As part of this week’s coursework for MI 227, I have chosen an article about Telemedicine. This is the topic I am very curious about, because in the Philippines, while having CHITS and RXBox being used in rural health facilities, and few private companies setting up telemedicine services, there are no current passed laws that directly govern the practice of telemedicine in the country.
Telemedicine is initially used to improve health care services on remote places. In reality, most of the quality health care services are accessed in the nearby cities. The people in the remote and scarcely populated areas would need to travel far to reach the nearest hospital. Among the countries with first adaptation of telemedicine is Norway. In the series of articles on the adaptation of routine telemedicine in Norwegian Hospitals that I have read, they have been using telemedicine since the early 1990’s. While it started very early, this present study was exploring implementation and participation of most hospitals in the adaptation of telemedicine within a five-year time frame (2009 to 2013).
Key points in the article are of the following:
- Data were extracted from Norwegian Patient Registry and only has number of inpatient and outpatient services from publicly-funded hospitals. The number of telemedicine consultations are of those for reimbursements are registered. Furthermore, there are no standards or frameworks in the country on measuring and reporting the telemedicine activity and utilization, only the quantitative number of consultations were recorded.
- While majority of the hospitals have participated the adaptation of telemedicine, it will not replace the face-to-face consultation (even if the article has repeatedly mentioned that telemedicine will replace the traditional consultation). While it seems like they are targeting to diminish the traditional consultation, it is far to happen at the moment, since as mentioned in the study, the telemedicine consultations are still small in numbers compared to the traditional face-to-face consultation. There are instances that the numbers have decreased or fluctuated in some years.
- One of the factors in the decrease in numbers is related to use of store-and-forward telemedicine such as transmission of still images, phone calls, SMS, are not considered as reimbursable telemedicine service and not counted in the numbers in the registered data used for the study.
- Telemedicine utilized in Norway is not limited to videoconferencing for primary care consultation. It varies in different services such as teledermatology, teleradiology, telepathology, telestroke, teledialysis, telepsychiatry, etc. It is also utilized to communicate from Provider to Provider for decision support and second opinions from several medical fields. For home care, complete paraphernalia to be used is recommended so that vital data can be taken and the patients are properly remotely monitored. Telemedicine is also used in oil and shipping platforms for emergency purposes. This is provision of medical support to the employees and/or guest travelling in large distances.
- Other Norwegian Hospitals followed suit in the adaptation because of Helse Stavanger’s increase in telemedicine activity. This hospital has set the pace and the trend in the adaptation of telemedicine on the national level.
Lesson learned and how it can be related to the Philippine setting:
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- It was noted that the national plan or a law governing such practice should exist. Same is the importance of governance and national plan for the Philippines. As mentioned earlier, there is no governing law in the Philippines. The Telehealth Act of 2012 was written but it is not yet passed as a law due to unclear guidelines and conflict to other laws (i.e., Medical Act of 1959). I have explained some of my thoughts about this Act in a previous blog post. While there is lacking on the governance, National Telehealth Center (NTC) was established to empower use of technology in health service delivery. Internal policies and procedures were identified and laid out that would help deliver the quality health services through the use of telemedicine. Security measures, as compliant to the Data Privacy Act of 2012, are implemented to safeguard patient’s right to privacy and confidentiality.
- To establish and use of standardization in the use and measurement of quality of the telemedicine activities (i.e., interoperability of the systems and EMR access, secure communication structure). While both countries has been pushing e-health and telemedicine to be utilized, there is no established guidelines or measurement or framework to monitor the quality of delivered telemedicine services.
- Payment scheme and coverage for reimbursements policy should be revised or have considerations. There is no coverage as of yet of Philhealth on telemedicine consultations. Like in Norway, it would greatly benefit the patient if this will be covered due to its convenience and of course, for the poor people residing in remote areas like GIDA.
- Even if there is low percentage out of overall outpatient consultations, Norwegian Hospital didn’t cease to provide telemedicine service. It actually set the pace and trend among hospitals over time. Such changes and adaptation take time and more research should be done for progress, improvement, and comparison. I think this will be a good start to monitor the quantitative and qualitative data for telemedicine as well for the Philippines while we are establishing the adaptation and expansion of the service nationwide. Like the use of CHITS and RXBox, these set the trend and framework for telemedicine. There are also services being developed and utilized from the private sector.
References:
- Zanaboni, P., Knarvik, U., & Wootton, R. (2014). Adoption of routine telemedicine in Norway: the current picture. Global Health Action, 7(1), 22801. doi:10.3402/gha.v7.22801
- Zanaboni, P., & Wootton, R. (2016). Adoption of routine telemedicine in Norwegian hospitals: progress over 5 years. BMC Health Services Research,16(1). doi:10.1186/s12913-016-1743-5
- Patdu, I. D., & Tenorio, A. S. (2017). Establishing the Legal Framework of Telehealth in the Philippines. Acta Medica Philippina. Retrieved from http://actamedicaphilippina.com.ph/content/establishing-legal-framework-telehealthphilippines
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