In June 2012, Congressman Joseph Emilio Abaya, LP filed a bill, labeled as “Telehealth Act of 2012”, that aims to regulate telehealth in the Philippines and set standards for its safe and ethical practice. In the Philippines, there is still a challenged in the lack of clear legal and social guidelines to guide telehealth practice, ensure patient safety and preserve patient information confidentiality .
Three years then, Biliran representative Rogelio J. Espina filed a similar bill during the House of Representatives Committee on Health Hearing last January 2015. A committee hearing attended by Dr. Portia Fernandez-Marcelo of the National Telehealth Center (NTHC), and Dir. Jaime Montoya of Department of Science and Technology – Philippine Council for Health Research and Development (DOST-PCHRD). The proposed act, actually, is very similar to the Telehealth Act, as it also aims to come up with a regulation on the practice of Telehealth in the Philippines .
Telehealth, as defined in the bill by Espina, is interchangeably used with telemedicine, and is defined as a mode of delivering health care services and public health via information and communication technologies to the management of patient’s health care while the patient is at the originating site and health care provider is at a distant site. However, in a stricter sense, telehealth is not the same as telemedicine. Telehealth is “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration” , while telemedicine, as defined by the World Medical Association, is the practice of medicine over a distance, in which interventions, diagnostic, and treatment decisions and treatment decisions and recommendations are based on data, documents, and other information transmitted through telecommunications system. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, and continuing medical education, etc. 
The use of telehealth, in essence, the telemedicine, benefits the people especially in the geographically and isolated areas (GIDA) in the Philippines.It is beneficial considering the geographic characteristic of the Philippines, where access to health care, especially in GIDAs, are difficult. The National Telehealth Center, where I’m currently working, pioneered a telemedicine initiative known as the National Telehealth Services Program (NTSP). The vision of the project is to empower the Doctors in the rural areas by connecting them with the experts at the Philippine General Hospital. At a point of care, whenever the doctors in the referring unit have difficulty in diagnosing a certain case, or needs the second opinion, instead of referring the patient to a nearby health facility, the doctor will just email/ SMS the case with all the necessary details to the Referral Hospital through the NTSP platform. With this, time and cost spent by the patient will be reduced since he/she does not need to travel to the Referral Hospitals. Second, for similar cases the doctor may already be able to diagnose and manage these cases, thus empowering his/her skills as a doctor. Lastly, this would also be beneficial to public health as a whole. To site an example, the discovery of an outbreak of Tinea imbrecata in one of the regions in the Philippines was made possible through NTSP. One doctor in the RHU referred a skin disease through the NTSP. The case was triaged by the NTSP to the assigned dermatologist in PGH, where the dermatologist diagnosed it as Tinea imbrecata. A case study immediately came after considering it is a rare skin disease. The case was featured in the FrontRow of GMA news.
(Photo capped from FrontRow, GMA Network)
However, although the perceived benefits of the telehealth, rules and regulations need to be in place to ensure there are check and balances in the practice of telehealth, thus should be the purpose of the telehealth bill. However, although this is the only billed filled in congress, I believe that the bill is half-baked and needs more improvement. For the purpose of this paper, I will site two (or more) sections that for me needs to be revised and be expounded further.
Section 6. Implementing Agency – The Department of Health shall be the lead agency in implementing this act. For the purpose stated, the DOH shall:
a) establish a National Telehealth Board;
b) Coordinate with the Department of Science and Technology through its Information and Communications Technology Office (DOST-ICTO)
While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.
Section 7. National Telehealth Board – To ensure the implementation of this Act and to serve as an executive body of the National Telehealth System, the National Telehealth Board shall be created and made an integral part of the Office of the Secretary of DOH.
The Board shall be composed of seven (7) members and shall be chaired by teh DOH Secretary, Members of the Board shall be as follows:
1) The Secretary of DOST
2) an Undersecretary of the Department of Interior and Local Government;
3) a representative from the League of Provinces in the Philippines
4) a representative from the League of Municipalities
5) a representative of the Philippine Health Insurance Corporation
6) a representative of the Associate of Municipal Health Offices;
7) a representative from the Philippine Medical Association.
Section 6 needs to be revised considering we already have Department of Information and Communications Technology (DICT), DOH will have to coordinate with the DICT and in addition the National Privacy Commission to ensure implementation of the ICT projects. In this section also, it would have been better if the scope and roles of the DICT, and now the NPC will be clearly stipulated.
In section 7, DICT and NPC secretary should be included, Executive Director of the National Institutes of Health, Executive Director, Philippine Council for Health Research and Development (PCHRD), DOST, at the very least. All these offices I added aims to provide guidance on the correct implementation of the telehealth in the Philippines, while the members of the board already stated above is necessary to ensure sustainability of the telehealth.
Also, a separate Article should be allotted to define and set guidelines on the ethics, privacy, confidentiality and safety in telehealth practice. In this article, Section 11-14/16 would be included to elaborate the government’s measures to ensure the ethical and safe practice of telehealth. The last point, I would like to emphasize in this blog is the ambiguity of Section 9. Databases. The bill failed to define “Database”, and in the context of information system database can be interpreted as the complete data records of the interactions, including the names, details of the patients. The word database was used very loosely to signify (maybe) record of transactions using telehealth. That still has privacy and confidentiality issues if not clearly defined.
I believe that the telehealth bill still needs a lot of revisions to be done and consultations with the experts (i.e. Health Informatics graduates) to ensure that concerns and issues regarding telehealth are covered, and individuals rights are safeguarded.
1 National Telehealth Center retrieved from telehealth.ph