Implementation Challenges of a Smarter and Integrated Local Health Information System
Esmenia Marceline Aguila | Sophia Danielle D. Actub | Eugene Miguel C. Adalia | Nikka Nate M. Aguirre | Angelus Gabriel Bradford F. Agulto | Agatha Denise Ma. T. Alfaro | Mariella Razen G. Alvaro | Luiz Darhine C. Apiado | Charissa Rosamond D. Calacday
Discipline: health studies
Abstract:
Health Information Systems (HIS) play a vital role in forming coordinated and data-driven
healthcare. However, in many local settings, these systems operate in isolation, unable to share data with
other platforms, which causes interoperability issues. Interoperability is essential for linking records,
enabling timely decisions, and achieving Universal Health Care (UHC). In response to this, the Smarter
and Integrated Local Health Information System (SMILHIS) emerged to connect health databases and
promote interoperability. However, SMILHIS’ implementation has faced challenges. Understanding these
challenges is essential for strengthening strategies, improving healthcare delivery, and supporting the
realization of Universal Health Care. This study used a descriptive qualitative design, employing Key
Informant Interviews (KIIs) with 10 purposively selected participants in Cagayan de Oro and San Carlos
City, Pangasinan. Thematic analysis revealed four major themes: (1) Governance and Strategic Direction,
including leadership turnover, shifting priorities, local autonomy, policy gaps, and the need for national
support; (2) Institutional Capacities and Readiness, highlighting staffing shortages, limited technical
expertise, and the need for training and organizational commitment; (3) Technological, Financial, and
Infrastructure Constraints, such as inadequate funding, equipment shortages, and data privacy concerns;
and (4) External and Environmental Challenges, including geographic inaccessibility and competition from
private systems. The study revealed that the success of health information systems is determined not only
by technology but also by governance, leadership stability, and institutional readiness. The results
underscore the importance of developing stable policies that can withstand political transitions, ensuring
long-term financial stability, building institutional and human resource capacity, and fostering stronger
coordination between national and local governments. By addressing these areas, HIS such as SMILHIS
can become more resilient and sustainable, leading to more efficient service delivery, continuity of care,
and promoting the country’s progress toward Universal Health Care.
References:
- Abisoye, A., & Akerele, J. I. (2022). A practical framework for advancing cybersecurity, artificial intelligence, and technological ecosystems to support regional economic development and innovation. International Journal of Multidisciplinary Research and Growth Evaluation, 3(1), 700–713. https://doi.org/10.54660/.ijmrge.2022.3.1.700-713
- Akwei, C., Damoah, I. S., & Amankwah‐Amoah, J. (2020). The effects of politics on the implementation of government programs/projects: Insights from a developing economy. Politics &Amp Policy, 48(6), 1161–1201. https://doi.org/10.1111/polp.12384
- Al-Issa, Y., Ottom, M. A., & Tamrawi, A. (2019). EHealth Cloud Security Challenges: A survey. Journal of Healthcare Engineering, 2019, 1–15. https://doi.org/10.1155/2019/7516035
- Bahinting, M. A. P., Ardiente, M. P., Endona, J. E., Herapat, M. A. A., Lambo, D. C., Librea, H. J. A., Librando, M. C. Y., Libron, J. B. B., Petaluna, M. J., Ygot, G. C., Taneo, J. D., Cabello, C. A., & Minyamin, A. V. (2022). Stronger than the Internet connectivity: A phenomenology. Psychology & Education: A Multidisciplinary Journal, 2(6), 465–476. https://doi.org/10.5281/zenodo.6791820
- Britiller, M. C., Amponin, A. M., & Pring, C. C. (2023). Effectiveness and challenges: The current situation of Electronic Health Records (EHRs) to improve health care outcomes. South East Asia Nursing Research, 5(1), 1. https://doi.org/10.26714/seanr.5.1.2023.1-18
- Ayton, D. (2023, March 21). Chapter 5: Qualitative descriptive research. Qualitative Research – a Practical Guide for Health and Social Care Researchers and Practitioners. https://oercollective.caul.edu.au/qualitative-research/chapter/__unknown__-5/
- Bagherian, H., & Sattari, M. (2022). Health Information system in developing Countries: A review on the challenges and causes of success and failure. Medical Journal of the Islamic Republic of Iran. https://doi.org/10.47176/mjiri.36.111
- Byrne, D. (2021). A worked example of Braun and Clarke’s approach to reflexive thematic analysis. Quality & Quantity, 56(3), 1391–1412. https://doi.org/10.1007/s11135-021-01182-y
- Campos, P. A., & Reich, M. R. (2019). Political analysis for health policy implementation. Health Systems & Reform, 5(3), 224–235. https://doi.org/10.1080/23288604.2019.1625251
- Co, P. A., Vîlcu, I., De Guzman, D., & Banzon, E. (2024). Staying the Course: reflections on the progress and challenges of the UHC law in the Philippines. Health Systems & Reform, 10(3). https://doi.org/10.1080/23288604.2024.2397829
- De Claro, V., Lava, J. B., Bondoc, C., & Stan, L. (2024). The role of local health officers in advancing public health and primary care integration: lessons from the ongoing Universal Health Coverage reforms in the Philippines. BMJ Global Health, 9(1), e014118. https://doi.org/10.1136/bmjgh-2023-014118
- Dodd, W., Brubacher, L. J., Bustos, M., Mijares, M. K., Mar, K. L., Little, M., & Lau, L. (2025). “I am the bridge”: Examining intersectoral collaboration among community health workers to address maternal and child health in the Philippines. SSM - Health Systems, 100057. https://doi.org/10.1016/j.ssmhs.2025.100057
- Doyle, L., McCabe, C., Keogh, B., Brady, A., & McCann, M. (2019). An overview of the qualitative descriptive design within nursing research. Journal of Research in Nursing, 25(5), 443–455. https://doi.org/10.1177/1744987119880234
- Evio, B. D., & Bonito, S. R. (2024). Formative evaluation of the implementation of eHealth in the Philippines: A qualitative study. Acta medica Philippina, 58(12), 35–47. https://doi.org/10.47895/amp.v58i12.9289
- García, A. P., De La Vega, S. F., & Mercado, S. P. (2021). Health information systems for older persons in select government tertiary hospitals and health centers in the Philippines: cross-sectional study. Journal of Medical Internet Research, 24(2), e29541. https://doi.org/10.2196/29541
- Garcia-Perez, A., Cegarra-Navarro, J. G., Sallos, M. P., Martinez-Caro, E., & Chinnaswamy, A. (2023). Resilience in healthcare systems: Cyber security and digital transformation. Technovation, 121, 102583. https://doi.org/10.1016/j.technovation.2022.102583
- Haris, M., & Yang, Q. (2023). Investigating the moderating role of political factors on internal success factors and project success: Empirical evidence from Pakistan. Sustainability, 15(11), 8910. https://doi.org/10.3390/su15118910
- Iqbal, S., Ummara, U., Nawaz, M. J., Ali, A., & Fatima, I. (2024). The role of political leadership achieving economic growth and project success through the mediating role of political stability: Investigation from Mega Project. iRASD Journal of Economics, 6(3), 786–809. https://doi.org/10.52131/joe.2024.0603.0240
- Kaboré, S. S., Ngangue, P., Soubeiga, D., Barro, A., Pilabré, A. H., Bationo, N., Pafadnam, Y., Drabo, K. M., Hien, H., & Savadogo, G. B. L. (2022). Barriers and facilitators for the sustainability of digital health interventions in low and middle-income countries: A systematic review. Frontiers in Digital Health, 4. https://doi.org/10.3389/fdgth.2022.1014375
- Lin, S. C., & Adler-Milstein, J. (2018). The relationship between hospital and EHR vendor market dynamics on health information organization presence and participation. BMC Medical Informatics and Decision Making, 18(1). https://doi.org/10.1186/s12911-018-0605-y
- Lorenzo, E., Paguio, D., & Asio, J. M. R. (2021). Budget allocation system of a highly urbanized local government unit in central Luzon, Philippines. International Journal of Humanities Management and Social Science (IJ-HuMaSS), 4(2), 39–50. https://doi.org/10.36079/lamintang.ij-humass-0402.283
- Luz, R., Mussi, C. C., Dutra, A., & Chaves, L. C. (2021). Implementation of large-scale health information systems. Revista De Gestão, 28(2), 106–132. https://doi.org/10.1108/rege-06-2019-0064
- Ma, W., Mu, R., & De Jong, M. (2021). How do political features influence the Co-Production of government projects? A case study of a Medium-Sized Chinese city. Sustainability, 13(14), 7600. https://doi.org/10.3390/su13147600
- National Objectives for Health Philippines 2023-2028. (2023). In Department of Health. Health Policy Development and Planning Bureau. Retrieved February 24, 2025, from https://doh.gov.ph/wp-content/uploads/2024/01/National-Objectives-for-Health-2023-2028.pdf
- Nilsen, E. R., Stendal, K., & Gullslett, M. K. (2020). Implementation of eHealth technology in community health care: The complexity of stakeholder involvement. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-05287-2
- Nkangu, M., Obegu, P., Ngo, N. V., Wanda, F., Sinsai, R., Kepgang, E., Kasonde, M., Kibu, O., Ndiforchu, V., Fantaye, A. W., Gobina, R. M., Fobellah, N., & Yaya, S. (2024). The role of intersectoral collaboration and continuous stakeholder engagement in the implementation of the BornFyne PNMS project in Cameroon. Digital Health, 10. https://doi.org/10.1177/20552076241287963
- Pakulska, T., & Religioni, U. (2023). Implementation of technology in healthcare entities – barriers and success factors. Journal of Medical Economics, 26(1), 821–823. https://doi.org/10.1080/13696998.2023.2226537
- Pallathadka, H., & Roy, P. D. (2025). The Pallathadka-Debroy Theory of community health engagement: A paradigm shift for primary healthcare transformation in resource-limited settings. Integrated Journal for Research in Arts and Humanities, 5(3), 450–458. https://doi.org/10.55544/ijrah.5.3.51
- Pallathadka, H., Leela, V. H., Patil, S., Rashmi, B., Jain, V., & Ray, S. (2021). Attrition in software companies: Reason and measures. Materials Today Proceedings, 51, 528–531. https://doi.org/10.1016/j.matpr.2021.05.596
- Philippine Council for Health Research and Development. (2024, March 14). NUHRA 2023-2028 - Philippine Council for Health Research and Development. https://www.pchrd.dost.gov.ph/publications/nuhra-2023-2028/
- Rajamani, S., Hultman, G., Bakker, C., & Melton, G. B. (2021). The role of organizational culture in health information technology implementations: A scoping review. Learning Health Systems, 6(3). https://doi.org/10.1002/lrh2.10299
- Ramasamy, T. N., & Baskaran, S. (2024). Paving the path to EMR implementation success: the role of vendor IT capability and coercive pressure. International Journal of Academic Research in Business and Social Sciences, 14(10). https://doi.org/10.6007/ijarbss/v14-i10/22739
- Renaldo, N., Suhardjo, N., Suharti, N., Suyono, N., & Cecilia, N. (2022). Benefits and challenges of technology and information systems on performance. Journal of Applied Business and Technology, 3(3), 302–305. https://doi.org/10.35145/jabt.v3i3.114
- Republic Act No. 11223 | GOVPH. (2019, February 20). Official gazette of the Republic of the Philippines. https://www.officialgazette.gov.ph/2019/02/20/republic-act-no-11223/
- Republic of the Philippines. (1987). The 1987 Constitution of the Republic of the Philippines. https://www.officialgazette.gov.ph/constitutions/1987-constitution/
- Schlieter, H., Marsch, L. A., Whitehouse, D., Otto, L., Londral, A. R., Teepe, G. W., Benedict, M., Ollier, J., Ulmer, T., Gasser, N., Ultsch, S., Wollschlaeger, B., & Kowatsch, T. (2021b). Scale-up of digital Innovations in health Care: expert commentary on enablers and barriers. Journal of Medical Internet Research, 24(3), e24582. https://doi.org/10.2196/24582
- Seposo, X. (2019). Developmental changes in the Philippine health system: accomplishments, successes, and challenges. Healthcare, 7(4), 116. https://doi.org/10.3390/healthcare7040116
- Tinam-Isan, M. a. C., & Naga, J. F. (2024). Exploring the landscape of health information systems in the Philippines: A methodical analysis of features and challenges. International Journal of Computing and Digital Systems, 15(1), 225–237. https://doi.org/10.12785/ijcds/160118
- Villanueva, L. A. S. (2021). Budget deliberation as communicative practice: The case of a rural municipality in the Philippines. International Journal of Asia Pacific Studies, 17(2), 283–319. https://doi.org/10.21315/ijaps2021.17.2.11
- Winter, A., Ammenwerth, E., Haux, R., Marschollek, M., Steiner, B., & Jahn, F. (2023). Basic concepts and terms. In Computers in health care (pp. 13–49). https://doi.org/10.1007/978-3-031-12310-8_2
- Yuwono, M. A., & Ellitan, L. (2024). Technological development and resource constraints: A critical analysis. Zenodo. https://doi.org/10.5281/zenodo.13267940
Full Text:
Note: Kindly Login or Register to gain access to this article.
ISSN 2984-8385 (Online)
ISSN 2984-8288 (Print)