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Health ICT governance architecture framework developed by ADB together with partners

Health ICT governance architecture framework developed by ADB together with partners

A new paper
from the Asian Development Bank (ADB) highlights efforts to develop a health
ICT governance architecture framework through consultations and close
collaboration with experts. 

The paper notes that a range of solutions, such as digital
disease surveillance systems, electronic medical records, and social health
insurance payment processes, are being implemented in different countries.
However, good governance for successful implementation and sustainability
throughout the health system requires a holistic approach which is often
missing. The health sector lags behind other sectors and industries in the development
and adoption of ICT governance frameworks.

To fill this gap, ADB developed a health ICT governance
architecture framework (HIGAF). The framework was further refined through consultations
with health sector ICT experts in the region further refined the framework,
leading to the creation of HIGAF 2.0. HIGAF 2.0 is designed specifically to
meet the evolving needs of developing member countries in the region.

The Asia eHealth Information Network (AeHIN), a peer-led network of digital health
experts from government, civil society, the private sector, developed
countries, development partners, and academia in more than 25 countries and ADB
can assist countries to develop and implement HIGAF 2.0.

HIGAF 2.0 simplifies key elements of the COBIT 5 framework for the governance and
management of enterprise IT and combines them with digital health resources,
including the WHO and International Telecommunication Union National (ITU) eHealth
Strategy Toolkit
and the Broadband Commission report Digital
Health: A Call for Government Leadership and Cooperation between ICT and Health
.
The framework also takes into account a global repository of digital health
standards, policies and architecture artefacts, stakeholder mapping and the
principles of good governance.

In HIGAF 2.0, the seven components of the WHO/ITU eHealth
Strategy Toolkit have been expanded to include information and architecture and
divided into: what to govern and how to govern.

Three tiers encircling the framework, represent three
digital health components from the WHO/ITU eHealth Strategy Toolkit, which
describe how to govern. The first tier is leadership, governance and
multisector engagement to enable the taking of system-wide decisions.

The second tier covers the governance process – legislation,
policy, and compliance – to create the enabling environment to ensure law enforcement
and alignment of IT policies nationwide and across sectors. It includes laws
and policies on data standards, privacy and security, which are key to
establishing trust and protection for the public as well as the health sector
workforce.

The third tier of strategy and investment ensures that
financing priorities are aligned across governments, donor agencies, and the
private sector.

The framework requires a national digital health strategy,
defined by the national health strategy, policies, and plans.

At the center of the framework, there are six digital health
components to be governed: Services and application, Standards and
interoperability, Architecture, Infrastructure, Information and Workforce.

The framework classifies the components of governance into
three main categories: process, structure, and stakeholders.

Governance Components/ Credit: ADB (Figure 9 from “Transforming Health Systems through Good Digital Health Governance”)

Stakeholders in digital health include government
ministries, decentralised levels of government, civil society organisations,
the private sector, and service providers. Stakeholders extend beyond the
health sector. Examples would be civil society organisations, private vendors,
and non-health ministries such as the ministry of ICT and ministry of finance.

A three-step process is presented for stakeholder mapping:
(i) identify stakeholders with roles in policy- and decision-making and
implementation in and beyond the health sector; (ii) identify those who will
use and will be affected by digital health solutions; and (iii) identify those
who bring in key resources (human, financial, and technological).

The WHO and International Telecommunication Union National
eHealth Strategy Toolkit provides guidance on how to map, engage, and consult
different stakeholder groups in creating an eHealth vision.

The paper highlights that a governance framework must take
into account the main stakeholders in health service delivery, and in health
care financing, consider public spending, out-of-pocket expenditure, and donor
funding, as well as health insurance mechanisms. Feedback should be sought from
frontline health workers and patients in planning and implementing digital
health.

Nationwide implementation
of digital health with exchange of patient-centric data would require
polycentric and diffused forms of patient-centered governance, as opposed to
traditional hierarchical, forms. But even in diffused forms of governance, the health
enterprise, with the MOH at its core, would need to maintain a central role in
regulatory functions such as policy making, coordination, and standard-setting.

When implemented, a digital health governance framework has
to reflect the power relations and lines of accountability between the
different stakeholders. For example, having a central actor responsible for
defining standards hierarchically lower than other stakeholders might make it
difficult to implement the digital health standards. Establishing a governance
structure is one of the first steps to be taken in COBIT 5.

The Broadband Commission has proposed three different possible
governance models. Digital health can be driven from within the MOH, which then
mobilises technical capacity and skills from other ministries. Alternatively,
the MOH drives digital health, but a government-wide agency provides ICT
infrastructure capacity. In a third model, the MOH leads health strategy, but
ICT is designed by a third-party agency.

Governance processes encompass policy and decision making,
planning, resource allocation, coordination, and monitoring and evaluation.
These are usually driven by the digital health enterprise with the MOH at its
core.

HIGAF 2.0 draws from COBIT 5 from governance processes. In
COBIT 5, processes are defined as “a set of practices and activities to achieve
certain objectives and produce a set of outputs in support of achieving overall
IT-related goals.” These processes can be divided into those concerning
governance and those pertaining to enterprise management. The former includes
practices and activities aimed at evaluating strategic options, providing
direction to IT, and monitoring the outcome. The latter processes cover
responsibility for planning, building, running, and monitoring.

Access the paper “Transforming Health Systems through Good Digital
Health Governance” here.

PARTNER

Qlik’s vision is a data-literate world, where everyone can use data and analytics to improve decision-making and solve their most challenging problems. A private company, Qlik offers real-time data integration and analytics solutions, powered by Qlik Cloud, to close the gaps between data, insights and action. By transforming data into Active Intelligence, businesses can drive better decisions, improve revenue and profitability, and optimize customer relationships. Qlik serves more than 38,000 active customers in over 100 countries.

PARTNER

As a Titanium Black Partner of Dell Technologies, CTC Global Singapore boasts unparalleled access to resources.

Established in 1972, we bring 52 years of experience to the table, solidifying our position as a leading IT solutions provider in Singapore. With over 300 qualified IT professionals, we are dedicated to delivering integrated solutions that empower your organization in key areas such as Automation & AI, Cyber Security, App Modernization & Data Analytics, Enterprise Cloud Infrastructure, Workplace Modernization and Professional Services.

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Planview has one mission: to build the future of connected work. Our solutions enable organizations to connect the business from ideas to impact, empowering companies to accelerate the achievement of what matters most. Planview’s full spectrum of Portfolio Management and Work Management solutions creates an organizational focus on the strategic outcomes that matter and empowers teams to deliver their best work, no matter how they work. The comprehensive Planview platform and enterprise success model enables customers to deliver innovative, competitive products, services, and customer experiences. Headquartered in Austin, Texas, with locations around the world, Planview has more than 1,300 employees supporting 4,500 customers and 2.6 million users worldwide. For more information, visit www.planview.com.

SUPPORTING ORGANISATION

SIRIM is a premier industrial research and technology organisation in Malaysia, wholly-owned by the Minister​ of Finance Incorporated. With over forty years of experience and expertise, SIRIM is mandated as the machinery for research and technology development, and the national champion of quality. SIRIM has always played a major role in the development of the country’s private sector. By tapping into our expertise and knowledge base, we focus on developing new technologies and improvements in the manufacturing, technology and services sectors. We nurture Small Medium Enterprises (SME) growth with solutions for technology penetration and upgrading, making it an ideal technology partner for SMEs.

PARTNER

HashiCorp provides infrastructure automation software for multi-cloud environments, enabling enterprises to unlock a common cloud operating model to provision, secure, connect, and run any application on any infrastructure. HashiCorp tools allow organizations to deliver applications faster by helping enterprises transition from manual processes and ITIL practices to self-service automation and DevOps practices. 

PARTNER

IBM is a leading global hybrid cloud and AI, and business services provider. We help clients in more than 175 countries capitalize on insights from their data, streamline business processes, reduce costs and gain the competitive edge in their industries. Nearly 3,000 government and corporate entities in critical infrastructure areas such as financial services, telecommunications and healthcare rely on IBM’s hybrid cloud platform and Red Hat OpenShift to affect their digital transformations quickly, efficiently and securely. IBM’s breakthrough innovations in AI, quantum computing, industry-specific cloud solutions and business services deliver open and flexible options to our clients. All of this is backed by IBM’s legendary commitment to trust, transparency, responsibility, inclusivity and service.