It’s the second to the last blog before the end of the semester. This week’s topic is all about telehealth. The question we were asked was…
How can telehealth support healthcare delivery in the Philippines?
To help answer this question, we were tasked to read and evaluate the Telehealth Act of 2014, and to suggest revisions, if any.
Telehealth, according to the Center for Connected Health Policy (n.d.) is “a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies.” It is not a specific service but a term that describes the variety of technology and tactics to deliver virtual medical, health, and education services.
The practice of the use of telehealth services is more common in developed countries such as the US. In the Philippines, however, it is not as popular. Quite frankly, I finished nursing school and medical school without encountering a lecture on what it is and how it can be applied to our setting.
The Philippines is an archipelago composed of more than 7,600 islands. Our geography, while it has blessed us with incredible sights and natural wonders, has also made it more difficult for healthcare to be accessed and delivered. It is the same geography that constitutes the physical factors that characterize geographically isolated and disadvantaged areas or GIDAs. GIDAs are communities with marginalized population that are physically and socio-economically separated from mainstream society. They physical factors are mainly to geography and also includes difficult access due to weather conditions. Socio-economic factors, on the other hand, include high poverty incidence, presence of vulnerable sector, communities in or recovering from situation of crisis or armed conflict (Department of Health, n.d.).
With telehealth, the population that could potentially most benefit are those residing in GIDAs. The idea is that since they have difficulty access to healthcare, healthcare will be brought to them. This is one of the objectives of the Telehealth Act of 2014.
House Bill No. 4199, also known as the Telehealth Act of 2014, declares that “the State shall protect and promote right to health of the people and instill health consciousness among them. Henceforth, it is the intent of the Legislature to recognize the practice of telehealth as a legitimate means by which an individual may receive health care services from a health care provider without in-person contact with health provider. Telehealth or Telemedicine shall not be construed to alter the scope of practice of medicine or any health care provider or authorize delivery of health care services in a setting or in a manner not otherwise authorized by law.”
Aside from the objective I mentioned above, other objectives of this Bill are to reduce the costs, set standards and establish regulations regarding the field, and strengthen the health system and infrastructure.
There are 20 sections to this Act. I have chosen the following to evaluate.
|Section 9. Database. – All telehealth center and originating sites shall coordinate with DOH for consolidation of pertinent databases. DOH shall maintain and manage a national database for consults on clinical cases as well as health and medical education exchanges.||Considering how important documentation is especially for something like this, I feel as if this section is severely lacking.
Having read the comprehensive IRR of the Data Privacy Act of 2012 in the previous blog, this, to me, needs further details. At the very least, the basic contents of the database should be enumerated. I would like to know if there are other types of data that should be gathered/documented when a consultation is done via telehealth.
|Section 16. Standard of care. – The standard of care is the same as regardless whether a health care provider provides health care services in person or by telemedicine. Telehealth or telemedicine shall not be construed to alter the scope of practice of medicine or any health care provider or authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law. Telehealth shall not replace health care providers or relegate them less important role in the delivery of health care. The fundamental health care provider-patient can not only be preserved, but also augmented and enhanced.||While I agree that the standard of care should be the same whether the consult is done in person or via telehealth, I think the Bill fails to capture the limitations on this type of service. Granted that the scope of medicine (or allied medical services) will not change in terms of what a doctor can do, it should also acknowledge that that the things a doctor cannot do. There is a science to the practice of medicine (and other disciplines) that simply cannot be done via a video call or similar means. Section 5. Scope can be elaborated further to include limitations. Or limitations could be in a whole new section together, and in that section include what can and cannot be penalized. The way I see this Bill so far is that it is not healthcare provider-friendly. The providers are not protected the same way the patients are.|
Overall, a good portion of the Bill, in my opinion, needs further refinement apart from the 2 sections I stated above. But the fact that it exists is promising, as this legitimizes the practice of telehealth (or telemedicine). This field will open up a lot of opportunities especially for patients and will help in positively changing the landscape of healthcare delivery to the Filipinos.
Have you read the Telehealth Act of 2014? What do you think? How open are you to the idea of using telehealth services? How do you think will that impact the way we practice medicine in the Philippines? Let me know in the comments below.
- Telehealth as defined by Center for Connected Health Policy (n.d.)
- GIDA as defined by the Department of Health (n.d.)
- Telehealth Act of 2014