The National Telehealth Initiative

The National Telehealth Initiative will provide under-served communities with a telehealth system that would allow for remote consultations, thus addressing at least three problems in Philippine health today, namely: the low doctor to patient ratio in the Philippines; the concentration of medical specialists in urban areas; and the fact that the services of high-expertise centers (examples: poisoning and trauma) are difficult to replicate in underserved regions because they are resource-intensive and expensive to maintain.

Project objectives include

1. to develop an appliance (RxBox) that collects health data from patients in rural health units and,
2. to establish an emergency care and coordination service system (ECCS) at the UP Manila National Telehealth center.

What agencies are involved in the Project?

The National Telehealth Center (NThC) ( http://www.telehealth.ph/ ) of the University of the Philippines Manila will implement the Project, with support from the Department of Health and the University of the Philippines.

Who will benefit from this Project?

• Medical benefits:
• toxin or trauma patients in rural test sites maximized by network coverage of K-Agrinet and MCT service communities ;
• patients who can benefit from remote access to expert specialists in PGH;
• doctors involved in diagnosis because of their access to advanced bioinstrumentation

• Economic benefits:
• government and university via patents; government and university via eventual OFW use and Medical Tourism;
• start–up entrepreneurs and biomedical companies (benefiting from domestic capabilities on ground-up design and construction of biomedical instrumentation)

• Technological benefits:
• Philippine academic institutions, academic degrees for research students from NIP, DEEE and PGH;
• Interdisciplinary research fields ranging from diagnostics to pathology

What are the objectives of the Project?

The program aims to develop new systems, services, and products that can extend health care expertise and assistance to the under-served areas in the Philippines through the appropriate use of ICT. The program has two major components with the following objectives:

Project Emergency Care & Coordination Services

1. Deliver telehealth services for poisoning and trauma. This includes:
• Provider-to-provider communication for emergency cases
• Online multimedia emergency assistance
• Coordination of referral to next level health facilities
• Expert assistance for interventions by field health providers
• Remote professional consultation and sharing of data between professionals for possible provision of second opinions
2. Design, develop and implement an electronic health record system for emergency telehealth services for poisoning and trauma, which includes:
• Continuity/portability of patient information
• Integration of multimedia data from disparate source (laboratory, radiology, pathology, etc)
• Patient learning for preventive care and disease management
• Remote learning, development and competence monitoring for healthcare professionals
• Online decision-support systems for simple cases
• Access to high-quality health information including current literature
• Provision of preventive health education and health-enquiry services
• Access to and updating of electronic healthcare records, providing the right information at the right time to the right person
• Set-up initial eAdministration framework for billing and administrative data management to support the healthcare process, including financing, Philhealth claims reimbursement and consultation fees
• Set-up manuals of procedures and ethically acceptable practice for telemedicine

Project LifeLink

1. To alleviate the intense need of the rural and urban poor population for medical diagnosis by utilizing GSM-based sensors for archipelago-wide health monitoring and data mining with the intent to influence community-based health policies and programs, rapid epidemic mitigation and response.

1. To develop an Rx Box, a portable medical diagnostic hardware containing biomedical sensors to measure vital physiological signals linked to a remote dynamic patient database situated in the call station.

1. To develop the necessary communications protocols for the Rx Box to transmit data. The test beds shall be situated in rural and urban poor communities from which health signals (sensor readings, video streaming, consultation and heart/lung sounds) shall be transmitted via internet, SMS, MMS and GPRS to remote medical specialists for evaluation.

1. To incorporate both hardware and software protocols to enable multimedia streaming through internet (PC) and 3G (mobile phones) for remote video consultation and emergency intervention to include the following services:
1. Remote real-time monitoring of health and biological signals
2. Audio-video remote medical consultation and diagnosis
3. Electronic health-information collection, analysis and reporting
4. Research and electronic statistical health analysis
5. Interoperability and mobility of systems and operations
6. Wireless telemicroscopy for microdiagnostics of TB and Dengue

How does the Project work?

The National Telehealth Initiative uses wireless technology (landline, internet, SMS, MMS, GPRS and 3G) to enhance access of rural patients to experts in poisoning and trauma at the Philippine General Hospital.

An RxBox will be stationed in health centers in local government units (LGU) where real-time remote monitoring of health signals can be done by experts stationed at the Emergency Case and Coordination Center. Critical cases can be monitored in real time even in hospitals outside the reach of wired network structures. The Rx Box can also be stationed in any rural health centers with attending physician, as well as to selected Multipurpose Community Telecenters (MCT) sites and K-Agrinet’s FITS center .

The simplified network architecture is given in the accompanying diagram (see figure). The medical attendant assisting the patient (with the Rx Box in an LGU) will contact the ECCS (via landline, mobile or internet) and will be hooked-up through the Middleware. The series of online diagnostics questions by the nurse on duty shall help diagnose the condition of the remote patient. An electronic algorithm for proper diagnosis will guide the nurse. Actual patient readings (ECG, Blood Pressure, Pulse-Ox) from the Rx Box are then sent by the Rx Box through the internet or GPRS (for far-removed sites) and integrated by the central server through the Middle Ware. These data are displayed in real-time and summarized for referral to a toxicology/trauma specialist should the case require. The specialist can be stationed in the TeleCenter or remotely situated and connect to it via landline, mobile phone or laptop. Video diagnosis is available (through the Rx Box Cam) that would enable visual inspection of the patient or demonstration of intervention protocols to the attending physician (who is with the patient) in emergency cases. Audio signals will also be streamed to carry voice or auscultatory sounds (heart, lungs and abdominal sounds) for further analysis.

A central operations center or COC (at the UP-PGH) will receive and coordinate the activities of the remote health facilities. Protocols for the ethical deployment of telehealth services will be co-developed and shared to the health staff of the remote facilities. Patients referred to the COC will be monitored as they are managed and transferred through the public health care system.

Remote health facilities will use an electronic health record system to manage their patients' information and this will be connected to the COC when there is a need to refer a patient to a higher level facility. The same connectivity can be used for more detailed consultations over voice-over-IP or videoconferencing. A biomedical device called RxBox can be attached to patients and the signals processed and sent to the COC for constant monitoring and interpretation. Based on the input of all of these (electronic health records, discussions over VOIP, and the RxBox device), appropriate care is relayed to the remote health staff.

What are the long-term goals of the Project?

With simple community training, the technology is envisioned to empower the aid-dependent local communities to become self-reliant integrated societies responsible for their own health security. In addition, the operational systems developed by the Project can serve as a template for centralized electronic medical repository in the country. The same network can be utilized for capacity-building of health professionals via remote access to knowledge databases, second opinions, education and training. Education and prevention can also be coursed through via internet training, multimedia downloads and automated SMS.

Who can be contacted for details about the project?

Inquiries may be directed to the Project’s Program Leader:

Alvin B. Marcelo, M.D.
Director, University of the Philippines Manila - National Telehealth Center
Telefax: (+63 2) 525 65 01
alvin (dot) marcelo (at) telehealth (dot) ph