IntroductionThe implementation of Universal Health Coverage (UHC) in the Philippines requires the formation of Local Government Unit (LGU)-centric Health Care Provider Networks (HCPNs). A cornerstone of this reform is the development of secure, scalable, and interoperable digital health ecosystems. However, significant challenges persist, including fragmented and non-standardized health information systems, siloed data repositories, and limited interoperability among Electronic Medical Records (EMRs) and Hospital Information Systems (HIS) particularly at the LGU level. This paper presents the design and deployment of the Smarter and Integrated Local Health Information System (SMILHIS), a Local Health Information Exchange (LHIE) platform developed to address these fragmentation issues.ObjectiveThis work aims to support LGUs in deploying an LHIE platform that improves health data exchange, enhances continuity of care, and strengthens local health systems. Specifically, the objectives are to: 1. Deploy a modular, open-source LHIE platform that enables real-time health data interoperability across primary, secondary, and tertiary facilities within LGUs; and, 2. Implement an HL7 FHIR-based integration model aligned with the OpenHIE architecture and national interoperability specifications.Findings and ConclusionThe implementation of SMILHIS in three pilot LGUs—Municipality of Pulilan in Bulacan, Cagayan de Oro City, and Pangasinan Province demonstrated both the technical feasibility and operational value of deploying an interoperable LHIE platform. Each pilot considered different use cases: in Pulilan, the integration of health data with regulatory and treasury systems required reconciling heterogeneous data structures; in Cagayan de Oro, the absence of authoritative registries within the HCPN created barriers to unified patient tracking; while in Pangasinan, the scale and geographic dispersion of the health network complicated real-time health service visibility. Despite these challenges, the SMILHIS platform integrated patient, provider, and facility registries, facilitated secure data exchange across multiple systems, and provided real-time referral and facility capacity dashboards. The key outcome of the study was the demonstrated ability of LGUs to implement an interoperable, standards-based LHIE that significantly reduced data duplication, improved referral coordination, and strengthened health system responsiveness. In addition to enhanced technological capability, the study also showed notable improvements in LGU digital health governance. Moreover, it contributed to strengthening human resource capacity through hands-on implementation experience and multi-sector collaboration, while promoting greater alignment with national government digital health standards. These institutional and technical gains highlight SMILHIS as both a practical solution and a capacity-building mechanism for sustainable digital transformation at the local level.
Epistemic and ethical limits of large language models in evidence-based medicine: from knowledge to judgment
BackgroundThe rapid evolution of general large language models (LLMs) provides a promising framework for integrating artificial intelligence into medical practice. While these models are capable