ICTM 111 (LEC)
Madla, Ray Anne Rose M.
Change Management in Health Informatics
BSMLS 1 Y1-2
INTRODUCTION
There are generally four kinds of changes that all
kinds of organizations might encounter, with the
likelihood of overlap among the conceivable
outcomes:
• Operational changes can influence the way
dynamic business tasks are led, including the
computerization of a particular business segment.
• Strategic changes occur when the business
direction, in relation to its vision, mission, and
philosophy, is altered. For instance, changing the
business technique from business growth to
increasing market share in the overall industry is a
case of strategic change.
• Cultural changes influence the internal
organizational culture, for example, the way the
business is conducted, such as actualizing a CQI
(continuous quality improvement) framework.
• Political changes in human resources occur
primarily due to political reasons of varying types,
commonly changes that happen on top patronage
levels in the government agencies.
Different sorts of changes typically have dissimilar
impacts on different organizational levels. For
instance, the operational changes tend to have the
highest impacts on the lower organizational levels,
because the frontline employees are mostly
affected. Employees working at the upper-levels
might be indifferent as to the changes, which may
cause significant distress to those attempting the
implementation of change.
Conversely, the effect of the political changes is
more strongly felt on the higher levels of the
organization. When change occurs relatively in a
bureaucratic organization, those working on the
bottom level often notice the change at the top
(Lorenzi & Riley, 2000).
October 25, 2022
There is no denying that organizational changes
have varying degrees of impact on both the
organization, and in effect, its clientele. This chapter
discusses Change Management contextualized in
Health Informatics, which is increasingly becoming a
course of action that health institutions avail of in
order to improve their services.
There are a wide range of change management
process models to explore and consider—each with
their own strategic approaches based on the
expertise and experiences of their developers. A
few of the more common change practice examples
include:
• Kurt Lewin’s three-step “Unfreeze-Change-
Refreeze” model, proposed by the universally
recognized founder of social psychology in the
1950s. It is still highly relevant today and often used
as the basis for many change management
strategies.
• Proski’s ADKAR® Model: an acronym for a strategy
that encompasses: “Awareness of the business
reasons for change; Desire to engage and
participate in the change; Knowledge about how to
change, Ability to implement change, and
Reinforcement to ensure change sticks”.
• Kotter’s 8-Step Model of Change, developed by
Harvard Business School’s John Kotter, focuses on
efficient and effective change management in a
competitive world. Highlights include building a
strong, collaborative team and a solid strategy;
creating effective communication channels;
supporting staff empowerment; using a phased and
steady approach; and securing the change within an
organization’s culture (QuickBase, 2017)
 ICTM 111 (LEC)
Madla, Ray Anne Rose M. October 25, 2022
Change Management in Health Informatics
BSMLS 1 Y1-2

APPLICATION OF CHANGE MANAGEMENT

Change management is a series of tools, techniques

and processes aimed at successfully effecting
change. These tools and techniques can be
implemented in a variety of contexts, but often they
support the application of other initiatives such as
Six Sigma, CRM, Total Quality Management or
enterprise applications such as SAP.

Downey (2008) describes common tools and

techniques that a change management practitioner
might use during a change initiative, which include:
• Questioning skills to gather information about the
‘as is’ and ‘to be’ status of the business process
• Process mapping for both ‘as is’ and ‘to be’
processes
• Gap analysis
• Business case development
• Project management
• Problem solving
• Requirements elicitation techniques
• Negotiation skills.
In addition to these techniques, Downey also
mentions that it is crucial that progress of the
change initiative can be quantified against the
objectives set by the organization. For this to be
successful, the organization needs to set clear
objectives and settle on key performance indicators
(KPIs) that can be used to track and evaluate the
change initiative against its objectives. These KPIs
might include:
• Reducing rework by x%
• Improvement in stakeholder satisfaction, for
example, customer/employee surveys
• Reduced time to market
• Enhanced speed of delivery
• The return on investment, that is, the total cost to
implement the initiative versus total savings gained
from the initiative per period.
THE ROLE OF HEALTH INFORMATION
MANAGEMENT PROFESSIONALS
Health Information Management (HIM)
professionals, credentialed with their academic
preparation, work experience, commitment to
patient advocacy, and professional code of ethics,
have a specialized skill set that uniquely qualifies
them to assume the role both of privacy official
and/or security officials who store, protect, and
transmit information in all media and formats (May,
2014). A Health Information Management
professional:
• Collects, aggregates, analyzes, and disseminates
patient health information.
• Committed to the timely and accurate collection
of health information and its maintenance, storage,
retentions, and disclosure.
• Represents patients’ interest in matters of privacy
and security, information release, and issues and
guidelines regarding record access.
 ICTM 111 (LEC)
Madla, Ray Anne Rose M.
Change Management in Health Informatics
BSMLS 1 Y1-2
• Certified by the American Health Information
Management Association.
• Ensures confidential patient information is kept
private, secure, and in accordance with federal and
state laws.
Health Information Management professionals are
the stewards and guardians of patient health
information. They represent the patient’s interests
in matters of privacy and security, information
release, issues and guidelines regarding record
access, and general consumer education about
personal health records.
They specialize in managing patient health
information and medical records, administering
computer information systems, and classifying using
standard coding systems, the diagnoses, and
procedures for health care services provided to
patients.
Those with health information management and
health information technology careers manage all
aspects of the content of patient medical records
and patient information systems. Job
responsibilities can include aspects of clinical
information documentation capture and
maintenance, data analytics and interpretation, as
well as designing, implementing, and maintaining
health information technology systems
THE PHILIPPINE HEALTH INFORMATION
PROFESSION
Advancements in ICT (information and
communication technology) are upsetting not only
traditional businesses, but even those not
immediately thought of as probable beneficiaries—
such as the healthcare sector.
From electronic patient records to the wireless
transmittal of patient files for remote diagnosis,
improvements in communication and technology
October 25, 2022
will lead to better delivery of healthcare services.
Telemedicine, or the use of electronic
communications to transmit and exchange medical
information and data to provide patient treatment,
is quickly gaining momentum within the country
and the rest of the ASEAN region.
With the increasing popularity of smart phones,
wireless tools and other comparable technology,
primary care and specialist referral services, as well
as remote patient monitoring and patient medical
health information are undeniably improved with
the help of telemedicine.
Thailand, Singapore, and Malaysia have started
adopting healthcare IT solutions to bring the sector
to the next level. In 2009, Singapore developed its
National Electronic Health Record initiative, which
permitted healthcare practitioners in the island
state access to a patient’s records across the
healthcare continuum.
Malaysia initiated a Hospital Implementation
System in 1993, with its first telemedicine project in
1996, and Thailand created its National Health
Information Committee in 2010.
Likewise, the Philippines has developed an e-Health
Strategic Framework and Plan for 2014 to 2020,
whose objective is to utilize information and
communication technologies in the health sector.
This will assist in the delivery of health services and
manage health systems for greater efficacy, with
the ultimate goal of providing universal healthcare
for the Filipinos.
One of the strategic goals of this framework is to
establish unified and coherent health and
management information systems, and also to take
advantage of ICT to reach and provide better health
services and support the attainment of the UN’s
Sustainable Development Goals.
 ICTM 111 (LEC)
Madla, Ray Anne Rose M.
Change Management in Health Informatics
BSMLS 1 Y1-2
In line with this, the Department of Health (DOH) in
Region 4Bhas launched the first interactive
telemedicine system in Marinduque, and seemingly
the entire country, at the Dr. Damian J. Reyes
Provincial Hospital. The system currently provides
medical consultations and diagnostics through
video calls (De Dios, 2016).
TELEMEDICINE IN THE PHILIPPINES
For an archipelago such as the Philippines, the
delivery of healthcare services might prove to be
challenging. Fortunately, the rise of Telemedicine
within the region, as discussed above, has been a
beneficial turn of events for the Philippine
Healthcare sector.
Multiple players in the Telemedicine scene in the
Philippines currently exist, ranging from mobile
apps to call center services.
Some providers of over-the-phone telemedicine
services are Medgate and Lifeline. Common
features include 24/7 call centers, diagnosis using
images sent via email, medical certificates, and
treatment plan summaries. These kinds of
telemedicine centers usually have a corresponding
mobile app to facilitate easier access. Unique to
Lifeline, however, is video consultation with
doctors, patient education, free doctor or nurse
home visits, and delivery of medication and
prescriptions in exchange for a fixed monthly
subscription fee.
Mobile App-based Telemedicine centers, on the
other hand, include MyPocketDoctor and
MyDocNow. These providers are usually in
partnership with other international telemedicine
centers.
October 25, 2022
Medway Healthcare Inc., by far, offers the most
comprehensive set of telemedicine services, being
the first medical clinic in the Philippines to mobilize
its Pre-Employment Medical Examination (PEME)
arm into the path of delivering interactive
healthcare. They offer Telefollow-up and
Teleconsultation procedures which are accessible
online and through a specially-designed computer
program.
In Telefollow-up, patients are notified of the
medical evaluation results via text messages on
their individual cell phones. Within 24 hours of
PEME, patients will already know if they are fit to
work, unfit to work or still with pending workups.
Follow-up visit to the clinic is then advised. Follow-
up of results using traditional landline call is also
accommodated.
Telemedicine efforts from the government and
other non-profit organizations have also ensued.
The National Telehealth Center is the leading
research unit in the University of the Philippines
responsible for developing cost effective tools and
innovations in the realm of information and
communications technology (ICT) for improving
health care. NTHC experienced a breakthrough,
when it first conducted telemedicine research-cum-
service in remote and undeserved areas from
Batanes to Zamboanga through partners in the then
Commission on Information and Communications
Technology’s (CICT, 2004-2008) and Department of
Science and Technology - Philippine Council for
Health Research and Development (DOST-PCHRD,
2008-2011). Today, the center partners with various
government and non-government institutions,
engaging them on eHealth research, training, and
service activities (National Telehealth Center, n.d.).
 ICTM 111 (LEC)
Madla, Ray Anne Rose M. October 25, 2022
Change Management in Health Informatics
BSMLS 1 Y1-2

The Department of Science & Technology

(DOST)has also begun distributing the breakthrough
“RXBox” telemedicine device developed by
engineers and researchers from University of the
Philippines (UP) Diliman and UP Manila to 1,000 far-
flung municipalities in the country, focusing on
disadvantaged municipalities to benefit from having
affordable health care in their respective
communities.

The RXBox was collaboration between a team of

engineers, doctors and researchers from UP Diliman
and UP Manila, led by electronics and
communication engineer Nathaniel Cruz, who is
currently with the National Telehealth Center.

RXBoxhas features that enable teleconsultations via

email, video call, or SMS. It has sensors that can
measure a patient’s blood pressure, temperature,
oxygen saturation rate, pulse rate, and even the
electrocardiogram rate, and this information may all
be sent to the specialist doctor via email or SMS,
aiding in patient care. Afterwards, the RXBox stores
and files data into a community health information
system (Ronda, 2016