the efficiency of the on analyst and instrument availability. The services and operations of the laboratory by queuing and worklist feature provides insights reducing manual tasks and procedures. about when an event occurred, how long it was, and who was involved. Worklist and workflow functions operate to facilitate more efficient A LIMS has six functional requirements and laboratory processes. features: sample management, workflow Quality control: Diagnostic tests executed in the management, reporting, electronic health clinical laboratory may yield two kinds of results, record, mobile, and enterprise resource a patient result or a quality control (QC) result. planning. QC results are used to verify whether or not the Sample management is used to ensure that instrument is working within prescribed sample mix-up is avoided. parameters. Based on the said results, the Workflow management refers to coding reliability of a patient’s test results will be methods, instruments, and procedures (i.e. each determined. laboratory test must be linked to an appropriate Barcode-generation, printing and reading: LIMS section or analyzer of the laboratory). modules are commonly linked to barcoding label Reporting refers to data analysis and generator which enables a fast and easy method formulation of recommendations for future to identify tubes, samples, documents, and many policy-making. An example is the others. The information can easily be found and implementation of necessary changes to retrieved effortlessly using a barcode scanner. laboratory protocol if LIMS reports show that the In-Built Bidirectional Interfaces with turn-around time for a certain test is not met by Equipment: A two-way communication between the laboratory. the information system and the clinical Electronic health record (EHR) contains a instrument is required. The LIMS downloads the lifetime record of patient information. test orders and specimen ID for each test. The The LIMS may be synced with gadgets of patients clinical instrument uploads the same information so that they may access their laboratory test for analysis. results even in the comfort of their homes. This is carried out through the mobile function. Enterprise resource planning (ERP) allows a medical technologist to perform inventory functions such as monitoring current laboratory supplies, storage capacity, and location of supplies. Applications of LIMS: patient registration, billing, contract management, accounts receivables. HEALTH MANAGEMENT INFORMATION SYSTEM To facilitate laboratory safety, the Occupational A materials management system (MMS) may Safety and Health Administration (OSHA) be used to manage hospital functions such as released the Occupational Exposure to purchasing, accounting, inventory management, Hazardous Chemicals in Laboratories Standard and patient supply charges. in 2011. One of the provisions in this standard is the creation of a chemical hygiene plan. The purchasing or procurement process in a A chemical hygiene plan discusses all aspects of hospital starts when a purchase request is the laboratory standards from purchase, storage. received from a certain department 8  (e.g. laboratory, nurse station, pharmacy). The of companies to serve the best interest of department sends this request to a central patients. supplies department. This purchase request is a form that primarily Establishing buying cycles: Buying cycles shall be contains the quantity and timeframe for the determined and understood by inventory items requested. personnel based on previous cycles to eliminate Once the requested items are confirmed for shortages and overages. purchase, a purchase order is made and an appropriate supplier is selected. Item Indents and Issues: Supplies that are The purchase order is then forwarded to the damaged or have indents while being selected supplier. transported may be returned to the supplier. The supplier then delivers the requested supplies Damaged items are then moved to another to a central supplies department. warehouse for them to be monitored. During receipt of delivery, the items shall be checked if all items requested were delivered Reorder level is the minimum quantity of an item and if they are in good condition. that a company has in stock. When the minimum Finally, these items are then released to the quantity is reached, the item shall be requesting department. ‘reordered’. Min/max inventory ordering method is the basic reordering method implemented in any enterprise resource planning (ERP) and other inventory management software. The Min value represents the stock level that prompts the reorder. The Max value sets the new targeted stock level Inventory is one of the biggest expenses for most that must be fulfilled upon the reorder. medical institutions. The main difference between the Max and Min Inventory control plays an important role in level is known as the Economic Order Quantity improving or refining the quality of health care (EOQ). services since lives of people are on the line and medical costs are increasing. Inventory management is a crucial function for In a health care facility, inventory control may be any product-oriented business. Common improved through certain strategies such as inventory handling methods include FIFO, LIFO ensuring shipment agency, aligning with sales and FEFO. projections, complying with regulations, and FIFO (First In, First Out): Inventory items are establishing buying cycles. used or sold based on the order they are Ensuring shipment accuracy: This means that purchased. This is the most common technique. received items are checked whether they are the LIFO (Last In, First Out): Last items to enter the ones ordered and the supplies are free from system are used or sold first. possible damages. FEFO (First Expired, First Out): Materials are Aligning with sales projections: Coming up with used or sold based on the dates they should be an inventory tracking report in comparison with consumed, regardless of when they are actual sales is challenging. However, it is purchased. necessary to prevent wastage, identify trends, and ensure that there is no excess inventory. Generic Tax Formula Configurations: Tax Complying with regulations: A health institution configurations are usually accounted on a per shall be responsive to the current trends and country basis. Taxes that can usually be needs of the highly regulated health care processed while posting documents are: tax on industry. The regulators monitor health sales and purchases, additional taxes like VAT, institutions and determine the success or failure of companies to serve the best interest of patients. 9  sales and use tax in USA, and withholding taxes Health service input: This is focused on (i.e. in India). managing the different resources needed in a Periodic Physical Stock Taking & Adjustment health system. These resources include with Tracking: An inventory count is a process medications, health professionals, and medical where a business physically counts its entire equipment. A health system shall use its inventory. MMS have barcodes and RFID (radio- available resources to address short-term frequency identification) to ensure accurate and population needs. convenient counting. Stewardship, or overall system oversight, is the main responsibility of the government. This sets HEALTH SYSTEM the direction, context, and policies of the entire A health system is a combination of resources, health system. organization, financing, and management that Health financing: This involves raising and leads to the delivery of health services to the pooling resources to pay for health services. population. The World Health Organization Finances may be obtained from collection of (WHO) defines a health system to be comprised revenues earned as payments from the services of all organizations, institutions, resources, and provided or management of financial risks people whose primary purpose is to improve through insurance companies that provide health. financial protection the less fortunate members of a population. WHO identifies three main goals of a health system: improving the health of populations, WHO released a single framework (see image improving the responsiveness of the health below) with six clearly-defined building blocks system, and providing fair health financing. and priorities which are necessary in Improving the health of populations: This is the strengthening health systems and improving the overarching goal of a health system. Health overall health outcomes of a population. status must be measured over the entire population and across different socioeconomic groups. Populations must be protected from existing and emerging health risks. Improving the responsiveness of the health system: This refers to the provision of satisfactory health services and engaging the society as an active partner in healthcare. A responsive health system allows people to be the focus of health services. Providing fair health financing: All health Service delivery refers to the timely delivery of systems must be adequately funded to provide quality and cost-effective health services. essential services to all citizens. A fairly-financed Health workforce includes individuals and health system is defined as one that does not groups that work towards the achievement of prevent individuals from receiving necessary the best health outcomes by being responsive, health services. fair, and efficient. The number of staff should be sufficient and fairly distributed to ensure competency, responsiveness, and productivity. The four vital functions of a health system are health service provision, health service input, Information (i.e. health information system) stewardship, and health financing. analyzes, disseminates, and uses reliable and relevant information on health status, determinants, and systems performance. Health service provision: This is the most visible Health products, vaccines, and technologies function of a health system. A health system shall must be made accessible through uninterrupted perform a wide range of activities to cater the supply, well-managed pharmaceutical services, health demands of a population. and education on proper use of medication. 10  Financing (i.e. health financing system) is a Generally, there are four kinds of changes that building block which takes care of the funding for all kinds of organizations might encounter: health care services to guarantee that people can operational, strategic, cultural, and political access health services when needed without a changes. fear of having insufficient resources to pay for Operational changes can influence the way them. dynamic business tasks are led, including the Leadership and governance involve the task of computerization of particular business ensuring effective stewardship of the entire operations. health system. Strategic changes occur when the direction (i.e. vision and mission) of the organization is altered. The Philippine Health System: In the Philippines, Cultural changes influence the behavior inside the Department of Health (DOH) is mandated to an organization. provide the appropriate direction for the Political changes in human resources occur nation's health care industry. Its other tasks primarily due to reasons such as changes that include (1) the development of plans, happen on the top patronage levels in guidelines, and standards for the health sector; government agencies. (2) technical assistance; (3) capacity building; (4) advisory services for disease prevention; and (5) control of medical supplies and vaccines. There are numerous key factors that leads an DOH coordinates are national health programs organization to success of applying change through the local government units or LGUs, management. which are under the supervision of the DOH regional health offices. The succeeding image Key Success Factors at the Leadership Level: shows the authority of each DOH regional health setting the vision and strategy roadmap for the office in the country. A brief explanation is organization; forming a governing body to set provided after the image. direction and priorities, and to allocate resources; defining reporting requirements for the project; and setting and managing the users’ expectations Key Success Factors at the Program Level: clear and timely dissemination of information; building a strong functional team; forming integrated teams to address and resolve critical and complex issues; providing proper training on the new changes especially on workflow and The provincial government (blue) is tasked to technology; empowering end-users to improve provide health services through provincial and the process; maintaining changes through district hospitals. The city (red) and municipal positive reinforcement; frequent celebration of (green) governments rely on public health and success to keep motivation and momentum; primary health care centers to provide primary other creative actions and incentives such as patient care. monthly prizes for high performing teams; monitoring and constant measurement of key CHANGE MANAGEMENT indicators to report progress and benchmarks; Factors that lead to change: regulatory changes, and involving those who are affected by the shifts in consumer behavior patterns, and change in decision-making accelerated pace of IT development Change management is defined as a series of Role of Health Information Management tools, techniques, and processes aimed at Professionals: Health information management successfully effecting change. (HIM) professionals have a special skill set that qualifies then to assume the role of privacy and 11  security officers who take care of the storage, protection, and maintenance of the information in the health care institution. HIM professionals should be committed to the timely and accurate collection and management of data capture, documentation, and maintenance of clinical information. In addition, HIM professionals are also involved in data analytics and interpretation, and in the management of health information systems. Telemedicine has been one of the focus of change management concerning the healthcare system in the Philippines. Examples of these telemedicine services are listed below. Medgate & Lifeline: These are providers that offer over-the-telephone telemedicine services. Lifeline provide services such as video consultations with doctors, patient education, free doctor or nurse home visits, and delivery of medication and prescriptions. My Pocket Doctor: This is an example of a mobile based-app telemedicine center. Applications such as this provides a 24/7 instant access to doctors and medical professions. RxBox and CHITS: The RxBox diagnostic telemedicine device was incorporated in the Philippines through the support of the Department of Science and Technology (DOST). This device includes sensors that can measure blood pressure, pulse rate, temperature, and even an electrocardiogram. Sensors were also added to detect fetal heart beats and uterine contractions during pregnancy 12