How the Philippines identified Zato as the best integration platform for a national health information exchange system
Like many countries, the Philippines has a huge, complex patchwork of fragmented health data. Data is stored separately in more than 44,000 health facilities, using multiple different applications which use different data formats and aren't set up to talk to each other. This poses significant challenges to effective delivery of healthcare services.
The challenge
Fragmented health data, stored by health facilities in multiple different, unconnected applications.Siloed data makes it much harder to:
- Share patient and other data between health facilities, and even between different departments within the same hospital
- Collate data for analysis to enable evidence-based reporting and planning, at facility, regional, and national levels
Universal health coverage and interoperability
"Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship."
The WHO's Global strategy for digital health 2020-2025 highlights interoperability as crucial to improving healthcare services and systems.
Integration platform: an important tool in providing universal healthcare
The Philippines Department of Health was interested in establishing a national health information exchange system. Such a system helps strengthen healthcare delivery, reporting, and planning by replacing siloed data with interoperable data - making it much easier to share, collate, and analyze data.
Managing complex data flows
Health information systems are complex. They contain many different stakeholders with varying views of their workflow and business needs. This spurs specializations which in turn create fit-for-purpose or bespoke applications. The result is a complex application and technology architecture where data is stored in multiple unconnected places, and managing its flow becomes a big concern.
An integration platform has proven effective in many countries in managing these data flows.
Given the high volume of transactions required for a healthcare system supporting 117 million people, an integration platform was identified as the ideal middleware.
An integration platform serves as a secure central hub for data transfer among connected applications, each linked solely to the platform, facilitating communication with others. This eliminates the need for multiple 1:1 connections between different applications, greatly simplifying the setup. Data security and ease of use are paramount.
"Interoperability is necessary for us to obtain universal health coverage. If data cannot flow from one system to another, then how can the same quality of healthcare be provided? If I go to a new hospital as a patient, and they don't have access to my previous health data, then I will not get the same quality of healthcare. So an integration platform, as an interoperability tool, is an important tool for us to obtain UHC."
The solution
The Department of Health commissioned a benchmarking evaluation to identify the best integration platform for a national health information exchange system.Evaluating integration platforms to identify the best option
A University of the Philippines team, led by Philip Zuñiga, developed a benchmarking framework for selecting an integration platform for a health information exchange. Criteria and weighting were defined in consultation with the Department of Health.
The team evaluated 12 integration platforms, both proprietary and open source. The list included the most well-known integration platforms that are widely used in health information systems worldwide.
Ease of coding18%
Security15%
Scalability15%
Sustainability15%
User support and documentation11%
Support for open source technologies9%
Dependencies7%
Ease of installation5%
Cross platform4%
Testimonials2%
The benchmarking prioritized ease of coding, security, scalability, and sustainability.
Zato meets 100% of benchmarking criteria
Out of 12 integration platforms assessed, Zato was the only one to fulfill 100% of the criteria. The average score was 84%.
"Zato got the highest score mainly because it uses Python, hence it was easier to code using it as compared to other integration platforms which were mainly written in Enterprise Level Java."
Successful prototype using Zato establishes proof of concept
Next, the team developed a prototype using Zato, testing the effectiveness of using an integration platform in a health information exchange. Zato satisfied all tests of queueing, authentication, data validation, data transformation, routing, and fault tolerance.
The success of the prototype provided proof of concept for using an integration platform for a national health information exchange in the Philippines, and for using Zato specifically.
The outcome
Zato scored 100% in the benchmarking evaluation and a successful prototype established proof of concept.What makes Zato such a good choice for a health data integration platform?
Zato enables government hospitals with constrained budgets to access a high-quality, affordable integration platform. This will allow them to create a service-oriented architecture, which results in better performance, better data governance, and better security.
"Because Zato is open source, it's more sustainable - unlike proprietary software, you can modify it however you want, you don't have to pay for multiple licenses for multiple users, and we were easily able to set it up within our Department of Health."
Philip Zuñiga, Assistant Professor, University of the Philippines
