Insights into Telehealth in the Philippines
By : Jorunnej S. Resma
Because of the COVID quarantine and the reduction in medical services provided by health professionals during this time, telehealth or telemedicine has recently become a very important technology. As a result, telemedicine consultations with patients became an essential practical innovation when out-patient clinic consultations were stopped from March to September. Doctors appeared to be hesitant to engage in telemedicine consultation in the past due to the constraints of diagnosing without a physical examination and physicians' comments about the lack of a payment mechanism following consultation. Better technology, pragmatism, and online payments have all helped to solve these problems.
To better appreciate health technology and its value proposition in the totality of health systems, it is recommended to read the WHO article “Health is Everybody’s Business (2007)” where there are 6 building blocks that require equitable investments to make for a robust health system. And this health system strengthening is fundamental for achieving better health services, efficiency and outcomes, in short, universal health care.
The inter-connectedness of Health Systems Six building blocks. Adapted from Health is Everybody’s Business, WHO 2007.
A key focus should be on redefining health technology to encompass the Information Communication Technology (ICT) used in healthcare, including access to modern diagnostics and medicines. One of the six building blocks is the use of ICT in health care.
The benefits of doing teleconsultation:
- Linkages to ePrescription: Because of the blockade, the Philippine government has now recognized and approved ePrescription and pharmaceutical delivery. With teleconsultation, the clinic doctor has the option to collaborate closely with a pharmacist to meet the patient’s medication needs. Tele-pharmacy consultations, if the law can be altered, can also expand the number of drug outlets in the country, allowing for better access to medicines. The existing regulations still require a certified pharmacist to be physically present in every retail pharmacy shop, and we simply do not have enough pharmacists in the country to grow drugstores and their reach to consumers.
- Easier scheduling and less physical waiting time at the outpatient clinic: Many patients complain about long lines at the front desk. Work-related opportunity costs are high, and this is not an efficient method to deliver health care. Many smartphone apps are being developed across the country to help with scheduling and administering access to health specialists.
- Opportunity for linkages with eHealth records: If ICT in health were to be developed beyond telemedicine consultation, that will be in the area of electronic health records. Imagine having such records in a digital format that are interoperable with other clinics and facilities. The potential efficiencies are immense. Naturally, there needs to be data privacy and safeguards.
- Easier scheduling and less physical waiting time at the outpatient clinic: Many patients complain of extensive wait times in reception. There is significant opportunity loss from work and this is not an efficient way to undertake health services. Many mobile applications are coming up in the country to assist in better scheduling and administering access to health professionals.
- Opportunity for linkages with eHealth records: If ICT in health were to be developed beyond telemedicine consultation, that will be in the area of electronic health records. Imagine having such records in a digital format that are interoperable with other clinics and facilities. The potential efficiencies are immense. Naturally, there needs to be data privacy and safeguards.
- Improvement in referral systems and closing the gap in health services fragmentation: The system can also be used for connecting a specialist doctor to a number of generalist doctors for comprehensive patient care.
- Advancing innovation: Some of the students, for example, are working to develop tele-physical rehabilitation sessions that will lessen or eliminate the need for physically challenged children to visit rehab centers in hospitals. Tele-radiology is becoming increasingly popular, which will benefit rural areas without radiology facilities, in part because there aren’t enough radiologists in the country, and since the law requires that an x-ray facility have an in-house radiologist. Furthermore, because each hospital facility lacks enough radiologists, the reading of the plates is delayed, resulting in a longer wait for patients to receive a proper diagnosis.
- Capacity Building: Telehealth can be a cost-effective way to continue medical, nursing, and pharmacy education. This could also lead to a drop in attendance at in-person medical meetings, which have seen increasing registration costs raise the cost of education.
Limitations to doing teleconsultation as shared by our doctors and patients:
- To pursue an interrupted telemedicine session, patients need have the necessary equipment and a stable IT connection with the doctor. A waiver is required to ensure that patients are aware of the inherent limits of such procedures.
- Payment for professional services rendered has also revealed difficulties. Both doctors and patients have expressed concern about the difficulty of paying doctors. Banks in the Philippines now offer internet platforms, although many residents are still constrained to make payments or deposits in person. This has now become a challenge due to the quarantine and restricted physical movements outside of the house. Processing the evidence of payment is a time-consuming process. Medical physicians’ requirements to declare taxes are also circumvented by such methods.
- Who controls the medical records? While we all agree that patients should own their data, the reality is that health data is held by providers (both doctors and care facilities) in the present health-care system. This creates trust concerns and makes it difficult for the patient to access data when it is needed.
There are various systemic and strategic actions that need to be taken in order for ICT in health and telehealth to be fully understood and prosper in the Philippines. First and foremost, the government must create a common integrated platform (i.e. HL7 for instance). If diverse electronic application suppliers are charged with developing software to capture health databases, this is crucial. Second, mechanisms for data and record interoperability must be established. Third, the cost of hardware, software, and training for healthcare professionals and facilities must be clearly defined. If this is to become the country’s regular operating practice, tremendous time and financial resources will be necessary. Finally, the issue of how telehealth providers are compensated must be addressed.
