Implementing a Cross-Border Next-Generation Personal Health Record in the Philippines and Taiwan: An Implementation...

Area of Science:

• Health Informatics
• Health Services Research
• International Health

Background:

• Electronic health record (EHR) system disparities impede cross-border continuity of care, particularly between countries with significant labor mobility and tourism, such as the Philippines and Taiwan.
• While both nations collect health insurance claim data, their systems lack full alignment with international standards like Health Level 7 International's International Patient Summary (IPS).

Purpose of the Study:

• To convert health insurance data from Taiwan's My Health Bank (MHB) and the Philippine Health Insurance Corporation's Claim Form 4 (CF4) into a cross-border personal health record (PHR).
• To align the converted PHR with the International Patient Summary (IPS) using Fast Healthcare Interoperability Resources (FHIR) standards.

Main Methods:

• Data elements from CF4 and MHB were mapped to the 17 sections of the IPS to assess alignment with required, recommended, and optional data fields.
• Identified missing data elements, including those for medical devices, social history, and advanced directives.
• Designed a FHIR-based integration architecture incorporating OAuth 2.0/SMART on FHIR for security and proposed a national uptake strategy.

Main Results:

• Taiwan's MHB covered 14 (82.4%) of the 17 IPS sections, while the Philippines' CF4 covered 12 (70.6%).
• Both systems demonstrated insufficient data elements for medical devices, social history, and advanced directives.
• An implementation plan was developed, emphasizing data interoperability, standardization, and privacy/security protocols, with a proposed phased approach starting with stakeholder engagement and pilot testing.

Conclusions:

• Aligning CF4 and MHB data with IPS standards through FHIR can establish a robust cross-border PHR ecosystem.
• This integration has the potential to significantly enhance patient safety, continuity of care, and inform policy development for both the Philippines and Taiwan.
• Sustained integration and maximized patient benefits necessitate ongoing collaboration, regulatory updates, and public awareness initiatives.