Republic of the Philippines Department of Health OFFICE OF THE SECRETARY

JUN 3 0 2022

ADMINISTRATIVE ORDER No. 2022 - 70 21

SUBJECT: Revised Implementing Guidelines of the Integrated Hospital Operations and Management Program (IHOMP)

I. RATIONALE

In line with the FOURmula One Plus (F1 Plus) for health, the Department of Health (DOH) commits to achieve better performance in the health system through this program. The governance pillar of the F1 Plus for Health recognizes the relevance of generating and utilizing data and information for evidence-based planning, policy development, program implementation, and decision making in the health sector. Pursuant to this, all health service providers and insurers are mandated to maintain a health information system that is consistent with DOH standards.

Republic Act No. 11223 or the Universal Health Care Act aims to ensure equitable access to quality and affordable health care for all Filipinos. The Integrated Hospital Operations and Management Program (IHOMP), formerly known as the Hospital Epidemiology Program (HEP), is a flagship program of the Health Facility Development Bureau (HFDB) which advocates the utilization of the HFDB Manual of Standards and its implementation to ensure effective and efficient hospital operations and management. To improve the compliance of the hospitals to the standards, one of the identified strategies of the program is the translation of the manual standards into a hospital based information system designed to provide timely and relevant information for decision-making. The program was re-conceptualized in 1995 and later expanded in 1997. To operationalize this, Administrative Order No. (A.O.) No. 44-A, series of 1999, entitled "Guidelines for the Implementation of the Integrated Hospital Operations and Management Program (IHOMP) within the Philippine Hospital System" was issued to respond to the current information needs and evolving requirements among hospitals at that time. IHOMP operates on the principles of Continuing Quality Improvement (CQI) and People-centered Care.

Republic Act No. 110332, Ease of Doing Business and Efficient Government Service Delivery, where the Whole-of-Government (WOG) approach aims for the review and harmonization of existing and applicable laws, regulations, issuance, and policies. Further, this shall make legal interpretations consistent across agencies.

In the pursuit of achieving the goals of UHC and aligning with the above mentioned policies, it is therefore necessary to further strengthen the implementation of IHOMP in all health facilities. This Order hereby repealed A.O. No. 44-A s. 1999, and prescribes revised guidelines for the improvement of hospital performance through sound and efficient clinical care and management systems with the end view of quality health service provision.

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II. OBJECTIVE

This Order shall provide the overall direction for the implementation of the Integrated Hospital Operations and Management Program (IHOMP).

III. SCOPE AND COVERAGE

This Order shall apply to all DOH Hospitals and its pertinent offices, Local Government Units (LGU), other government and private hospitals. Other government hospitals include those under the administrative supervision and control of the Office of the President (OP) and the Department of National Defense (DND), Department of Interior and Local Government (DILG), Department of Justice (DOJ), and State Universities and Colleges (SUCs).

In the case of Bangsamoro Autonomous Region in Muslim Mindanao, the adoption of these guidelines shall be in accordance with RA 11054 (Bangsamoro Organic Act) and the subsequent laws and issuances to be issued by the Bangsamoro government.

IV. DEFINITION OF TERMS

• A. Integrated Hospital Operations Management Program (IHOMP) refers to the program under the Health Facility Development Bureau (HFDB) that ensures the implementation of standards and guidelines aimed to improve efficiency and effectiveness of health care services through creation and use of information for clinical, administrative, and monitoring purposes in hospitals and other health facilities.
• B. Integrated Hospital Operations Management Section (IHOMS) refers to a functional unit in the hospital that serves as the implementation arm of the program. It shall oversee the implementation of both manual standards and the hospital information system, regardless of service provider. The section shall be composed of a program manager, program coordinators, and systems administrators.
• C. IHOMP Committee or its equivalent, refers to a multidisciplinary team composed of representatives from the various services, departments or units in the hospital concerned in the continuing improvement of health services through standards implementation. The Committee or its equivalent shall provide directions and feedback to the IHOMS.
• D. HFDB Manual of Standards - refers to a comprehensive set of manuals developed to provide developmental standards on the operations of hospitals and other health facilities. The individual manual is best used in conjunction with the other manuals in the set as it serves as a holistic guide on the effective and efficient implementation of hospital and health facility services and patient care.
• E. Continuous Quality Improvement (CQI) according to AO No. 2020-0034, refers to a process through which the level of quality is defined, pursued, achieved and continuously improved through the establishment of formal mechanisms/ systems and structure within the organization. It is a strategic approach to provide the best health care possible for all. It is also a preventive strategy that uses constant

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• innovation to improve work processes and systems by reducing time-consuming and low-value activities.
• F. People-Centered Health Services according to AO No. 2020-0003, refers to an approach to care that consciously adopts the perspectives of individuals, families, and communities, and sees them as participants as well as beneficiaries of trusted health systems that respond to their needs and preferences in holistic and humane ways.
• G. Health Facility Development Unit (HFDU) according to AO No. 2019-0031, refers to a functional unit in all Centers for Health Development (CHDs) that serves as a counterpart of the DOH Central Office HFDB.
• H. Whole-of-Government Approach (WGA)- according to ARTA Joint Memorandum Circular No. 2019-001, s. of 2019, refers to the ability of government agencies to work together: It also refers to the change in emphasis away from structural devolution, disaggregation, and single-purpose organizations towards a more integrated approach to public service delivery characterized by seamless government transactions, integrated policy design and implementation across several agencies, interoperability of government processes, horizontal coordination, and strengthened linkages among government units. refers to the review and harmonization of existing and applicable laws, regulations, issuances, and policies to make legal interpretations consistent across agencies.

V. GENERAL GUIDELINES

All hospitals shall:

• A. Be guided by the overall goal of IHOMP which is to improve the efficiency and effectiveness of health care services through the adoption of the HFDB Manual of Standards.
• B. Establish and implement IHOMP and shall conform to the principles of CQI and Integrated People-Centered Health Services in its implementation.
• C. Ensure an organizational culture that supports quality, collaboration and teamwork, flexible bureaucracy, transparency and active involvement of management.
• D. Conduct and participate in Learning and Development Interventions (LDIs) relative to the comprehensive implementation of strategic technical assistance offering both clear guidance and room for emergent change and ensure implementation.
• E. Conduct periodic assessment and monitoring of compliance to the standards, and functionality of hospital operation to ensure continuity of implementation of improvement.
• F. Implement and maintain an integrated health information system (iHIS) that conforms and complies with the standards and rules set forth under this policy, the DOH and PhilHealth Joint Administrative Order (JAO) 2021-0001 on Guidelines on the Implementation and Maintenance of an iHIS, DOH & PhilHealth JAO 2021-

0002 on Mandatory Adoption and Use of National Health Data Standards for Interoperability, and other subsequent issuances as required under Section 36 of the UHC Act and its Implementing Rules and Regulations.

VI. SPECIFIC GUIDELINES

A. Strategic Framework

• 1. IHOMP shall be guided by the framework as provided in Annex A with the following strategic focus:
  • a. Ensure easy access to references and capacity building for health facility standards through innovative platforms (i.e Web-based standards, e-Learning, eBooks);
  • b. Enable good governance and promote data-driven, evidence-informed policy and decision making in hospital operations through the use of an iHIS for the collection, processing, and submission of health and health-related data and reports at all levels of data processing:
    • i. Regardless of type of system development (i.e. in-house or outsourced), nature of ownership (i.e. Government-owned or private-owned), and stage of system implementation (i.e. for deployment or ongoing implementation), all iHIS that are being implemented or to be implemented by hospitals shall be required to undergo and pass standards conformance and interoperability validation (SCIV) as provided under DOH, PhilHealth, and DITC JAO 2021-0001 on Guidelines on the implementation of SCIV and other subsequent issuances.
    • ii. Likewise, the existing Integrated Hospital Operations and Management System (iHOMIS) shall be configured and transitioned by DOH through Knowledge Management Information Technology Service (KMITS) to a fully integrated health information system as provided by this policy and relevant issuances.
  • c. Streamline monitoring and evaluation activities through innovations to facilitate the use of hospital operations related data to steer regional and national level decision making, policy development, and planning.
  • d. Health facilities shall update their Citizen's Charter to be consistent with system improvements.

B. Program Implementation

• 1. The operations and management of hospitals shall be guided by the HFDB Manual of Standards listed in Annex B. Hospitals managed by the LGUs, other national government agencies (NGAs) including state universities and colleges (SUCs), private sector, and other types of health facilities may adopt the applicable provisions of the different manuals.
• 2. The IHOMP Committee shall oversee the planning, implementation, sustainability and improvement of the program. All hospitals are given the discretion to:
  • a. Maintain their existing IHOMP Committee;
  • b. Create a separate IHOMP Committee to be composed of representatives

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• from the different units of the hospital; or
• c. Delegate its function to the CQI or Quality Management System (QMS) of the hospital.
• 3. The IHOMP Committee or its equivalent shall coordinate with the IHOMS unit of the Hospital to ensure the efficient translation of standards to their iHIS.
• 4. The information (i.e administrative, clinical and patient information) or health and health-related data being collected by the hospital shall be utilized for planning, policy development, program implementation and decision-making.
• 5. All government hospitals shall develop a change management plan, refer to the Hospital Health Information Manual (HHIM) for reference to aid in the conversion of the HFDB Manual of Standards to a fully computerized-based information system. This shall consist of specific activities and timelines in achieving targets towards the full implementation of a hospital information system that is recognized by DOH.

C. Logistics Support

• 1. All hospitals shall commit to support the operations of IHOMP through the provision of necessary resources including, but not limited to adequate and capable human resources, software, hardware, and other information technology devices, as well as the provision of suitable office working environment for the smooth operations of IHOMP in the health facilities.
• 2. All hospitals shall allocate funds for IHOMP activities such as LDIs for the personnel, conferences, launching, advocacy activities and others related to the program implementation.

D. Capability Building

• 1. The technical capacity, to include program management, monitoring and coaching of the HFDU personnel involved in the implementation of IHOMP shall be strengthened
• 2. The LDI of the LGUs for hospital operations shall be established and strengthened through the CHDs to promote a holistic approach and ensure functional linkages between the national, regional and provincial levels.
• 3. The health facilities shall ensure that LDIs aligned with IHOMP are in place to ensure continuous staff development of both professional and administrative personnel. The LDI activities of the program shall be conducted in coordination with the Professional Education, Training and Research Office (PETRO).

E. Social Mobilization

• 1. Promote the development of the culture of quality and continuing quality improvement.
• 2. The HFDB Manual of Standards and other policies pertaining to hospital operations and management shall be made readily available by HFDB to the hospitals and other health facilities through various platforms.

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• 3. Conferences and other related activities that may be a venue for sharing of best practices and innovations on hospital operations and management shall be conducted or organized through the initiative of the program, the HFDUs and the hospitals, at least annually/ shall be made readily available through various platforms by HFDB to the hospitals and other health facilities.
• 4. The cascading of materials, such as video orientations or electronic LDI developed and provision of technical assistance shall be strengthened through the HFDUs.
• 5. The hospital management shall endeavor to actively participate in the program and program-related activities, and support the hospital in achieving a complete and holistic electronic medical records that are fully compliant with DOH standards.
• 6. The program shall formulate mechanisms on how to incentivize hospitals implementing IHOMP to encourage increased participation.
• 7. A Promotion and Communication Plan shall be developed to promote the IHOMP in collaboration with the DOH Health Promotion Bureau (HPB)

F. Assessment, Monitoring, and Evaluation

• 1. Shall be a coordinated activity between the CHDs, MOH-BARMM, hospitals and relevant DOH CO Units to ensure the implementation of the IHOMP-related activities and provision of assistance as necessary.
• 2. The assessment, monitoring and evaluation of the standards and program implementation shall be guided by the process as reflected in Annex C.
• 3. The processes and procedures in DOH, LGUs, and other government hospitals shall be in compliance with the HFDB Manual of Standards for hospitals and shall be determined by the accomplishment of the IHOMP Self Assessment tools through the DOH Data Collect Hub through this link hfpddc.doh.gov.ph. In addition to this, self-assessment tools shall be developed by HFDB for each manual of standards to establish baseline compliance of hospitals and monitor compliance to the developmental standards. On the other hand, private hospitals are encouraged to adopt the applicable provisions of the various manuals as they deem appropriate.
• 4. All DOH hospitals shall submit the self-assessment tools for the IHOMP and HFDB Manuals of Standards to the HFDUs and MOH-BARMM. LGUs, other government hospitals and private hospitals may utilize the said tools for guidance and for other purposes of CQI in their facilities.
• 5. The accomplished self-assessment tools shall be validated and evaluated by HFDUs to identify gaps and or problems encountered in the implementation of the program. The areas of the hospital that need improvement and technical assistance are identified. Hospitals shall plan for actions or interventions to address the identified gaps and/or problems encountered.
• 6. The execution of the IHOMP, including the implementation of the HFDB Manual of Standards shall be monitored annually or as determined by the

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HFDB, through the use of the tools developed to measure compliance. The recommendations from its implementation shall be reviewed and updated every five (5) years or as the need arises.

G. Reporting/Feedback Mechanism

• 1. The Program Implementation Review (PIR) shall be conducted annually by the:
  • a. HFDU of the CHDs and MOH BARMM for hospitals under their respective regions or authority; and
  • b. HFDB, KMITS with CHDs and MOH BARMMas participants to report on the status of program implementation of hospitals under their jurisdiction.
• 2. Mechanisms on data sharing among the networks such as but not limited to the following shall be formulated by HFDB:
  • a. IHOMP Assessor's Reference, as supplementary to the IHOMP Self-Assessment Tool;
  • b. Development of dashboards for program owners and implementers; and
  • c. Others as deemed necessary.

VII. ROLES AND RESPONSIBILITIES

A. Health Facility Development Bureau (HFDB) shall:

• 1. Lead in the planning, policy development, and program implementation of IHOMP and provide policy directives;
• 2. Conduct of manual review and assessment of possible obsolete, redundant provisions, at least every five years.
• 3. Conduct IHOMP assessment as needed and provide appropriate technical assistance, coaching and mentoring for continuous improvement of hospital systems and operations;
• 4. Train and organize potential resource speakers for the different manuals to ensure uniform interpretation of standards;
• 5. Create a network and establish a support system and feedback mechanism for the regional counterparts and program implementers;
• 6. Conduct regular Program Implementation Review (PIR) and consolidation of reports on issues, concerns and other matters pertaining to IHOMP;
• 7. Monitor documented improvements in the quality of hospital services, and patient experiences among others and consolidate the reports of the Regional HFDUs on the status of the program;
• 8. Coordinate with the HFDUs, hospitals and other concerned offices on matters pertaining to IHOMP;

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• 9. Initiate the conduct of capacity building or LDI activities for HFDUs such as but not limited to the orientation of new policies and standards, and training on the validation of IHOMP tools; and
• 10. Provide funding support to the HFDUs for IHOMP activities and hiring of personnel.

B. All hospitals, both government and private shall:

• 1. Utilize the HFDB Manual of Standards to improve efficiency of hospital operations and provide management support in its implementation;
• 2. Incorporate IHOMP in their hospital development plan;
• 3. Maintain or create the IHOMP Committee or delegate the function to the CQI or QMS Committees or its equivalent;
• 4. Establish or strengthen the IHOMS or its equivalent;
• 5. Conduct regular meetings to discuss issues, concerns and other matters on the implementation of the program and provide feedback and advice to hospital management;
• 6. Ensure quality of documentation in order to:
  • a. Provide management with quality data to be utilized for planning, program implementation, policy development and evidence-based decision making:
  • b. Generate the hospital statistical report annually or as necessary and other required data; and
  • c. Share good practices within the network.
• 7. Report and coordinate with the HFDUs for any issues concerning IHOMP; and
• 8. Develop an action plan to address identified gaps or areas of improvement of the hospital in terms of the implementation of the standards and the program in general.

C. Health Facility Development Units (HFDUs) in Centers for Health Development (CHDs) and MOH-BARMM shall:

• 1. Support the implementation of IHOMP and its related activities;
• 2. Validate the accomplished self-assessment tools, monitor compliance to standards and implementation of the action plan and evaluate the implementation of the program in the hospitals within their respective regions;
• 3. Submit reports on the findings and the status of implementation of IHOMP in the hospitals annually or as needed within their respective regions and provide HFDB with feedback on the policies, standards or guidelines that needs to be reviewed, updated or developed and refer matters that need to be elevated;

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• 4. Cascade materials and provide technical assistance to hospitals and provincial offices within their respective regions to ensure standardized implementation of the HFDB manuals of standards, policies on hospital operations and management and other related IHOMP issuances and activities;
• 5. Establish networks, collaborate and coordinate with other HFDUs and provide support for effective implementation of IHOMP;
• 6. Provide funding support and other needed resources for the implementation of activities for IHOMP; and
• 7. Coordinate accordingly with the appropriate provincial offices for the planning and implementation of hospital operations, programs and projects.

D. Health Facilities and Services Regulatory Bureau (HFSRB) shall:

• 1. Refer to the HFDB Manuals of Standards as the basis for setting up the minimum licensing requirements for hospitals;
• 2. Recognize documents being generated by the hospital information system in place vis-a-vis the manual documentation of the hospitals specifically, accept printed forms in lieu of the manual logbook required by licensing; and others as identified.
• 3. Provide HFDB access to the Online Hospital Statistical Reports System (OHSRS), as the data which shall be utilized for the evaluation of technical papers related to development of hospitals, its operations and health facility standards.

E. Knowledge Management and Information Technology Service (KMITS) shall:

• 1. Coordinate with HFDB on matters relative to the development, expansion, enhancement, modification and integration of health information systems for hospitals and other health facilities;
• 2. Develop a feedback mechanism to ensure that the issues, problems and other concerns encountered by the systems administrators and hospitals in the utilization of any health information system are documented and reported to HFDB. This is to determine the concerns related to the standards and its implementation and provide timely intervention thereafter;
• 3. Ensure that the standards developed by HFDB are included in the criteria or parameters used for the conformance and interoperability validation of the various health information systems prior to its implementation in the hospitals;
• 4. Provide technical assistance to HFDB, HFDUs and IHOMS relative to implementation of any health information systems in the hospitals; and
• 5. Ensure that their CHD counterpart collaborates with the HFDU and provides further guidance and technical support in the implementation of the program.

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F. Field Implementation and Coordination Team (FICT) shall:

Coordinate with their respective CHDs, MOH-BARMM and hospitals' various operating units to ensure the implementation of the IHOMP - related activities and provide technical and administrative assistance as necessary.

VIII. SEPARABILITY CLAUSE

If any clause, sentence, or provision of this Order shall be declared invalid or unconstitutional, the other provisions unaffected thereby shall remain valid and effective.

IX. REPEALING CLAUSE

1999 Administrative Order no. 44-A s. 299 and other issuances inconsistent with or contrary to this Order shall be repealed, amended or modified accordingly.

X. EFFECTIVITY CLAUSE

This Order shall take effect after fifteen (15) days following its publication in a newspaper of general circulation and upon filing of three (3) certified copies to the University of the Philippines Law Center.

FRANCISCO T. DUQUE III, MD, MSc

Secretary of Health

JUN 3 0 2022

Annex A. Overall Strategic Framework

Vision:

Quality, Safe, People-Centered, and Efficient Hospital Operations in the Philippines by 2030.

Mission:

To ensure effective and efficient hospital operation through the implementation of standards, supported by continual innovative system and technology improvement.

Values:

Commitment to quality service; Accountability and integrity; empowered leadership and management; Excellence, Competence; Stewardship of resources; Self-development; and Teamwork

Goals:

Enhance the preventive and promotive role of hospitals, both government and private, through the improvement of management systems and procedures within the hospitals.

Objectives:

• 1. To implement standards and policies for the hospital operations management.
• 2. To standardize the systems and procedures of hospital operations including the flow of information.
• 3. To fully utilize hospital data/information for evidence-based decision making, clinical management of patients and policy and standard development.
• 4. To enhance and expand hospital information systems, such as but not limited to Integrated Hospital Operations and Management Information System (IHOMIS), HOMIS Billing System (HBSys), Universal Health Care Information System (UHCIS), etc., to address the growing needs and linkages with other health facilities and information systems developed by other NGAs.

IHOMP Strategic Focus

Strategy 1: Ensure easy access to references and capacity building for health facility standards through innovative platforms (ie Web-based standards, e-Learning, eBooks).	evidence-informed policy decision -making in hospital operations through the use of an iHIS for the collection, processing and submission of health and health-related data and reports at all levels of data	evaluation activities through innovations to facilitate the use of hospital operations related data to steer regional and national level decision making, policy development,
Outcome: DOH standards are updated and readily available to all health facilities.		Outcome: Standards are adopted for both government and private hospitals.

Activities:

Conversion of Manuals to eBooks (ePUB or Web-based); movement to e-Learning platform through the DOH Academy.

Activities:

Harmonizing data collection for compliance to standards.

Provide inputs in the development of HIS including iHOMIS HBSys, UHCIS, and others to make it responsive to the needs of the hospitals (ie support the transition to webbased platform, bridging of eNGAS as applicable):

Activities:

Expansion of scope with other hospital information systems to adopt DOH Standards.

Dashboard development

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Annex B. List of HFDB Manual of Standards

No.	Title	Latest Edition	Year Published
1	Manual of Organization and Management of the Administrative and Finance Service for Hospitals		2008
2	Hospital Property and Supply Management Manual	1st	2008
3	Hospital Nursing Service Administration Manual	4th	2020
4	Hospital Pharmacy Management Manual	4th	2020
5	Hospital Nutrition and Dietetics Service Management Manual	3rd	2020
6	Manual for Medical Social Workers	5th	2010
7	National Standards in Infection Prevention and Control for Health Facilities	3rd	2021
8	Manual of Standards on Quality Management Systems in the Clinical Laboratory	2nd	2019
9	Manual of Standards and Guidelines on the Management of the Hospital Emergency Department	2nd	2022
10	Revised Organizational Structure and Staffing Standards for Government Hospital CY 2013 Edition	1st	2013
11	Hospital Health Information Management Manual	4th	2021
12	Health Care Waste Management Manual	4th	2020
13	Manual on Packaging and Transport of Laboratory Specimens for Referral	1st	2018
14	Manual of Standards on Laboratory Biosafety and Biosecurity	1st	2018
15	Manual on Technical Guidelines for Hospital Planning and Design 250-Bed Hospital (Level 3)	1st	2017
16	Manual on Technical Guidelines for Hospital Planning and Design 100-Bed Hospital (Level 2)	2nd	2015
17	Manual of Standards for Management of Hospital Finance Service	1st	2021
18	Procedures Manual for Government Hospitals	3rd	2021
19	Manual of Standards for Primary Care Facilities	1st	2020
20	Philippine Health Facility Plan 2020-2040	1st	2020

Link to the Digital Copies: http://bit.ly/DOHHFDBManuals

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Annex C. Process Flow of the Assessment, Monitoring and Evaluation of Program Implementation

Process Flow	Description	Office/Organiz ation Responsible
Advocates and promotes use of standards Assesses baseline compliance	1. Advocates or promotes the utilization of the existing standards and tools. The manuals are made easily available and accessible to the hospitals and other health facilities.	Health Facility Development Bureau (HFDB)
Accomplishes self-assessment tool and submits to HFDU Validates the accomplished tool	2. Assesses the baseline compliance of hospitals in terms of the standards through the administration of the self-assessment tool/s.	HFDB through the regional counterparts.
Provides technical assistance and refers to HFDB accordingly Formulates action planning Monitors the implementation of action plan Schedules re-assessment of hospital	3. Accomplishes self-assessment tool and submits to the Health Facility Development Unit (HFDU) in their respective Centers for Health Development (CHDs) and Ministry of Health — Bangsamoro Autonomous Region in Muslim Mindanao (MOH-BARMM). The submission should include necessary documents for means of verification.	Hospital
	4. Validates the accomplished self-assessment tool/s and other documents.	HFDU in the CHDs and MOH-BARMM
	5. Provides technical assistance to hospitals, especially in identified areas for improvement. Refers to HFDB as deemed necessary based on the ratings on the assessor's reference.	HFDU in the CHDs and MOH-BARMM

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11. Conducts Program Implementation Review (PIR) annually. Submits report/s to HFDB annually and as required on the status of IHOMP\nimplementation, including standards that need to be reviewed.	MOH- BARMM, and
	HFDB

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