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Telehealth and 



eMedicine 

ICT Tools in Achieving 

Universal Health Care

PORTIA FERNANDEZ-

MARCELO, MD MPH

Director


 

 

*based from previous slide



Telehealth and eMedicine

The Philippine Health Situation



Finding Solutions through eHealth: 

The National Telehealth Center





Telehealth and eMedicine

 

 


 

 

The Philippine Health Situation



Lower Middle Income 

Country (LMIC)

94Million, 63% live in 



urban centers

Country of youths: 50% 



population < age 21

Double disease burden: 



infectious + lifestyle and 

chronic diseases

Modest improvement 



in health indicators vs 

SEA nations- 

4

th



 highest: 

IMR = 32/1000LB,



2

nd



 highest:

MMR= 221/ 



1000000LB

 


Accessibility

Remote areas, 



difficult to reach

Affordability



High Out-of-Pocket 

expenses

Universal Health 



Care → still to 

happen


Health Human Resource: 

Maldistribution

 of health 

professionals



Health Workforce Density per 

10,000 population 

(WHO, 2010)

MD: Philippines=12 World=14

Nurses: Philippines =61

World =28

But where are they?

Migration and brain drain inevitable

Seek greener pastures

The Philippine Health Situation



The Philippine Health Situation

Widening 

inequity

 in health

Disparity in health service 

delivery and utilization



Poor quality of data and 

information

Maldistribution of skilled 

health workers

High out-of-pocket payment 

(including drugs), low 

health expenditure by 

government 

Food security and 

safety risk

Dual burden of diseases

Disasters, and chronic 

emergency in Mindanao

Slow progress in 

maternal and child 

health and nutrition

High population growth

-DOH, 2010 presented during  the WHO-PHL Consultative Meeting


Row 1

Row 2


Row 3

Row 4


0

2

4



6

8

10



12

Column 1


Column 2

Column 3


8

 

 

*based from previous slide



Finding Solutions

 

 

Opportunities: ICT and Health



Information and communications technology (ICT)

essential infrastructure and tools, great enabler to 



people 

for 



knowledge

 creation, sharing and dissemination.

boost the 



innovative capacity

 of all sectors and 

contributes to more than 40% of overall 

productivity

 

growth


 

(EU KLEMS, 2007 in EC, 2009).  

by facilitating greater access to 



health

 and 


education

 

services, and creating 



economic

 opportunities for 

disadvantaged groups

 

(Daly, 2003, K. Chen, 2004, Jensen, 2007; Mercer, 2001; 



Oberski, 2004; Reisman, Roger, & Edge, 2001; UNDP, 2001; The World Bank, 2001 in Fong, 2009: 

471-472.)   



 

 

eHealth



 

 

Information science, computer science, and health 



care. 

Resources, devices, and methods required to 

optimize the acquisition, storage, retrieval, and use 

of information in health and biomedicine. 

Tools: computers but also clinical guidelines, 

formal medical terminologies.

Health informatics 


 

 


Opportunities

Broadband infrastructure continuously improving



Open source software becoming more popular

Computerization is ubiquitous in all institutions 



but security is certainly a valid concern

Free email groups vs. institution-based



Increasing public awareness on the benefits of 

ICT


Opportunities

According to International Telecommunications 



Union 2010 Report

Mobile Phone Users per 100 population



PHILIPPINES 

100.5/100 

WORLD



49/100

Internet Users per 100 population



PHILIPPINES  9/110  (UP TO 35%, DOST-ICTO 2012) 

WORLD


   22/100

Philippines is the Texting Capital of the world



 

 


“No one is 

left behind, 

especially 

the poor.”

 

 

The National Telehealth Center



 

 

*based from previous slide



The National Telehealth Center

 UP Board of Regents: 1998



To improve the health of Filipinos 

through the optimal use of ICT

 

 

*based from previous slide



The National Telehealth Center: 

Targets


 

 


 

 


 

 

Asia eHealth 



Information 

Network 

(AeHIN) 

 

 

 

*based from previous slide



e-Health Policy Advocacy

UP Manila



 

 

*based from previous slide



e-Health 

Policy Advocacy

Standards and 

Inter-operability

Philippine National Health 

Information Systems



 

 

eHealth



 

 

*based from previous slide



Functional Areas of eHealth

Telemedicine / telehealth – tele (distance)





mHealth – mobile technologies

Electronic Medical / Health Records



eSurveillance and Tracking

eLearning for Health



 

 

*based from previous slide



The National Telehealth Service Program

 

 


32

What is CHITS?



EMR

 for 

Health Centers

Modular System

E-Governance

2

Electronic Medical / Patient Record



Integrating health 

information through data 

modeling and business 

process re-engineering

Family

Barangay


Patient

DEMOGRAPHICS

CONSULTS TODAY

CHITS

CONSULTS TODAY

CHITS

Notifiable Diseases

Immunization

Maternal Care

Immunization

Child Care

DOTS

PhilHealth



Maternal Care

Immunization

Child Care

DOTS


PhilHealth

MODULES

USER

INTERFACE

VERTICAL

PROGRAMS

Maternal and 

Child Health

Immunization

Notifiable 

Diseases


REPORTS

CORE MODULES

BEFORE

BEFORE


NOW

NOW


a new way of doing things…

 

 

CHITS Project



• Pilot in Pasay City health centers in May 2003

• Improved health information management

• Improved computer literacy among government 

midwives and nurses

• Demonstrated electronic records management to UP 

medical students plus

Awardee 2x, Health Market Innovations, PIDS-CHMI, 2011

Finalist, Stockholm Challenge, 2006

Best e-Gov projects, APEC Digital Opportunities Center, 

2006


Compendium of Best Practices in Local Health 

Systems,  DOH, 2006 



Maternal Record

Before

After

Family Planning

Before

After

Screenshots

Data Visualization

Average Duration of Consult

Reason for Consult

Immunizations Received

MONITOR


CCT-4Ps compliance 

conditionalities



Number of Prenatal Visits

MONITOR


CCT compliance 

conditionalities



Birth DELIVERY Location

MONITOR


CCT compliance 

conditionalities



Family Planning Method

PhilHealth Coverage

Only 431 (of 25K patients) have Phil Health 



numbers recorded

YEAR

No. of Patients Registered

2004


34

2005


279

2006


104

2007


11

2008


1

2009


1

2010


1

MONITOR


PhilHEALTH 

utilization: 

OP/PC Benefits


mCHITS in Navotas City

rCHITS and LGU Dashboard  

Certificate Course on eHealth

National Telehealth Service Program



           Adding a Patient Record and Health Worker Profile                                             

to the R4Health Database

1.

On the main screen, search for the icon of R4Health (figure 1)  then tap it. 



2.

Enter your PIN then tap Login (Figure 2)

         

1. Sa main screen, hanapin ang icon ng R4Health (Figure 1 )at i-tap 

ito.

2. I-enter ang PIN at i-tap ang Login (Figure 2)



3.

Tap the Add Patient button. (Figure 3)

          (Only the healthworker can perform this function)

3 . I-tap ang Add Patient button



Figure 2: R4Health Main Screen

Figure 3: Selection of Adding or Searching  a Record

R4Health

Real Time Regular Routine Reporting for Health        

PRIMARY CARE BENEFITS 

 CONSULT/ & COMPACK 

MEDICINES DISPENSING

Figure 48: Add New PCB Consult/COMPACK Dispense 

Figure 47: PCB Consult/COMPACK Dispense Link 

Certificate Course on eHealth

National Telehealth Service Program


Some R4Health Data 

(August 2,2012 – January 15, 2013)

No. Of Patients Enrolled 14,118 



No. Of  Children who received Vaccination 2,087

No. Of Children who received Deworming tablets (PCB) 443



No. Prenatal Care Reports 1,052 

No. Of (Fetal) Delivery Reports 342 



No. Of Postnatal Care Reports 232 

No. Of Family Planning Service Reports 845 



No. Of PCB Services Reports 3,062



 

 

RxBox



                 

  Electronic TB Diagnostic Committtee

Telemedicine in the Philippines

CICT 


2004

SERVICE


RESEARCH

6 years of experience and 

collaborations with DOH-DTTBs

with research support from 

DOST

   DOST, 2008

DTTBs 


2007-

2011

UP Manila and UP Diliman



BUDDYWORKS

Project

How do we do Telemedicine?

We train health workers how to use the 

cellphone to effectively collaborate with doctors 

and specialists (in their regional network).

RXBOX: undergoing field testing

UP Diliman VC Research 

Eng. Luis Sison PhD

& the RxBox



2006

mHealth

University of the Philippines – 

Philippine General Hospital

Teleconsults per Clinical Specialty

 

(October 2007-December 2012)



 

2-3 teleconsults per day

3-40 teleconsults per 

month


Internal   

Medicine


Pediatrics

OB Gyn




            

Region 8 Teleconsults: 



Region 8 vs Central  Clinical Specialists



 



October – December 2012    

Stories of TELEMEDICINE

  Teleradiology, teleorthopedics

Ortho: wash-out the antibiotic for 

one week then CS/debridement

Batanes: 23/M Post Traumatic Osteomyelitis



Batanes: 23/M Post Traumatic Osteomyelitis

Saved patient P8400 for one week 

“unnecessary” stay in Manila

Saved PGH P10,500 by asking 

antibiotic wash-out to be done in 

Batanes General Hospital instead of 

the PGH surgical bed


Sarangani: Tinea imbricata among 

IP Community (teledermatology)

Message of dermatologist:

...It appears to be a lovely case of 



Tinea imbricata or Tokelau 

ringworm caused by the 

dermatophyte Trichophyton 



concentricum. This is a relatively 

rare dermatophytosis but is found 

among Filipinos in Mindanao or other 

rural areas. The first reported case 

was in 1789 by Williams Dampier-- of 

a Filipino from Mindanao. One early 

case report was on a Filipino from 

Mindoro (1962 MC Fernandez of 

PGH). A co-resident of mine CTan 

reported one case in the 1990s, a 

Badjao patient from MIndanao if I 

recall.  

You really should make a case report 

of your patient, and try to document 

any other cases existing in her 

community...  



Batanes: 55/F  sudden onset of blindness

 suddenly lost sight after 

'hitting a spider' she felt 

on her eye. 

Tele-Ophthalmology


Saved patient Php 36600 in 

Travel/Accommodations

55/F Acute Angle Closure Glaucoma 

Ophtha: 


Passed prescription to 

Batanes MHO

Patient was managed 

conservatively in the island

Monitored remotely

Tele-Ophthalmology



ENT

Telemedicine 

Services

Feedback from DTTBs & MHOs

Very Useful

Useful

Not Useful



0

5

10



15

20

25



DTTB/MHO Rating of DE's Response 

N

u

m

b

e



o



T

e

le

re

fe

rr

a

ls

17

0



21

  “

Very useful

 to us dttbs 

esp those in remote areas

 where 

net access aren’t that gud. Responses r readily sent so 

mgmt is not compromised. Very helpful since its 

jst a txt 

away 

and pxs are then quickly managed.” -DTTB, 

Agutaya, Palawan

Over-all Certificate Course Rating

26

357 

Trained

276

 Currently Enrolled 

Referring Physicians

144 

Doctors-to-the-Barrios 



132

 Municipal Health 

Officers

NTSP Training – for Telemedicine 


How do we do Telemedicine?: 

RxBox


We train health workers how to use the 

cellphone to effectively collaborate with doctors 

and specialists (in their regional network).

RXBOX: undergoing field testing

UP Diliman VC Research 

Eng. Luis Sison PhD

& the RxBox


68

Rxbox


• Measures Vital Signs

Heart rate and electrical heart activity



Blood pressure

Oxygen saturation of blood



Tocometer

Fetal Heart Tones



Partograph

• Transmit Vital Signs 

(from remote rural town) 

→  

Internet → medical specialist in urban center



The National Telehealth Service Program

69

RxBox


70

Baler


71

Baler


72

The National Telehealth Service Program

Backbone and Platform 



For RxBox + future telemedical devices

For future telemedicine services →  telegenetics, 



teleophthalmology, teleprostheses, etc.

Primary target: remote underserved areas 



Providing access to specialty clinical care 



73

An Online Method for Diagnosis of Difficult TB 

Cases for Developing Countries

eTBDC


e-TB Diagnostic Committee

Alvin MARCELO, Zafar 

FATMI, Paul Nimrod 

FIRAZA, Shiraz SHAIKH 

and Richard E SCOTT


74

TB Problem in Developing Countries

High TB Disease burden – TB epidemic!



Philippine – top 9

th

 country; 



Pakistan – 6

th

 



Lack trained physicians and chest specialists in remote 

and rural areas

Large section of the population receives treatment 



from the private sector. 

75

PHILIPPINES



• PPP – public private sector partnership in TB 

Control since 2004

• TBDCs – TB Diagnostic Committee – adopted

PAKISTAN



• Similar systems for TB control

• Does not have TBDC

TB Problem in Developing Countries


76

Results -PHILIPPINES

• Decisions of face to face TBDC is comparable to electronic 

TBDC.


• Electronic TBDC decisions are at par with the culture 

results


• F2F TBDC has a lesser delay as compared to eTBDC

 Technology infrastructure



 Physician comfort with technology



77

Results - PAKISTAN

• e-TBDC 

=

 F2F diagnosis using the culture 

result (Gold standard)

• e-TBDC diagnosis was more sensitive and 

specific vs. F2F diagnosis


78

CONCLUSIONS

• The use of “iPath” for hosting e-TBDCs is 

a potential alternative to the current 

practice of face-to-face TBDCs

• Using telehealth solution, can improve 

TBDOTS coverage 

• Reduction delay in diagnosis related to 

the conventional process – not 

demonstrated: 

Limitations in technical capacities of 



physicians and IT infrastructure 

79

8 years of Telemedicine in the 

Philippines

• Telemedicine is possible in geographically 

isolated and disadvantaged areas (GIDA)

• Telemedicine is fraught with ethical, social, 

and legal challenges (read: should only be 

done by trained health professionals and 

certified personnel). Protocols are important.

• Telemedicine is expensive for few sites, but 

costs go down with more sites


80

8 years of Telemedicine in the 

Philippines

• Telemedicine – connects. Links rural 1* care 

MD and specialists – professionally, socially

• Telemedicine – is a supportive tool

1* care MD can take care of majority of cases but 



appreciate the support

• Current benefits are not enough → 

improvements needed


admin@info.telehealth.ph

Contact us!



Document Outline

  • Slide 1
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  • Slide 30
  • Slide 31
  • Slide 32
  • Slide 33
  • Slide 34
  • Slide 35
  • Slide 36
  • Slide 37
  • Screenshots
  • Data Visualization
  • Average Duration of Consult
  • Reason for Consult
  • Slide 42
  • Slide 43
  • Slide 44
  • FAMILY PLANNING METHOD
  • Slide 46
  • Slide 47
  • Slide 48
  • Slide 49
  • Slide 50
  • Slide 51
  • Slide 52
  • Slide 53
  • Slide 54
  • Slide 55
  • Telemedicine Teleconsult Monthly Stats per Clinical Specialty (October 2007-December 2012)
  • Slide 57
  • Slide 58
  • Slide 59
  • Slide 60
  • Slide 61
  • Slide 62
  • Slide 63
  • Slide 64
  • Slide 65
  • Slide 66
  • Slide 67
  • Rxbox
  • RxBox
  • Slide 70
  • Slide 71
  • The National Telehealth Service Program: Backbone and Platform
  • An Online Method for Diagnosis of Difficult TB Cases for Developing Countries
  • Problem
  • Pakistan Tb-Control Situation
  • Discussion-Philippines
  • Discussion-Pakistan
  • Conclusions
  • Slide 79
  • Slide 80
  • Slide 81


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