PhilHealth

NHDR OVERVIEW

Republic Act (RA) 11223 (An Act Instituting Universal Health Care (UHC) For All Filipinos, Prescribing Reforms in the Health Care System, and Appropriating Funds Therefor), also known as the “Universal Health Care Act” provides the legal basis for health reforms in the country. Health reforms are guided by the principles of whole-of-government, whole-of-society, and whole-of-system approach to ensure that health funds are spent judiciously, address the increasing demand for better health services, and increased accountability for results or outcomes.

Section 31 of the Universal Health Care Act mandates that all public and private, national and local health-related entities shall be required to submit health and health-related data to PhilHealth including, among others, administrative, public health, medical, pharmaceutical and health financing data. The health and health-related data shall be submitted to PhilHealth by all health-related entities through a National Health Data Repository, in compliance with Implementing Rules and Regulations (IRR) Section 31.1 of the RA 11223 as well as the guidelines that shall be jointly developed by Department of Health (DOH) and PhilHealth, in consultation with the Department of Information and Communications Technology (DICT) and the National Privacy Commission (NPC).

There are four (4) approved policies that supports the establishment of the National Health Data Repository (NHDR), namely:

1. DOH and PhilHealth Joint Administrative Order # 2021-0002 - Mandatory Adoption and Use of National Health Data Standards for Interoperability
2. DOH and PhilHealth Joint Administrative Order # 2021-0001 - Implementation and Maintenance of an Integrated Health Information Systems
3. DOH, PhilHealth, and DICT Joint Administrative Order # 2021-0001 - Implementation of the Standards Conformance and Interoperability Validation
4. DOH and PhilHealth Joint Memorandum Circular # 2021-0001 - Implementation Guidelines on the Processing and Submission of Health data

The PhilHealth shall establish and maintain the NHDR for all health and health-related data submitted by health care providers, insurers, and health-related entities; considered as the overall Data Controller insofar as it controls the processing and health and health-related data; and assume full responsibility in complying with existing and applicable laws, rules, and other relevant issuances relating to the submission and processing of health and health-related data, including data protection.

SEVEN BUILDING BLOCKS OF NHDR

1. Leadership and Governance

2. Legislation, Ethics, Policy and Compliance

3. Investment Strategy and Sustainability

4. Standards and Interoperability

5. Human Resource

6. Services and Applications

7. Digital Infrastructure

The NHDR Framework is built on components derived from the WHO eHealth Toolkit, organized into two key dimensions: the Enabling environment and the ICT environment. The enabling environment encompasses the policies, practices, and actions that ensure the efficient and effective operation of the NHDR. Meanwhile, the ICT environment focuses on the technological infrastructure, including hardware, networks, services, and applications, which facilitate the implementation of digital health interventions.

ARCHITECTURAL COMPONENTS

These are the architectural components that make up the NHDR in order to achieve integration and interoperability of all data processing systems. The architectural components that make up the NHDR are the Data Storage Component, Compute Services Component, and Client Services Component.

The Client Services Component shall include the following initial systems:

1.Dataset Submission – through the dataset submission system health care providers, insurers and health-related entities with certified or validated information systems or applications can submit health and health-related data to the NHDR using centralized or decentralized model of submission.

2.Business Intelligence and Analytics – this is where all health and health-related data (whether restricted, private, or public) shall be integrated, processed, and analyzed for insights to support the operational, tactical, and strategic planning of the DOH and PhilHealth.

3.Data Access Request – through this, health and health-related data will be made available and accessible to every stakeholder in the right way, and processed in a lawful, ethical, secure, consistent, and efficient manner at all levels of health care utilization.

4.eHealth Services and Applications - eHealth services, applications or solutions using the NHDR shall be designed and developed, to support systems that can benefit even the general public. Examples include frontline applications like finding a doctor, health service, drug/medicine, etc.

5.Open Data - NHDR's Open Data will include the presentation of statistical data with visualizations, and its metadata. Open Data will allow the DOH and PhilHealth to share data under an open data license where data can be freely used, re-used and redistributed by anyone without restrictions other that proper source attribution.

A. Who are going to submit data to the NHDR?

Health-Related Entities include but not limited to, health care facilities, national and local government agencies involved in the provision of health services, and agencies involved in the collection of health data.

Stakeholders/Agencies involved in the provision of health services and/or processing and submission of health and health-related data, and those identified by the DOH and PhilHealth.

B. What kind of data are to be submitted to the NHDR?

Health and Health-Related Data collectively refers to a set of specific variables or parameters that relates to individual and population health and well-being, including but not limited to administrative, public health, medical, pharmaceutical and health financing data. Health and Health-related data includes, but is not limited to:

Administrative data: Information related to the operations and management of health facilities, such as patient demographics, service utilization, and financial transactions.

Public health data: Data on disease occurrence, prevalence, and distribution within the population.

Medical data: Clinical information about patient diagnoses, treatments, and outcomes.

Pharmaceutical data: Data on drug prescriptions, dispensing, and consumption.

Health financing data: Information related to health insurance coverage, claims, and payments.

C. What data standards are to be used?

All health and health-related data that will be submitted and processed through the NHDR shall conform to the standards and rules set forth under the DOH and PhilHealth Joint Administrative Order # 2021-0002 on the Mandatory Adoption and Use of National Health Data Standards for Interoperability, and other subsequent issuances.

D. How will the data be submitted to the NHDR?

Section 36 of RA 11223 states that “All health service providers and insurers shall each maintain a health information system consisting of enterprise resource planning, human resource information, electronic health records, and an electronic prescription log consistent with DOH standards, which shall be electronically uploaded on a regular basis through interoperable systems.” (Use of validated health information system like Electronic Medical Record, Hospital Information System, or Clinic Information System.)

CENTRALIZED SUBMISSION TO NHDR

The Centralized Dataset Submission Model shows how health care providers, insurers, and health-related entities are to submit health and health-related data directly to the NHDR.

DECENTRALIZED SUBMISSION TO NHDR

The NHDR shall also collect data through a decentralized data submission model. National and local government units that collect and process health-related data, such as licensing information from the DOH and census data from the PSA shall also submit to NHDR. The DOH and PhilHealth shall review and select which processed data are to be submitted to the NHDR to ensure quality and relevance.

MANDATORY NATIONAL HEALTH DATA STANDARDS – HEALTH RECORD

Health Care Institution – referes to health facilities that are accredited with PhilHealth which includes, among others, hospitals, ambulatory surgical clinics, TB-DOTS, freestanding dialysis clinics, primary care benefits facilities, and maternity care package providers.

Health Information Systems – like Hospital Information Systems, Electronic Medical Record Systems, Clinic Information Systems, others.

WHAT ARE SOME OF THE EXPECTED BENEFITS OF THE NHDR?

Clients/Patients

1. Improve the ability of clients to access health care services

2. Enable management of one’s complete health record

3. Support early detection and treatment of preventable communicable and non-communicable diseases.

4. Improve care coordination

5. Reduce costs like repeated laboratory tests

Healthcare Providers

1. Improve access to health information at the point of care

2. Improve exchange of patient information with other healthcare providers

3. Monitor and track their patients more effectively, reduce paperwork

Researchers / Academe

1. Greater access to evidence-based information

2. Improve access to networks and resources

Health-related Business Entities

1. Provide health content as a commodity

2. Facilitate research and development

3. Enable broad and cost-effective marketing for health products and services

Government

1. Improve determination on health action plans, issues, and challenges

2. Make informed decisions

3. Enhance analysis of disease patterns and trends

4. Deliver more reliable, responsive, and timely health reporting