Reply To: Scaling up Interoperability

Alvin Marcelo

Hello all…Thanks for mentioning the Philippines.

Our story started at the Asia eHealth Information Network ( way back in 2011 when we formed the network with support from WHO. At a 2011 conference on health information systems interoperability in Hoi An, Vietnam, all of the participants had come to the conclusion that there was no interoperability even within Ministries of Health. As such, how can the MOH ask private sector to interoperate with public sector when within itself, the latter was not integrated?

In AeHIN, we resolved to bring together eHealth advocates from different countries and create a space for discussing how we can solve the interoperability problem. It may seem funny looking back but the learning process was more important than the content:

1. Training on Standards (2013) — a basic analyses of non-interoperability would point to lack of standards as the culprit. So AeHIN opted to get training on HL7 — a health information standard. However, after training 26 people from 13 countries on HL7, we came to the conclusion that HL7 was indeed an important standard but it was very comprehensive and complex. We needed to have a blueprint to know how to use HL7 effectively. A simple analogy is that you may think of HL7 as a standard “hollow block” but you still need a blueprint to tell you how to arrange the hollow blocks to serve your purpose.

2. Blueprint (2014). AeHIN then thought of blueprints and sought training for enterprise architecture (which allows you to create blueprints). Thirty people from 9 countries underwent TOGAF – an EA methodology. After this, we thought we could be interoperable (HL7 plus TOGAF). But no, when we started asking the EA participants to start crafting the blueprint, they said there should be a clear governance structure and mandate behind the EA activity or else it will be moot.

3. IT Governance (2015). AeHIN sought out IT Governance training and found COBIT5 ( Thirty participants underwent COBIT5 training and this is how the Philippines got to adopt COBIT5 for its national eHealth program. IT Governance provides a systematic framework to address system complexity and gives assurance to all stakeholders that the information system is organized to address this complexity.

In July 2014, a multisectoral governance steering committee (patterned after the WHO-ITU National eHealth Strategy Toolkit) chaired by the Philippine Minister of Health and co-chaired by the Minister of ICT adopted COBIT5 as their IT Governance framework. From thereon, various aspects of the framework were activated and invested on.

One specific aspect of COBIT5 is APO03 or “Manage the enterprise architecture”. For this, the national steering committee established a Health Enterprise Architecture Expert Group which advises them on EA matters. The current EA of the Philippines is patterned much after the OpenHIE architecture ( with local extensions.

In summary, information systems within a facility is complex in and of itself — what more for national-scale health information systems?

The solution: IT Governance which provides mandate for enterprise architecture which in turn serves as a guide to the many stakeholders in the country.

And our story continues — I would be happy to keep RHINO informed of the developments —

Alvin Marcelo
Member, National eHealth Governance Technical working Group (Philippines)
Executive director, AeHIN