An archipelago of 7,107 islands, the Philippines is using digital health to overcome physical distance and the lack of clinical resources through community-based telehealth programs.
Digital health in the Philippines traces its roots to the University of the Philippines (Manila) National Telehealth Center (UPM-NTHC), which pioneered open-source telemedicine and mHealth projects that connected remote patients with specialists in the Philippine General Hospital (PGH). This community-based approach in delivering eHealth solutions has gathered momentum in recent years, as the lack of doctors, nurses and other allied health workers in underserved areas became more severe.
NTHC’s latest project—called RxBox—is a biomedical device used by health workers to perform basic physiologic measurements. The custom-made device has ports on the side where sensors—such as a blood pressure monitor, ECG, pulse oximeter, fetal heart monitor, maternal tocometer, and a temperature sensor are attached. The government’s mission to improve maternal and child mortality and morbidity rates was considered in the type of sensors to include in the device. A touchscreen Android tablet serves as the interface, and the data is transmitted via the Internet, through text (SMS) or over TV white space (Super Wi-Fi) spectrum technology.
RxBox is integrated with the Community Health Information Tracking System (CHITS), an open-source EMR. Originally a SMS-based child injury surveillance program, CHITS has been developed further to include other clinical modules. It has been launched as an mHealth solution, and as a suite of health apps (Web-based CHITS, mobile reporting tool for fieldwork and LGU dashboard). Another iteration, rCHITS, includes modules in pre-natal care, post-partum care, newborn screening and immunization.
Philippine eHealth Strategic Framework and Plan
These telehealth projects are part of the Philippine eHealth Strategic Framework and Plan, which provides a roadmap for digital health adoption. By the end of 2015, the program aims to achieve the following:
- 1,000 RxBox units distributed
- Launch of telereferrals, teleconsultations, teleparasitology, and teledermatology programs
- 2,500 rural health units using the iClinicSys EMR with Philhealth eClaims
- 51 public hospitals using the Integrated Hospital Operations and Management Information System (iHOMIS) with Philhealth eClaims
In addition, the following eHealth projects are expected to be done by December 2014:
- Philippine Health Information Exchange
- National Disease Registry
- Philippine Health Enterprise Data Warehouse (Cloud Computing)
- iHOMIS Expansion
- Interconnecting RHUs/Regional Hospitals
- Standards (SNOMED, HL7, Loinc) for Standardization and Interoperability
- Integrated Health Goods Licensing Information System (IHG-LIS)
- ClinicSys EMR Implementation
The Philippine government has tapped the private sector in further developing its eHealth projects. Backed by Qualcomm Wireless Reach, Wireless Access for Health (WAH) leverages the high penetration of mobile devices in the Philippines, low-cost tablets and smartphones, and open-source software. Erin Gavin, project manager, described it as using “3G technology to improve health care by reducing the time required for reporting and improving access to accurate and relevant patient information for clinicians and government decision makers.”
The project has “expanded the CHITS EMR platform that supports data collection and reporting from the barangays [local government unit] through the mobile midwife platform and sends patient alerts through the Synchronized Patient Alert Via SMS feature.” WAH enhanced CHITS to be compatible with the Philippine Field Health Service Information System (FHSIS).
WAH allows health workers to track patient data, generate reports, and record outbreaks. Accessing patient records now takes seconds instead of minutes, and health reports—previously taking days via courier to arrive—now takes only minutes to transmit.
As of March 2014, the platform has achieved the following:
- Adopted in 68 clinics in 14 provinces
- Served > 2,500 patients a day
- 950 clinicians trained
- 1 million patient consultations
- 500,000 patient records recorded
Recent mHealth programs include the SMS Telereferrals used by the DOH in its “Doctor-to-the-Barrio” (DTTB) program, and health education programs giving mobile phone users reminders on vaccination, dengue prevention, tuberculosis and health seminars. The rCHITS (Real time Monitoring of Vital Maternal and Child Health Indicators through the Community Health Information Tracking System) project uses SMS for field workers to report maternal and child health services rendered, create appointments, and remind patients.
Health IT in Hospitals
Major hospitals have also implemented their own health IT programs. A few examples:
- The Medical City (TMC) partnered with software provider Exist in implementing “a Health Exchange engine that integrates HL7-compliant clinical data from various ancillary systems, Master Patient Index, Clinical Data Repository, and an EMR Platform that allows doctors to dynamically build notes using a forms-based tool.” TMC also has an award-winning teleophthalmology program for screening patients at risk for diabetic retinopathy.
- Makati Medical Center (MMC) implemented Indra’s Hospital Management and Information System consisting of administrative and clinical modules, including an EHR platform.
- St. Luke’s Medical Center implemented a number of health IT applications. According to Mike Muin, M.D., former Medical Informatics Consultant of the hospital, he and his team successfully rolled out St. Luke’s “hospital information system, the implementation and development of ancillary systems, and the integration of clinical applications using HL7 and open source technologies.”
- Mary Johnston Hospital and OffSiteCare Resources (OSCR) implemented a cloud-based EHR solution called HarmoniMD, according to Healthcare IT News.
The increased adoption of EHRs by the government and private sector in the Philippines reflects a wider trend in the Asia-Pacific region, where the EHR market—which generated $1.2 billion in revenue in 2012—is projected to nearly double to $2.2 billion by 2018, according to a Frost & Sullivan report.
According to TigerMine Research, “96% of Filipino netizens use social media, which accounts for a whopping 42% of total screen time in the country, more than any other country in Southeast Asia.” However, hospitals and care providers in the Philippines have been slow to engage patients because of privacy and other concerns.
Since its social media usage is among the highest in the world, this is an opportunity for the Philippines to optimize. The benefits of social media were seen during the aftermath of Typhoon Haiyan. Using emergency telecommunications equipment, relief workers used crowd-sourced maps to direct efforts, and gathered tweets, text messages and social media objects to pinpoint areas of damage.
Social media is being used by Philippine-based healthcare organizations for outreach and health education, but more engagement is yet to be seen. To help catalyze the discussion on social media and healthcare in the Philippines, a group of Filipino physicians launched HealthXPh, as a “platform of engagement” between stakeholders.
As a developing country, the Philippines continues to struggle with limited funding, organizational inefficiency, lack of healthcare personnel and infrastructure problems. However, through telemedicine, mHealth and health IT, digital health is helping it to overcome some of these challenges. Homegrown medical devices like the RxBox used in telehealth programs are helping doctors reach more patients in far-flung provinces. Low-cost, open-source EMR projects are making health workers more efficient in providing care. World-class hospitals are rolling out HIMSS-standard EHR implementations. Finally, a well-planned health IT strategy to tie it all together could help the Philippines bridge the gap in healthcare.
About the author: Jof Enriquez is a US-licensed registered nurse and medical writer who is based in the Philippines. You can follow him on Twitter @jofenriq.