Implementing a Cross-Border Next-Generation Personal Health Record in the Philippines and Taiwan: An Implementation Case Report Using Health Level 7 International Fast Healthcare Interoperability Resources

TL;DR

This paper describes creating a cross-border health record system between the Philippines and Taiwan using FHIR standards to improve care continuity.

Contribution

A novel cross-border PHR implementation using FHIR standards to align Philippine and Taiwanese health data with the IPS framework.

Findings

MHB covered 82.4% of IPS sections, while CF4 covered 70.6%.

Both systems lacked data on medical devices, social history, and advanced directives.

A FHIR-based integration architecture with OAuth 2.0/SMART on FHIR was proposed for secure interoperability.

Abstract

Disparities in electronic health record systems hinder cross-border continuity of care, particularly where labor mobility and tourism intersect (eg, between the Philippines and Taiwan). Both nations collect claim data, yet neither fully aligns with international standards such as the Health Level 7 International, International Patient Summary (IPS).

This implementation report aimed 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) aligned with the IPS using (Fast Healthcare Interoperability Resources) FHIR standards.

We mapped each data element from CF4 (n=7 main sections) and MHB (n=12 major data items) to 17 sections of the IPS. We analyzed whether these elements matched IPS requirements (required or recommended or optional) and identified missing fields (eg, device use, social history, and advanced directives). We also designed a FHIR-based integration architecture, addressing system security with OAuth 2.0/SMART on FHIR and proposing a national uptake strategy for accelerating cross-border PHR implementation.

Of the 17 IPS sections, MHB covered 14 sections (82.4%), while CF4 covered 12 sections (70.6%). Both systems lacked sufficient data elements for medical devices, social history (eg, alcohol or tobacco), and advanced directives. We developed an implementation plan focusing on data interoperability, standardization, and privacy or security protocols. We propose a multiphase approach—beginning with the stakeholder engagement and pilot testing in both countries.

Aligning CF4 and MHB data with IPS standards via FHIR can facilitate a robust cross-border next-generation PHR ecosystem. This approach may enhance patient safety, continuity of care, and policy development for the Philippines and Taiwan. Further collaboration, regulatory updates, and public awareness are vital to sustain integration and maximize patient benefits.

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