Tell-A-Med: The Trials and Triumphs of Going Online in Medicine

Tell-A-Med: The Trials and Triumphs of Going Online in Medicine

November 15, 2021

By: Charlene Divine M. Catral, UPCM 2027

Despite all efforts, the COVID-19 pandemic remains a dire crisis. Countless lives continue to be lost as the mutating coronavirus ravages our country. Of the many problems the Philippines faces, the lack of reach in areas where help is most needed has become even more pervasive. Indeed, the pandemic took the Philippines by storm — silent but rabid — and called for the nation’s utmost fortitude and creativity to simply make ends meet.

Promotion of use of telemedicine has been an ongoing effort by physicians and public health advocates since the early 2000s — an avenue to reach more Filipinos, especially those in remote and isolated areas. Strengthening telemedicine in the country would prove useful, especially for geographically isolated and disadvantaged areas (GIDA) where health interventions are heavily needed yet are difficult to access.

In the Philippines, developing our telemedicine is a continuing effort of physicians and public health advocates to expand the reach of our healthcare system, especially for fellow Filipinos from geographically isolated and disadvantaged areas. Photo by Joaquin Arriola, UPCM 2026.

Republic Act No. 11223, better known as the Universal Health Care Act (UHC), is among the current thrusts in healthcare equity, emphasizing that health is a right, not a privilege. This indicates that all Filipinos have a right to quality healthcare goods and services that are affordable and accessible to all. However, a long road lies ahead for stakeholders to fully enjoy the benefits of the UHC. The UHC Law stipulated the organization of technology-enabled healthcare provider networks throughout the Philippines; and telehealth plays a major role in this envisioned system.

To gain a better perspective of these obstacles and opportunities, we interviewed Dr. Portia Marcelo, Professor of Community Medicine, UP College of Medicine (UPCM) and former Director of UP Manila’s National Telehealth Center (NTHC, in 2011 to 2017). She led projects to expand UP Manila’s Telehealth efforts to up to 600 rural municipalities nationwide. She built on the work of other professors of the UPCM who pioneered telehealth in the country. The NTHC is the research unit with focus on the use of information and communications technology (ICT) for health (alternative names include eHealth and digital health).

Telehealth as an instrument to strengthen the Philippine healthcare delivery system spans nearly two decades of advocacy. NTHC’s initiatives were a response to poor healthcare access. It began in 2004, led by Dr. Herman Tolentino, Director of the NTHC and concurrent Clinical Associate Professor at UPCM Medical Informatics Unit (MIU) and Department of Anesthesiology. With funding from the government’s Commission on ICT, they implemented the first nationwide telehealth project Buddyworks implemented in 10 sites. In 2007, Dr. Alvin Marcelo, Professor of Medical Informatics (UPCM MIU) and Surgery, took over the NTHC, initiated the National Telehealth Service Program (NTSP) funded by the Department of Science and Technology Philippine Council for Health Research and Development (DOST PCHRD). The NTSP provided support to the Doctors-to-the-Barrios (DTTB) serving GIDA by linking them with the medical faculty of the UPCM-PGH. When the primary care DTTB encounter clinical dilemmas, they pose their queries to the UP-PGH medical faculty. The NTSP shifted the web-based Buddyworks telehealth platform to an SMS-based one, more useful in the GIDA. It incorporated and developed the first version of the RxBox telemedicine appliance. Developed with Dr. Luis Sison, Professor of Engineering in UP Diliman, the RxBox would have its second version in 2012. Dr Portia Marcelo and Dr Sison designed RxBox-2 to be interoperable with Community Health Information Tracking System (CHITS) — electronic medical records system (also developed by UPCM and the NTHC) and seamlessly linked with the NTS telehealth platform. Other pioneering telehealth projects supported or co-developed by the NTHC include the Medical Teleparasitology Project led by Dr. Vicente Belizario (current Dean of the UP College of Public Health, and Professor of Parasitology) implemented in the Cordillera Administrative Region and Davao Region. Telepsychiatry efforts were led by UPCM Professor Emeritus Dr. Lourdes Ignacio, with the UPCM-PGH Department of Psychiatry providing support to Infanta, Quezon in the aftermath of Typhoon Reming. The teledermatology Dermlink project led by Dr. Belen Dofitas, Associate Professor of Dermatology, was intended for neglected tropical diseases and other dermatology conditions in remote communities of Mindanao; the same NTS platform was used. The Mag-Ina Telereferral System (MINTS), seamlessly linked with CHITS, allows the referral of parturient mothers found to have complicated birthing processes from the primary care lying-in clinic to the nearest hospital, better equipped to manage complex cases. The MINTS allows exchange of patient clinical data between health facilities organized into a healthcare provider network in Quezon City, the first of its kind in the Philippines. The Hearing for Life Project led by UPCM Dean Dr. Charlotte Chiong, and Dr. Philip Fullante, Clinical Associate Professor of Otolaryngology, also saw use of telehealth for newborn hearing screening healthcare provider networks in Iloilo, Bacolod and Romblon.

The need for telemedicine has been thrust into the limelight ever since the COVID-19 pandemic struck. This avenue has facilitated providing health services while minimizing physical contact between patient and healthcare providers. Photo by Joaquin Arriola, UPCM 2026.

Through their efforts, telemedicine has moved beyond proof-of-concept, supporting physicians and primary care health professionals who attend to patients in rural, remote areas, delivering better quality care. UP’s telehealth efforts introduced concepts and actual use of telemedicine/ telehealth modalities to these communities. These were, unfortunately, time-bound projects: they existed while the research was ongoing. While the health sector eagerly collaborated, there was no enabling policy to support telehealth expansion and sustain its implementation specially for GIDA.

Dr. Portia Marcelo describes telehealth’s boost in use amidst the COVID-19 pandemic in the Philippines. First, as a means to triage non-COVID cases from probable and COVID cases, then as a means to follow up on patients while also minimizing physical contact. The DOH provided hotlines for Filipinos to access for their medical queries and engaged with private companies to provide telemedicine services in the country. Dr. Marcelo narrates how despite these achievements, there remains many concerns, including that of poor internet connectivity and even basic electrical power that characterize many of the GIDA and rural municipalities in the country. “It (telemedicine) definitely reached a lot of people amidst this COVID pandemic. But these are the same people who do have access to care even in non-pandemic times.” The question remains, “what about those in GIDA?” Thus, telehealth advocacy is anchored not only on the overall health sector strengthening, but is also built on the call for more urgent social development of rural communities.

Dr. Marcelo also discussed how despite the lack of legislation that governs telemedicine, the local government units of Navotas, Marikina, and Taguig have already carried out efforts in telemedicine for their constituents amidst the pandemic. The Department of Health released the first set of guidelines during the pandemic, namely the DOH-National Privacy Commission Joint Memorandum Circular 2020-0001 “Guidelines on the Use of Telemedicine in COVID Response” and the DOH-UPM Joint Memorandum Circular No. 2020-0001 “Telemedicine Practice Guidelines”. These are large strides towards the common goal, but there must be proper infrastructure and equipment for more Filipinos to have access to these digitized health services such as online consultations.To further improve telemedicine in the country, the understanding of digitized healthcare must be reframed: it is another form of medical practice but not less. Thus, Filipinos should not only be made aware of the benefits of telemedicine, they should actually have access to telemedicine and basic health and social services. And, it goes to say, that the Government should properly allocate resources for all these.

We also interviewed a patient who has engaged in telemedicine services. She acknowledges telemedicine as a new and cost-efficient approach to address the imposed barriers of lockdown. It has provided her with the comfort she needed from a professional as well as relief knowing she was safe within the four walls of her home. She expresses how telemedicine is beneficial for she “ Feels at peace and able to fully express herself in front of the camera”. Teleconsults allow her to avoid inconveniences like traffic; all one has to do is open a laptop or phone and call the doctor. However, she worries that others may not be as fortunate to experience this service due to lack of internet access, electricity, or availability of a device — all of which are considered “basic needs” to some Filipinos but luxuries to most.

The patient further recounts other limitations such as limited assessment to see the patient’s real-time habits and behavior which may influence her diagnosis. To address this, doctors have adapted by employing different strategies. Among those employed by the patient’s physician, she noted the use of daily journals to capture her lifestyle habits for the doctor to understand her current condition.Familial support and cooperation are necessary to assist in the treatment of the patient and maintain a safe and healthy environment for optimal health.

With the numerous headways made for telemedicine, there are still no regulating policies to govern telemedicine in the country. The future of a developed Philippine healthcare system remains grim for as long the government refuses to prioritize health, even during a pandemic. Photo by Joaquin Arriola, UPCM 2026.

Although telemedicine is here to stay, there are still no laws or legislation governing telemedicine in the Philippines. The NTHC began advocating with Congress for such a law beginning in 2009. Eventually what was proposed included House Bill No’s. 6366 (Telehealth Act of 2012) and 4199 (Telehealth Act of 2014), and Senate Bill No. 1618 (The Philippine eHealth Systems and Services Act in 2016). Unfortunately, they have been left to gather dust. Although telehealth / telemedicine became more explicitly stated in the DOH National Objectives for Health and DOST- DOH National Unified Research Agenda beginning 2011, the question remains: whose responsibility is it when the telemedicine system faces complications? The country needs leaders that can take accountability for these programs. To be within sight of a disease-free country, the dawn of these promising opportunities must be held close by trailblazers who can purposefully bring Filipinos the quality of life they deserve.