This document outlines several key challenges to implementing electronic health records (EHR) in primary health care in the Philippines: 1) Unique patient identification is needed to track individuals' records across different facilities, which the proposed "Filipino Identification System Act" could help address. 2) A unified data dictionary and use of standard clinical terminology is required so records have consistent meaning, but language differences exist across the archipelago. 3) Computer literacy training is needed for health workers to use EHRs, which initiatives like "DigiBayanihan" aim to provide. 4) Costs of infrastructure, training, support and maintenance must be considered in cost-benefit analyses of transitioning from paper to EHR systems

1. IMPLEMENTING
ELECTRONIC HEALTH
RECORDS IN PRIMARY
HEALTH CARE
Issues and Challenges
By: Fides Simbulan, RN
Health Informatics 201

2. Unique Patient Identification for all
Filipinos
 The most basic requirement in a pursuit towards
Electronic Health Records (EHR). Used to track an
individual and all records in different primary facilities,
and eventually in all other levels of healthcare.
- The full implementation of House Bill 5060, or the
proposed “Filipino Identification System Act, is a huge step
to make this possible in Primary Health Care where not all
citizens would typically and possibly be identified by their
SSS Number, TIN, etc.

3. Unified Data Dictionary
 Data Dictionary must follow Clinical Data Standards to
ensure a standard meaning across all records.
Standard terminologies must be in place for the use of
all.
 To be able to address Clinical Data Entry issues, all
users must be educated and trained of the use of Data
Dictionary and its contents.
 One major concern in this aspect is the existence of
different dialects in different places, the Philippines
being an archipelago

4. Computer Literacy
 Training and education of clerks and other barangay
health workers must consist of Computer Literacy
aspect for EHR implementation
- DOST’s project with INTEL Philippines, DigiBayanihan
(among other movements) aims to cover this challenge
that we are facing with a national digital literacy
movement. This movement aims 5 million computer
literate Filipinos by the end of 2015.

5. Funding Allocation
 The Health sector must weigh the cost benefit analysis in
the long term use of an EHR, against the manual system.
 Funding should include total costs of Infrastructure
(especially in Primary health care facilities where technology
does not penetrate well), System Implementation, Training
and Education, Support and Maintenance, Research and
other special concerns to maximize the use of HER upon
implementation

6. Privacy of Information and
Unauthorized Disclosure
 The implementation and use of EHR brings about
concerns in terms of information privacy and patient
confidentiality
 This must be covered with an existing law, aligning the
advocacies of Data Privacy Act of 2012
 Concerns on the Filipino people being not aware of the
privacy concerns in use of
electronic medical records
must be addressed by the
health sector for equality and
right to privacy.

7. Capacity Building
 Knowledge and expertise are vital in sustaining a system
implementation. One of the hurdles in areas of primary care is the
expertise of personnel involved in maintaining a computerized
system
 The Health Sector must find project allocation lineups relating to
strengthening skills and competencies of Barangay Health
Workers and other Primary Health Workers
 This also includes training of all end users for a cost-effective
implementation of EHR

8. Healthcare IT Infrastructure
Incompatibilities
 Information Technology Infrastructure in the
barangays and far-flung areas are mostly
non existent or not strong enough to handle huge systems
like EHR
 This includes: Computer platforms, Data Management
Storage, Network and Telecommunications platforms,
Internet platforms, and even technical support
 Other concerns are insufficient electrical supply and
inadequate data back up

9. Knowledge and Information
Dissemination
 People involvement in creation and implementation of
an EHR is one of the key points concerning
implementation in primary healthcare
 The local population will support and maintain a system
when the sense of ownership is present
 All target users, maintenance staff and workers, and
even the administration must be well knowledgeable on
the benefits of an EHR implementation to ensure
compliance

10. References:
 Chapter 3. Issues and Challenges in Electronic Health Records: A Manual
for Developing Countries. World Health Organization, 2006.
http://www.wpro.who.int/publications/docs/EHRmanual.pdf
 Tierney, William M., et al. "Experience implementing electronic health
records in three East African countries." Stud Health Technol Inform
160.Pt 1 (2010): 371-5.
 Sood, Sanjay Prakash, et al. "Electronic medical records: a review
comparing the challenges in developed and developing countries." Hawaii
International Conference on System Sciences, Proceedings of the 41st
Annual. IEEE, 2008.