NCDs, one among the growing concerns in health today, was accounted for  half of the causes of deaths in the country. According to the article, initiatives under the NTSP,  are becoming relevant in addressing non communicable diseases. With mobile phones, a general practicing doctor in a remote rural area can now be assisted in handling a difficult case by a clinical specialist in Manila. A patient’s health can be monitored longitudinally using an electronic medical record deployed in government health facilities. With these innovations, the Philippines posit the beginnings for mHealth solutions in the country.

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[PHOTO NEWS] Communities in poor or low-income resource setting need to adjust in a positive environment for technology diffusion. The Philippines’ Department of Health with the National Telehealth Center has invested in a social preparation research as one of the components of the National Telehealth Service Program. This research assess the needs and readiness of the target sites in adopting to telemedicine. In this photo Jeric Aldrin Bayan, Research Assistant at NTHC, interviews a barangay health worker during a focus group discussion at Roñio Hall, Gandara Elementary School, Gandara, Western Samar. Photo by JFlores, Research Assistant for NTSP Social Preparation Research

An endorser of the Reproductive Health and Sin Tax Bills, the NIH will lead policy recommendations that are critical to address issues in Kalusugan Pangkalahatan (KP), most specifically in KP’s third strategic thrust: the attainment of the Millennium Development Goals (MDGs).

Since KPs’ launch, NIH has supported DOH direction to universal health care by aligning its research agenda to help meet the challenges of the MDGs. According to Dr. Manuel B Agulto, Chancellor of UP Manila, this underscores NIH’s “unique position” as provider of technical expertise in health research and development to DOH and other sectors.

“Relevant research is the backbone of any policy; we as NIH would help put forth policies relevant to the country’s needs,” says Dr. Shelley Dela Vega, Director, Institute of Health Policy and Development Studies (IHPDS). IHPDS, one of the eleven institutes under NIH, will lead this year’s anniversary.

As 2015 approaches, the Aquino administration is pressured to meet Millennium Development Goals 4, 5, and 6. Health policies based from evidence in research would strategize funding for better infrastructure, facilities, and human resources to serve the best doctors and health researchers of the country. With the recent approval of the 1 billion NIH building in the 2013 UP budget, support for research and development in the health sector is expected to escalate.
NIH was instrumental in the passage of 2 laws – Republic Act 9288 or “The Newborn Screening Act of 2004” and Republic Act 9709 or “The Newborn Hearing Screening Act of 2009”. Both were signed into law by Pres. Gloria Macapagal-Arroyo to protect the “future generation of our country.”

Along with the DOH Secretary, gracing the event are: UP System President Alfredo Pascual, and Dr. Manuel B. Agulto, UP Manila Chancellor.

The anniversary is in conjunction with the 11th Metro Manila Health Research Development Consortium and the 4th Science and Technology Week of UP Manila.

Manila, Philippines-The Univerisity of the Philippines Medical Alumni Society in America (UPMASA)  donate laptops and mobile phones to support telemedicine practice of UP graduates enrolled under the Doctors to the Barrios Program.

In the photo are doctors from the provinces of Aurora, Quezon, Isabela, Cagayan Valley, Eastern, and Western Samar receiving the laptops from the National Telehealth Center staff.

UPMASA has been supporting the NTHC’ National Telehealth Service Program (NTSP), a nationwide initiative with the Department of Health that aims to extend specialize care to remote communities through telemedicine. Since 2006, NTHC has been conducting telemedicine to areas as far as Batanes down to Tawi-tawi.

Emmanuel Pajarillaga, NTHC eHealth Nurse, teaches a doctor on how tap use a smartphone’s screen for activating controls on the phone.

Baguio City, Philippines – 78 health workers from six provinces  of Cordillera Administrative Region (CAR) are trained on using mobile phones and email for delivering quality care through Department of Health’ (DOH) Telemedicine Project.

The project, formally launched as the National Telehealth Service Prorgam (NTSP), is a program of the DOH in partnership with the National Telehealth Center (NTHC), University of the Philippines Manila. It is one of the many efforts of DOH in “using ICTs (information and communications technology) for Kalusugan Pangkalahatan (Universal Health Care)”. Representatives fromDOH - National Center for Pharmaceutical Access & Management, Philippine Health Insurance Corporation, who are members of the NTSP’s Project Management Committee, and DOH-Center for Health Development-CAR, are present to observe and support the health workers as they participate in the Certificate Course on eHealth. The said course on eHealth is part of the capacity building trainings of NTSP.

Better health reform

“Let’s try it again” says Dr Portia Marcelo-Fernandez, NTHC Director as she explains factors that impede delivery of quality health care in the country. In her lecture, she said that problems in the health care system, like the lack of health care professionals in rural remote communities, impede better coverage and quality of health services in the country.

“If the DOH wanted to achieve universal health care at all, we should also aim for better, more systematic health reform” added Marcelo, “and using ICTs is part of it”.

ICT is an umbrella term for the convergence of communication platforms and technologies to access, deliver, and store information. It has various applications in the field of health, governance, and education. Since 2004, NTHC has been implementing projects in telemedicine, with various government offices including DOH, to improve access to medical specialists, especially those in remote rural communities.

The training catered to needs of health workers from all 75 municipalities in CAR. First of the two-day training is devoted to explaining the role of health workers as frontliners in the collection of health data while the second day is on equipping doctors on creating teleconsults and on teaching nurses and midwives on using smart phones for health data reporting. A continuing medical education is also held in the morning of the training’s second day.

Dr Portia Fernandez-Marcelo, NTHC Director, acts as patient in one of telemedicine’s return demo for teledermatology. DOH Telemedicine project receives image-based consults of dermatology cases.

With technology comes responsibility

“In a time when the ratio of using mobile phones exceed the population, we should definitely use these available tools to improve the health situation, ” said Dr. Patrick Sylim, NTHC Research Associate during his talk on how telemedicine in the NTSP works.

“But using technology requires a high degree of responsibility. In telemedicine, we should adhere to the same ethical principles when we were sworn in as medical personnel, ” said Dr. Ryan Bañez, NTHC eHealth Analyst in his talk on the ethical and legal consideration in the practice of telemedicine .

“A doctor may readily call a colleague and ask for an expert opinion but there are certain guidelines that have to be observed in this practice,” he said.

During the open forum, doctors asked about possible legal liabilities in telemedicine. Bañez underscored that the responsibility for patient care remains that of the doctor sending the teleconsult. Currently, there are no  laws regulating the practice of telemedicine and telehealth, “but in the meantime, existing laws such as the Medical Act of 1959, apply, which defines the doctor-patient relationship, including liabilities” Bañez said.

“The use of cellphones and internet for health care is not always without harm and certainly has limits.  Health workers are expected to demonstrate the same or even higher degree of professionalism and responsibility for information exchanged through these tools”, added Marcelo.

Health information for better health

Health workers discussed the limitations of manual and paper-based recording and problems quality of health. “Submitting reports to various DOH offices took time, by the moment they receive the data from our health centers / rural health unit, it is already stale and irrelevant,” Marcelo said, “authorities may not be able to respond to a disease outbreak immediately”

In a stacking game, health workers learned the importance of their role as health data collectors submitting reports to various DOH offices. “If we don’t report the right data to DOH, much resources will be wasted,” said Dr. Marcelo.

“Coordination, team work, and communication are important in forming the base of the stacks,” explained Dr. Arlene Ottao, Municipal Health Officer of Barlig, Mt. Province. Trainers correlate the base of the stacks which forms the health data structure in the country’s health care system.

“We are disheartened by the fact that there are a lot of projects initiated but very few have flourished. We hope you understand that we have a lot of work as health workers, but then, we hope that we will be able to maximize this telemedicine initiative,” said Dr Rhodora Montesa, municipal health officer of Asipulo, Ifugao. All health workers agreed that that the results of the telehealth project is something to look forward to.

Since November 2011, NTHC has been working closely with DOH in implementing NTSP nationwide. Aside from CAR, NTHC has started training health workers of Eastern Visayas (Region 8), Masbate and Tawi Tawi as part of its priority sites. Aside from specialists in Philippine General Hospital, the Eastern Visayas Regional Medical Center has come on board, and specialists began addressing teleconsults from municipalities from Region 8.

On behalf of the National Telehealth Center, we would like to thank you for attending the Certificate Course on eHealth. We hope that you will be one with us and the Department of Health in using locally available tools, such as mobile phones and computers, to improve delivery of care most especially to those who needed it most. Click the lecture title to download the presentation.

Continuing Medical Education Slides

5 December 2012

Gender Fairness
Dr. Ants Cordero

Disease and Disasters
Dr. Adrian Paul Rabe

Weight Loss
Dr. Adrian Paul Rabe

7 December 2012

Teledermatology
Dr. Charissa Mia Salud-Gnilo

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The proposed AO will also institutionalize the NTSP that aims to “improve access of rural communities and Geographically Isolated and Disadvantaged Areas to specialized medical care through telemedicine and R4Health” and will help DOH provide real time field data through electronic mobile reporting system to policy makers. Once the AO is passed, more reliable health data will be available for planning and implementation of health services, budgeting and procurement of supplies for DOH health programs.

“Sana di maging katulad ng ibang programa para samin, maganda ang panimula, pero sa implementation, kakaiba at di natututloy. Sana sa policy level palang, look at us (Indigenous Peoples) not as subjects of study or objects of development,” said Zenaida Brigida Pawid, NCIP Chairperson in a multi-sectoral consultation on the NTSP AO held this October at the University of the Philippines (UP) Manila. The said consultation mapped issues, culture, and health concerns of IPs and other sectors in Telemedicine.

Clockwise: UP Manila Chancellor Manuel Agulto, panelists from National Institutes of Health-UP Manila, NCIP, DOH, and DSWD, participants of the round table discussion on the National Telehealth Service Program.

The meeting was in coordination with the DOH-Bureau of Local Health and Development and DOH- Health Policy and Planning Bureau and was attended by the Department of Social Welfare and Services (DSWD), the National Institutes of Health (NIH), and telehealth domain experts in the Philippine General Hospital.

“There are a lot of values and attitude system that can be learned from the IPs,” elaborated Pawid after Dr. Gene Nisperos of NTHC presented the proposed AO guiding principles.

“We have no stats – for birth, marriage, and death,” added Pawid. “What we can offer you, together with the 7 ethnographical regional director, is to provide you information that can help  you gather and build database from ground level.” Pawid raised that most neglected IP groups, such Dumagats, Aetas, Agtas, Mamanoas, Palawanos, and Mangyans, have no basic social services and therefore should be a major consideration in creating health data bases.

“NTHC should be sensitive on this in delivering telemedicine services. We have a lot to learn,” added Dr. Portia Marcelo, NTHC Director.

Once instituted, DOH-Bureau of Local Health Development  is proposed to secure funding for NTSP in the next years of implementation. Philippine Health Insurance Corporation is rallied to develop financing schemes for Telehealth services or transactions.

NTHC consolidates outputs from this and will draft recommendations for the AO.

December of last year, NTHC convened a round table discussions on the ethical basis and legal framework of Telemedicine. Various government agencies, research unit, and hospitals participated in the event. Amongst notable efforts in instituting the NTSP is filling of House Bill 6336 which will push for a “Telehealth Act of 2012.

Developers and implementers from 21 countries in the 2012 OpenMRS Implementers Meeting

OpenMRS (Medical Record System) is a patient-centric medical record application that records medical interactions between health care providers and patients. It is a flexible technology platform that supports delivery of health care in some of the most challenging environments, and is an ideal tool for delivering IT services to the health sector because its design decisions are based on real needs, and is adaptable to the unique needs of users around the world. Being open source, all processes and software have been made transparent; and knowledge, skills, experiences and failure have been publicly documented.

OpenMRS is now in use on every continent in the world in countries including South Africa, Kenya, Rwanda, Lesotho, Zimbabwe, Mozambique, Uganda, Tanzania, Haiti, India, China, United States, Pakistan, the Philippines, and many other places. This work is supported in part by many international organizations including international and government aid groups, NGOs, as well as for-profit and nonprofit corporations.

OpenMRS is built and maintained by a community of developers, implementers, and users working toward a shared and open foundation for managing health information in developing countries. This year’s event will be attended by OpenMRS implementers and developers in 21 countries from around the world.

Seeing the advantages of using OpenMRS as a framework for developing electronic medical records (EMRs) for primary health care centers in the Philippines, the NTHC embarked on a large-scale implementation of its Community Health Information Tracking System (CHITS) using OpenMRS starting December 2011, making it the largest implementer of OpenMRS in both the Philippines and Asia.

By hosting the 2012 OpenMRS Implementers Meeting from October 9-12, the NTHC hopes to encourage more Filipinos to become active members of the OpenMRS community and build more health care capacity in the country. This year marks the first time the meeting is being held outside the continent of Africa, and it presents an opportunity for the Philippines to take on a leadership role in Asia as an OpenMRS implementer. The local governments of Quezon City and Navotas, who are implementing the system, will also be able to showcase their efforts in providing support to primary health care centers in the Philippines through implementations of CHITS-OpenMRS.

Diliman, Quezon City – The National Telehealth Center (NTHC), University of the Philippines Manila gained recognition and overwhelming support from the ICT4Development community when it presented six of its research outputs in the recent ICT4PhD Conference.

eHealth researches showcased were products of the center’s work with various agencies and remote communities over the last two years. Mobile phones, computers, open source tools and how it help manage  health information for improving health care were staged themes of the presentations.

Dr. Geohari Hamoy, NTHC Research Associate, presented Dr. Portia Marcelo-Fernandez's study on the "Acceptability of mobile technology reporting by government Agencies as a tool towards monitoring the MDGs in 3 municipalities in the Philippines"