Portia fernandez marcelo, md mph
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eMedicine ICT Tools in Achieving Universal Health Care PORTIA FERNANDEZ- MARCELO, MD MPH Director
*based from previous slide Telehealth and eMedicine ● The Philippine Health Situation ● Finding Solutions through eHealth: ● The National Telehealth Center ● Telehealth and eMedicine
The Philippine Health Situation ● Lower Middle Income Country (LMIC) ● 94Million, 63% live in urban centers ● Country of youths: 50% population < age 21 ● Double disease burden: infectious + lifestyle and chronic diseases ● Modest improvement in health indicators vs SEA nations- ● 4
highest: ● IMR = 32/1000LB, ● 2 nd highest: ● MMR= 221/ 1000000LB
● Accessibility ● Remote areas, difficult to reach ● Affordability ● High Out-of-Pocket expenses ● Universal Health Care → still to happen
Health Human Resource: Maldistribution of health professionals Health Workforce Density per 10,000 population (WHO, 2010) MD: Philippines=12 World=14 Nurses: Philippines =61 World =28
Migration and brain drain inevitable Seek greener pastures The Philippine Health Situation The Philippine Health Situation Widening inequity in health Disparity in health service delivery and utilization Poor quality of data and information Maldistribution of skilled health workers High out-of-pocket payment (including drugs), low health expenditure by government Food security and safety risk Dual burden of diseases Disasters, and chronic emergency in Mindanao Slow progress in maternal and child health and nutrition High population growth -DOH, 2010 presented during the WHO-PHL Consultative Meeting
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*based from previous slide Finding Solutions
Opportunities: ICT and Health Information and communications technology (ICT) : essential infrastructure and tools, great enabler to people ● for knowledge creation, sharing and dissemination. ● boost the innovative capacity of all sectors and contributes to more than 40% of overall productivity
growth
(EU KLEMS, 2007 in EC, 2009). ● by facilitating greater access to health and
education
services, and creating economic opportunities for disadvantaged groups
(Daly, 2003, K. Chen, 2004, Jensen, 2007; Mercer, 2001; Oberski, 2004; Reisman, Roger, & Edge, 2001; UNDP, 2001; The World Bank, 2001 in Fong, 2009: 471-472.)
Information science, computer science, and health care. Resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health and biomedicine. Tools: computers but also clinical guidelines, formal medical terminologies. Health informatics
Opportunities ● Broadband infrastructure continuously improving ● Open source software becoming more popular ● Computerization is ubiquitous in all institutions but security is certainly a valid concern ● Free email groups vs. institution-based ● Increasing public awareness on the benefits of ICT
Opportunities ● According to International Telecommunications Union 2010 Report ● Mobile Phone Users per 100 population – PHILIPPINES 100.5/100 – WORLD 49/100 ● Internet Users per 100 population – PHILIPPINES 9/110 (UP TO 35%, DOST-ICTO 2012) – WORLD
22/100 ● Philippines is the Texting Capital of the world
“No one is left behind, especially the poor.”
The National Telehealth Center
*based from previous slide The National Telehealth Center UP Board of Regents: 1998 To improve the health of Filipinos through the optimal use of ICT
*based from previous slide The National Telehealth Center: Targets
Information Network (AeHIN)
*based from previous slide e-Health Policy Advocacy UP Manila
*based from previous slide e-Health Policy Advocacy Standards and Inter-operability Philippine National Health Information Systems
*based from previous slide Functional Areas of eHealth ● Telemedicine / telehealth – tele (distance) ● mHealth – mobile technologies ● Electronic Medical / Health Records ● eSurveillance and Tracking ● eLearning for Health
32 What is CHITS? EMR for Health Centers Modular System E-Governance 2
Integrating health information through data modeling and business process re-engineering Family Barangay
Patient DEMOGRAPHICS CONSULTS TODAY CHITS CONSULTS TODAY CHITS Notifiable Diseases Immunization Maternal Care Immunization Child Care DOTS PhilHealth Maternal Care Immunization Child Care DOTS
PhilHealth MODULES USER INTERFACE VERTICAL PROGRAMS Maternal and Child Health Immunization Notifiable Diseases
REPORTS CORE MODULES BEFORE BEFORE
NOW NOW
a new way of doing things…
CHITS Project • Pilot in Pasay City health centers in May 2003 • Improved health information management • Improved computer literacy among government midwives and nurses • Demonstrated electronic records management to UP medical students plus Awardee 2x, Health Market Innovations, PIDS-CHMI, 2011 Finalist, Stockholm Challenge, 2006 Best e-Gov projects, APEC Digital Opportunities Center, 2006
Compendium of Best Practices in Local Health Systems, DOH, 2006 Maternal Record Before After Family Planning Before After Screenshots Data Visualization Average Duration of Consult Reason for Consult Immunizations Received MONITOR
CCT-4Ps compliance conditionalities Number of Prenatal Visits MONITOR
CCT compliance conditionalities Birth DELIVERY Location MONITOR
CCT compliance conditionalities Family Planning Method PhilHealth Coverage ● Only 431 (of 25K patients) have Phil Health numbers recorded YEAR No. of Patients Registered 2004
34 2005
279 2006
104 2007
11 2008
1 2009
1 2010
1 MONITOR
PhilHEALTH utilization: OP/PC Benefits
mCHITS in Navotas City rCHITS and LGU Dashboard Certificate Course on eHealth National Telehealth Service Program Adding a Patient Record and Health Worker Profile to the R4Health Database 1. On the main screen, search for the icon of R4Health (figure 1) then tap it. 2. Enter your PIN then tap Login (Figure 2)
1. Sa main screen, hanapin ang icon ng R4Health (Figure 1 )at i-tap ito. 2. I-enter ang PIN at i-tap ang Login (Figure 2) 3. Tap the Add Patient button. (Figure 3) (Only the healthworker can perform this function) 3 . I-tap ang Add Patient button Figure 2: R4Health Main Screen Figure 3: Selection of Adding or Searching a Record R4Health Real Time Regular Routine Reporting for Health PRIMARY CARE BENEFITS CONSULT/ & COMPACK MEDICINES DISPENSING
Certificate Course on eHealth National Telehealth Service Program
Some R4Health Data (August 2,2012 – January 15, 2013) • No. Of Patients Enrolled 14,118 • No. Of Children who received Vaccination 2,087 • No. Of Children who received Deworming tablets (PCB) 443 • No. Prenatal Care Reports 1,052 • No. Of (Fetal) Delivery Reports 342 • No. Of Postnatal Care Reports 232 • No. Of Family Planning Service Reports 845 • No. Of PCB Services Reports 3,062
Electronic TB Diagnostic Committtee Telemedicine in the Philippines CICT
2004 SERVICE
RESEARCH 6 years of experience and collaborations with DOH-DTTBs with research support from DOST DOST, 2008 DTTBs
2007- 2011 UP Manila and UP Diliman BUDDYWORKS Project How do we do Telemedicine? We train health workers how to use the cellphone to effectively collaborate with doctors and specialists (in their regional network). RXBOX: undergoing field testing UP Diliman VC Research Eng. Luis Sison PhD & the RxBox 2006 mHealth University of the Philippines – Philippine General Hospital Teleconsults per Clinical Specialty
(October 2007-December 2012) 2-3 teleconsults per day 3-40 teleconsults per month
Internal Medicine
Pediatrics OB Gyn
● Region 8 Teleconsults: ●
● ● October – December 2012 Stories of TELEMEDICINE Teleradiology, teleorthopedics Ortho: wash-out the antibiotic for one week then CS/debridement Batanes: 23/M Post Traumatic Osteomyelitis Batanes: 23/M Post Traumatic Osteomyelitis Saved patient P8400 for one week “unnecessary” stay in Manila Saved PGH P10,500 by asking antibiotic wash-out to be done in Batanes General Hospital instead of the PGH surgical bed
Sarangani: Tinea imbricata among IP Community (teledermatology) Message of dermatologist: ...It appears to be a lovely case of Tinea imbricata or Tokelau ringworm caused by the dermatophyte Trichophyton concentricum. This is a relatively rare dermatophytosis but is found among Filipinos in Mindanao or other rural areas. The first reported case was in 1789 by Williams Dampier-- of a Filipino from Mindanao. One early case report was on a Filipino from Mindoro (1962 MC Fernandez of PGH). A co-resident of mine CTan reported one case in the 1990s, a Badjao patient from MIndanao if I recall. You really should make a case report of your patient, and try to document any other cases existing in her community... Batanes: 55/F sudden onset of blindness suddenly lost sight after 'hitting a spider' she felt on her eye. Tele-Ophthalmology
Saved patient Php 36600 in Travel/Accommodations 55/F Acute Angle Closure Glaucoma Ophtha:
Passed prescription to Batanes MHO Patient was managed conservatively in the island Monitored remotely Tele-Ophthalmology ENT Telemedicine Services Feedback from DTTBs & MHOs Very Useful Useful Not Useful 0 5 10 15 20 25 DTTB/MHO Rating of DE's Response N u m b e r o f T e le re fe rr a ls 17 0 21 “ Very useful to us dttbs esp those in remote areas where net access aren’t that gud. Responses r readily sent so mgmt is not compromised. Very helpful since its jst a txt away and pxs are then quickly managed.” -DTTB, Agutaya, Palawan Over-all Certificate Course Rating 26
Trained
Currently Enrolled Referring Physicians
Doctors-to-the-Barrios 132 Municipal Health Officers
How do we do Telemedicine?: RxBox
We train health workers how to use the cellphone to effectively collaborate with doctors and specialists (in their regional network). RXBOX: undergoing field testing UP Diliman VC Research Eng. Luis Sison PhD & the RxBox
68 Rxbox
• Measures Vital Signs Heart rate and electrical heart activity Blood pressure Oxygen saturation of blood Tocometer Fetal Heart Tones Partograph • Transmit Vital Signs (from remote rural town) → Internet → medical specialist in urban center The National Telehealth Service Program 69 RxBox
70 Baler
71 Baler
72 The National Telehealth Service Program : Backbone and Platform For RxBox + future telemedical devices For future telemedicine services → telegenetics, teleophthalmology, teleprostheses, etc. Primary target: remote underserved areas Providing access to specialty clinical care 73 An Online Method for Diagnosis of Difficult TB Cases for Developing Countries eTBDC
e-TB Diagnostic Committee Alvin MARCELO, Zafar FATMI, Paul Nimrod FIRAZA, Shiraz SHAIKH and Richard E SCOTT
74 TB Problem in Developing Countries ● High TB Disease burden – TB epidemic! Philippine – top 9 th country; Pakistan – 6 th
Lack trained physicians and chest specialists in remote and rural areas Large section of the population receives treatment from the private sector. 75 • PHILIPPINES • PPP – public private sector partnership in TB Control since 2004 • TBDCs – TB Diagnostic Committee – adopted • PAKISTAN • Similar systems for TB control • Does not have TBDC TB Problem in Developing Countries
76 Results -PHILIPPINES • Decisions of face to face TBDC is comparable to electronic TBDC.
• Electronic TBDC decisions are at par with the culture results
• F2F TBDC has a lesser delay as compared to eTBDC ● Technology infrastructure ● Physician comfort with technology 77 Results - PAKISTAN • e-TBDC
F2F diagnosis using the culture result (Gold standard) • e-TBDC diagnosis was more sensitive and specific vs. F2F diagnosis
78 CONCLUSIONS • The use of “iPath” for hosting e-TBDCs is a potential alternative to the current practice of face-to-face TBDCs • Using telehealth solution, can improve TBDOTS coverage • Reduction delay in diagnosis related to the conventional process – not demonstrated: ● Limitations in technical capacities of physicians and IT infrastructure 79 8 years of Telemedicine in the Philippines • Telemedicine is possible in geographically isolated and disadvantaged areas (GIDA) • Telemedicine is fraught with ethical, social, and legal challenges (read: should only be done by trained health professionals and certified personnel). Protocols are important. • Telemedicine is expensive for few sites, but costs go down with more sites
80 8 years of Telemedicine in the Philippines • Telemedicine – connects. Links rural 1* care MD and specialists – professionally, socially • Telemedicine – is a supportive tool ● 1* care MD can take care of majority of cases but appreciate the support • Current benefits are not enough → improvements needed
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