The Philippines has adopted the AeHIN National eHealth Capacity Roadmap to build its national eHealth system. This recommends first establishing an eHealth strategy and governance structure, then developing an enterprise architecture and standards to ensure interoperability. The country created a National eHealth Governance Steering Committee and technical working groups to develop its Philippine eHealth Strategic Framework and Plan 2013-2020. This included establishing standards, privacy guidelines, and plans for a Philippine Health Information Exchange. However, challenges remain around inter-agency collaboration, integrated planning, and program management. The roadmap provides a framework, but strong governance is still needed to address complexities and ensure the system supports patient care and public health.

1. eHealth Governance in the Philippines: State-of-the-Art
Alvin B. Marcelo, Portia F. Marcelo
Abstract
eHealth is defined by the World Health Organization as the use of information and
communications technology in health. Countries are beginning to realize 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 to build capacity in the public and private health sectors to cooperate and
collaborate around better information systems in support of patient care and public health.
Introduction
The Philippines underwent rapid reforms in governance over its national eHealth strategy at the
start of the Aquino administration. In 2016, the
Philippine Health Agenda 1
was released which cited eHealth as one of its main pillars. This paper reviews the context
behind the eHealth transformations the country has undergone in the past six years including its
chronology. It then proposes a roadmap for further reforms in the Duterte administration to
ensure that the benefits of eHealth reach all Filipinos.
Background
The Philippines is one of the fastest growing economies in Asia but is still saddled by the double
burden of disease. It exports personnel skilled in software engineering and is considered a
leader in business process outsourcing. Despite these advances however, the country has yet
to leverage its ICT expertise to reap the benefits for the health sector.
This paper discusses the efforts of the Philippine government to establish a multi-sector
governance structure to oversee the effective use of ICT in health. It lists the achievements and
the challenges that remain. Lastly, it recommends a roadmap to further strengthen and expand
eHealth to all Filipinos.
Objective
Describe the evolution of Philippine eHealth Strategic Framework and Plan and recommend a
roadmap for the next six years (2016-2022)

2. Methodology
This paper used a case study approach employing desk review of policies and key informant
interviews. It then maps the strategy vis-a-vis known eHealth development frameworks to
determine progress and remaining gaps.
Results
The researchers were able to gather various policies that relate to eHealth in the Philippines to
wit:
Draft National eHealth Strategy October 2010
The Department of Health shared a draft national eHealth strategy at a summit organized at the
beginning of the Aquino administration. Participants in the summit agreed that a multi-sectoral
ICT for Health Technical Working Group (ICT4H) should be formed under the leadership of the
DOH to assist the agency with policy directions.
Subsequently, the ICT4H began wide consultations across various sectors (health,
telecommunications, academe, private, etc.) to understand stakeholder needs. By February
2012, the ICT4H submitted its recommendations2
to DOH, to wit:
1. Governance and architecture: DOH needs to establish clear governance structures and
a transparent enterprise architecture (blueprint) to guide stakeholders
2. Standards and interoperability: DOH needs to recommend standards for interoperability
based on this architecture.
3. Compliance: once defined, DOH must ensure there are mechanisms to ensure
compliance to these standards and to achieve the benefits of interoperability
4. Capacity-building: a systematic approach to building capacity in the health and ICT
sector will be needed to ensure the success of the national eHealth program.
Around the same time, the World Health Organization together with the International
Telecommunications Union released the National eHealth Strategy Toolkit3
. Delegates from the
Department of Health and Department of Science and Technology attended an orientation and
began the work of enhancing the draft eHealth strategy around the framework proposed by the
toolkit (see figure).

3. At the first general meeting of the Asia eHealth Information Network, the participants launched
the National eHealth Capacity Roadmap (see figure). The roadmap started with the crafting of
the strategy followed by adoption of IT governance. The governance then empowers a health-
sector wide enterprise architecture which ensures interoperability through standards.
Subsequently, the capacity roadmap recommends building capacity for program management
and IT operations. This sequence was adopted by the Philippines resulting in a cohort of
certified professionals who provided support to the national eHealth strategy.

4. By July 2013, the DOHand DOST had released a joint department memorandum creating the
National eHealth Governance Steering Committee and Technical Working Group (see figure). A
consultative meeting on the draft Philippine eHealth Strategic Framework and Plan 2013-2020
was held thereafter and was formally approved by the Steering Committee in its first meeting
October 2013.

5. At their second meeting on January 2014, at the height of the Typhoon Haiyan relief operations,
the Steering Committee agreed to adopt COBIT5 (www.isaca.org/cobit) as the IT governance
framework for the PeHSFP and mandated the TWG to move forward on consensus agreements
reached by the participating agencies. By July 2014, a program management office (PMO) was
launched ensuring regular meetings with proper documentation. From thereon, commitments
and activities of agencies were tracked and monitored.
Standards, privacy, enterprise architecture, and private sector
In their initial meetings, the TWG agreed on the priority areas that need to be addressed.
Standards and interoperability was high on the list. Privacy was also a concern raised by private
hospitals who were wary of sharing personal patient information to the DOH. Consistent with the
recommendations by the WHO-ITU Toolkit, the Standards Expert Group (SEG) and the Privacy
Expert Group (PEG) were created. After some members of the TWG received certification
training on enterprise architecture, they suggested the creation of the health enterprise
architecture expert group (HEAEG). Subsequently, realizing the need to update the private
sector and understand their perspectives, the TWG invited them into the Advisers Group.
Relevant eHealth Policies
With resources coming from the national eHealth Steering Committee, these expert groups
convened and developed policies required to create a conducive environment for health
information exchange. The Standards Expert Group released the Standards Catalog4
and the

6. Standards Change Management Manual while the Privacy Expert Group published the eHealth
Privacy Guidelines5
.
The Philippine Health Information Exchange
Based on its vision (see figure), the major project of the PeHSFP was the Philippine Health
Information Exchange (PHIE). To this end, a proof-of-concept was commissioned after which a
procurement for commercial level PHIE was approved. An administrative order detailing its
implementation was also released6
. Unfortunately, procurement problems prevented the correct
sequence resulting in severe delays. As of this paper’s publication (November 2016), the PHIE
is still not in operation two years after it has been approved for funding.
Results and discussion
Computerizing a single hospital is an expensive endeavor and has been found to be prone to
failure7
. The reason is that hospitals have complex business processes and decision-making
algorithms that require collaboration across different departments. Effective hospital systems
must ensure that information are accessible to these departments at the right time and format
the health professionals can understand in order to make a decision. This complexity
contributes to the failed implementations.
Logically, national-scale health information systems, such as computerizing all hospitals in a
country, are in orders of magnitude more complex. There are almost two thousand hospitals
and three thousand local health centers in the Philippines each one using at least one of the
twenty available electronic medical records. Without an overseeing governance body and a
guiding blueprint, these systems have mushroomed into various areas in the country creating
silo information and has strained frontline workers with the burden of data encoding with
questionable primary care and public health benefit.
It was within this context that the national eHealth governance structure was created. Knowing
that information systems are complex, the Steering Committee was intent on establishing an
interoperability framework that enabled facilities to use any system responsive to their business
needs (e.g., primary care) while maintaining compliance with the reportorial requirements of the
DOH programs (e.g., public health reporting). This balance required collaboration of national,
regional, provincial, and local authorities and could only be made possible if there were clear
governance mechanisms in each of these levels (horizontally) and between then (vertically).
The Steering Committee’s decision to adopt an IT governance framework (COBIT5) was
groundbreaking for the Philippines and for Asia. Amidst the seemingly overwhelming
complexity, the governance framework provided a semblance of order and control from which
the leaders can observe the progress of the PeHSFP. This was still contingent on the
appropriate implementation of the governance framework and the availability of expert
resources to provide feedback to the Steering Committee. But it gave a solid ground to start the
eHealth transformation in the country.

7. COBIT5 is a comprehensive governance framework and helps in organizing the many
components needed for successful implementation of enterprise information technology. In the
case of eHealth, the enterprise was defined as the multi-agency body composed of DOH,
DOST, PhilHealth, and UP Manila. However, with differing mandates and agendas, these
agencies faced substantial challenges with aligning their activities under the directions set by
the Steering Committee.
For example, on the directive to lower maternal deaths using eHealth, there is as yet a lack of
clear alignment of activities of DOH, DOST, PhilHealth and UPM to show progress to the
Steering Committee. Properly aligned plans should clearly demonstrate the steps each agency
must undertake (and the interrelationship of these steps with each other) to ensure that
maternal deaths are decreasing. These will then be reported regularly to the Steering
Committee in their quarterly meetings.
The PHIE was designed to provide the backbone for the interagency collaboration but it was
stalled in procurement. The Steering Committee must look for more innovative ways to finance
its projects in order to overcome the barriers to implementation.

8. More challenges remain such as inter-agency transparency, integrated investment planning,
properly sequenced procurement, program management and monitoring. While they may seem
insurmountable, as long as the Steering Committee demands good governance from
themselves and down their line agencies, these challenges can be addressed systematically.
Proposed Roadmap
The AeHIN Roadmap has served the country well but its full value can only be achieved with
good governance and transparency. The whole country depends on government to lead but is
also dependent on private sector to implement. Using IT Governance frameworks, government
can clarify these roles and ensure that a healthy collaborative environment exists between
regulatory and operational entities.
An enterprise architecture (or blueprint) is an important resource for all stakeholders. If
government invests on a national blueprint, this will help stakeholders make the right
investments on technologies that are architecturally-compliant.
With the increasing number of interested stakeholders and new policies being generated, a
more robust program management office should be established to ensure proper coordination
and communication.
Summary
Country awareness on eHealth is increasing but most are overwhelmed by its complexity. While
many stakeholders understand the benefits ICT can bring to healthcare, without an overall
governance body and a guiding blueprint, they will create siloed solutions that will be parochial
and miss out on the possibility of offering patient-centered coordinated care.
The AeHIN National eHealth Capacity Roadmap being implemented in the Philippines
demonstrates that following a proper sequence of reforms starting from strategy (WHO-ITU
National eHealth Strategy Toolkit) to governance (COBIT5) to architecture (TOGAF) and to
program management can build stronger systems that allows public and private sectors to
cooperate and collaborate around better information systems in support of patient care and
public health.
1 The Philippine Health Agenda. Department of Health.
http://www.doh.gov.ph/philippine_health_agenda (last accessed November 15, 2016)
2 ICT for Health Technical Working Group Final Report, February 7, 2012.
http://bit.ly/ict4hrecommendations. Last accessed November 15, 2016

9. 3 WHO-ITU Natinal eHealth Strategy Toolkit. 2012. https://www.itu.int/dms_pub/itu-
d/opb/str/D-STR-E_HEALTH.05-2012-PDF-E.pdf
4 National eHealth Standards Catalog. http://bit.ly/standardscatalog (last accessed
November 15, 2016)
5 National eHealth Privacy Guidelines. http://bit.ly/ehealthprivacyonline (last accessed
November 15, 2016)
6 Adoption of the Philippine Health Information Exchange. PhilHealth.
http://bit.ly/adoptphie (last accessed November 15, 2016)
7 Iyoke CA, Ugwu GO, Ezugwu FO, Lawani OL, Onah HE. Risks associated with
subsequent pregnancy after one caesarean section: A prospective cohort study in a
Nigerian obstetric population. Niger J Clin Pract. 2014; 17(4):442-448.