Telemedicine Roadmap For Philippine LGUs

Telemedicine
Roadmap for
Philippine Local
Government Units
Telemedicine
Roadmap for
Philippine Local
Government Units
In collaboration with the

City Government of Parañaque.
© Copyright 2023 WHO Philippines
Telemedicine Roadmap for Philippine Local Government Units © 2023 by World Health Organization
Philippines is licensed under Attribution-NonCommercial-ShareAlike 4.0 International. To view a copy of
this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/
Under the terms of this license, you may copy or redistribute the material in any medium or format. You
may also remix, transform, or build upon the material for non-commercial purposes, provided the work is
appropriately cited, with a link to the license and an indication for any changes made. You may do so in any
reasonable manner but not in any way that suggests the licensor endorses you or your use.
In any use of this work, there should be no suggestion that WHO endorses any specific organization,
products or services. The use of WHO logo is not permitted. If you adopt the work, then you must license
your work under the same or equivalent Creative Commons license. If you create a translation of this work,
you should add the following disclaimer along with the suggested Citation: “This translation was not created
by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this
translation. The original English edition shall be the binding and authentic edition.” The mention of specific
companies or of certain manufacturers’ products does not imply that they are endorsed or recommended
by the World Health Organization in preference to others of a similar nature that are not mentioned. All
reasonable precautions have been taken by the World Health Organization to verify the information
contained in this publication. However, the published material is being distributed without warranty of any
kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with
the reader. In no event shall the World Health Organization be liable for damages arising from its use.
The views expressed in this publication are those of the authors and may not necessarily represent the
decisions or policies of the World Health Organization.
WHO Philippines
Ground Floor, Building 3, Department of Health,
San Lazaro Compound, Rizal Avenue, Sta. Cruz,
Manila, Philippines
1
Telemedicine Roadmap for Philippine Local Government Unit
Quote from the

Parañaque CHO —
Urban Health Project 2023
Already, I have seen many milestones achieved with

telemedicine. Slowly but surely, we are making progress
in addressing health inequity in Parañaque City by
providing and enabling this kind of environment for
our communities. I have witnessed this with my own
eyes, and our patients are very pleased. Our healthcare
providers have expressed how easy and seamless it is
for our patients to access treatment and how quickly they
can provide the necessary care. Access to treatment and
medical personnel is crucial. We may think it’s a small
matter, but it’s very important for our communities.
2
Telemedicine Roadmap for Philippine Local Government Units
My dear colleagues,
If you delve deeper into what we will be working I must commend SeeYouDoc for their dedication,
on, telemedicine will actually change the mindset going the extra mile to reach the barangays. Dr. AJ,
of our community. It will alter their health-seeking thank you for being personally present; I’ve seen
behavior in the coming years because it will be pictures, and it brings me joy because this is what
much easier for them to access healthcare. It’s a we need — hands-on involvement. It makes the
significant development, and they will be thinking, barangays feel that we haven’t forgotten them. I
‘I can just talk to my doctor anytime.’ This is what cannot thank Dr. John Juliard Go enough for always
we are looking forward to in Universal Healthcare, being there to support us, along with Ms. April
especially since telemedicine will provide access David from WHO, for trusting us to handle and be
to patients’ data through a digital database. It part of this partnership. Thank you so much, from
will be effortless for us to have that data readily the bottom of my heart.
available, a dream come true. In fact, it’s on our
wishlist for the future. I am also very proud of my team; they are
exceptional. I’m never disappointed in them. They
With telemedicine, I’m confident that it will open have always been dedicated health workers who
doors to a stronger relationship with the private support all our programs and are highly proactive.
sector. I know that we will be involving them in They are also very creative, often coming up with
the coming days, in the coming months, especially innovative ideas. You will be in good hands.
once we have fully established telemedicine in
our area. I’m genuinely looking forward to realizing all the
discussions we’ve had. Thank you so much to the
I continually stress to our City Health team that SeeYouDoc team, Dr. AJ, our WHO Philippines
our goal is to deliver results that will impact our partners, and supporters, to my dear team who are
communities positively and be sustainable in the on board. I eagerly await your accomplishments
long run. We hope to achieve a strengthened and significant achievements in telemedicine.
and more active community in terms of health
programs and services. It’s our wish that, Maraming salamat!
once we complete this second phase of the
partnership, we can institutionalize telemedicine - An excerpt from Parañaque City Health Officer
in Parañaque City, being one of the first to fully Dr. Olga Virtusio’s message, translated into
implement telemedicine in all our barangays. English, during the WHO Philippines Urban Health
This is how we demonstrate that health is a Project 2023 Kickoff Meeting.
crucial part of the city’s progress.
4
Acknowledgments
We extend our heartfelt gratitude to the WHO and their dedicated teams of doctors, nurses,
Philippines and their donors for their generous and barangay health workers (BHWs) who are
support in allocating resources to enhance the beneficiaries of the Urban Health Projects (2022,
health service delivery in Parañaque City through 2023). Their valuable insights into their operations
the Urban Health Projects. Special appreciation and willingness to embrace telemedicine services
goes to Ms. April David and Dr. Jojo Go for their have been instrumental. Special gratitude goes to
trust and invaluable guidance. Dr. Olga Virtusio and Dr. Ruben Ver Bombeta for
their leadership in rallying the City of Parañaque
Our appreciation also extends to the Department and their unwavering advocacy for telemedicine in
of Health, Department of Interior and Local alignment with the Universal Healthcare Act.
Government, PhilHealth, National Privacy
Commission, as well as the numerous implementing We would also like to thank our partners, Regnum
agencies and experts who have been instrumental Christi Philippines Medical Missions and Mano
in shaping the Philippines’ telemedicine policy. Amiga Academy, for collaborating with us on our
Their vision continues to drive the implementation recently concluded outreach program, Libreng
of telemedicine in our country, and their guidance Tuli, Konsulta, atbp (2023), and for providing data
has made the Urban Health Projects possible, and photos.
turning this roadmap into a reality.
Lastly, the success of this project is attributed to
We are deeply thankful for the dedicated efforts the passionate and capable contractual team
of the University of the Philippines Manila College who executed the project from its inception to
of Medicine - Health Informatics Unit and the completion. We extend our special thanks to Dr.
American Medical Association® in leading Arnulfo Rosario, Jr., Mr. Noel Del Castillo, Mrs.
research and documentation for telemedicine in Vanessa Del Castillo,, Ms. Marie Rose Ramos,
the Philippines and abroad. Their commitment to Mr. Isaiah Tismo, Ms. Jamie Floirendo, Ms.
making these resources accessible to the public Phoebe Cates Eustaquio, Ms. Ymereen Lalata,
is commendable. Ms. Daniella Druga, Mr. Bryan Vizcarra, Mr. Jay-
Ar Dagooc, Mr. Michel Jean Navarro, Mr. Saint
Our sincere appreciation goes to the nine Sunny Rosalia, Ms. Carla Galit, Dr. Binji Hussien
barangays (2022: Brgy. Moonwalk, Brgy. Sto C. Pangaibat, Mr. Carlo Cadaoas, and Ms. Argie
Niño, Brgy. Vitalez; 2023: Brgy. Don Bosco, Del Castillo for their integral roles as contributors
Brgy. Don Galo, Brgy. La Huerta, Brgy. Marcelo in the success of this project.
Green, Brgy. San Martin de Porres, Brgy. Tambo)
5
Abbreviations
ADHD Attention Deficit Hyperactivity Disorder
ADB Asia Development Bank
AI Artificial Intelligence
AO Administrative Order
BARMM Bangsamoro Autonomous Region for Muslim Mindanao
BAA Business Associate Agreement
BHW Barangay Health Worker
BNS Barangay Nutrition Specialist
CAHPS Consumer Assessment of Healthcare Providers and Systems
CCMC Cebu City Medical Center
CDC US Center for Disease Control and Prevention
CHD City Health Department
CHITS Community Health Information Tracking System
CHO City Health Officer
CPG Clinical Practice Guidelines
CPH Census of Population and Housing
CSO Civil Society Organizations
CWHS City Wide Health Systems
DBM Department of Budget & Management
DICT Department of Information and Communications Technology
DC Department Circular
DILG Department of Interior and Local Government
DOF Department of Finance
DOI Digital Object Identifier

6
DOST Department of Science and Technology
DPA Data Privacy Act RA 10173
DSL Digital Subscriber Line
EHR Electronic Health Records
ECG Electrocardiogram
ECQ Enhanced Community Quarantine
FDA Food & Drug Administration
GAA General Appropriations Action
HCPN Health Care Provider Networks
HD High Definition
HEPO Health Promotions Office
ICU Intensive Care Unit
ICT Information and Communications Technology
IHIS Integrated Health Information System
IRR Implementing Rules and Regulations
IATF Inter-Agency Task Force
IARTCT Inter-Agency Regional Telemedicine Coordination Team
JAO DOH-DILG-PHIC Guidelines on the Implementation of Telemedicine
in the Delivery of Individual-Based Health Services
KOFIH Korea Foundation for International Healthcare
KMITS Knowledge Management and Information Technology Service
KPI Key Performance Indicators
KYC Know-Your-Customer
LIPH Local Investment Plan for Health

7
LDRRMO Local Disaster Risk Reduction Management Office
LOINC Logical Observation Identifiers Names and Codes
LGU Local Government Unit
MA SeeYouDoc (MA) Analytics
MD Doctor of Medicine
MHO Municipal Health Officer
MN SeeYouDoc (MN) Medical Network
MOA Memorandum of Agreement
NEHTWG National eHealth Technical Working Group
NEHPMO National eHealth Program Management Office
NGA National Government Agencies
NTC National Telecommunications Commission
NPC National Privacy Commission
OHG Omnibus Health Guidelines
PAPO Philippine Alliance of Patient Organizations
PBBM President Bongbong Marcos
PAGASA Philippine Atmospheric, Geophysical and Astronomical Services Administration
PCPN Primary Care Provider Network
PCHRD Philippine Council for Health Research and Development
PH Philippines
PHAP Private Hospitals Association Philippines
PHIC PhilHealth
PRC Professional Regulation Commission
PTR Professional Tax Receipt

8
RA Republic Act
ROI Return of Investment
RTCT Regional Telemedicine Coordination Team
SARS Severe Acute Respiratory Syndrome
SHF Short Health Fund
SLA Service Level Agreement
SMART Specific, Measurable, Achievable, Relevant, and Time-bound
SMS Short Messaging System
UP University of the Philippines
UPM University of the Philippines Manila
UPM-NThC University of the Philippines Manila - National Telehealth Center
UHC Universal Healthcare
US United States of America

10
Executive Summary
Even before the pandemic, the Philippines faced current telemedicine policy in the interim,
significant challenges in its healthcare system. institutionalizing telemedicine adoption and
Regional and socioeconomic disparities persist, implementation by May 19, 2022. However,
including uneven distribution of resources and much of the infrastructure for adherence is yet
healthcare professionals, and governance issues to be implemented. Consequently, healthcare
impacting health budget utilization (Dayrit et al., providers have relied on their interpretations,
2018) and health service delivery in the country. leading to varying degrees of success.
The unique geography of the Philippines, with Telemedicine offers patients a multitude of
over 7,600 islands, poses logistical challenges in advantages, including time and cost savings
healthcare access. In rural areas, where 70% of by eliminating the need for in-person visits,
the population resides, limited access to quality overcoming transportation hurdles, enhancing
healthcare services is a significant issue. The convenience in accessing medical providers,
distribution of health facilities and providers facilitating improved communication with the
contributes to this problem, with only 13% of care team, enabling effective management of
healthcare providers and 40% of tertiary hospitals chronic conditions within the comfort of one’s
located in non-urban areas (National eHealth home, broadening access to specialized care often
Program, n.d.). Furthermore, Metro Manila, as the unavailable in remote or underserved regions, and
largest metropolitan area in the country, faces minimizing the risk of spreading or contracting
severe congestion and traffic issues, with 98 contagious diseases. It is most effective when
hours, or 4 full days, lost to traffic annually (Moody, applied in the following use cases: overcoming
2022, as cited in Philstar.com, 2022). logistical barriers, follow-up care, behavioral
health (AMA®, 2022). It may include real-time
The COVID-19 pandemic revealed a lack of audio/video, phone calls, and messaging, as well
preparedness on a national scale but also as store-and-forward technologies (Isip-tan, I. T.,
sparked ingenuity and presented an opportunity et al., 2020b, p. 3-4).
for improving healthcare service delivery,
including the case for adopting telemedicine. This Telemedicine is not without its challenges. While
roadmap aims to guide local government units in recognized as a valuable addition to healthcare
the successful implementation of telemedicine in services, it is not intended to replace on-site
the Philippines. (face-to-face) consultations, which remain the
gold standard in clinical care (DOH-NPC, 2020a).
In addition, the financial schematization of an
INTRODUCTION TO TELEMEDICINE adaptable and workable telemedicine benefit
package in the Philippine setting is an added
Telemedicine refers to the delivery of healthcare challenge to the long list of goals that PhilHealth
services, where physical barrier is a critical factor, must contend with in the coming years. The
by all health care professionals using information actual implementation itself presents a unique
and communication technologies for the exchange set of challenges that must be navigated during
of valid information for diagnosis, treatment and preparation.
prevention of disease and injuries, research and
evaluation, and for the continuing education Despite this, telemedicine is a necessary component
of health care providers, all in the interests of in pursuit of the Universal Health Care Act, which
advancing the health of individuals and their promotes the integration of health systems and
communities (DOH-DILG-PHIC, 2021, p. 3). the use of digital technologies for health services
(DOH-DILG-PHIC, 2021). Therefore, the question
As of September 2023, there is no official regarding telemedicine is not a matter of if but a
legislation regulating the practice of telemedicine matter of when.
in the Philippines. The DOH-DILG-PHIC
Joint Administrative Order 2021-0001 is the Telemedicine in the Philippines needs a dedicated
champion, a strategic plan with follow-through,
and concrete data for scalability.
11
TELEMEDICINE STEPS TO data mapped through LOINC (Khan, A. et al., 2006)

IMPLEMENTATION & SUSTAINABILITY with the use of crucial parameters like Syndromic
Data into a surveillance system (Adeleye, O. et al.,
Stumpf S. H., et al. (2002) reminds us that 2007). Overall, integrating telemedicine with other
implementation planning should follow a proper systems enhances overall patient care efficiency.
sequence, beginning with research, followed
by feasibility studies and implementation, with In addition, as handlers of potentially extensive
policy review occurring at the end of the path. volumes of sensitive data, telemedicine platforms
Often however, telemedicine projects are put that gather personal private information and
into action without prior feasibility studies or a sensitive personal data are obligated to adhere to
strong foundational understanding, which leads the Republic Act No. 10173 or the Data Privacy Act
to their failure even before they commence. This of 2012, necessitating the establishment of a Data
underscores the necessity for clear guidelines on Sharing Agreement between the telemedicine
the proper implementation of telemedicine. platform and the healthcare provider.
Implementers can refer to the Annex 2B:

Telemedicine Implementation Checklist for a quick TELEMEDICINE MONITORING & REPORTING
reference. A detailed discussion is available in
Chapter 2: Telemedicine Steps to Implementation Telemedicine, with its inherent digital nature,
& Sustainability of this guide. generates vast amounts of patient data and
interactions in real-time. For example, telemedicine
in real time retrieval of surveillance data based on
TELEMEDICINE PLATFORM syndromic geo spatial databases (Adeleye, O. et
al., 2007), can actually provide better treatment
A telemedicine platform is an integrated plans for the community. This allows better data
system of products and features that enables analysis in terms of health data collaboration
healthcare organizations to provide telemedicine among local government units. Effective use of
services. Key stakeholders include patients, this information holds potential for improving
doctors/physicians, other healthcare workers, healthcare delivery, patient outcomes, and
telemedicine operations/management team. In resource allocation, provided that an easy-to-use
the concept of the Universal Healthcare (UHC) system for managing and visualizing this data is
Act, a telemedicine platform is a requirement for accessible to key stakeholders.
the PCPN to offer telemedicine services within
the HCPN and as a basis for interacting with As of September 2023, the existence of the
patients, other providers, and vice versa. Telemedicine SWG and the development of the
guidelines for the telemedicine scorecard under
Since telemedicine platforms require extensive the DOH-DILG-PhilHealth are not yet in place.
data entry, it’s crucial to standardize its Therefore, a need for a well-defined interim metrics
architecture. Interoperability among healthcare system is present. Without a clear standard in
systems is essential for the seamless exchange place, monitoring a telemedicine operation and
and utilization of health data. An HL7-FHIR (R4) evaluating the success of its implementation
compliant telemedicine platform puts it in a unique becomes challenging. It is here that we look for
advantage for enhanced compatibility with other other players, particularly in the private sector to
platforms and PhilHealth reimbursements. help fill-in the gaps.
The telemedicine platform is just one piece of In December 2020, DOST-PCHRD launched the
the puzzle in a comprehensive public health Startup Research Grant, aligned with Republic
integration with other systems like the EMR, HIS Act 11337 (Innovative Startup Act), to support
and Laboratory references (Rosario, A. J. et al, research and development in the Philippine
2024). A well integrated telemedicine platform healthcare startup sector. Notably, it funded a
would be beneficial to a standardized laboratory privately-owned startup’s project to develop an
12
interactive telemedicine analytics platform, the

first of its kind in the Philippines.
The resulting platform, named SeeYouDoc (MA)

Analytics, and developed using recommended
KPIs from available telemedicine research, offers
a range of features, including a dashboard for an
overall organizational performance overview, an
appointment heat map, demographics of doctors
and patients, ratings and complaints tracking,
and revenue analysis. SeeYouDoc MA is currently
at Technology Readiness Level (TRL) 9, which
translates to commercial availability of the product
(DOST-PCHRD, n.d.b).
OUR RECOMMENDATION TO POLICY MAKERS
The road to a full telemedicine implementation is

still a long way from where we are today.
In our Stakeholder Interviews, we discovered that

challenges in adhering to telemedicine protocols
go beyond behavioral factors. Healthcare
providers often struggle due to understaffing
and excessive workloads. Their appreciation for
telemedicine is hindered by these challenges.
Additionally, implementing agencies lack
critical infrastructure components, such as the
Telemedicine SWG, the telemedicine scorecard,
and financial frameworks for reimbursement.
The disconnect between LGUs and government
agencies may require further investigation,
although it’s beyond our project’s scope.
One fundamental assumption is that the absence of

formal legislation governing telemedicine practice
in the Philippines worsens these challenges,
creating a ‘chicken and egg’ problem. Without a
law in place, adherence remains optional, and the
loop remains open.
The way forward is for telemedicine champions

to take decisive steps, confront the challenges
head-on, and relentlessly refine the telemedicine
system until it attains to the level of stability and
excellence we aspire to achieve. We ask for steps
to be taken to incentivize these champions and
support them however much we can.
13
Introduction
On Friday, July 21, 2023, President Ferdinand R. Though the pandemic highlighted a significant
Marcos Jr. issued Proclamation No. 297 finally opportunity for a more efficient service delivery,
lifting the State of Public Health Emergency common physical barriers and logistical disruptions
throughout the Philippines, after more than such as the nature of our topography also make
three years (PBBM, 2023). We may not yet access to healthcare difficult.
have a cure for COVID-19, but this proclamation
marks a significant milestone in our road to › The Philippines as an archipelago in the South-
recovery as a nation, and the conclusion of an East Asia Region comprises 7,641 segmented
era predominated by fear. islands and sustains a population of 109
million as of the 2020 Census (Philippine
Dayrit et al. (2018, p. xix), gives us a look into the Statistics Authority, 2021).
pre COVID-19 pandemic state of the medical
landscape in the Philippines. They explain › At present, 70% of the population living
that amidst widespread efforts to improve the in rural areas are still struggling with no
healthcare service delivery in the country, there or limited access to quality inpatient and
persist regional and socioeconomic disparities outpatient care services. Recent health
in its availability and accessibility. These include, demographics studies showed that the
among others: segmented distribution of the health facilities
and healthcare providers contribute largely
› A maldistribution of infrastructure and human to this alarming situation as exemplified
resources across the different regions, with by the fact that only 13% of healthcare
a bias towards Metro Manila and highly providers and 40% of tertiary hospitals are
urbanized cities. situated in non-urban areas; let alone that on
the average, the time it takes to travel to a
› The increased likelihood of health care local health facility usually takes around 39
professionals to find employment overseas minutes (National eHealth Program, n.d.).
than to find incentive to stay in the country.
› As its capital city, Metro Manila experiences
› Governance and implementation challenges a 43 percent congestion level and 98 hours
that continue to impact the utilization of the lost to traffic annually, which can be visualized
health budget, and as an example, more as spending four days of every year in traffic
than 50% of the total health spending was jams alone as documented in a research by
discovered to be out of pocket. insurance technology site GoShorty (Moody,
2022 as cited in Philstar.com, 2022).
» The proportion of out of pocket payment to
total health expenditure (more than 50%) › In addition, more tropical cyclones (TCs) are
has been historically high, compared to entering the Philippine Area of Responsibility
15–30% seen in emerging economies with (PAR) than anywhere else in the world. With
successful and more equitable health- the average of 20 TCs in this region per year,
financing strategies. Even in Asia, this about 8 or 9 of them cross the Philippines. The
proportion is high compared to 36.8% in Viet peak of the typhoon season is July through
Nam, 46.9% in Indonesia, 35.3% in Malaysia October, when nearly 70% of all typhoons
and 11.9% in Thailand (World Bank, 2016, develop (PAGASA, n.d.).
as cited in Dayrit et al., 2018, p 114).
1
Enterprise Architecture (EA) is the blueprint of an eHealth roadmap (not just telemedicine). Before we can begin with plans for
interoperability and health information exchange systems, it is important to note that EA is the main framework by which all integration
14
When the Department of Health (DOH) recorded

the first COVID-19 fatality in the country and the The main objective of this roadmap is
first death outside of China on February 2, 2020 to serve as a guide in the preparation,
(Luna, 2020), we saw how, in a span of a month, implementation, and monitoring of
our Filipino frontline healthcare workers quickly telemedicine within the context of
found themselves dangerously overburdened. Philippine local government units (LGUs).
Hospital beds became a scarce resource and As a secondary objective, it serves
patients with chronic but less severe cases were as a compilation of our insights into
reprioritized. The Philippines was simply not scalability, sustainability, best practices,
prepared for a calamity on the scale of COVID-19. common pitfalls to watch out for, and the
appropriate alignment with an Enterprise
As the possibility of a national economic collapse Architecture1.
grew ever more real, Republic Act No. 11469, also
known as the Bayanihan to Heal as One Act was
enacted by Former President Rodrigo Duterte on 1. The primary users of this roadmap are
March 23, 2020. This allowed the national budget the local government units (LGUs) at
to be shifted in an emergency to address the both the local barangay and city-wide
disruptions caused by the virus on the lives and or province-wide levels from primary
livelihood of the Filipino people. to tertiary care levels.
On March 28, 2020, the DOH and the National 2. Secondary users of this roadmap
Privacy Commission (NPC) issued Joint are telemedicine implementers and
Memorandum Circular No. 2020-0001, entitled program managers at all administrative
Guidelines on the Use of Telemedicine in COVID-19 levels, development partners, other
Response formally introducing telemedicine in government agencies, and various
a move to address the patients displaced by stakeholders from both nonprofit and
COVID-19 cases. In a collaborative effort, numerous for-profit sectors who may not be
telemedicine vendors from the private sector directly involved in service delivery but
promptly stepped in, hosting volunteer physicians actively participate in the planning,
in their platform, and even offering temporary free implementation, or monitoring of the
services. While it faced challenges in real-world telemedicine program.
application, the telemedicine initiative, combined
with public compliance in government and IATF 3. Lastly, the insights and
protocols, effectively alleviated the burden on the recommendations presented in this
healthcare system for a time. roadmap can also apply to private
practices that are considering
Though the threat of COVID-19 declines, much integrating telemedicine into their
of the challenges highlighted in this introduction current operations. Note that aspects
can still be felt today, many years later, and will specific to private practice are not the
remain to be catalysts for the next calamity, focus of this roadmap and adjustments
unless the focus is shifted. By learning from our should be made accordingly.
experiences, we ensure that the Philippines, as a
global example, responds to healthcare threats
with promptness, effectiveness, and resilience.
work is geared towards the supefluousity of health information across all networks and information systems whether Telemedicine,
EMR or HIS. It is imperative for an LGU to assimilate the plan architecture of local telemedicine to their existing or planned enterprise
architecture at the local level. EA is the glue of all integration systems.
Table of Contents
Quote from the Parañaque CHO — Urban Health Project 2023 1
Acknowledgments 4
Abbreviations 5
Executive Summary 10
Introduction 13
Disclaimer 22
Chapter 1: Introduction to Telemedicine 25
1.1 Telemedicine in the Philippines Today 25
A. Telemedicine First Questions 28
B. Common Uses and Benefits of Telemedicine 30
Benefits for Patients 31
Benefits for Physicians 32
Benefits for HCPNs 32
1.2. The Case for Implementation 33
A. Compliance with the DOH-DILG-PHIC JAO 2021-0001
for the Universal Healthcare Act 35
Responsibilities of the LGU 38
What Should Telemedicine Look Like? 38
B. Defining Minimum Investments of Telemedicine in LGUs 41
1.3. Financial Mechanism Situation 45
Who Funds the Telemedicine Implementation? 45
Financial Mechanism: A Note for Policy Makers 45
1.4. Understanding Barriers to Implementation 46
15
Chapter 2: Telemedicine Steps to Implementation & Sustainability 51
2.1. Introduction to the Telemedicine Road to Implementation 52
2.2. Preparation 53
Step 1: Identify 53
Objective 53
Action Items 53
Best Practices 54
Step 2: Recruit 55
The Core Team 55
The Physician Champion 57
The Care Team 57
Preparing for the LGU Telemedicine Operations Team 58
Objective 58
Action Items 59
Best Practices 60
Step 3: Define 61
SMART Goals 61
Objective 62
Action Items 62
Best Practices 63
Step 4: Scout 63
Vendor Evaluation Guide 63
On Contracting 3rd-Party Telemedicine Vendors 67
Objective 67
Action Items 67
Best Practices 68
16
Step 5: Decide 68
Objective 68
Action Items 68
Best Practices 69
Step 6: Contract 70
Objectives 70
Action Items 70
Best Practices 71
Step 7: Develop 71
The Telemedicine Service Capability Profile 71
Objective 72
Action Items 72
Best Practices 73
Step 8: Train 74
Objective 74
Action Items 74
Best Practices 75
Step 9: Engage 75
Patient Touch Points 75
Objective 76
Action Items 77
Best Practices 77
2.3. Implementation & Sustainability 78
Step 10: Launch 78
Objective 78
Action Items 78
Best Practices 79
17
Step 11: Evaluate 80
Objective 80
Action Items 80
Best Practices 81
Step 12: Scale 81
Expanding your Telemedicine Operation 81
Lobbying for a Telemedicine Ordinance 81
Lobbying for a Telemedicine Ordinance: Utilizing The Special Health Fund 83
Establish the LGU Telemedicine Operations Team 83
Demand Generation 84
Creating a Referral System 84
Objective 85
Action Items 85
Best Practices 86
Chapter 3: Telemedicine Platform 87
3.1 Introduction to the Concept of a Telemedicine Platform 87
3.2 Integration of Systems 90
Internal Integrations 90
External Integration via HL7-FHIR (R4) 92
3.3 Data Privacy & Security Compliances 93
Registration of Patients 93
Encounter between Patient and Healthcare Providers 94
Chapter 4: Telemedicine Monitoring & Reporting 95
4.1 Telemedicine Evaluation Situation 95
4.2 Development of a telemedicine analytics platform 98
The DOST-PCHRD Funds the Development of a Telemedicine Analytics Portal 99
SeeYouDoc (MA) Analytics 99
18
Chapter 5: Conclusion 103
5.1 A Retrospective 103
5.2 The Urban Health Projects in Parañaque City 105
A. The Challenge 106
B. Methodology 108
C. Findings 108
Urban Health Project 2023 109
Urban Health Project 2022 113
D. Results 117
What Went Well 117
What Could Have Worked Better 117
Outreach Component: A Note for Telemedicine Implementers 119
5.3 Recommendation for Policy Makers 120
Annexes 122
Annex 1A: Recommended Telemedicine Consultation Process Flow 123
Annex 1B: Principles of Telemedicine Practice 124
Annex 1C: Preparing for the Telemedicine Consultation 126
Annex 1D: Determining Internet Bandwidth Speed 127
Annex 2A: Telemedicine Implementation Feasibility Assessment Form 129
Annex 2B: LGU Telemedicine Implementation Checklist 138
Annex 2C: Sample Telemedicine Ordinance 141
Annex 2D: Sample Budget Proposal for the Telemedicine Ordinance in Parañaque City 146
Annex 4A: SeeYouDoc MA Analytics 148
References 154
19
22
Disclaimer
Development and Funding This roadmap was Independence of Views The views and
developed by the World Health Organization recommendations expressed in this roadmap
Philippines as part of the Technical Assistance are solely those of its contributors and may not
to Support the Expansion of Telemedicine in the necessarily reflect the decisions or policies of
Remaining Barangays of Parañaque under the the World Health Organization nor the World
Urban Health Project (2023). It was funded by the Health Organization Philippines. It is important
World Health Organization Philippines, with WHO to note that the contributors were contracted in
Registration No.: 2023/1363555-1 and Purchase this project by the World Health Organization
Order No.: 203160381-1. Philippines, but the content is independent and
based on their research and expertise.
Disclaimer and Clarification This roadmap is
not intended to provide medical, legal, financial, For questions, you may send an email to
or consulting advice. It should not be considered medical@seeyoudoc.com, currently led by Chief
a substitute for the advice of a licensed attorney Medical and Marketing Officer (CMMO) Dr.
or other certified consulting professionals. While Arnulfo Jr. Rosario, MD, MPH, CCS.
we use the term ‘roadmap,’ it is essential to clarify
that this document is not designed to replace or
supersede existing telemedicine or healthcare
policies and laws in the Philippines. These policies
and laws are issued by governing bodies and
accredited entities, including but not limited to the
Department of Health, the Department of Interior
and Local Government, the Philippine Health
Insurance Corporation, the National Telehealth
Center, the Telemedicine SWG, the University
of the Philippines Manila, among others. This
roadmap is a compilation of our experiences and
best practices in implementing telemedicine in the
Philippine LGU setting. It does not comprehensively
address all potential legal and other issues that
may arise when acquiring health information
technology products or services. Every healthcare
organization is unique and must consider its
specific circumstances and requirements, which
cannot be fully contemplated or addressed in this
roadmap. Before entering into any legally binding
agreements, a healthcare organization should
seek legal counsel from an experienced attorney.
IN PHOTO: A telemedicine encounter with an obscured patient during the WHO Urban Health Project (2022) in Parañaque City.
Telemedicine saw increased use during the pandemic, but remains relatively unfamiliar, especially in rural areas with limited internet access.
Introduction
to Telemedicine
1.1 Telemedicine in the Philippines Today
As of September 2023, there is no official

legislation regulating the practice of telemedicine Refers to the delivery of healthcare
in the country. services, where physical barrier is a critical
factor, by all health care professionals
The current telemedicine policy recognized by the using information and communication
Department of Health is the DOH-DILG-PHIC Joint technologies for the exchange of valid
Administrative Order (JAO) 2021-0001 Guidelines information for diagnosis, treatment and
on the Implementation of Telemedicine in the prevention of disease and injuries, research
Delivery of Individual-Based Health Services and and evaluation, and for the continuing
is referenced extensively throughout this material. education of health care providers, all in
the interests of advancing the health of
This JAO 2021-0001 follows the WHO definition individuals and their communities (DOH-
for telemedicine which: DILG-PHIC, 2021, p. 3).
Telemedicine offers several clear advantages. It Furthermore, though telemedicine has a wide use
simplifies access to medical care by eliminating in teleconsultation, it is also a big part of telehealth
logistical barriers and allows for convenient in general where various applications have
scheduling of appointments. Communication been implemented for local health innovations
via chat or video provides enhanced privacy (Rosario, A. J., et al., 2023). This puts telemedicine
compared to in-person consultations. Additionally, and telehealth in the center of remote health
it enables the easy retrieval of documents, management and development.
including prescriptions.
Telemedicine can be synchronous or asynchronous
Examples of telemedicine applications include based on its timing classification as defined in
real-time audio or video transmissions, simple the JAO 2021-0001. Synchronous telemedicine
phone calls between doctors and patients, or real-time communication is the standard
and messages via SMS, chats, or emails for timing classification. The use of asynchronous
scheduling follow-up on-site sessions (Isip-tan, telemedicine is recommended to complement
et al., 2020b, p. 3-4). the synchronous model, particularly in larger-
resourced facilities, but it should not be used as a
stand-alone framework.
26
27
TABLE 1.1 Types of Telemedicine
T YPE DEFINITION
Synchronous Refers to real-time telephone or live audio-video communication that

Telemedicine connects physicians and patients in different locations via smartphone,
tablet, or computer. In this telemedicine modality, involved individuals are
simultaneously present for the immediate exchange of information, as in
the case of videoconferencing (US CDC; WHO).
Asynchronous Refers to "store-and-forward” technologies where messages, images,

Telemedicinea or data are collected at one point in time and interpreted or responded to
later. It also includes remote patient monitoring or the direct transmission
of a patient’s clinical measurements from a distance to their health care
provider. (US Centers for Disease Control and Prevention [CDC]; American
Medical Association [AMA®]).
Note: Adapted from the DOH-DILG-PHIC (2021), Section V: Definition of Terms
a
The use of asynchronous telemedicine is recommended when “healthcare providers belonging to secondary, tertiary and
specialized levels of care should be able to provide asynchronous telemedicine for assistance to another health care provider,
and/or refer back patients to their assigned primary care provider” (DOH-DILG-PHIC, 2021, p. 5).
While telemedicine experienced a surge in own interpretations to the best of their ability and
usage during the pandemic, its concept and within their funding capacity, leading to differing
use remain relatively unfamiliar. This becomes iterations and patient experiences, with varying
particularly evident as you venture into rural areas degrees of success.
where essential infrastructure, such as internet
connectivity, is still lacking. However, even within Despite the existence of official guidelines, a
major cities, public health facilities rarely have a proven and well-defined telemedicine model to
telemedicine component in their service delivery. replicate was also lacking. Consequently, both
patients and physicians did not grow confidence
The JAO 2021-0001 outlines a collaborative in the technology, hindering its public reception.
effort between healthcare provider facilities and
governing bodies, aiming to support the initiative. Telemedicine in the Philippines requires a dedicated
This support includes aspects like PhilHealth’s champion. A strategic plan may not be sufficient
telemedicine reimbursement mechanism and the without actual follow-through and without
development of a Code of Ethics, Clinical Practice leading by example. At the very least, telemedicine
Guidelines (CPG), and certification programs for needs a well-defined path, illuminated by actual
physicians, led by the National TeleHealth Center numbers for scalable implementation and broader
(NTC), among others. However, much of this coverage. Moving forward, it’s crucial to sustain
infrastructure has yet to be initiated. this momentum to prevent redundancy and the
need to start all over again.
As a result, healthcare provider facilities from both
the private and public sector had to rely on their
28
A. TELEMEDICINE FIRST QUESTIONS
During the COVID-19 pandemic, a series of Notably, this literature also served as the foundation
literature on telemedicine was developed by for the development of the JAO 2021-0001,
volunteer faculty, alumni and students from the making it a valuable resource for understanding
University of the Philippines Manila College of some of its key concepts. Below is a compilation
Medicine - Health Informatics unit. Their primary of their responses which seeks to address the first
goal was to assist Filipino physicians in their questions asked about telemedicine practices in
transition to telemedicine, for Filipino lawmakers the Philippines.
to consider gaps in legislation on telemedicine, as
well as to help medical educators in developing
training materials on the subject.
TABLE 1.2 Telemedicine First Questions
QUESTION RESPONSE FROM THE UP MANILA - HEALTH INFORMATICS UNIT
QUESTIONS FROM PHYSICIANS
Who can practice Any physician with a valid license from the Philippine Professional
telemedicine in the Regulation Commission (PRC) can engage in telemedicine with patients
Philippines? physically residing in the Philippines.
What are Telemedicine requires proficiency in digital communication skills, clinical

the minimum acumen and knowledge of technology and equipment to be used, while
competencies to adhering to ethical practice.
practice telemedicine?
What are the The JAO 2021-0001 has specified a set of minimum investments for
minimum workstation telemedicine infrastructure for LGUs which supersedes the information
requirements to set up in this response.a
for telemedicine?
How can physicians › Choose which patients will benefit from a teleconsultation.
help patients Inform the patients of the hardware, software, internet connection
prepare for the and room/environment requirements.
teleconsultation?
› Discuss if the patient will be accompanied during the
teleconsultation and if certain maneuvers for physical examination
need to be done.
› Orient the patient of the process flow before, during and after the
telecommunication.
29
QUESTION RESPONSE FROM THE UP MANILA - HEALTH INFORMATICS UNIT
QUESTIONS FROM PHYSICIANS
How can we For a safe teleconsultation, ensure quality of care, verify identity of
safeguard both the participants, protect confidentiality, obtain consent, prepare contingency
patient and physician plans in case of disconnection and emergencies, document the
in a teleconsultation? encounter properly, issue a valid e-prescription, encourage feedback
and monitor outcomes.
How can physicians › Healthcare organizations may create implementation groups to assist
ensure that healthcare professionals as part of a digital technology strategy.
teleconsultations
empower patients › Teleconsultation with the following may also help: two-way
and support self- communication, analysis of patient-generated health data, tailored
management? education and individualized feedback.
› Individualized health coaching and telemonitoring were shown to be

of help in management and improvement of some chronic diseases.
› Multiple touchpoints during implementation can maximize the

impact of telemedicine.
QUESTIONS FROM PATIENTS
What is the workflow The physician must first prepare the equipment, location, records and
in a typical patient- secure consent. After communicating an agreeable agenda, conducting
to-physician the virtual history and physical exam, and getting patient feedback, a
teleconsultation? summary and plan should be discussed with the patient. Afterwards,
the physician should complete the documentation.
How can patients Patient concerns on technology are usually rooted in lack of familiarity
be advised about and uncertainty of using technology correctly. These may be addressed
the limits of by proper explanation and demonstration. Discuss the issue of
teleconsultation? recording the teleconsultation with patients as doing so without consent
can harm the physician-patient relationship.
Patients may feel that teleconsultation is inferior as it lacks physical

human interaction. Promoting a natural environment may help improve
patient perception on teleconsultation. Explaining the intrinsic limitations
of telemedicine may also properly set the expectations of the patient
Note: Adapted from Isip-tan, et al., 2020a, 2020b, 2020c
a
Refer to Chapter 1-B of this document: Defining Minimum Investments of Telemedicine in LGUs, for the minimum
telemedicine setup required for LGUs under the DOH-DILG-PHIC JAO 2021-0001.
Note that any subsequently published official legislation from the Philippine Government may override any
information presented.
30
B. COMMON USES AND BENEFITS OF TELEMEDICINE
While the scope of telemedicine can sometimes

seem ambiguous, it is most effective when applied
in the following use cases:
TABLE 1.3 Telemedicine Use Cases
USE CASE E X AMPLES
Overcoming › Access care from the convenience of the patient’s home

Logistical Barriers
› For patients who face mobility barriers and lack a caregiver or
assistance with transportation to the doctor’s office
› Urgent care for established patients with low-risk, infectious diseases,

such as conjunctivitis or urinary tract infection
› For long-term patients who are temporarily relocated out of state
› Pre-orthopedic surgery preparation
› Expand access to and expedite clinical trials
Follow-up Care › Patients on treatment protocols who need close follow-up care and
multiple visits to ensure compliance and manage medication
› Care for chronic and complex conditions, including virtual consults on

lab results, symptom triage, lifestyle management, and remote patient
monitoring (RPM) check-ins
› Post-operative wound care
› Group education consults with prediabetic and diabetic patients on

healthy eating, exercise, and wellness tips
Behavioral Health › Address shortages in local or on-site mental health services in rural or
underserved populations by connecting patients to a specialist
› For routine follow-ups with anxiety, depression, and ADHD patients

who are adjusting to new medications
› Routine virtual psychotherapy appointments
Note: From the AMA® Telehealth Implementation Playbook (2022), p. 11.

31
BENEFITS FOR PATIENTS
Luz (2019, as cited in Isip-Tan, I. T. et al., 2021c) › To advise on the choice of specialists for
has called for preserving humanism while using specific cases.
telemedicine to improve medical care. He believes
that telemedicine will not fully replace traditional › To reduce hospitalization time - such as when
care and that the first visit should be in person. monitoring patients after discharge.
He then enumerates the following circumstances
where telemedicine may be useful: › To facilitate or redirect overwhelmed public
healthcare in cases where there is a long
› To reassess or monitor known patients. Such waiting for a consultation.
as when to adjust or check for medications
adherence, or answer simple questions. › To help patients in remote regions where there
are no access to healthcare resources; such
› To share information on additional tests, patients can receive general guidance as in
especially when these are normal. The patient cases of diarrhea, fractures, childbirth, trauma
does not have to go back to the office just and other ordinary situations.
to know that everything is normal. To avoid
unnecessary hospital visits, such as to get In the Omnibus Health Guidelines (OHG) (2022)
results of simple tests, in which case medical issued by the DOH for each life stage, the use of
advice can be given at a distance, saving time telemedicine is explored:
and discomfort in addition to reducing costs.
TABLE 1.4 Telemedicine Use per Life Stage based on DOH Omnibus Health Guidelines (2022)
LIFE STAGE DEFINITION USE OF TELEMEDICINE
Children Refers to a person No mention.

from newborn to below
10 years of age.
Adolescents Refers to a person Telemedicine can be provided when a physician

between the ages of is physically inaccessible (e.g. such as during a
10 to 19 years of age national emergency with community quarantine
who is in transition from in effect, among others) and for the management
childhood to adulthood. of chronic health conditions, or follow-up
(RA No. 10354 “The consultations after initial treatment (DOH-DILG-
Responsible Parenthood PhilHealth Joint Administrative Order No. 2021-
and Reproductive Health 0001 “Guidelines on the Implementation of
Act of 2012”). Telemedicine in the Delivery of Individual-Based
Health Services”).
32
LIFE STAGE DEFINITION USE OF TELEMEDICINE
Adults Refers to an individual Adults are encouraged to report the results

aged 20 years to 59 of their self-monitoring or self-testing to their
years and 11 months. healthcare providers, whether through a physical
consult or through telemedicine, in order to
receive timely and appropriate clinical diagnosis
and management.
Elderly Refers to a person at Senior citizens are encouraged to report the

least 60 years old (RA No. results of their self-monitoring or self-testing
9994 “Expanded Senior to their healthcare providers, whether through
Citizens Act of 2010”. a physical consult or through telemedicine, in
order to receive timely and appropriate clinical
diagnosis and management.
Note: Adapted from the DOH DC 2022-0344 (2022b); Definitions from the DOH AO 2022-0018 (2022a).
BENEFITS FOR PHYSICIANS BENEFITS FOR HCPNS
Ghia, et. al (2013) conducted a study in rural In Module 9 Lecture 3: Implementing Telemedicine
India to understand the benefits of telemedicine (retrieved September 12, 2022 from DOH-
for physicians in their clinical workflow. A total KMITS), DOH highlights the ability of telemedicine
of 300 completed e-surveys were answered by to connect services within the HCPN. They
physicians of varying specialties. The following explain that telemedicine will enable hospitals
list of benefits were acknowledged: obtaining and healthcare facilities with online services to
laboratory results; making appointments; link their health services in their network such
transmission of ECG, X rays and still images; as but not limited to: EMR, triage, frontdesk and
telephonic consultation for patients, health consultation services.
education, monitoring patients at home (follow
up), preoperative services, obtaining second In addition, telemedicine can make facility public
opinions and referral of patients for tertiary care. information more accessible, which is useful
when addressing concerns such as searching for
Furthermore, they explained that web-enabled available beds, searching for an ICU or available
telemedicine systems can help improve the facilities, and searching for a specific type of
delivery of health care consultations to patients doctor or specialty.
in remote areas, who often do not get access to
highly specialized health care systems, provided
these patients can be ensured access.
33
1.2 The Case for Implementation
It’s important to clarify that telemedicine is not social networking “friend” with a patient.
meant to replace an on-site consultation with Such online “friendships” compromise the
physicians at a private facility. While telemedicine physician-patient relationship, leading
is encouraged, the gold standard for clinical care to interactions that are extraneous, do
remains to be face-to-face consultation (DOH- not prioritize the patient’s therapeutic
NPC, 2020a). interests, or lead to problematic physician
self-disclosure whether it is intentional or
Ethically, telemedicine is also not without its inadvertent (Isip-tan, et al., 2020e, p 6).
challenges. For example:
› Malpractice risks These include failure to
› Potential marginalization While telemedicine diagnose, negligent treatment, and medication
can make healthcare accessible, there are cases. These stem from miscommunication,
those who will be disenfranchised because poor image qualities, and lack of proper
of knowledge gaps, equipment costs and documentation or workflow protocols (Isip-
internet bandwidth. (Langarizadeh, 2017 as tan, et al., 2020e, p 9).
cited in Isip-tan, et al., 2020e).
» In telephone medicine, the most common
» In the validation of this roadmap, one of allegation was failure to diagnose, followed
our target implementation sites, Brgy. by negligent treatment, and medication
Moonwalk, Parañaque City emphasizes related cases. The leading error type was
that: “It’s less common for patients in mission poor documentation while faulty triage
sites to have access to telemedicine due to decisions came at a close second due to
limited internet connectivity. Face-to-face incomplete history taking over the phone.
(on-site) consultations are needed for lab Lack of workflow policies and protocols
exam results and for symptoms that can’t result in dropped messages and delayed
easily be described through video calls, responses to patients (Katz, et al., 2007).
such as stomach ache or stomach rigidity.”
» Other causes of malpractice in telemedicine
› Social media risks The following need to are lack of proper informed consent,
be considered when using social media violations of confidentiality and data
platforms for telemedicine: patient privacy privacy, and negligence from online or
and security, data ownership and possible telephone prescription. It is very common
erosion of the patient-physician relationship to give telephone prescriptions to a patient
and professional boundaries (Isip-tan, et al., complaining of a seemingly mild symptom.
2020e, p 5). For example: Like conventional medicine, data acquired
in telemedicine must be handled with
» Although patients have the right to retract utmost care. Any breach in security may
their consent, once an image has been compromise the data stored in it and may
uploaded to social media, retrieving all cause disclosure of sensitive information
possible copies becomes impossible (Caryl, 1997).
(Palacios-Gonzáles, 2015), especially
in case of a data breach (Isip-tan, et al.,
2020e, p 6). The case for the implementation of telemedicine,
however, remains. All projects come with their
» Establishing a social media relationship, own set of challenges that can either be mitigated
for example to add a patient as a “friend” or eliminated. It is a matter of creativity and
or ask a patient to add a physician as a sound judgment as to what action is appropriate.
“friend” is ethically questionable (Denecke, For example:
2015; Chretien, 2013). This is because
the professional boundaries of such › A guided approach, such as the framework
interactions become unclear. Guseh (2009) recommended in Chapter 02, ‘Telemedicine:
and Chretien (2013) advise physicians Steps to Implementation & Sustainability,’
to never extend a request to become a coupled with a self-assessment of challenges
34
and opportunities, contributes to the success Section 19 of Republic Act (RA) No.
of implementing telemedicine services in 11223, otherwise known as the “Universal
healthcare facilities. Health Care (UHC) Act,” provides that
the Department of Health (DOH), the
» If a facility sorely lacks infrastructure Department of the Interior and Local
to implement telemedicine, such as Government (DILG), the Philippine Health
equipment and internet access or has other Insurance Corporation (PhilHealth), and
more pressing priorities, those should be the local government units (LGUs) shall
addressed first. endeavor to integrate health systems
into province-wide and city-wide health
› Capacitating health care providers (i.e. primary systems (P/CWHS) to ensure effective
to tertiary and specialty care providers) on and efficient delivery of population-based
the appropriate use of telemedicine and and individual-based health services, and
provision of response activities to ensure safe, health systems operations.
coordinated, and integrated care (DOH-DILG-
PHIC, 2021, p. 3). Corollary to the operationalization of this
strategy, Section 18.1 of the Implementing
» The physician should be aware and respect Rules and Regulations (IRR) of the said Act
difficulties that may arise with technology, provides for remote access and delivery of
and thus must be prepared to recommend individual-based health services through
in-person consultation when connecting via the use of digital technologies for health.
telemedicine is impossible and in cases of From recent events of public health concern
emergency (Isip-tan, et al., 2020e, p 4). such as the coronavirus disease 2019
(COVID-19) pandemic and other health
› Even though face-to-face is the gold-standard, threats, one digital health technology that
there are steps that can be taken to achieve has been widely adopted to ensure access
a high quality teleconsultation and projecting and delivery of continuous, coordinated,
a natural environment. This is to ensure that and integrated individual-based health
telemedicine would not be inferior to in-person services and information is telemedicine
consult (Isip-tan, et al., 2020e, p 10). (DOH-DILG-PHIC, 2021, p 3).
› Concerning malpractice risks, these can

be mitigated by putting in place workflow
policies and protocols such as guidelines In March 2021, Fernandez-Marcelo MD and her
on effective communication, accurate team presented their study in the role of Telehealth
documentation, express consent policies, in the Universal Health Care (UHC) Roadmap.
and proper handling of messages and calls She details a parallel and stepwise approach to
(Isip-tan, et al., 2020e, p 10). the implementation of telehealth for UHC, in the
form of a strategy roadmap, and a risk-based
Issues concerning implementation are one of the regulatory framework. For the detailed steps and
key factors that hinder the realization of the value more information, please refer to their upcoming
of telehealth in improving healthcare processes. publication Beyond COVID-19: Telehealth for
In the Philippines, the passage of the Universal universal health care: guiding principles and
Health Care (UHC) Act (RA 11223) recognized the recommendations for a parallel and stepwise
importance of maximizing telehealth solutions in approach to local and nationwide implementation.
making health services available, accessible, and
affordable for all Filipinos. Utilizing telehealth to › Strategy roadmap towards scaling up
strengthen the Philippine health service delivery and mainstreaming of telehealth solutions
system spans nearly two decades of advocacy Fernandez-Marcelo MD discusses a plan to
(Fernandez-Marcelo, 2021). advance eHealth and telehealth initiatives in
the Philippines. It emphasizes leadership and
governance, proposing the establishment of
an eHealth Policy and Coordinating Council.
35
Strategy and investment priorities include › Risk-based regulation for telehealth solutions
articulating health priorities, developing an implementation Fernandez-Marcelo MD also
eHealth Enterprise Architecture, and allocating outlines a strategy for eHealth regulation
budget percentages for eHealth activities and risk management. It emphasizes the
and research. Standards and interoperability use of risk-based regulation for telehealth
are crucial, with a focus on clinical practice solutions, aligning with international practices.
guidelines and the Philippine Health Information The typology of telehealth solutions is used
Exchange. Infrastructure improvements and to determine the level of regulation, with a
consideration of environmental impacts are focus on those directly impacting patient
suggested. The need for education, training, care. Risks and risk controls are categorized
and accreditation of the eHealth-telehealth into pre-HCPN, ready for HCPN, and in-
workforce is highlighted, along with the HCPN phases, with a strong emphasis on
importance of continuous training and training health workers and patients, ensuring
curricular enhancements. quality standards, and meeting technical
requirements. The goal is to prepare providers
and telehealth solutions for participation in a
Health Care Provider Network (HCPN).
A. COMPLIANCE WITH THE DOH-DILG-PHIC JAO 2021-0001

FOR THE UNIVERSAL HEALTHCARE ACT
The following is an outline of the DOH- Telemedicine in the Delivery of Individual-Based

DILG-PHIC Joint Administrative Order 2021- Health Services and its technical concepts:
0001 Guidelines on the Implementation of
TABLE 1.5 Technical Outline of the DOH-DILG-PHIC JAO 2021-0001
CONCEPT SUMMARY
Objective This Order institutionalizes the adoption and implementation of telemedicine

as an integral mode for the delivery of individual-based health services.
More specifically, it aims to:
› Provide the standards and guidelines for telemedicine;
› Define the minimum investments and financing mechanisms in telemedicine; and
› Set the implementation governance that will direct, coordinate, and guide the
LGUs, public and private health care providers, and stakeholders in the adoption
and use of telemedicine.
Scope This Order shall apply to the implementation of telemedicine across the country;
and shall cover:
36
CONCEPT SUMMARY
› all public and private, national and local health care providers regulated by
DOH and PhilHealth,
› medical associations and specialty societies, pharmaceutical outlets,

telemedicine service providers
› all patients and individuals who will consult through telemedicine,
› all LGUs (i.e. provinces, cities, and municipalities),
› all national, regional, local and branch offices under the DOH, DILG,and
PhilHealth, Food and Drug Administration (FDA), Department of Information
and Communications Technology (DICT), Professional Regulation Commission
(PRC), National Privacy Commission (NPC), University of the Philippines Manila
— National TeleHealth Center (UPM-NThC), and all others concerned.a
General 1. The provinces, highly urbanized cities (HUCs), and independent component
Guidelines cities (ICCs) that committed to integrate their local health systems shall adopt
and implement telemedicine technologies in the delivery of individual-based
health services within their defined catchment area that will require:
a. Organizing telemedicine services within their health care provider

networks (HCPN);
b. Capacitating health care providers (i.e. primary to tertiary and specialty care
providers) on the appropriate use of telemedicine and provision of response
activities to ensure safe, coordinated, and integrated care;
c. Promoting telemedicine among their constituents to ensure steady demand

for these services;
d. Providing the necessary infrastructure and other operational requirements

to accommodate their current needs; and
e. Issuing policies, but not limited to, ordinances to ensure budgetary support.
2. The implementation of telemedicine in the delivery of individual-based health

services shall be a collaboration among DOH, DILG, and PhilHealth, together
with DICT, PRC, NPC, UPM-NThC, LGUs, medical associations, specialty
societies, patient groups, health care providers, and other stakeholders.
Timeline The provinces, HUCs, and ICCs shall establish integrated and coordinated LGU
telemedicine services, within one (1) year from the effectivity of this Order, that
reference and complement the (a) service delivery design of HCPN as provided
under DOH AO No. 2020-0019, and (b) service classification of individual-based
health services as provided under DOH AO No. 2020-0040.b
Published: May 19, 2021

37
CONCEPT SUMMARY
Funding Costs for the organization of LGU telemedicine services shall be charged using their
own administrative funds.
Health care provider networks or any of its component health facilities shall shoulder
all costs related to the engagement of a third-party telemedicine provider using
their own administrative funds.
Violations Violation, complaints and possible sanctions that may be imposed shall be in
and accordance with laws and rules such as, but not limited to:
Complaints
1. Sections 22-29 of RA 2382 (The Medical Act of 1959) and the PMA Code
of Ethics;
2. Sections 10-15 of RA 9711(FDA Act of 2009) and other relevant issuances

from FDA;
3. Article VI, Section 44 and Article VII, Section 45-46 of RA 10918

(Philippine Pharmacy Act);
4. Rule XII, Section 51 and Rule XIII, Sections 52-65 of RA 10173

(Data Privacy Act 0f 2012) and other relevant issuances from NPC;
5. Article 2176 of the Civil Code;
6. Article 365 of the Revised Penal Code; and
7. All other laws, as applicable.
Note: Adapted from the DOH-DILG-PHIC (2021)
a
In the case of Bangsamoro Autonomous Region for Muslim Mindanao (BARMM), the implementation of telemedicine in the
delivery of individual-based health services under the integrated P/CWHS shall be in accordance with Article IX, Section 22
of RA11054, otherwise known as the “Organic Law for the BARMM” and subsequent laws and issuances. Likewise, in the
adoption by the Ministry of Health - BARMM of its own guidelines for Telemedicine, the same shall be consistent with the
provisions of this Order and other subsequent issuances, and in coordination with the DOH.
b
This Joint Administrative Order shall take effect after fifteen (15) days following its complete publication in a newspaper of
general circulation and upon filing three (3) certified copies to the University of the Philippines Law Center.
38
RESPONSIBILITIES OF THE LGU 8. Comply with existing or applicable laws, rules

and regulations on contracting third-party
Section VIII of the JAO 2021-0001 specifies the telemedicine providers, if applicable;
role and responsibilities of the LGUs within the
telemedicine network: 9. Report technical and other operational issues,
concerns, and/or problems that may arise in
1. Lead and ensure the adoption and the implementation of telemedicine services to
implementation of telemedicine services the Regional Telemedicine Coordination Team
within their P/CWHS based on the standards for appropriate action; and
and guidelines as stipulated in this Order and
any subsequent updates or changes hereto; 10. Provide relevant inputs and feedback to further
improve the adoption and implementation of
2. Provide the needed resources, investments, telemedicine services at the local level.
and support mechanisms to facilitate
the institutionalization and seamless
implementation of telemedicine services WHAT SHOULD TELEMEDICINE LOOK LIKE?
within their P/CWHS;
The following illustration outlines the planned
3. Ensure proper complementation of efforts at structure of telemedicine implementation in the
the local level; country, as explained in Module 9 Lecture 3:
Implementing Telemedicine (retrieved September
4. Create an LGU Telemedicine Operations 12, 2022 from DOH-KMITS) in their cascade of the
Team that will collaborate with the Regional JAO 2021-0001:
Telemedicine Coordination Team in the
implementation of telemedicine services
within their P/-CWHS; 1. DOH-DILG-PHIC
The Secretaries of the DOH and DILG, and
5. Assist KMITS and the Regional Telemedicine the President and Chief Executive Officer of
Coordination Team in the monitoring of the PhilHealth, in consultation and coordination
implementation/presence of LGU telemedicine with interagency eHealth partners and
services characteristics; concerned stakeholders, shall provide overall
policy directions and oversight relating to the
6. Ensure efficient generation and monthly implementation of telemedicine in the delivery
submission of implementation’s progress of individual-based health services.
status to the Regional Telemedicine
Coordination Team through the LGU a. Telemedicine Sub-Working Group (SWG)
Telemedicine Operations Team; Under the DOH-DILG-PHIC, the Telemedicine
SWG was created to ensure Performance
7. Act as both personal information controller and Monitoring and Evaluation of telemedicine
processor, and ensure the security, integrity, capacities in health care provider networks.
confidentiality, and availability of telemedicine They will function under the strategic
data being collected, processed, maintained, guidance of the Interagency National eHealth
transmitted or exchanged through their Technical Working Group (NEHTWG).
integrated health information systems and
LGU telemedicine referral systems, uphold the Specifically, they are assigned to (a) review
rights of the data subjects, adhere to general and monitor the progress of implementation
data privacy principles, and observe the of telemedicine services; (b) conduct the
requirements for lawful processing, pursuant necessary consultations and coordination
to RA 10173, otherwise known as the Data with concerned stakeholders; and
Privacy Act of 2012, and other existing or (c) submit monthly assessment and
applicable laws, rules, and regulations; accomplishment reports to the NEHTWG
for performance monitoring and evaluation
(DOH-NPC, 2020b).
39
i. The Telemedicine SWG comprises policy 3. Local Government Units (LGUs)

and technical experts on telemedicine
from relevant agencies and organizations. a. LGU Telemedicine Operations Team
Refers to a group of assigned health and
These are the Lead Agencies (DOH, DILG, non-health personnel in the LGU who
PhilHealth), and Member Agencies: Dept. prepare for and respond to any telemedicine
of Information and Communications referral for a patient as coordinated by the
Technology (DICT), Professional referring health care provider that provided
Regulation Commission (PRC), National the telemedicine consultation (JAO 2021-
Privacy Commission (NPC), National 0001, p 3). A telemedicine response could
Telehealth Center (NTC), Food and Drug be in the form of transporting a patient to
Administration (FDA), Private Hospitals a physical health facility, purchase and
Association Philippines (PHAP), Philippine delivery of medicines, coordination for
Medical Association (PMA), Philippine laboratory and diagnostics depending on
Alliance of Patient Organizations (PAPO), the capacity of the LGU as explained by the
other Medical Associations & Specialty DOH in Module 9 Lecture 3: Implementing
Societies, and LGUs. Telemedicine (retrieved September 12,
2022 from DOH-KMITS).
b. National eHealth Program
Management Office (NEHPMO) i. It comprises a team from the Provincial/
An existing office from the DOH- City Health Office (healthcare-focused)
KMITS, serves as the overall technical and Local Disaster Risk Reduction and
and administrative secretariat on all Management Office (logistics-focused).
matters relating to the implementation of
telemedicine. b. Healthcare Provider Networks (HCPN)
i. The HCPNs comprises a Primary Care

2. Inter-Agency Regional Telemedicine Provider Network and General Care
Coordination Team (IARTCT) (Secondary and Tertiary) Hospitals.
Each region will have a Regional Telemedicine
Coordination Team (RTCT) that will make up c. Apex Hospitals
the IARTCT. Ensure proper complementation
of efforts at the local level; d. Specialty Care (National Specialty Centers
and other types of Specialty Care)
The RTCT shall provide administrative,
coordination, TA or support, including resolution
of technical and other operational issues and/ 4. Primary Care Provider Network
or problems, lead the evaluation of third-party
telemedicine providers, with the assistance of a. Barangay Health Units/Stations
KMITS, and conduct performance monitoring
of telemedicine service operations of the LGU b. Any Primary Care Facility
within their jurisdiction, in coordination with
the LGU Telemedicine Operations Team.
a. The RTCT comprises the (ICT) personnel

from the DOH Center for Health
Development, Regional Offices of the DILG
and PhilHealth, and the designated apex
hospital(s) of an HCPN: the Regional DOH
Office, Regional PhilHealth Office, Regional
DILG Office, Representatives of Designated
Apex Hospitals within their jurisdiction.
40
FIG. 1.1 Telemedicine Structure in the LGU Setting
Note: Adapted rom the DOH-KMITS (retrieved on September 12, 2022), slide 17, 32
41
B. DEFINING MINIMUM INVESTMENTS OF TELEMEDICINE IN LGUS
In Module 9 Lecture 3: Implementing Telemedicine within their HCPN and further classification of
(retrieved September 12, 2022 from DOH-KMITS), individual health services.
DOH explains that each LGU should be able to
build the telemedicine set-up they would like The minimum compliance for every LGU is
to have, based on design of the service delivery characterized by the following infrastructure:
TABLE 1.6 Minimum Telemedicine Setup in LGUs
SE TUP S T R AT E G Y
OPERATIONS
Adoption and All health care providers that are part of the HCPN, including their apex
routine use of hospital, shall adopt and transition to the routine use of telemedicine in the
telemedicine delivery of individual-based health services for their catchment population as
among health part of their business operations in accordance with their service capability
care providers. and standard service delivery protocols.
Establishment All HCPN shall organize an LGU telemedicine operations team, which shall
of an LGU be subsumed under each LDRRMO, that shall prepare for and respond to any
telemedicine telemedicine referral to and from any health care provider within the HCPN
operations team. based on standard protocols.a
Telemedicine All HCPN shall determine, provide and regularly monitor the services, human
service capability resources, equipment, infrastructure, and other qualifying requirements of
profiling. all health care providers and members of the LGU telemedicine operations
team in the implementation of LGU telemedicine services based on minimum
uniform standards set by DOH, DILG, and PhilHealth.b
1. Details on the service capability, specific telemedicine services being

provided, clinic hours, and contact information shall be included in
the directory that shall be posted in each health facility, and likewise
disseminated to all health care providers and the LGU telemedicine
operations team within the HCPN. Accordingly, changes or updates in the
directory shall be communicated to all concerned.
2. All HCPNs shall maintain a directory of the LGU telemedicine operations

team with scheduling assignments of personnel, contact details, and
availability of resources (e.g. ambulance, patient transport vehicles, etc.) that
shall be disseminated and made accessible to all health care providers.
Demand All HCPNs shall develop and implement an adaptable communication

generation and strategy for demand generation for telemedicine in consideration of the
communication. population and local context. In developing the strategy, a critical consideration
is that the catchment population are well informed and assured of access to
telemedicine at all levels of health care utilization.c
42
OPERATIONS
Support All HCPN shall establish a functional telemedicine referral system with the
telemedicine following minimum process capabilities:
referrals.
› Process Capability 1: Health workers/health facilities can directly
coordinate/refer patients to specialized care when needed.
› Process Capability 2: Health workers/health facilities can provide

asynchronous telemedicine to another health worker/health facility for
assistance to their assigned primary care facility.
› Process Capability 3: Health workers/health facilities can coordinate and

refer to the LGU telemedicine operations team patients requiring home
visits or emergency care to the nearest, suitably resourced health facility.
› Process Capability 4: Health workers/health facilities shall document

doctor consultation, prescription, etc.
› Process Capability 5: Health workers/health facilities can rely on solid

security and privacy measures of the technology.
Standardized All HCPN shall standardize their telemedicine service operations in their
LGU catchment area to include the following minimum requirements:
telemedicine
service 1. All HCPN shall: (1) develop and implement an LGU telemedicine service
operations strategy and plan that shall be subsumed under the health information
management/ICT development component of the LIPH for P/CWHS,
following the standards set by the DOH, DILG, and PhilHealth; (2) develop
and implement localized telemedicine service protocols that take into
account the catchment population, local context, and available resources;
and (3) issue policies relating to budget support and operations.
2. All HCPN, as led by the P/CHO and its apex hospital, shall regularly implement
capacity building and mentoring activities of all health care providers and
members of the LGU telemedicine operations team on appropriate use
of telemedicine and response activities, localized standard protocols, and
other relevant guidelines such as on enterprise architecture, ICT service
management, data management, data privacy, and cybersecurity, and
ensure the availability of resources (e.g. human resources, ICT equipment
and infrastructure, ambulance, patient transport vehicles, etc.) to guarantee
quality provision of telemedicine services.
3. Equipment (see next)

43
EQUIPMENT
Primary 1. A designated telemedicine workstation;

Care Provider
Network 2. A directory of scheduling assignments for individual health care providers,
(i.e. Primary clinic hours, and contact information within their health facility;
Health Facility,
BHUs) 3. A directory of other health care providers and LGU telemedicine operations
team within the HCPN, service capability of health care providers, operating
hours, and contact information;
4. A stable internet connection with appropriate bandwidth speed;

Refer to Annex 1D: Determining Internet Bandwidth Speed;
5. Communication devices: landline, mobile phone with camera, tablet,

laptop or desktop computer (i.e. consider the use of dual monitors and high
definition webcam positioned at eye level);
6. Noise-canceling headphones, speakers, and microphones;
7. Secure, privacy-enhancing and non-public-facing video conferencing

or communication software/facility that is interoperable to an electronic
Integrated Health Information System (iHIS);
8. and an electronic iHIS with the following validated modules that conform
and comply with the minimum uniform standards set by the DOH, DILG,
and PhilHealth:
a. Telemedicine for recording and processing of telemedicine consultation

data, generation of electronic clinical abstract, consultation summary,
prescriptions, referral forms, and submission of telemedicine reports to
DOH, DILG, and PhilHealth;
a. Referral system management for referral of patients to/by another

health care provider or to the LGU telemedicine operations team,
tracking and monitoring of telemedicine response activities, and receipt
of telemedicine response report; and
a. PhilHealth electronic claims processing and provider payment for

processing and submission of telemedicine claims to PhilHealth.
LGU 1. A designated telemedicine workstation;

telemedicine
operations team 2. A directory of health care providers within the HCPN, service capability,
telemedicine services being provided, clinic hours, and contact information;
3. A directory of scheduling assignments of the LGU telemedicine operations

team personnel and contact information;
4. A stable internet connection with appropriate bandwidth speed;

44
EQUIPMENT
5. Communication device: landline, mobile phone with or without camera,

hand-held two-way radios, tablet, laptop or desktop computer;
6. Noise-canceling headphones, speakers, and microphones;
7. Secure, privacy-enhancing and non-public-facing videoconferencing or

communication software/facility that is integrated to the electronic LGU
telemedicine referral system;
8. An electronic integrated LGU telemedicine referral system for receiving

and managing telemedicine referrals, recording, processing and tracking
of telemedicine response activities, generation of telemedicine reports
and back referrals to a health care provider, and/or its assigned primary
care provider, and submission of telemedicine reports to DOH, DILG, and
PhilHealth through the Regional Telemedicine Coordination Team. The
referral system shall conform and comply with the minimum uniform
standards set by the DOH, DILG, and PhilHealth;
a. The telemedicine service capability profile for health care providers shall
form part of the annual Health Facility Profiling of DOH and PhilHealth.
b. Details on the service capability, specific telemedicine services being

provided, clinic hours, and contact information shall be included in
the directory that shall be posted in each health facility, and likewise
disseminated to all health care providers and the LGU telemedicine
operations team within the HCPN. Accordingly, changes or updates in
the directory shall be communicated to all concerned.
c. All HCPNs shall maintain a directory of the LGU telemedicine

operations team with scheduling assignments of personnel, contact
details, and availability of resources (e.g. ambulance, patient transport
vehicles, etc.) that shall be disseminated and made accessible to all
health care providers.
9. and Ambulance, transport vehicles, and other logistical requirements
a
The LGU telemedicine operations team will also collaborate with the Regional Telemedicine Coordination Team for provision
of any TA and performance monitoring.
b
The telemedicine service capability profile for health care providers shall form part of the annual Health Facility Profiling of
DOH and PhilHealth.
c
This communication strategy shall form part of the health information management/ICT development component of the Local
Investment Plan for Health (LIPH) for P/CWHS.
45
1.3 Financial Mechanism Situation
Telemedicine pricing practices vary from one WHO FUNDS THE

country to another and from the public to the TELEMEDICINE IMPLEMENTATION?
private sector. The private sector often follows a
standard B2C model that monetizes its services Section VII of the JAO 2021-0001 states that:
from patients and clients. On the other hand, the
government sector’s financial incentives and
investment returns rest on its public thrust. Costs for the organization of LGU
telemedicine services shall be charged
Here in the Philippines, the Department of Health using their own administrative funds
(DOH) is the lead agency that promotes the use of (DOH-DILG-PHIC, 2021, p. 4).
telemedicine under the UHC act, while PhilHealth is
the designated arm to formulate the guidelines for Health care provider networks or any of its
benefit packages and reimbursement mechanisms component health facilities shall shoulder
for healthcare providers. all costs related to the engagement of a
third-party telemedicine provider using
Paragraph 1 of Section VII. G. from the JAO 2021- their own administrative funds (DOH-
0001 states that: DILG-PHIC, 2021, p. 12).
PhilHealth, in coordination with DOH, shall Given the significant variation in financial
implement a telemedicine benefit package capabilities among public facilities both within
and reimbursement mechanism for health and across LGUs, placing the responsibility
care providers, which shall be issued as solely on health facilities is not a sustainable
a separate policy. Likewise, the DOH, approach. As discussed in Step 12 of Chapter 2.3
UPM-NThC, medical associations, and Implementation & Sustainability, the establishment
specialty societies shall issue a handbook of a comprehensive telemedicine budget through
on recommended rates for telemedicine an LGU telemedicine ordinance will help secure the
services (DOH-DILG-PHIC, 2021, p 12). long-term viability of telemedicine implementation.
As of writing, there is no benefit package for

telemedicine under PhilHealth, and this is one of FINANCIAL MECHANISM:
the initial gaps that must be addressed. A NOTE FOR POLICY MAKERS
In the interim, healthcare providers are instructed As emphasized in the UHC Act, PhilHealth must
to charge consultation fees that are appropriate, include telemedicine in the benefit development
reasonable, and commensurate with the plan. Theoretically, the telemedicine framework
telemedicine services provided, and in accordance should be under the Konsulta development
with RA 2382, otherwise known as the “Medical process. However, the Philippine UHC Surge
Act of 1959,” RA 10699, otherwise known as Team has not yet come up with a definite
the “National Athletes and Coaches Benefits and telemedicine policy.
Incentives Act,” and other existing or applicable
laws, rules, and regulations (DOH-DILG-PHIC, It is clear that without a clear reimbursement policy,
2021, p 12). demand cannot be generated for telemedicine.
46
Without demand, telemedicine will not be As a creative example, the Local City Government
prioritized. Without the full support of PhilHealth of Baguio for instance has developed a home-
and the DOH, the burden once again falls to the grown modification of the iClinicsys for its
individual facilities and perhaps the LGUs looking EMR implementation in its public run primary
to implement telemedicine in their operations. health care units. They have also successfully
reimbursed packages from various DOH
But perhaps with financial modeling and creativity, programs to PhilHealth. This is one success story
other LGUs could likewise mechanize its funds to of innovation, self-reliance, and proper use of
provide telemedicine services to its constituents in funding. Incentivization of a program framework
its direct needs such as in times of calamities or to HCPNs may entice PhilHealth to promote a
disasters (e.g. floods and earthquakes, etc.) (Litvak, local model to a national proposal for the benefit
M., et al., 2022) where physical on-site consultations package development.
will be close to impossible. Local initiative is not
an unusual endeavor. Remuneration packages in Financial schematization of an adaptable and
various telemedicine public health programs can workable telemedicine benefit package in the
be initialized, spearheaded and piloted by a local Philippine setting is an added challenge to the long
government unit while PhilHealth is grappling with list of goals that PhilHealth must contend with in
the development of a national policy for benefit the coming years.
package reimbursement schemes.
1.4. Understanding Barriers to Implementation
In the next Chapter, we will begin to introduce the clinics, community health advocacy, funding
Telemedicine Road to Implementation strategy. organizations that support telemedicine projects
However, it is important to consider and anticipate and the implementation planning for such projects
the challenges we will meet along the way, identify across six years.
opportunities in our current approach, and most
importantly how we can improve our chances of They explain how there is a predictable set of
successful implementation. barriers that one can expect whenever planning
implementation of any telemedicine project,
Stumpf S. H. et al. (2002) from the University especially at community sites. These predictable
of Southern California Keck School of Medicine barriers are classified into technology, and non-
offers a narrative account of their experience as a technology. Furthermore, they found that technology
campus-based telemedicine systems deployment barriers comprise a relatively small subset, and
and evaluation shop in implementing various that it is the non-technology barriers that most
telemedicine projects ranging from community frequently undermine project implementation.
47
TABLE 1.7 Common barriers to telemedicine implementation
BARRIER DISCUSSION
Immediate and Telemedicine projects implemented prematurely and without a feasibility study
widespread can quickly begin drifting in a sea of dashed expectations.
implementation
breakdown Marketing promises for ease of use and instant results often fail to deliver.
Electronic medical records, high resolution digital images, faster bandwidth
speeds, and processors that easily and quickly handle multimedia programs
create the perception that telemedicine is a plug-and-play or point-and click-
solution that can overcome access to care barriers, especially within underserved
communities. Unfortunately, this is not the case.
Example 1: A statewide project sought to install telemedicine systems in

mostly rural sites serving the most vulnerable populations. The high-profile
undertaking had support from a major foundation, a core of external champions
and a coordinating committee. The correct collaborative partners were included
and a set of initial implementation sites identified.
The system had been demonstrated as effective at a lower level of technology,

with certain limitations, under a well-documented feasibility study by another
group for a similar project. Differences for the proposed project were judged
to be minor and manageable. They included a different version of supporting
software, a different method of telemedicine delivery (plain old telephone
service vs. the Internet), and an expansion from one site to ten. The new
telemedicine equipment manufacturer also provided the software, so that was
assumed to be sufficient. And though clinical coordination on a grander scale
would be required, the project team believed problems and solutions would be
generalizable. Reality proved different.
Technology needs varied by site, with bandwidth an issue at some. The email
solution required an unanticipated modification in the new manufacturer’s
software. Complications compounded quickly, with subsequent loss of
confidence on all fronts once it became clear that the vendor did not have a true
software engineer. Installations fell seven months behind schedule, threatening
the entire project. System feasibility became a sensitive subject.
Inadequate A project without a dedicated, local on-site project coordinator will lack leadership.
leadership
The project coordinator should be a central resource with some understanding
of all aspects of the project, from technology to the needs of patients and
healthcare workers, but should not be the same person who called for the
project. When the project coordinator role is parsed among different staff--such
as the business manager, clinical coordinator, and consulting physician--the
project will struggle from the start.
Example 1: A local site did not hire a project coordinator despite funds budgeted
for the role. Project leadership defaulted in name to the external evaluator, who
held no influence within the medical group. Responsibility for various tasks,
from installation of on-site cable service to coordination
48
BARRIER DISCUSSION
of patient flow, was divided among individuals. Although they met monthly,
none of them held management authority. The project languished, falling eight
months behind schedule.
Example 2: The project was presented to a core group of community-

based organization leaders who did not possess sophisticated knowledge
of telecommunications or telemedicine. Our technology assessment called
for significant equipment upgrades. The community organization director
authorized the installation of a DSL line and the purchase of several new
computers sufficient to manage the telemedicine system. A junior manager
was appointed to be our project contact but left abruptly without notifying
our technology team. The DSL line was installed in a different building than
originally identified. The community organization director, upon learning of the
mistake, questioned support for the installation and the entire project.
Lack of Local physician endorsement is an absolute requirement of any healthcare project.

physician
buy-in A physician inside the local group has to bring the project to the community and
be a flag-bearer and project advocate and champion. The physician champion
lobbies the stakeholders, sponsoring institutions and other physicians. If a
champion cannot be identified or is insufficiently empowered to have an impact
on policy and procedures, the project will become orphaned, left to fend for itself
without sponsorship, and be at risk of cancellation.
Unavailability It is essential to have an IT specialist on site to troubleshoot all the predictable

of technical problems that arise with use of the equipment. In some cases, this person will
expertise or act as a local security officer. In community sites especially, the level of technical
support knowledge among staff varies greatly.
Example 1: Motivated staff often tamper with workstation settings, potentially

disrupting access to applications. Others use computers for personal interests,
introducing viruses to the system or otherwise compromising the project. Having
someone on site who can quickly return workstations to functional status is
very beneficial.
Staff resistance The belief that one implementation strategy will succeed across multiple
to changing sites can be fatal to a project. Each site must be viewed as a unique system
habits functioning according to established patterns. Different clinical sites often
exhibit similar problems, but each responds differently and requires a separate
approach. The most common solution is individualized training that anticipates
or quickly responds to difficulties as they develop.
49
BARRIER DISCUSSION
Resistance Evaluation is integral to all project implementations. Funding sources are entitled
to evaluation to know project impact and stakeholder value.
protocol
However, evaluation experts often use familiar methods perceived as
burdensome to the end users--satisfaction surveys being the most common,
least informative and most intrusive. An evaluation strategy that is likely to be
viewed as helpful and embraced by users gathers information that meets the
needs of local interests, such as a format assessing quality-of-care indicators.
Example 1: In the first site visit, the external evaluator proposed that information
be collected on patients not served by the new telemedicine system, intended
to demonstrate a need for continued funding and subsequent expansion of the
service. The local medical director did not want to document failure to provide
treatment or service, because that might compromise the quality-of-care
ranking, which would in turn potentially threaten the medical group’s services
contracts. This basic conflict of interests grew into a conflict of personalities,
from which the project suffered.
Note: Adapted from Stumpf S. H. et al. (2002)
This list is non-exhaustive but are some of the more easily identified challenges. It’s important to recognize these early on
from within your team and make adjustments accordingly. Additionally, we have compiled our own list of challenges that we
encountered in the Urban Health Projects. See Chapter 05: Conclusion for further reading.
This list is non-exhaustive but are some of the As best practice, they recommend that:
more easily identified challenges. It’s important to
recognize these early on from within your team 1. Implementation planning follow a proper
and make adjustments accordingly. Additionally, sequence, beginning with research, followed
we have compiled our own list of challenges by feasibility studies and implementation,
that we encountered in our own implementation. with policy review occurring at the end of
See Chapter 5.2: The Urban Health Projects in the path;
Parañaque City for further reading.
2. Take small steps before big ones, and;
3. Document mistakes to devise better strategic

solutions.
IN PHOTO: Talks among key leaders and physicians of the Urban Health Project (2022) in Parañaque City. Stumpf S. H. et al.
(2002) underscores the importance of physician champions to bring the project to the community and be a project advocate.
Without physician buy-in the telemedicine implementation will become orphaned, left to fend for itself without sponsorship, and
be at risk of cancellation.
Telemedicine Steps
to Implementation
& Sustainability
If you have skipped ahead to this Chapter, you It is crucial to recognize that every practice
might miss the contextual understanding of the varies in terms of size, vision, operations, and
current state of telemedicine in the Philippines, implementation stages, and the points mentioned
the minimum requirements for setting up your here should be tailored to the practice. We
operations per the DOH-DILG-PHIC JAO 2021- recommend reading this playbook in its entirety
0001, as well as the common pitfalls to avoid. before proceeding.
2.1 Introduction to the Telemedicine Road to Implementation
Implementing digital health systems is challenging. by feasibility studies and implementation, with
Digital health systems change the way people do policy review occurring at the end of the path.
their jobs and change the way they receive health Often however, telemedicine projects are put into
information. Before planning or implementing action without prior feasibility studies or a strong
digital health systems, it is important to know if foundational understanding, which leads to their
an organization, institution, or even a region or failure even before they commence.
country is ready to adopt new technologies and
processes. It is especially important to understand In their Telehealth Implementation Playbook
how healthcare providers, patients, and program (2022), the AMA® illustrates a 12-step framework
managers perceive digital health systems— for effectively building and scaling telemedicine
positively or negatively. Measuring readiness is programs across various operational sizes and
one of the first steps in developing a digital health stages in the U.S. We have chosen this framework
strategy (ADB, 2021). as the primary resource for this chapter due to it
being backed by the most extensive research and
Stumpf S. H., et al. (2002) reminds us that practical medical expertise available, globally, to
implementation planning should follow a proper date. However, for our purposes, these guidelines
sequence, beginning with research, followed have been modified to suit the Philippine setting,
taking into account our DOH-DILG-PHIC JAO
2021-0001 telemedicine policy and the Universal
Healthcare Act.
52
53
2.2 Preparation
This phase details steps leading to telemedicine
implementation.
STEP 1: IDENTIFY
Look beyond the pressure to implement is a feasible solution that can satisfy these
telemedicine systems for its sake or to satisfy an requirements. If the project has more pressing
operational directive. priorities before the telemedicine implementation,
make sure that those are addressed first.
In the previous Chapter, we learned that the
telemedicine implementation in the LGU is an Creating a clear project plan provides purpose and
ancillary requirement for compliance with the context to the project, serving as a foundation for
UHC act. However, due diligence necessitates program evaluation. Additionally, it helps secure
making sure that the needs of the practice are buy-in from key stakeholders and promotes long-
properly assessed and the telemedicine program term project stability.
OBJECTIVE
Determine if telemedicine is the next priority of this facility..
ACTION ITEMS
TABLE 2.1 Step 1: Identify — Action Items
STEP AC T I O N I T E M S
Goal Here’s how you can put this in to action:
1. Conduct a Stakeholder Interview

Gather representatives from the practice/operation and identify your needs.
Brainstorm a list of your gaps in care—where you lose efficiency, where your staff
encounters pain points, or where patients’ health or satisfaction suffers. Use the
Annex 2A: Telemedicine Implementation Feasibility Assessment Form to guide
your questioning.
2. Check with your IT & security, finance and legal teams

Make sure to get a good grasp of the technical feasibility of setting up a telemedicine
platform in your practice by consulting with your technical team early. From here,
lean on their recommendations and listen for potential challenges that will need to
be addressed to avoid significant roadblocks later.
3. Find a space for the telemedicine workstation

You will need a dedicated space for your physician to conduct the telemedicine
encounter that is private, quiet, well-lit (Greenhalgh, 2020, as cited from Isip-tan, et.
al., 2021a), and free from distractions.
54
4. Source your equipment

Prepare to source your equipment. Refer to Table 1.6 Minimum Telemedicine Setup
in LGUs for the list of equipment you will need to procure.
5. Document your challenges

Look back on Chapter 1.4 Understanding Barriers to Implementation and perform a
self-assessment check.
6. Plan small and find your focus

Once you’ve identified if the telemedicine implementation is your true priority, it’s time
to plan how this will look like. Remember to start small and gradually add services
as your staff and patients grow comfortable. Which of your services are easiest to
implement and which ones should be parked for later?
Output By the end of this step, you should have:
Conducted a Stakeholder Interview
A shortlist of your practice’s needs or actionable items (called Identified

Needs) to improve your current healthcare service delivery using S.M.A.R.T.
(specific, measurable, assignable, realistic and time-related) parameters
A space for your telemedicine workstation
Equipment for your telemedicine operations
Performed a self-assessment of your challenges and made adjustments

or commitments
A shortlist of your currently offered services that can be digitized, grouped into at
least 2 implementation phases
Note: Adapted from the AMA® Telehealth Implementation Playbook (2022), p 20-23
BEST PRACTICES
Conduct a Stakeholder Interview

› Ensure the active participation of front-line staff › During stakeholder interviews, make sure
in your discussions to prevent oversight of on- everyone is using the same set of questions
site processes during brainstorming sessions. with the definitions for technology and other
You can also use patient satisfaction and terminology explicitly defined. Try not to let
experience surveys to identify potential areas the interviewees take the conversation too far
for improvement. away from the set questions (ADB, 2021).
55
› If you are an external implementer, consider Source your equipment

arranging a visit to observe the operational › In terms of infrastructure, check what resources
aspects firsthand. you already have at your disposal, and which
ones will need to be procured later. Then begin
» Familiarize yourself with key personnel you to establish a budget and funding source.
need to engage with, and then arrange
a well-timed interview to inquire about
the viability of telemedicine operations, Plan small and find your focus
assess available resources, identify › Do not attempt to digitize the whole practice
challenges, and determine the practice immediately to avoid overwhelming your
and community’s top priorities. staff and patients.
» In some communities, there is a cultural › Plan to section the telemedicine implementation

protocol of consulting chiefs, or village or into a phased approach, starting with the
community leaders. Conversely, in some easiest services to implement (Phase 1), then
communities, proactive engagement may gradually digitizing more services as your
be required to ensure sufficient consultation team and patients become more comfortable
with women and women’s groups. It is (Phase 2, 3, etc.).
important that these considerations are
given sufficient readiness assessments
(ADB, 2021). General tips
› Connect with peers in similar practices who
have experience with telehealth implementation
for guidance when facing obstacles.
STEP 2: RECRUIT
It’s time to recruit the key players in your assigned to manage and monitor the program, no
telemedicine operation. one will be responsible to ensure its success and
maintain quality.
You will need to identify a Core team, a Physician
Champion, and the Care teams which comprises Depending on your manpower and available
1) the on-site doctors, nurses and healthcare resources, this core team can be as extensive
workers, as well as the offsite LGU Telemedicine or as compact as you want. The AMA suggests
Operations team. Your on-site care team can expanding this team to multiple departments:
involve the entire facility or a specific group Core, Leadership, Advisory, Implementation team
dedicated to the telemedicine operation. to prevent overreliance on a single individual or
inversely create work redundancies. Each team’s
During the planning stage, there’s no need to roles and responsibilities are covered in the table
engage the entire staff, especially the Care team. below. The core team may also consist of the
This provides flexibility for making adjustments. healthcare providers (including the physician
Working alone or with a small implementation champion) however, their focus will be on the
team also helps you move things faster. As you decision-making and team management.
progress to later steps, you can gradually involve
the rest of the team. In the context of Philippine LGUs, we recognize
that there is typically a limited number of personnel
available to fulfill this responsibility. In this case,
THE CORE TEAM the Community Medical Officer, the head nurse
and with the addition of available key officials
It’s a good idea to establish a core team within from the local government or key personnel from
the practice who will be responsible for the growth the practice who can fill in some necessary roles
of the telemedicine program early on. If no one is can function as a single “core” team.
56
TABLE 2.2 AMA® Recommended Telemedicine Core Team Structure Framework
ROLE R E S P O N S I B I L I T I E S A N D C A N D I DAT E S
Leadership High-level decision makers who authorize key decisions and provide
Team budgetary approval and whose alignment is important for wide-scale success
› Board of Directors
› C-suite Executives
› Practice Owners/ Partners
Core The team responsible and accountable for putting together the plan
Team and driving the project forward day to day
› Clinical Representative(s) (physician, nurse, etc.)
› Administration Representative(s)
(practice manager, administrator, scheduler)
› Information Technology or Information Security Representative(s)
› Project Manager(s)
› Payor Contracting
› Priority Department Representatives
Advisory A group of advisors for the Core team to consult for perspective and
Team guidance and who ensures the team’s decisions and leadership proposals
are strategically sound
› End Users
› Practicing care team members
› Patient Advisory Board/Patients/ Caregivers
› Organizational Navigation
› A program sponsor
› Retired Leadership team members
› Benefactors
57
ROLE R E S P O N S I B I L I T I E S A N D C A N D I DAT E S
Implementation On-the-ground teams in impacted departments who will be informed of the

Team plans and ultimately carry out the day to-day process of implementation
› Nurse Manager
› Additional Priority Department Representatives
› Billing/Coders/Schedulers
› Superuser to provide on-the-ground technical support
› Information Technology or Information Security Representative(s)
Note: Adapted from the AMA® Telehealth Implementation Playbook (2022), p 84
As precaution, carefully consider who needs to It’s advisable for the physician champion to hold
be at the table (AMA®, 2022, p 26). It’s possible a respected position within the practice, as the
to have too many people inside the core team, scope of their influence is an important aspect.
which could slow down important decision- A physician champion’s effectiveness diminishes
making. Alternatively, missing a key person or role when their presence isn’t visible in the practice, so
from within the core team, especially during the appointing a physician champion from a different
planning stages can result in rework or difficulties facility will not work. In larger facilities, having
with developing buy-in. multiple physician champions can provide even
greater benefits.
THE PHYSICIAN CHAMPION

THE CARE TEAM
Stumpf S. H., et al. (2002) also reminds us to appoint
a physician champion inside the core team that Depending on your available resources, this can
will bring the project closer to the community by either be a new dedicated healthcare provider
being a flag-bearer, and a project advocate. The team of doctors and nurses for your telemedicine
physician champion lobbies the stakeholders, operation or an expansion of your existing team
sponsoring institutions and other physicians. If a through additional roles. The care team operates
champion cannot be identified or is insufficiently on-site, delivering care to telemedicine patients
empowered to have an impact on policy and similar to the traditional face-to-face experience.
procedures, the project will become orphaned, left
to fend for itself without sponsorship, and be at risk
of cancellation.
58
PREPARING FOR THE LGU

TELEMEDICINE OPERATIONS TEAM
In Chapter 1.2. B. Defining Minimum Investments The LGU Telemedicine Operations team serves as
of Telemedicine in LGUs, we explained the a shared resource that plays an important role in
telemedicine structure in the Philippines. In enabling referrals across healthcare facilities within
summary, within the LGU, there exists the HCPN an HCPN. However, the initial creation of this team
which comprises the Primary Care Facility, requires a collaboration with the LDRRMO and the
General Care Hospitals, Apex Hospitals, Specialty C/MHO, and the support of your City/Provincial
Care and the Telemedicine Operations team. Mayor. In certain instances, this team may already
exist in your LGU, thanks to previous telemedicine
implementers, and won’t be an additional task
on your agenda. In other cases, though, you may
LGU need to be the one to advocate for its formation.
› Specialty Care (National Specialty Centers
and other types of Specialty Care) In this early stage, we recommend reaching out
to your LDRRMO and City/Provincial Mayor and
› Apex Hospitals opening a discussion for the creation of this team.
Refer to the Step 12: Scale for tips on this approach.
› Healthcare Provider Network
» Primary Care Provider Network
• Primary Facility
• Brgy Health Unit/Stations
» General Care
(Secondary and Tertiary) Hospitals
› Telemedicine Operations Team
OBJECTIVE
Find the right people.
59
ACTION ITEMS
TABLE 2.3 Step 2: Recruit — Action Items
1. Create the Core team

This team is housed within the facility and is responsible to ensure the success
of the telemedicine operation and its navigation across challenges. They are
also responsible for the bulk of reporting and presentation tasks aside from the
decision-making.
2. Identify your physician champion(s)

The physician champion is there to advocate for, and increase enthusiasm and
confidence in the use of telemedicine among their staff and patients.
3. Choose your on-site Care team

Will the entire healthcare operations support the telemedicine operation, or will a
select team be appointed?
4. Prepare the offsite LGU Telemedicine Operations team

Once established, this team will be responsible for catering to all referral requests
from the new HCPNs that will be rolling out their own telemedicine program.
5. Host the kick-off meeting

Gather the Core team and introduce the telemedicine project. Clarify each
member’s roles and responsibilities, and get an idea of the project’s feasibility
and potential timeline.
A Core team
A Physician Champion(s)
A Care team
Either 1.) started discussions on the creation of a LGU Telemedicine

Operations team with the LDRRMO, and the C/MHO or 2.) already have an
existing LGU Telemedicine Operations team
Hosted the kick-off meeting
60
BEST PRACTICES
Create the Core team Host the kick-off meeting

› It’s a good idea to appoint the minimum › You do not need to involve the Care team
number of persons in the core team, while (operations) at this point yet.
avoiding overlaps in roles and responsibilities
to keep each member relevant. › Try to gain a thorough understanding of your
organization’s needs and internal processes to
» While some overlap in roles and identify roadblocks in the implementation.
responsibilities may not be immediately
detrimental, it can dilute decision-making » At your first meeting, work on estimates
in situations where a crucial member is and try to keep the topics loose, you will
absent. This may result in decisions that be able to define numbers and specifics in
are biased towards the perspective of later meetings.
certain individuals.
» Potential discussions could include: priority
» For lower resourced practices, some services to adapt to telemedicine; timeline
members may need to flex their roles to and milestones for the succeeding steps
continue the service delivery. In such cases, in this framework; budget and funding
it is important to be aware when there is source exploration.
need for additional manpower and be ready
to budget for such.
General tips
› Try to setup a regular assessment (e.g. bi- › Try to keep your meetings brief and productive.
anually) to replace/remove members who
cannot retain their function. » Meetings in general must always add value
to the project as they detract members from
more relevant work.
Identify your Physician Champion
› At a minimum, the physician should be » The introduction and waiting period for late
designated within the facility for visibility, attendees should not consume the entire
and ideally, they should hold an established duration of the meeting.
position where their opinions carry significant
weight in decision-making processes. » Emails or similar tools can be used to
completely replace simple updates.
Prepare the offsite LGU Telemedicine » Pay attention for instances where certain
Operations team members may not be needed in the meeting.
› Use the DOH-DILG-PHIC Joint Administrative
Order (JAO) 2021-0001 Guidelines on the » Lastly, agreeing and setting a time limit can
Implementation of Telemedicine in the prevent fatigue and maintain momentum.
Delivery of Individual-Based Health Services
as a reference for mobilizing offices from the › Create house rules. Early on, try to establish
LDRRMO, the C/MHO, and the Mayor’s office. house policies in terms of availability,
commitment to deadlines, etc.
› This takes some time, be prepared to
handle referrals to other healthcare facilities » This ensures that as your project progresses,
manually for now. minor inconveniences like tardiness to
meetings, and project deadlines do not
hinder overall progress.
› Refrain from announcing your telehealth

project publicly until Step 9.
61
STEP 3: DEFINE
SMART GOALS
After the kick-off, your Core team’s first action
item should be to discuss the numbers for the When creating goals, make sure the goals are
project. Without goals and a baseline assessment, realistic and clear for everyone. Create a space
you won’t be able to quantitatively measure the for people to share how they feel about the goals.
success of the project after implementation. Pay attention to any challenges mentioned and
distribute the workload accordingly.
Prepare to present your baseline data by
performing an analysis of your practice’s current
operations, highlighting your top services and Vague or general goals often don’t
patient groups. Then connect your baseline data get done, even if they’re great ideas.
with your Identified Needs from Chapter 1 and Turn vague goals into actionable ones
create goals using SMART parameters. Use this by making them SMART. SMART is
step to set specific short- and long-term goals with an acronym that stands for specific,
measurable metrics and a process for tracking your measurable, achievable, realistic, and
progress to guide your team along the way. time-bound. This article will show you
why you need each SMART component,
You can create the goals prior to the presentation and how to apply them to your own goals
then validate it during the meeting with your Core (Martins J., 2023).
team to save time, or involve the Core team within
the meeting and create the goals from there.
TABLE 2.4 Example of a SMART goal
BASELINE PERFORMANCE ANALYSIS S A M P L E S M A R T G OA L S
IDENTIFIED NEED:
OUR SENIOR CITIZENS ARE HAVING A HARD TIME GETTING THEIR MEDICINES.
› We have 10 patients per day belonging to Short Term Goal:

Elder age group (>60 years old). Reduce the number of missed medication
pick-ups by 50% within the next three months
› Ate Rosalyn, a BHW, receives an ave. through improved communication and reminders.
15 SMS and 3 call requests from Senior
Citizens inquiring about window hours for Long Term Goal:
getting their medicine. Achieve a 90% or higher medication pick-up
rate for senior citizens within the next twelve
months through optimized communication
channels and support.
› We have 25 services in total. Short Term Goal:

Implement a digital platform for patients to
› We see only 100 patients per day vs our access information about available health
catchment population at 35,000. services within the next six months, reducing
consultation times by 20%.
› Patients spend an extra 30 mins on ave
during consultations asking questions Long Term Goal:
Increase our patient capacity to 200 patients
per day within the next twelve months.
62
Creating your goals should not consume an entire 3. Explore budget and funding source.
meeting unless you have the resources for it. Be
sure to open a discussion during the meeting to 4. Explore current limitations.
hit as much of these topics as possible:
5. Explore current manpower.
1. Validate your priority services and
implementation phases. 6. Anticipate the workload distribution
and provide solutions.
2. Validate timeline with clear milestones
for when the succeeding steps in this
framework should be taking place.
OBJECTIVE
Define your KPIs.
ACTION ITEMS
TABLE 2.5 Step 3: Define — Action Items
1. Conduct a Baseline Analysis

This will produce numbers for you to play around with, and create metrics from.
2. Create short- and long-term SMART goals

Stick to a modest 3-5 prioritizing your most severe needs. Narrow down the scope
appropriately and identify its ancillary metrics. Refer to the previous table for
examples in application.
3. Plan performance monitoring

Create a timeline for tracking your progress and mark milestones for when these
KPIs should be reached with endpoints for growth and expansion.
A baseline data
3-5 short-and long-term goals
A plan for monitoring performance with specific checkpoints
63
BEST PRACTICES
General tips
› Do not skip your baseline analysis and goal » Silence does not always mean yes.
creation as this is important data to look When clarifying roles and responsibilities
back on when measuring your success after especially during virtual meetings, pay
implementation. attention to silence or a lack of input from
your Core team. It can mean confusion or
› Try not to get slowed down by creating the a lack of commitment. Always aim for a
perfect goals. hard “yes”.
» Make sure to keep everything realistic to » Ask team members where the workload
remove unnecessary pressure on the team. becomes too great or where the
responsibility may not be evenly distributed.
› Once set, have the team’s commitment to Be aware of some challenges presented
ensure all deadlines are met. previously that remain unsolved.
STEP 4: SCOUT
When in the market for a telemedicine platform, Having a long-term partner also provides the
building a fully compliant, ground-up telemedicine advantage of avoiding future complications,
platform can be expensive and unrealistic including the need to plan for contingencies,
for small practices. Today, practices have the navigate employee turnover, and facilitate the
option to simply outsource this responsibility to smooth adaptation of new procedures for both
emerging telemedicine vendors in the market who staff and patients.
specialize in this technology, removing setup costs,
compliance checks, and risks. This is typically done
through a subscription model, making it even more VENDOR EVALUATION GUIDE
practical due to an easy cancellation policy.
In choosing the right telemedicine platform, the
The AMA® (2022) emphasizes that if you do seek JAO 2021-0001 calls for the development of an
a new, outside vendor, you should go into the evaluation mechanism of third-party telemedicine
process with the intent of finding someone who providers by DOH, DILG, and PhilHealth, that shall
will be a long-term partner and not just someone be provided in a separate issuance. Part of the
to execute a transaction. In this way, you can have: Inter-Agency Regional Telemedicine Coordination
Team (IARTCT) team’s responsibility is also the
› An expert resource always on hand in evaluation of 3rd-party telemedicine providers.
challenging situations And the idea is that HCPNs will only need to defer
to their choice of telemedicine vendor to partner
› Support throughout your implementation with in their region.
process (e.g. from operations, training, to
technical expertise), from start to finish (and However as both the DOH-DILG-PHIC evaluation
beyond) mechanism and the IARTCT’s infrastructure is not
yet available, you will need to rely on your core
› Have a partner who is equally motivated as team to help you in the vendor selection process.
you to achieve a successful outcome
64
In Annex B.2. of JAO 2021-0001 they have 5. The platform is as easy as possible for patients
included the following minimum considerations to access and use, and for the physician to
and advises all healthcare providers to practice manipulate its features and present oneself
their autonomy and discretion on the best appropriately to the patient.
platform to use:
6. The platform is secure, privacy-enhancing and
1. The platform is supportable across all devices non-public facing.
(e.g. laptop/desktop computer or tablet, etc.),
and possibly, can be integrated to a new EMR In the interim, we will again refer to the UP
system, or interoperable with your existing Manila Health Informatics Unit, specifically
EMR system. in their Guidance for Assessing Telemedicine
Vendors (2020). They explain that when
2. The quality of service with the use of the considering a telemedicine vendor/provider, the
platform is equal or better than face-to-face physician or the organization should determine
consultation. their goals and aims in adapting a telemedicine
technology. Features of telemedicine platforms
3. The platform allows for remote patient cannot be tailored as one-size fits all programs,
monitoring, and clinical validation. but should be adjusted accordingly. In addition,
expectations on the scale of the project must be
4. The web-side manners are properly observed anticipated at the beginning.
and addressed when using the platform.
The following table references the 6 key
variables for evaluation of telemedicine vendors.
For a more detailed explanation, please refer to
the provided resource.
TABLE 2.6 Telemedicine Vendor Evaluation Guide by the UP Manila Health Informatics Unit
KEY VARIABLE E VA L UAT I O N I T E M S
Business 1. What is the company category – Clinical Decision Support, Big Data,
Information Analytics, or Telemedicine alone or with EHR Interoperability?
2. What is the company’s main value proposition?
3. What is the total cost of using this platform (i.e., subscription fees,
equipment and set-up, training, customization, maintenance)?
4. Can the platform help me / my organization realize my / our goals

for implementing a telehealth service?
5. What other sources of additional information are available

(i.e., executive summary, pitch deck, demo video)?
65
Technology Hardware
1. How well does it operate with the current IT network and speed?
(How long does it take for the platform to load?)
2. Does it support HD audio or video?
3. If I use its video call function, is it able to provide continuous

video streaming?
4. Can the platform be run on different devices (i.e., iOS, Android,

how about browser differences)?
Software
1. Can it directly integrate with a new EHR or be interoperable with a
preexisting EHR?
2. Can you customize the platform to fit your needs? (organizations will
have specific needs, hence flexibility to customize the software or
program is important)
3. What modes of communication does it support (i.e., email, chat, voice

calls, video calls)?
4. Does it have other features that are beneficial (i.e., ePrescription,

scheduling, billing, consent)?
5. Does the platform use device storage or is it cloud-based?
6. Does the platform store information (i.e., text, video, audio)?
Security/ 1. Is data collection in compliance with the currently existing data privacy law?
Data Privacy
2. Who else owns or will have access to the patient’s data?
3. Is it collected and/or shared in a hub or repository?
4. Is it sold, used for marketing, or used to generate revenue or train

new algorithms?
5. Is there user authentication and authorization?
6. Are there processes in place for updates, security patches

and maintenance?
7. Does it provide a high level of data security (i.e., encryption, DPA

compliance, signed BAA)?
8. Are there measures to mitigate cyberthreats?

66
Patient-Facing concerns
1. Are patients able to provide consent through the platform before each visit?
2. Do patients have access to their personal data?
3. If patients have privacy and security questions, who should they contact?
Physician-Facing concerns:
1. How will the platform ensure the patient’s privacy and confidentiality
of information?
2. What options are available to export patient data if I choose to

discontinue using your telehealth technology service?
Customer Service 1. Is there technical support for both physicians and patients?
2. Is the vendor able to provide quality service for their technical support?
3. Do they have a content program that offers information on news and

best practices in the telemedicine field, even after launch?
Usability 1. Is the platform interface user-friendly?
2. Is it intuitive or easy to use for the doctor and the patient?
3. Does the platform allow teleconsults with multiple specialty physicians?
4. Are there billing features for patients/clinicians (i.e., autofilling CF4 form
of Philhealth, support for HMO claims)?
Clinical Validation 1. Does the platform allow recording and analysis of clinical outcomes?
2. Can the telehealth visit data be analyzed? (to refine, adjust, and allocate
future resources, as well as support the academic advancement by
contributing data for research)
Note: Adapted from AMA Telehealth Implementation Playbook (2022); Mussman (2016); Sime (2018); Iafolla (2020) as cited
in Isip-tan, I. T., et al. (2020d), p 6-7.
It is important to note that this reference will be superseded once the standards from the DOH, DILG, and PhilHealth are
established. Instead, it serves as a suggested guide during the interim period.
67
In the validation of this roadmap, one of our 1. A Memorandum of Agreement (MOA), Service
target implementation sites, Brgy. Moonwalk, Level Agreement (SLA), contract, or its
Parañaque City prioritizes telemedicine equivalent between the HCPN and the third-
platforms that are “easy to follow, user friendly, party telemedicine provider shall be legal and
and with available staff to assist the brgy/health binding only to the contracting parties.
center for training.”
2. The DOH, DILG, and/or PhilHealth shall not be
responsible nor held liable for any action of the
ON CONTRACTING 3RD-PARTY third-party telemedicine provider with regard
TELEMEDICINE VENDORS to its engagement with the HCPN,or vice-
versa that may result in any damage, loss, or
Section VII. F. of the JAO 2021-0001 states injury to any or both parties.
that LGUs are allowed to contract third-
party telemedicine providers provided that Additionally, HCPNs or any of its component
appropriate legal documentations are secured health facilities shall shoulder all costs related
such as memorandum of agreements, service to the engagement of a third-party telemedicine
agreements, contracts or other legal instruments. provider using their own administrative funds.
OBJECTIVE
Scout and evaluate your telemedicine vendors.
ACTION ITEMS
TABLE 2.7 Step 4: Evaluate — Action Items
1. Shortlist Telemedicine Vendors

Use the Table 2.6 Telemedicine Vendor Evaluation Guide by the UP Manila Health
Informatics Unit to shortlist one or two preferred telemedicine vendors.
A shortlist of telemedicine vendors
68
BEST PRACTICES
Shortlist Telemedicine Vendors General Tips

› Start by tapping into your network, which › Consider how the vendor can scale your
includes seeking word-of-mouth referrals from operations in the future.
established practices and conducting research
on third-party reviews.
› Request proposals, case studies, or live demos

on how the vendor can help you with the goals
you identified in Step 3.
STEP 5: DECIDE
Here, a decision is needed on whether to proceed In a private practice, you may be the decision
with the implementation, or wrap-up and postpone maker, or you may not need to pitch to a board
it at a later time. of directors or your CEO for approval. However,
thoroughly evaluating budget and ROI against
In the Philippine LGU context, this decision will your objectives will help determine the impact
probably be made by the City Mayor or Provincial telehealth will have on your practice. Thinking
Governor. Gaining buy-in from your leadership through key business elements of your project
is a key element of long-term success for your helps you strengthen your plan and increase your
telemedicine program. It’s important to help them probability for success (AMA®, 2022, p 40).
make the correct decision by documenting the
foundation you’ve created thus far, as you will need
their full support for policy changes and funding.
OBJECTIVE
Meet with your decision makers.
ACTION ITEMS
TABLE 2.8 Step 5: Decide — Action Items
1. Create a proposal
Share the problem you’ve identified, how telehealth can solve that problem, can
deliver value, and is aligned with organizational goals (Step 1 & 2). Outline
69
what success looks like and the metrics you will use to keep the team informed
of progress (Step 3). You will also introduce which vendor is most suited for the
job based on the initial evaluations and how partnering with them will deliver a
positive outcome for the organization (Step 4).
2. Create a proposal
Get official approval to proceed with the telemedicine implementation from your
decision-makers.
A proposal for implementing telemedicine in your practice
A go-signal to proceed with the implementation
BEST PRACTICES
Create a proposal Get official approval

› Try to include these into your presentation. › Seed your project early.
» Clearly define resources needed to move » In informal encounters and casual

forward with this implementation (funds, conversations with your decision makers,
additional staff, additional bandwidth, mention the telemedicine project you
political support, official approval, etc.) are working on early, so that getting an
(AMA®, 2022). official approval at this stage will become
much easier.
› Use storytelling to engage others in your
initiative.
» You can utilize your physician-champion to

share how this could impact the facility via
a personal narrative.
70
STEP 6: CONTRACT
If all goes well, you’ve gotten the official green 2. Discuss the level of support or training you’ll
light. It’s now time to decide on your vendor for expect from them as your partner, and think
your telemedicine program. creatively about where they can provide
additional value or share the risk with your
AMA® (2022) says to lay the groundwork for a organization.
successful long-term vendor relationship.
1. Think beyond financial considerations to align 3. Ensure your negotiations and agreed
on expectations for how you’ll work together parameters are clearly captured in key legal
and communicate. documents.
OBJECTIVE
Contract your telemedicine partner.
ACTION ITEMS
TABLE 2.9 Step 6: Contract — Action Items
1. Decide on your telemedicine partner

As mentioned in Step 4, your document checklist should encompass an MOA, an SLA,
and a contract with your telemedicine provider. Additionally, you should establish a
Data Sharing Agreement with your vendor to delineate each party’s responsibilities
for safeguarding patient data privacy.
2. Setup your virtual clinics

Your telemedicine platform may now initiate the creation of an online profile for your
facility and begin the process of onboarding your health services. For a smoother
transition, revisit Step 1 and consider adopting a gradual, phased approach to avoid
overwhelming your staff and patients.
A certified true copy of MOA, an SLA, a Contract, and a Data Sharing

Agreement between the telemedicine platform and your facility/practice
A virtual clinic for your facility
71
BEST PRACTICES
Decide on your telemedicine partner › Work with your legal, financial, procurement,
(AMA®, 2022, p 43) or IT teams as necessary to get the new
› Rather than looking for someone to close contract signed or existing contract updated.
a transaction with, look for a telemedicine A strong contract underpins a successful long-
partner that can support your operations in term relationship by providing:
the long run.
» Aligned expectations
› Identify the timeline for the current contract
and outline when terms will be renegotiated. » Written, agreed-upon terms to hold each
party accountable
› Clearly outline the plan to scale your program,
and align on any relevant contingency plans. » Legal protection for you and your vendor
› Aside from your service-specific KPIs,

mark milestones in your facility that your
telemedicine vendor can help you meet.
STEP 7: DEVELOP
AMA® (2022) explains that accommodation of the 2. Consider how to incorporate telehealth
new technology (telemedicine appointments, etc.) appointments with the least amount of
will likely require an adjustment to your internal workflow disruption, especially at first, to
team’s daily operations. help seamlessly introduce the technology to
your practice.
A clear workflow is vital to ensure each Care
team member understands their role and how to 3. Seek to understand the preferences and
maximize the value of the telemedicine program. needs of both patients and clinicians, such as
An effective workflow should be able to clear up the times of day that may work best for them
any operational traffic through clear instructions, and what types of barriers they may have to
designations, staff roles, and responsibilities. It engage in a telehealth visit, to ensure your
should be freely accessible and must be kept up to workflow accounts for these details.
date whenever new processes are changed.
The goal of this document is to guide your team in THE TELEMEDICINE SERVICE
everything they need to know to deliver the best CAPABILITY PROFILE
care possible to your patients on the go-live date
or Day One. In Section VII A.2.C. the JAO 2021-0001 touches
on the Telemedicine service capability profiling
In designing the workflow, they suggest the following: which is one of deliverables in the annual Health
Facility Profiling of DOH and PhilHealth.
1. Document your daily logistics such as
your physical workspace arrangement, This document serves as a concise directory of
appointment scheduling procedure, staff time, the facility’s service capabilities, to be displayed
and general communication. Be sure to clarify in every health facility and distributed to all
which processes have been updated as well healthcare providers and the LGU Telemedicine
as those with no changes. Operations team within the HCPN. It provides
a foundational basis that can later be expanded
into a more detailed workflow — which is the
requirement of this step.
72
TABLE 2.10 AMA® Recommended Telemedicine Team Structure Framework
CONCEPT R E Q U I R E D I N F O R M AT I O N
Directory of the health 1. specific telemedicine services being provided

facility service capabilitya 2. clinic hours,
3. and contact information
Directory of the LGU 1. scheduling assignments of personnel,

telemedicine operations 2. contact details, and
team’s service capabilitya 3. availability of resources
(e.g. ambulance, patient transport vehicles, etc.)
Note: Adapted from the JAO 2021-0001, Section VII A.2.C.
a
Accordingly, changes or updates in the directory shall be communicated to all concerned.
OBJECTIVE
Create a workflow for your telemedicine operation.
ACTION ITEMS
TABLE 2.11 Step 7: Develop — Action Items
1. Update your service capability profile

Have the Core team consult with the Care team and update your service capability
profile to include your telemedicine operations.
2. Create a clear, detailed workflow

Build upon your service capability profile and add the information highlighted in
best practices.
An updated telemedicine workflow, ready for Day One
73
BEST PRACTICES
Create a clear, detailed workflow

› Treat this document as a living guide and » Identify what support clinicians and
bible that any single person can refer back to staff will need to effectively complete a
for reference. telehealth visit.
» Keep it clear and documented, minimally » Assign clear roles and responsibilities for
disruptive and ready for adjustments. any new actions necessary for integration.
› Supply them with the knowledge that this » Check that you have a proper environment
workflow will be applied on-the-ground that will support successful telehealth visits
starting on Day One. (e.g., strong Wi-Fi connection, sufficient
internet bandwidth, quiet/private space,
» Make sure that the new workflow is clear video of clinician).
agreeable to everyone by clarifying roles,
distributing responsibilities, and allowing › Develop resources to support and socialize
improvements. the new workflow (written procedures for
each department, communication templates).
› Identify updated procedures, such as patient
and case identification, appointment scheduling, › Partner with your vendor to identify
patient training, appointment logistics, consent, opportunities for efficiency (e.g., patient
platform assistance, and billing. communication, rooming, etc.) based on your
team’s needs.
» Discuss how telehealth will be plotted in
your daily schedule and how the care team › Conduct internal telehealth test visits as well
will be notified. as collect patient and staff feedback and
iterate as necessary.
» Define clear triage protocols for when a
telehealth appointment is appropriate
and ensure the clinic staff and scheduling
teams are trained to distinguish when it is
an acceptable alternative to an in-person
appointment.
74
STEP 8: TRAIN
It’s time to involve the Care team.
The Care team includes the on-site healthcare Conduct an in-depth technical training for the
workers in your practice and may also include the platform to increase confidence in the technology
LGU Telemedicine Operations team (if they are when putting it into practice. Depending on your
already established. These front-line staff play operational size, it may be feasible to break the
a critical role in promoting telehealth and patient training in batches. You can also request that the
engagement, making it essential for them to training be conducted by the vendor.
understand their roles and responsibilities within
the implementation.
OBJECTIVE
Train the Care Team.
ACTION ITEMS
TABLE 2.12 Step 8: Train — Action Items
1. Train your doctors and healthcare workers

Make sure that everyone is familiar and confident in using the platform. This includes
your on-site core team, care team, and offsite LGU Telemedicine Operations team.
Refer to Annex 1C: Preparing for the Telemedicine Consultation for proper decorum
and etiquette training.
2. Test your workflow

Make sure that no one is flying blind on Day One. Conduct test scenarios and slowly
disseminate the new workflow. Be open for feedback from the Care team and
incorporate optimizations with your Core team.
A trained staff, ready for Day One
75
BEST PRACTICES
Conduct technical training for your care team » Try to collect the feedback and consult
› Refer to Annex 1C: Preparing for the with your core team first before making the
Telemedicine Consultation of this guide for changes as opposed to updating on the
best practices. fly. Make sure to communicate all official
changes to all personnel timely.
› Aim to have a tested, bulletproof workflow at
least 1 day before Day One. › As we near Day One, perform a reassessment of
the telemedicine challenges outlined in Chapter
1.4 Understanding Barriers to Implementation.
General tips
› Train staff to educate patients. » Be aware of and document any new or
unique challenges you have encountered
› Be careful of too many changes to the workflow. so far.
» Eliminate threats now before Day One.
STEP 9: ENGAGE
At this point, it is now safe to announce your PATIENT TOUCH POINTS
telemedicine implementation to the public.
Use this guide to educate patients about
Patients can help cut down the workload in telemedicine on specific milestones.
preparation by staying informed of your service
capability such as available services, window hours,
etc., and knowing where and how to get them.
TABLE 2.13 AMA® Recommended Patient Communication Touch-Points
TOUCH POINTS S T R AT E G Y
Announce › Timing: Go-live date; Quarterly; Before/after visits; New patient; Plan
telemedicine to message the same patient about three times about telemedicine
launch before engagement
› Topic: Showcase benefits including increased convenience; increased

access to specialized care not locally available; decreased time and
money spent getting to care; use cases; evidence; appropriate uses;
where to sign up
› Channels: In-person; Office collateral; Email newsletter; Patient portal;

Website; Social media
76
Educate patient › Timing: Once visit is scheduled

about using
telemedicine › Topic: How to download the app or platform; learn more about the
telehealth process; what to expect; payment/billing practices; FAQs
› Channels: Email; Phone
Telemedicine › Timing: Day of visit; 15 minutes before visit

encounter reminder
› Topic: Walk through check-in process; provide link to meeting
› Channels: Email; Text
Follow-up case › Timing: After visit
› Topic: Collect patient satisfaction feedback; schedule any necessary

follow-up care
› Channels: In telemedicine platform; Email; Text
Scaling › Timing: Quarterly

announcements
› Messaging: New use cases and/or capabilities of telemedicine solution
› Channels: Website; Social media; Patient portal; Email; Text
Note: Adapted from the AMA® Telehealth Implementation Playbook (2022), p 60
Note that these are general suggestions that should be used within the context of your operational resources.
OBJECTIVE
Don’t forget the patients.
77
ACTION ITEMS
TABLE 2.14 Step 9: Engage — Action Items
1. Prepare for telemedicine launch

Launch your marketing for the new program and the initial services that will
be covered.
2. Start educating patient about using telemedicine

Pay attention to the time-specific milestones and keep in contact with the patients
throughout. Anticipate frequently asked questions and prepare to answer them.
3. Present confidence in the new technology

Set correct expectations on the use of the new technology. Provide assurance
that the team will be providing the same care as on-site encounters and that any
questions can be freely asked.
A marketing plan for announcing your new telemedicine program
A communication plan for providing support throughout the cascade of care
BEST PRACTICES
Present confidence in the new technology General tips

› Create a space to allow patients to tell you if › Use free AI tools such as ChatGPT, and free
there are technical difficulties so that you may graphics design tools to speed up marketing
provide additional assistance. asset creation.
› When announcing your telemedicine program,

focus on the value that it will bring.
78
2.3. Implementation & Sustainability

This phase details the final steps leading to your
Day One operations and how you can keep the
momentum.
STEP 10: LAUNCH

This is Day One! During the implementation phase, make sure to:
Your hardwork has brought you here. You’ve 1. Collect qualitative feedback from both
prepared a lot and the team is more than ready patients and staff. How do they feel about
to take on the day ahead. Remember to give the new technology?
room for your care team and LGU Telemedicine
Operations team to adjust to the new process 2. Keep an eye on your quantitative performance.
and deliver their best efforts. Prepare to jump in How is it faring against your KPIs and short-
to provide technical support, customer support, or term goals?
emergency assistance.
3. At the end of Day One, make sure to schedule
Mark the first 30 days from launch as the a quick debrief with your Care team to
implementation phase of your project. identify: What worked well? What could’ve
worked better? It’s up to you if you want to
schedule this regularly (e.g. once a week).
OBJECTIVE
Launch your telemedicine program.
ACTION ITEMS
TABLE 2.15 Step 10: Launch — Action Items
1. Launch your new telemedicine program

Put your new workflow to the test and collect feedback from patients and staff.
Prepare to support the Care team as necessary. The Core team’s presence can
also instill confidence in the new technology.
2. Collect qualitative feedback

Check in on your staff and patients and see how they feel about the new program.
3. Check quantitative performance

Give room for the numbers to come in, but always check for progress.
4. Schedule debrief sessions

Get feedback from your care team and tweak your workflow accordingly.
79
Launched your new telemedicine program
A collection of qualitative data
A general idea of your quantitative performance
At least one debrief session
BEST PRACTICES
Schedule a debrief meeting General tips

› Try to wrap the meeting in a maximum › Be prepared to support patients and staff with
of 30 mins or 1 hour depending on your any technical issues during the visit.
operational size.
› Ensure you are tracking key success metrics
» Your care team’s feedback is the most outlined in Step 3 (Defining Success).
important at this point. Make sure to allocate
the bulk of the time for the care team. › Evaluate how documentation and billing
procedures are working; adjust as necessary.
› Pay attention to new challenges and experiences
presented by the team. Then align separately
with your core team on the best approach and
communicate it at the next meeting.
80
STEP 11: EVALUATE

After launch, an evaluation should be conducted 2. In addition to hard metrics, such as number
by the Core team for quality assurance and of patients seen via telemedicine, reduction
accounting. in no-shows, and/or clinical outcomes,
remember to consider qualitative metrics,
In an ideal scenario, a longer time frame is needed to such as how telemedicine has impacted
measure the true impact of telemedicine. However, patient and staff satisfaction and compliance
not all practices can afford an extended testing with treatment as a result of access,
period. An initial 30-day implementation period convenience, and continuity of care.
is advisable to assess early goal achievement.
This assessment can help justify ongoing funding 3. If you haven’t hit your goals, determine if
in reports to leadership and determine overall this is due to an issue with the telemedicine
initiative success. In performing the program- technology, patient engagement, or the
evaluation, AMA® (2022, pg. 68) recommends to organizational implementation. Then, look for
consider the following: opportunities to restructure the program for
improvement. If you are achieving success,
1. Focus on the key success metrics you identified compile your most compelling data to justify
in Step 3 (Defining Success). Relevant data scaling your program for greater impact.
points you’ve collected will allow you to
determine whether you’ve achieved success.
OBJECTIVE
Evaluate your success.
ACTION ITEMS
TABLE 2.16 Step 11: Evaluate — Action Items
1. Evaluate the program in specific points in the timeline

Compile your quantitative and qualitative data and conduct an assessment of
your metrics with your core team and leadership.
2. Determine if the implementation was successful

Your budget will dictate when it is appropriate to call the final assessment on
whether the implementation was successful. A successful implementation should
look to scaling as the next step.
Evaluated your program’s success based on whether you’ve made reached

your goals from Step 3 or have made significant progress
81
BEST PRACTICES
General tips
› You’ve prepared a lot to get this far. Make » Strive to hit your KPI or phased goals
sure that the momentum is not wasted by every time.
knowing your program’s performance by
heart and leaning on your core team’s active
monitoring to navigate through challenges.
STEP 12: SCALE
Universal health coverage is a primary new phases (Phase 2, Phase 3, etc.) until you’ve
goal for Pacific island countries. Digital incorporated all your health service offerings.
technologies are becoming part of that
solution. Sustainable gains in using In addition, you may also be able to explore the
digital technologies for healthcare can possibility of adopting a virtual version of your
be made by strengthening leadership existing paper-based systems through your
and governance, developing capacity, telemedicine provider, such as your EHR, or
and collaborating at a regional level prescription tracking system.
(ADB, 2021)
Once you’ve identified your target area for
expansion, remember to circle back to Step
As the last step in our implementation journey, it’s 7. Evaluate possible workflow changes to
crucial to plan for scaling and ensuring the long- accommodate a larger program, then proceed
term success of the telemedicine project. From this through the remainder of the steps, modifying your
point, you can: program as needed.
1. Expand your telemedicine services;

LOBBYING FOR A TELEMEDICINE ORDINANCE
2. Discuss the passing of a telemedicine
ordinance; As you grow your telemedicine operation, you’ll need
to look into a more stable funding source. This should
3. Establish the offsite LGU Telemedicine be your first priority while expanding your operations.
Operations team;
Unless your practice has private funding, creating
4. Develop and implement a comm strategy for and lobbying for a barangay or city-level ordinance
demand generation; is key in making sure that your program is here
to stay. In Section VI. A. of the JAO 2021-0001,
5. Expand the medical network and create a the DOH-DILG-PHIC mentions the possibility of
referral system; “Issuing policies, but not limited to, ordinances to
ensure budgetary support.”
EXPANDING YOUR TELEMEDICINE OPERATION Letigio D. (2021) reports that Cebu City passed an
ordinance authored by former Cebu City Councilor,
Now that you have completed your Phase 1 Mr. Alvin Diaz that would provide telemedicine
implementation from Step 1, consider other areas services to its residents. Under the ordinance, a
telemedicine can improve your practice. Is there budget of P5 million was allocated for the program
a new patient population you’d like to reach? from the city’s annual budget to support the Cebu
Another department or location? Plan these into City Medical Center (CCMC) and City Health
Department (CHD) upon implementation.
82
FIG. 2.1 Cebu City Ordinance No. 2634: An Ordinance Establishing Telemedicine Services In The Cebu
City Medical Center (CCMC) And City Health Department (CHD), Providing Funds Thereof
Note: From personal communication, Atty. Chappy Piramide retrieved via email August 09, 2023
83
This ordinance can be mirrored and customized The SHF should be sourced from any or all of
based on the needs of each LGU and its jurisdiction. the following: (a) financial grants & subsidies
Your budget will start with the infrastructure from NGAs (DOH) as included in the GAA; (b)
you will need in your facility as specified in income from Philhealth premiums; (c) donations &
Chapter 1.2.B Defining Minimum Investments in financial grants from CSOs & other international
Telemedicine and customized further based on the development organizations (ADB); (d) and other
needs of your community. fund sources such provincial/city/municipal budget
intended for health.
A template of which is provided in the Annex 2C:
Sample Ordinance for Telemedicine. A budget Expense items that are allowed under the SHF:
breakdown is shown in Annex 2D: Sample Budget population-based health services, individual-
Proposal for the Telemedicine Ordinance in based health services, health-system operating
Parañaque City as used in the Urban Health Projects. costs, capital investments, remuneration of
additional health workers, incentive for all health
workers (incl. BHWs & BNS).
LOBBYING FOR A
TELEMEDICINE ORDINANCE: A provincial/city health board shall: formulate the
UTILIZING THE SPECIAL HEALTH FUND local investment plan for health; decide on the
allocation of SHF; create a resolution approving
The government recognizes the financial the budget. Therefore their guidance should be
implications of implementing the Universal consulted when looking to utilize this funding.
Healthcare Act. The Special Health Fund is
a budget allocation which LGUs can use for
improving their health systems and is encouraged ESTABLISH THE LGU
to be used in the telemedicine aspect. TELEMEDICINE OPERATIONS TEAM
As your operations expand, accommodating patient

Section 20 of the same Act provides service requests, such as medication delivery to a
that all health resources intended for patient’s home or patient transfers to other facilities
health services to finance population- will become increasingly important. Therefore, the
based and individual-based health next priority should be to establish and support
services, health system operating costs, the LGU Telemedicine Operations team, which can
capital investments, and remuneration of effectively address these logistical challenges.
additional health workers and incentives
for all health workers shall be pooled to As part of the minimum requirements in the JAO
the Special Health Fund (SHF) (DOH- 2021-0001, each LGU must have an offsite
DBM-DOF-DILG-PHIC, 2021). telemedicine counterpart to the HCPNs, Apex
Hospitals and Specialty Care telemedicine network
to provide assistance in referral response (e.g.
buying/delivering medicine, patient transfer, etc.).
Furthermore, the DOH-DBM-DOF-DILG-PHIC
specifies that the creation of the SHF seeks to:
All HCPN shall organize an LGU
Telemedicine Operations team, which
1. Ensure a more strategic and efficient pooling shall be subsumed under each LDRRMO,
and management of health resources to that shall prepare for and respond to any
reduce fragmentation in health financing, telemedicine referral to and from any
promote integration of local health systems, health care provider within the HCPN
and improve equity in access to health services; based on standard protocols (DOH-DILG-
PHIC, 2021, p 5).
2. Provide appropriate incentives and financing
mechanisms to achieve and sustain managerial,
technical and financial integration; and
This LGU Telemedicine Operations team comprises
3. Ensure transparency and proper accountability staff from the CHO/MHO office to handle the
on the use of health resources. medical affairs, and a complement team at the
84
LDRRMO for the logistics. Having support from the Take note that the materials used must always serve
LDRRMO is key to addressing urgent cases. to keep your patients 1) well-informed and 2) assured
of access at all levels of health care utilization.
The JAO 2021-0001 does not specify a maximum
number of LGU Telemedicine Operations teams to
be established, beyond the minimum requirement CREATING A REFERRAL SYSTEM
of one. Therefore, it is feasible to station multiple
teams at strategic locations within the LGU to Lastly, your practice/facility may consider digitizing
ensure faster response times. Additionally, we the manual referral system by integrating into a
recommend that the LGU Telemedicine Operations medical network. Your telemedicine provider could
team operates 24/7 through rotational shifts to assist in reaching out to essential facilities within
promptly respond to requests from any facilities your HCPN and incorporating them into a unified
within the HCPN. network. This initiative can facilitate seamless
referrals across facilities and connect them with
With regards to funding, the establishment of the LGU Telemedicine Operations team as a
a telemedicine ordinance in the LGU will help shared resource.
allocate funding for the manpower behind the LGU
Telemedicine Operations team. Please refer to In building the referral system, take note of the
Table 1.6 Minimum Telemedicine Setup in LGUs for following requirements specified under the JAO
the recommended minimum equipment to be set 2021-0001:
aside for the LGU Telemedicine Operations team.
1. Health workers/health facilities can directly

DEMAND GENERATION coordinate/refer patients to specialized care
when needed.
Part of the responsibility of the LGU and the
implementing practice/facility is to create a 2. Health workers/health facilities can provide
marketing strategy for communicating the asynchronous telemedicine to another health
availability of telemedicine services. worker/health facility for assistance to their
assigned primary care facility.
All HCPNs shall develop and implement 3. Health workers/health facilities can coordinate
an adaptable communication strategy and refer to the LGU Telemedicine Operations
for demand generation for telemedicine team patients requiring home visits or
in consideration of the population and emergency care to the nearest, suitably
local context. In developing the strategy, resourced health facility.
a critical consideration is that the
catchment population are well informed 4. Health workers/health facilities shall document
and assured of access to telemedicine at doctor consultation, prescription, etc.
all levels of health care utilization (DOH-
DILG-PHIC, 2021). 5. Health workers/health facilities can rely on
solid security and privacy measures of the
technology.
There are no specific requirements regarding

the format or sourcing of these materials. You
can potentially make use of readily available
telemedicine resources found online or provided by
your telemedicine vendor. Digital materials that can
be saved offline is a great way to accommodate
low-resourced areas. In addition, effective
utilization of social media can be helpful to ensure
that your marketing strategy is communicated to a
greater audience.
85
OBJECTIVE
Sustain the momentum.
ACTION ITEMS
TABLE 2.17 Step 12: Scale — Action Items
1. Expand your telemedicine services

Continue to expand your telemedicine services based on your next priority. Leverage
your success metrics to position your program for expansion.
2. Discuss the passing of a telemedicine ordinance

Open a discussion with your LGU to prioritize and to secure adequate funding for
your practice’s telemedicine program.
3. Create the offsite LGU Telemedicine Operations team

Additionally, lobby for the creation of the LGU Telemedicine Operations to support
the telemedicine operation within your LGU’s jurisdiction.
4. Develop and implement a comm strategy for demand generation

Keep your patients well-informed of your telemedicine services. Utilize social media
to boost your reach.
5. Expand the medical network and create a referral system

Work with your telemedicine provider to onboard other facilities within your HCPN
to start implementing telemedicine in their practice and support virtual referrals
from your facility.
A fully digitized practice
A telemedicine policy or ordinance in your LGU
An LGU telemedicine operations team
A telemedicine marketing strategy
A telemedicine referral system

86
BEST PRACTICES
Discuss the passing of an ordinance General tips

› Get acquainted with the timeline of when the › Know that Step 12 takes time to organize.
budget planning is made within the LGU and
make sure to have a draft ordinance ready and » Focus on doing what you can with the
discussed beforehand. resources that you have.
» Lean into your LGU or connections to

mobilize items that need additional
influence to set up (such as the telemedicine
ordinance and the establishment of the LGU
Telemedicine Operations team.)
IN PHOTO: A developer performing maintenance on the telemedicine platform during the WHO Urban Health Project (2023).
Telemedicine
Platform
For transparency: The intention of this chapter of WHO Philippines’ contractual partner.
is to share the ideal technologies and practices However, this information can be a valuable
gained through the implementation of the Urban resource for LGUs considering the assessment
Health Projects in Parañaque City, funded by the and procurement of similar third-party
World Health Organization (WHO) Philippines. telemedicine platform providers, as well as for
The project employed the SeeYouDoc platform other telemedicine providers looking to improve
as its telemedicine solution, the flagship product their systems.
3.1 Introduction to the Concept of a Telemedicine Platform
A telemedicine platform is an integrated system significantly allow faster and efficient exchange
of products and features that enables healthcare of health data across systems (e.g. EMR, HIS,
organizations to provide telemedicine services. Laboratory Data etc.). Moreover, this in turn
would also allow a much improved quality of
It serves as an important tool to enhance and health data services. From this standpoint, similar
maximize the healthcare delivery system. As a tool standardization can be applied to a telemedicine
it must also adapt to interoperability standards platform that is deemed to be chosen by a local
and guidelines just like Fast Health Interoperability government health unit. The importance of
Resources (FHIR) in Electronic Medical Record standards and interoperability must be clear from
(EMR) and Logical Observation Identifier Names both the perspective of health and local executives,
and Codes (LOINC) in laboratory data (Khan, A. as part of the overall enterprise architecture of a
N., 2006) for better data efficiency management. local health governance.
Standardization, in any system for that matter, will
Telemedicine should be appropriately integrated
to other eHealth systems for a much more › Assisting patient concerns
comprehensive remote health care delivery. The
success of its implementation will depend on the › Managing the setup of healthcare
key stakeholders of telemedicine. The following services and authorizations of other
are the general key stakeholders in a local health healthcare workers
government unit (key stakeholders vary from one
LGU to another): › Assisting doctors in encoding
medical records
Local Government and Health Executives Telemedicine Operations/

› Decision Makers Management team/Technical Team
› Monitoring the performances of their
doctors, healthcare workers, and
Patients processes within their Healthcare
› Avails healthcare services provider network
› Managing the medical facilities and

Doctors partners for their referral system
› Provides healthcare services
› Establishing policies and mechanisms
to reward performance and
Other healthcare workers drive adoption of technology
› Managing the schedules of the doctor implementations
88
89
As discussed in Chapter 1.1.B, Benefits for PCPN to offer telemedicine services within the
HCPNs, telemedicine will enable hospitals and HCPN and as a basis for interacting with patients,
healthcare facilities with online services to link other providers, and vice versa.
their health services in their network, such as
but not limited to: EMR, triage, front desk, and The service capabilities of a telemedicine platform
consultation services. In the concept of UHC, a should include the following:
telemedicine platform is a requirement for the
TABLE 3.1 Recommended Minimum Telemedicine Platform Service Capabilities
FEATURES S E R V I C E C A PA B I L I T Y
Directory Capability for users to view, search and select from a list of healthcare
services, facilities and physicians they can avail
Appointment Capability for users to request an appointment based on the selected

Management schedule and service. Can be used to avail virtual or on-site (face-to-face)
healthcare services
This includes the capability to issue a medical diagnosis, health advice and
counseling, issuance of electronic prescription (which shall contain a digital
signature, name, license number, Professional Tax Receipt (PTR), if applicable
of the issuing licensed physician.), and/or referral, if needed.
Video Capability for multiple users like patients, physicians, and healthcare workers
Conferencing to communicate in a video conference
Electronic Capability for patients to view their prescription, service requests (lab or
Medical Records diagnostics) and medical results
(EMR) Database
Capability for physicians to encode and share their diagnosis, care plan,
prescription, and service requests
Documentation Capability for the platform to collect proper documentation of

System
› Consultation details that are routinely and similarly collected in a
face-to-face consultation;
› Patient and provider location;
› Family members or other companions present during the

telemedicine consultation;
› Patient consent;
› Referring licensed physician, if applicable;

90
FEATURES S E R V I C E C A PA B I L I T Y
› Telemedicine platform or communication or video conferencing

software used; and
› Patient’s feedback about the telemedicine consultation/experience.
Chat System Capability for multiple users to communicate with each other based on real-
time virtual messages
Referral System Capability for healthcare workers and doctors to refer patients to other
healthcare providers. Preferably should be applied within the network of the
LGU or through its healthcare partners from the private sector
Analytics Capability to monitor performances of entire healthcare facilities in real-time,

Dashboard based on appointments, feedback of patients, service delivery, and other
metrics explored in Chapter 4: Telemedicine Monitoring & Reporting
Patient Feedback Capability for patients to provide feedback on the telemedicine experience
System and for healthcare providers to capture feedback on their performance
Note: From the DOH-DILG-PHIC (2021)
These features are only the minimum expectations for telemedicine platforms. It does not yet include the ability to file
PhilHealth electronic claims processing as the guidelines for this framework is not yet available within PhilHealth.
It is also recommended that the features that configurable or at least tailored to the practice’s
should be included by a platform of choice be specific needs.
3.2 Integration of Systems
Solving the integration of healthcare systems stakeholders is a crucial component. During the
remains a significant challenge, with most implementation of the telemedicine program in
telemedicine platforms handling integration within Parañaque City, all stakeholders were provided
their own platforms. unique interfaces, equipped with key features
that enhance their roles within the telemedicine
platform, as illustrated below:
INTERNAL INTEGRATIONS
Within a telemedicine platform, the seamless

integration of information flow among
91
TABLE 3.2 Telemedicine Interfaces in Use in the Urban Health Project (2023)
INTERFACE S E R V I C E C A PA B I L I T Y
Patient portal › A patient/user account can manage multiple sub-patient profiles
› Every patient profile can be used to avail healthcare services
› Data within patient profiles are scoped within the user account
› Enables patients to have a filtered view of their medical records as encoded

by the physician
Doctor portal › A verified, licensed physician can provide healthcare services both virtual
and on-site
› Enables physicians to perform clinical management, including attending to

patients, updating and sending medical records
› Enables physicians to receive service requests from other facilities such as

patient referrals
Clinic portal › A portal built for clinic and administrative staff to help physicians manage
their schedules, services, and appointments
› Enables clinic users to refer patients to physicians via service request
› Enables clinic to receive inward referrals from medical facilities
Facility portal › A portal built for healthcare facilities to manage multiple clinics
› Enables facility users to refer patients to clinics via service request
› Enables facility to receive inward referrals from healthcare provider networks
Medical › A portal built for healthcare provider networks to manage multiple

Network healthcare facilities
portal
› Enables network users to refer patients to healthcare facilities via service request
› Enables network users to receive inward referrals from other healthcare

provider networks and partnered private healthcare providers
The telemedicine platform is just one piece of other systems enhances overall patient care
the puzzle in a comprehensive public health efficiency. The only limiting factor is the cross
integration with other systems like the EMR, HIS compatibility of these systems and the platform
and Laboratory references (Rosario, A.J., et al, of choice, as well as the resources available for
2024). Generally, integrating telemedicine with each practice.
92
EXTERNAL INTEGRATION VIA HL7-FHIR (R4) in one place. As an example, a local facility that
uses the FHIR framework can easily process a
https://www.hl7.org/fhir/R4/modules.html referral from another FHIR facility even though
they are from different countries.
Since telemedicine platforms require extensive
data entry, it’s crucial to standardize its With the National Health Data Repository
architecture. Interoperability among healthcare functions completed, an HL7-FHIR R4 compliant
systems is essential for the seamless exchange telemedicine platform puts it in a unique advantage
and utilization of health data. This is where FHIR for two things:
integration becomes essential in the development
of a telemedicine platform or application, 1. The platform would make the Health
facilitating seamless coordination among Information Exchange to other systems more
healthcare providers. readily available, and more “readable” by other
health databases.
FHIR (Fast Healthcare Interoperability Resources,
Release 4) is the most widely used standard for 2. PhilHealth will be able to reimburse DOH
interoperability in sharing patient health data. programs on telemedicine platforms that
FHIR standards enable comprehensive integration support the use of HL7-FHIR in their systems.
of Electronic Medical Records (EMR) and Electronic
Health Records (EHR), allowing healthcare
providers to access data from laboratories, HL7 provides a range of benefits for healthcare
pharmacies, and from various medical facilities all providers, patients, and other stakeholders, including:
TABLE 3.3 Benefits of Using the HL7-FHIR (R4) Framework
Maximizing value HL7 provides the guidelines to help software vendors and healthcare
from EHRs providers store and share data. This ensures that data can be integrated
easily across systems, exposed in a cohesive manner and appreciated
by healthcare providers and staff, reducing administrative burden and
improving care delivery.
Improved care HL7 enables the seamless exchange of patient data between different
coordination healthcare providers, allowing for more coordinated and comprehensive care.
Better With access to more complete and accurate patient data, healthcare
decision-making providers can make more informed decisions about patient care, leading to
better outcomes and higher patient satisfaction.
Reduce errors With HL7’s common data exchange language, providers can easily access
and improve and use patient information from various sources, including electronic health
patient care records, medical devices, and other systems.
Increased efficiency HL7 streamlines communication between healthcare systems and devices,
reducing the need for manual data entry and minimizing the risk of errors.
93
Cost savings By reducing the need for duplicate tests and procedures and enabling more
efficient care delivery, HL7 can help to reduce costs for both healthcare
providers and patients.
Innovation HL7 enables the collection and analysis of large-scale patient data,
supporting research efforts and the development of new treatments
and therapies.
Note: Adapted from Orion Health (2020)
3.3 Data Privacy & Security Compliances
In the validation of this roadmap, an anonymous information on his or her behalf. The term
note from one of our target implementation sites excludes: (1) A person or organization who
states “[Data privacy] has been a big issue with performs such functions as instructed by
our patients. We also need protection as the another person or organization; and (2) An
health provider.” individual who collects, holds, processes
or uses personal information in connection
As handlers of potentially extensive volumes with the individual’s personal, family or
of sensitive data, telemedicine platforms that household affairs.
gather personal private information and sensitive
personal data are obligated to adhere to the (i) Personal information processor refers
Republic Act No. 10173 or the Data Privacy to any natural or juridical person qualified
Act of 2012. The telemedicine platform provider to act as such under this Act to whom
assumes the dual roles of Personal Information a personal information controller may
Controller (PIC) and Personal Information outsource the processing of personal data
Processor (PIP) defined below, and in accordance pertaining to a data subject (NPC, 2012).
with the succeeding scenarios.
REGISTRATION OF PATIENTS
(h) Personal information controller refers
to a person or organization who controls Users assuming the Patient role who wish to
the collection, holding, processing or use access healthcare services can register for
of personal information, including a person an account on telemedicine platforms. The
or organization who instructs another registration process typically involves collection
person or organization to collect, hold, of basic information to create user accounts,
process, use, transfer or disclose personal including an email address, mobile number,
password, and basic personal information.
94
In this scenario, the telemedicine platform acts as In this scenario, the telemedicine platform acts as a
a PIC in which they have control over the following: PIP, and healthcare provider becomes the PIC that
uses the system to do the following:
1. Access to view user information

except for passwords. 1. Access the personal and health information
of the patient.
2 Ability to verify validity of user information,
commonly known as Know-Your-Customer 2. Create medical records from the encounter
(KYC). with the patient.
3. Revoke users who violate the Terms and 3. Send medical records such as prescriptions
Conditions of the platform. to the patient.
ENCOUNTER BETWEEN PATIENT AND While safeguarding patient privacy is primarily

HEALTHCARE PROVIDERS the responsibility of the healthcare provider,
as mediator of the encounter, the telemedicine
In a consultation, users assuming the Patient role platform may also share responsibility in cases
may request an appointment with a physician of security breaches resulting from negligence,
within a clinic, which belongs to a healthcare insider threats, data interception, cyberattacks, etc.
organization. Therefore, it is crucial to establish a Data Sharing
Agreement between the telemedicine platform
Telemedicine platforms must collect the Express and the healthcare provider before initiating
Consent of the patient to share their information patient engagement. This agreement serves the
to the healthcare provider and proceed with the following purposes:
encounter. After which, the healthcare provider
may now conduct the necessary procedures to
provide the healthcare services as needed. 1. Define the separation of responsibility of the
telemedicine provider and the healthcare
provider on how both parties will protect the
data privacy of the patient.
2. Mandate the healthcare provider to comply

with the Data Privacy Act of 2012.
IN PHOTO: Dr. Ruben Ver Bombeta discusses the Milestones & Outcomes of the Urban Health Projects in Parañaque City.
Photo taken at the Holiday Inn, Makati City, October 16, 2023.
Telemedicine
Monitoring & Reporting
4.1 Telemedicine Evaluation Situation
Paragraph 1 & 2 of Section VII. I. from the JAO Monitoring results shall serve as basis
2021-0001 states that: for annual advisory updates that shall be
jointly issued by DOH, DILG, and PhilHealth
every January of the succeeding year
Regular monitoring shall be conducted by (DOH-DILG-PHIC, 2021, p 12).
the Regional Telemedicine Coordination
Team, together with KMITS and the LGU
Telemedicine Operations Team, using an As discussed in Chapter 1.2. A. What Should
agreed method, tools, and performance Telemedicine Look Like?, the monitoring of the
indicators as provided under the local telemedicine implementation in the country falls
health systems maturity model and under the responsibility of the Telemedicine
related telemedicine scorecard that shall Sub-Working Group (SWG), an arm of the DOH-
be issued as separate guidelines by DOH, DILG-PHIC, which also reports to the NEHTWG.
DILG, and PhilHealth. Specifically, they are assigned to:
(a) review and monitor the progress However, we do have a general idea of what this
of implementation of telemedicine may look like based on Annex 3.3 Weekly Status
services; (b) conduct the necessary Reports of the same document issued by the
consultations and coordination DOH-NPC, which were previously applied to the
with concerned stakeholders; and program implementation of telemedicine services
(c) submit monthly assessment during the period of Enhanced Community
and accomplishment reports to the Quarantine due to the COVID-19 pandemic.
NEHTWG for performance monitoring Please note that these indicators may not align
and evaluation (DOH-NPC, 2020b). precisely with the metrics we are seeking within
the context of individual healthcare provider
facilities, especially post-COVID-19, and that they
As of September 2023, the existence of the were not readapted in the current JAO 2021-0001
Telemedicine SWG and the development of the policy, but they serve as a reference point as we
guidelines for the telemedicine scorecard under prepare for future issuances.
the DOH-DILG-PhilHealth are not yet in place.
96
97
TABLE 4.1 DOH-NPC Weekly Status Reports (During ECQ, COVID-19)
ME TRICS
Demographics › Name of telemedicine provider
› Total #, names, and contact details of LGUs engaged
› Total #, names and addresses of health facilities engaged as providers

of telemedicine services
› Total #, names and contact details of physicians engaged as providers

of telemedicine services
Summary of › Total # of unique individual patients who sought health services through
Telemedicine telemedicine per healthcare provider per day (disaggregation: individual
Consultations health facility vs individual physician)
› Total # of telemedicine consultations received per healthcare provider per

day (disaggregation: companion-assisted patient consultation vs non-
companion assisted/individual patient consultation; individual health facility
vs individual physician)
› Type of telemedicine consultations received per healthcare provider

(disaggregation: COVID-19 vs non-COVID-19 health concerns; individual
health facility vs individual physician)
› Reasons for consultations received per healthcare provider (disaggregation:

COVID-19 vs non-COVID-19 health concerns; individual health facility vs
individual physician)
› Clinical classification (disaggregation: COVID-19 vs non-COVID-19 health

concerns; individual health facility vs individual physician)
› Type of disposition per telemedicine consultation received (disaggregation:

COVID-19 vs non-COVID-19 health concerns; individual health facility vs
individual physician)
Feedback › Average patient satisfaction rating of the telemedicine services provided by

the healthcare provider
› # of patient complaints received by healthcare providers
› # of patient complaints closed by healthcare providers
› Types of complaints (i.e. privacy and security breach, medical errors, etc.)
› # of telemedicine provider complaints received from healthcare providers

98
ME TRICS
› # of telemedicine provider complaints from healthcare providers closed
› Types of telemedicine provider complaints (i.e. disengagement, etc.)
› # of security incidents and personal data breaches reported within NPC

protocols (incident reporting mechanism)
Note: From the DOH-NPC, 2020b, p 11-12
4.2 Development of a telemedicine analytics platform
Telemedicine, with its inherent digital nature, technologies in Information and Communication
generates vast amounts of patient data and (ICT), public health surveillance has become more
interactions in real-time. Effective use of this progressive with the use of electronic medical
information holds potential for improving healthcare records systems, geographic information systems,
delivery, patient outcomes, and resource allocation. and telemedicine.
Moreover, it enables healthcare professionals
to identify gaps in care, assess the efficacy of Telemedicine in the Philippines requires a
telehealth interventions, and ensure compliance dedicated champion, and this responsibility may
with regulatory standards, provided that an easy- not rest solely with the DOH or the LGU. It is here
to-use system for managing and visualizing this that we look for other players, particularly in the
data is accessible to key stakeholders. private sector to help fill-in the gaps.
As discussed in previous chapters, and aside

from the challenges to be expected during The paradigm shift that we have to
implementation, much of the infrastructure outlined appreciate now is that we really need
by the government to support telemedicine the private sector to support national
initiatives are simply not yet in place. Indeed, government-initiated programs. I
a strategic plan alone may not suffice without hope that with stronger private sector
concrete follow-through and leading by example. initiatives, through the Startup Research
Grant program, we can help these
Telemedicine complements public health startups” Executive Director Montoya
harmoniously. Public health is programmatic said, expressing the DOST-PCHRD’s
in nature, and surveillance and monitoring of commitment to strengthen its support
community health status are based on specific to the Filipino health startups (DOST-
health indicators. With the advent of improved PCHRD, n.d.).
99
THE DOST-PCHRD FUNDS › This platform offers (a) a dashboard page

THE DEVELOPMENT OF A where users can see the overall performance
TELEMEDICINE ANALYTICS PORTAL of their organization’s operations at a glance;
(b) an appointment heat map where medical
Launched in December 2020, the Startup Research organizations can identify which hours and
Grant is the DOST-PCHRD’s contribution to the days of the week their virtual facility is serving
implementation of Republic Act 11337 or the the most appointments; (c) a doctor and
Innovative Startup Act which aims to promote R&D patients demographics page; (d) a ratings and
in the Philippine startup industry. The program complaints page where patient feedbacks can
provides research funding for privately-owned be monitored; and (e) a revenue page where
health startups to flourish R&D in the industry patients’ mode of payment can be determined.
based on priority sectors such as healthcare.
One of these projects allowed a milestone to SEEYOUDOC (MA) ANALYTICS

be reached in the telemedicine landscape:
Development and enhancement of an interactive SeeYouDoc (MA) Analytics was designed using
analytics platform for medical facilities to SCRUM methodologies and is powered by the
provide assessment of telemedicine adoption Google Data Studio engine. Given its digital
(Implementing Agency: SeeYouDoc Corp.). nature, the data collected from telemedicine
integrated practices can be visualized in real-time.
› SeeYouDoc is an e-health startup founded Validation was done at representative medical
in 2018 with a mission of Digitizing the facility implementation sites comprising one (1)
Healthcare Experience in the country through rural health unit, one (1) private hospital, one (1)
telemedicine and innovation. SeeYouDoc offers public hospital, and one (1) apex hospital.
a telemedicine platform which also integrates
tools for healthcare providers such as SeeYouDoc MA deploys metrics proposed from
e-prescriptions, and digital payment systems. studies conducted by the Pan American Health
Organization (2015), Zielinski & Marino (2020),
› Through SeeYouDoc, the DOST-PCHRD the UP Manila Medical Informatics Unit (2020),
funded the development of an enhanced and the Consumer Assessment of Healthcare
interactive analytics platform to measure the Providers and Systems (CAHPS) (Agency for
effectiveness of telemedicine in the operations Healthcare Research and Quality, 2015) among
of medical facilities, the first of its kind in the others. Keeping in mind the end users of the
Philippines. This was later announced as platform, the scope was narrowed down to focus
SeeYouDoc (MA) Analytics. on three key drivers: a) patient telemedicine
experience, b) financial revenue of medical
facilities, and c) better scalability.
TABLE 4.2 SeeYouDoc (MA) Analytics Identified Metrics
ME TRICS
Dashboard › Total appointments

Overview Count of all appointments received by the medical facility based on a
selected date range
› Active practitioners
Count of medical providers affiliated to the medical facility
» Published practitioners
Count of medical providers affiliated to the medical facility who is
searchable by users when they visit SeeYouDoc
100
ME TRICS
› Average appointment length (in hours)

Average time of telemedicine encounters happening in that medical facility
› Doctor Patient Ratio

Ratio of medical providers onboard with the virtual facility of the
medical facility in SeeYouDoc and the patients availing of their services
in SeeYouDoc
› Active Patients
Count of patients who have availed of the medical facility’s services and
who has an active account in SeeYouDoc
› Total Revenue
Amount of revenue generated by the medical facility with using SeeYouDoc
› Total Appointments per Month

Count of all monthly appointments received by the medical facility
› Appointments
Description of the appointments received by the medical facility
in SeeYouDoc
› Appointment Count by Specialization

Count of all appointments received by specializations of the medical
providers affiliated to the medical facility
Appointments › Appointment heat map

Heat map of the appointments received by the medical facility in a
weekly basis
› Appointments by services availed and by status

Matrix of the services availed by patients and its corresponding
appointment status with the medical facility
› Average appointments per month

Average number of appointments received by the medical facility in
SeeYouDoc per month
› Appointments by patient sex

Breakdown of patients by sex availing of services of the medical facility
in SeeYouDoc
› Appointment count by specialization per day

Appointment count being received by each medical provider
specialization per day
› Appointments by specialization
Breakdown of appointments received by medical provider specializations
onboard in the virtual facility of the medical facility in SeeYouDoc
101
ME TRICS
Demographics › Practitioner specializations

Onboarded medical providers of the medical facility in SeeYouDoc
described by specialization
› Active practitioner accounts

Medical providers affiliated to the medical facility who has an active
account in SeeYouDoc described by medical provider name and their
corresponding specialization
› Patient sex breakdown

Breakdown of patients by sex
› Repeat vs new patients

Breakdown of patients by their profile (whether they are a new or
repeat patient)
Ratings › Practitioner Ratings

Ratings received by the practitioner from the patient after their telemedicine
encounter in SeeYouDoc
› Average ratings by month

Average practitioner ratings received from patients per month
› Comments
Comments provided by patients when rating their telemedicine experience
› Number of complaints by month

Count of complaints filed by patients when rating their telemedicine
experience
› Complaints
Details of complaints provided by patients when rating their
telemedicine experience
Revenue › Revenue over time

Revenue generated by the medical facility in SeeYouDoc on a monthly basis
› Source of cash-in payments

Breakdown of cash-in method used by patients who availed services to
the virtual facility of the medical facility in SeeYouDoc (i.e. whether a patient
uses gcash, grabpay, etc.)
› Mode of cash-in payment

Breakdown of mode of cash-in method used by patients who availed
services to the virtual facility of the medical facility in SeeYouDoc (i.e.
whether a patient uses card or online payments)
102
ME TRICS
› Appointments by mode of payment

Breakdown of appointments by mode of payment (i.e. whether a patient
avails of free or uses online credits for their appointment with the
medical facility)
› Number of transactions per service and status

Breakdown of transactions based on the services of the medical facility in
SeeYouDoc availed by patients
Note: From SeeYouDoc (personal communication, 2023)
In addition, SeeYouDoc MA uses filter options commercial availability of the product (DOST-
such as dates and other metric-specific PCHRD, n.d.b). It is available as an add-on in the
parameters to quickly narrow down the SeeYouDoc MN Platform which is a portal dedicated
results. SeeYouDoc is also accepting future to the management of telemedicine operations at
enhancement requests for the SeeYouDoc MA the HCPN level. Interested healthcare providers
such as additional metrics or features. are invited to visit the SeeYouDoc website (www.
seeyoudoc.com) to learn more.
SeeYouDoc MA is currently at Technology
Readiness Level (TRL) 9, which translates to See Annex SeeYouDoc MA for illustrations.
IN PHOTO: SeeYouDoc Founder and CEO Noel Gary del Castillo, MTM, talks about the challenges that telemedicine implementation
in the Philippines face during the Sustainability Planning for the Urban Health Projects. Photo taken on September 15, 2023 at the
Sequioa Hotel.
Conclusion
5.1 A Retrospective
FIG. 5.1 Validation of the Telemedicine Roadmap for Philippine Local Government Units (LGUs)
at the Holiday Inn, Makati City on October 16, 2023
IN PHOTO: Dr. Binji Pangaibat answers a question for the validation of the Telemedicine Roadmap for Philippine Local Government
Units. Photo taken on October 16, 2023 at the Holiday Inn, Makati City.
The Urban Health Projects (2022, 2023) us our previous experiences, we set out to establish
in Parañaque City was about establishing our baselines and conducted our stakeholder
telemedicine services in model barangay health interviews for each of our target sites. We asked
centers. The development of this roadmap was a our usual questions and tried our best to match
key deliverable in the second iteration of the WHO each problem presented with a possible solution.
Urban Health Project (2023).
We had to get things done in five months. The
In creating the roadmap, an attempt to exhaust timeline for the development of this roadmap
all available resources on telemedicine best overlapped with the implementation of
practices in the Philippines was made. Through telemedicine in our target sites. By the time we’d
this research, we gained insights on how to set up the virtual facilities of each target site, the
implement telemedicine effectively, and in a roadmap was still undergoing revisions. Our on-
manner that increases the likelihood of success site team learned to deal with the challenges
even post-project completion. We learned the head-on and managed them not with finesse but
importance of physician champions, streamlined to the best of our ability. The learnings that we
workflows, and starting with small, focused were getting from developing the roadmap were
implementations. Additionally, we encountered simply not going to make it in time.
challenges that we can now anticipate and better
prepare for in the future. And so we pass our learnings to you.
It is regrettable that we were unable to apply Initially dubbed the “Telemedicine Playbook,”
these insights at the start, or even during the this Telemedicine Roadmap for Philippine Local
implementation. Government Units (LGUs) was later renamed as
such, as we recognized early on that our roadmap
As project implementers, our end goal was to would serve as a precursor for the development of
establish telemedicine implementations for each such materials, ideally from our health authorities,
target site however means necessary. Taking with particularly the DOH.
104
105
This roadmap should arm you with preparatory This project was a labor of love and took many
insights to navigate these challenges and more. months to complete. We wish you the best of luck
And in the next sections, we will try to share our in your own telemedicine implementation and look
project findings and thought processes throughout forward to seeing more facilities in the Philippines
the Urban Health Projects, with the hope that embrace telemedicine as a means to enhance
you can learn from them. We reiterate that the healthcare systems in pursuit of the Universal
information presented here should be considered Healthcare Act, and to improve the quality of life of
within the appropriate context, as a comprehensive all Filipinos, wherever they may be.
resource based on our findings and research from
available materials.
5.2 The Urban Health Projects in Parañaque City

FIG. 5.2 Project Review (Year 1-3) and Sustainability Planning for the Urban Health Projects.
Photo taken on September 15, 2023 at the Sequioa Hotel
In a procurement request for Year 3 of the Urban

Health Project, the WHO notes how engaging that crisis preparedness and response is
local communities, including those in slum areas, not effective without the participation of
is crucial for delivering people-centered healthcare vulnerable communities. When involved in
and building resilient systems: the mitigation process, the communities’
“confidence, capacities, and coping
mechanisms develop in an upward
Previous experience in other pandemics, spiral”, and they are more accepting of
such as the Ebola in West Africa, and and amenable to remedial initiatives and
SARS and Influenza Pandemic (H1N1) approaches. Engaging local communities
in Asia, show that interventions that is generally important to delivering high-
adopted a community-centric lens were quality, people-centered health care, and
more successful than others in driving to building resilient and inclusive systems
sustainable impact. Studies revealed for development (WHO, 2023).
106
Since 2021, the World Health Organization SeeYouDoc, founded in 2018, has been dedicated
(WHO) and the Korea Foundation for International to digitizing the healthcare experience by using
Healthcare (KOFIH) have collaborated with the tech innovations and modern solutions like
Department of Health (DOH) to support projects telemedicine and was chosen as the contractual
targeting urban poor communities in Parañaque partner for both Year 1 (2022) and 2 (2023) of the
and Valenzuela City. Urban Health Project in Parañaque City.
A. THE CHALLENGE
In a broader context, our challenge was to The following is a summary of our deliverables and
establish telemedicine services in Parañaque City. target sites under the Urban Healthcare Projects.
TABLE 5.2 Urban Health Projects in Parañaque City (2022, 2023)
PROJECT TARGE T SITES

DURATION (BRGYS) DELIVERABLES
Aug 12, 2022 1. Moonwalk 1. In coordination with key stakeholders, support

to the establishment of the model Barangay Health
Dec 12, 2022 2. Sto. Niño Care Center through the promotion of the use of
telemedicine and digital health.
3. Vitalez
2. Facilitate implementation of Health outreach
activities for urban poor communities.
Jun 01, 2023 1. Don Galo 1. In coordination with key stakeholders, support
to the establishment of the model Barangay Health
Oct 30, 2023 2. La Huerta Care Center through the promotion of the use of
telemedicine and digital health, and expanding it
3. Tambo to all barangays in Parañaque.

4. Don Bosco 2. Facilitate implementation of Health outreach
activities for urban poor communities.
5. Marcelo Green
3. Document a playbook on how to prepare,
6. San Martin implement, and monitor a telemedicine system
de Porres within a local government health system.
107
FIG. 5.3 Map of the WHO Urban Health Projects (2022, 2023)
108
B. METHODOLOGY
The establishment of model barangay health The questions revolved around the assessment
care centers in Brgy. Moonwalk, Brgy. Sto. Niño, of the current operations on healthcare delivery
and Brgy. Vitalez involved rapid assessment of of their respective offices, current views and
current systems, telemedicine capacity building, experiences on telemedicine, visions for the
stakeholder orientation, progress monitoring, establishment of model health care centers, and
and a health outreach activity in Parañaque capacity to conduct telemedicine and outreach
City. Activities were conducted using the agile activities. From the sessions conducted, the team
methodology framework which involved an then collated all insights from the interviews
iterative process of activity preparation, execution, and developed an affinity map to guide us in the
and review with the project sites. deliverables of the project.
The team conducted four (4) interview sessions The same workflow would be repeated in the
with the sites: one session for the CHO, and 2nd iteration of the UHP (Urban Health Projects),
separate sessions for each of the three barangay which would now involve Brgy. Don Galo, Brgy.
sites. The sessions were conducted by asking La Huerta, Brgy. Tambo, Brgy. Don Bosco, Brgy.
interviewees questions on telemedicine developed Marcelo Green, Brgy. San Martin de Porres.
by the team.
C. FINDINGS
The stakeholder interviews are an integral part of Annex. This form contains an updated set of
the baseline assessment to be conducted prior to questions and can serve as a supplementary
any implementation. They offer insights into any document when conducting stakeholder
potential challenges down the road, as well as interviews, guiding you in the next steps of the
any other considerations that may require creative implementation phases.
solutions. However, the questions should be
pertinent and updated to the most recent available We also emphasize the importance of asking
resources on telemedicine. the same set of questions consistently to prevent
deviations in the responses.
Although not included in the actual implementation,
we’ve developed a Telemedicine Implementation The following information has been anonymized.
Feasibility Assessment Form, available in the
109
URBAN HEALTH PROJECT 2023
FIG. 5.3 Urban Healthcare Project (2023): Libreng Tuli, Konsulta, Atbp
IN PHOTO: Host Mr. Johnny Bondoc of Regnum Christi interviews 2 patients.

Photo taken August 18, 2023 at Mano Amiga Academy.
110
TABLE 5.3 Analysis of the 6 Stakeholder Interviews Conducted during the Urban Health Project
in Parañaque City (2023)
INTERVIEW
QUESTIONS RESPONSE ANALYSIS
1. Have you In response to the question regarding the use of telemedicine services, it
ever used is evident that the majority of participants (A, B, C, and F) have not directly
telemedicine engaged with formal telemedicine platforms.
services in
your practice? Instead, they rely on more informal methods such as Viber and Facebook
Messenger for teleconsultations. Participants A, B, D, and F have mentioned
the use of these messaging platforms for connecting with patients. Participant
C highlighted a unique approach with paperless consultations, involving the
Barangay Health Workers (BHW) connecting patients to the Health Center
through phone calls. Participant E, while not directly engaging in telemedicine,
does use group chats for communication when the doctor is unavailable.
Overall, the responses indicate a reliance on ad-hoc methods and a limited

adoption of structured telemedicine platforms in these barangays.
2. Do you have Each barangay (A, B, C, D, E, and F) has implemented some form of telemedicine
an existing initiative, albeit with variations in their approach. There are clear variations in terms
telemedicine of structure, communication methods, and operational hours. Participant B seems
program in to have a more organized and flexible telemedicine program, while Participant
your facility? A’s approach appears to be less structured and more ad-hoc. Participants C, D,
and E have structured programs with defined hours of operation.
› Participant A mentioned that while there is no specific telemedicine

program, they do conduct telemedicine consultations through Viber or
Facebook Messenger, primarily for follow-up consultations. However, they
noted that there are no specified window hours for telemedicine services,
suggesting an ad-hoc nature.
› Participant B appears to have a more structured approach, with a group

chat for consultations and the ability to share information online. They
conduct telemedicine services daily from 9AM to 5PM, and they have
flexibility for emergencies, referring patients to hospitals when needed.
› Participant C conducts telemedicine consultations primarily through

phone calls, focusing on senior citizens who cannot visit the Health Center
physically. Their telemedicine services are available during clinic hours from
8AM to 5PM on weekdays.
› Participant D seems to have a comprehensive approach, with nurses

and midwives collecting patient details, conducting virtual consultations
primarily through text and sending pictures via Viber, and having set hours
of operation from 8AM to 5PM on weekdays.
› Participant E primarily uses Messenger and Viber for communication and

stores records on the health center’s desktop. Their services are available
during clinic hours from 8AM to 5PM on weekdays, with the option for
patients to send concerns beyond this schedule.
111
INTERVIEW
› Participant F conducts text-based telemedicine consultations through

Messenger and Viber, with a structured schedule for check-ups involving
various healthcare professionals and specific days for different patient groups.
3. What are There is an indication that the barangays are committed to delivering a wide
the usual array of healthcare services to their communities, aiming to meet the diverse
services offered healthcare requirements of their residents. Collectively, essential services
by your facility? including medical consultations, dental services, prenatal care, and immunization.
Some facilities also offer specialized services such as maternity care, nutrition,
anti-rabies vaccination, tuberculosis care, and COVID-19 vaccination.
Additionally, there seems to be a focus on providing a comprehensive range

of services throughout the week, with designated days for specific types
of care, ensuring accessibility for residents. This approach allows for the
efficient allocation of resources and healthcare personnel to cater to various
healthcare needs.
4. What are the Collectively, these barangays serve a diverse range of patients, including
usual patient children, adults, and seniors. There is a common emphasis on serving
demographics? low-income populations, which underscores the importance of accessible
healthcare services in these communities. The patient demographics also
highlight variations in the volume of patients seeking specific services across
the barangays.
› Participant A’s demographics vary by service, with prenatal services

catering to 15-20 patients, dental services to 6-10 patients, and pediatric
vaccination to 30-40 patients.
› Participant B serves around 10-15 patients for prenatal care and 10

patients for dental services.
› In Participant C’s health center, they offer medical consultations both face-
to-face and via telemedicine. Face-to-face consultations serve around 50
patients, a mix of children and seniors. Telemedicine consultations serve
1-5 patients, with patients primarily falling into the low-income group.
› Participant D’s health center caters to children aged 0-5 years old and
adults aged 30-60 years old, with most patients also belonging to the low-
income group.
› Participant E provides face-to-face medical consultations to 30 patients,

with patients spanning from children aged 0-10 years old and adults aged
30 years and above.
› In Participant F’s health center, there is a significant volume of patients,

with 50 face-to-face patients and 10 virtual patients per day. Their patient
demographics include children aged 0-5 years old and adults aged 30
years and above.
112
INTERVIEW
5. As a In general, the healthcare providers in these barangays hold mixed views on the
healthcare role of telemedicine in healthcare service delivery.
provider, what
is your current While some see the potential benefits of telemedicine, particularly for specific
outlook for patient groups like seniors or those unable to access the health center, others
telemedicine? prefer traditional face-to-face consultations.
Several respondents emphasize the importance of physical examination by

the doctor, suggesting that certain medical concerns require in-person visits.
However, there is recognition of telemedicine’s value for programs such as
medical consultations, follow-ups, and systematic scheduling.
6. What There is a mix of internet connectivity quality across these barangays, with
telemedicine some having fast and reliable connections while others experience slower
infrastructure or fluctuating speeds. Personal devices and city-provided equipment are
is currently used for telemedicine consultations. Some barangays are also exploring the
in place in implementation of EMR systems to enhance healthcare management.
your facility?
› Participant A’s internet connectivity provided by the city, which is crucial
for teleconsultations. They also mention the availability of cell phones for
communication, with plans to implement an Electronic Medical Record
(EMR) system using iClinicSys.
› Participant B mentions having an internet connection, albeit slow, provided

through a project by the City Mayor. They primarily use personal devices for
telemedicine consultations, and there is a laptop mainly used for encoding
COVID-19 patient information and vaccination records.
› In Participant C’s barangay, there are two internet connection providers

(Cable Link and PLDT), with a fast internet connection at the health center
provided by the City Health Office. They have a desktop and a dedicated
smartphone for teleconsultations.
› Participant D’s barangay has a fast internet connection for clerical purposes,
but the health center experiences issues due to electricity fluctuations.
Internet speed ratings differ between the barangay and health center. Both
have computers and phones donated by the City Health Office.
› Participant E mentions having slow internet connections for both the
barangay and health center, with different providers (PLDT and Converge
for the barangay, and Cable Link for the health center).
› In Participant F’s barangay, they have internet connectivity at both the

barangay and health center, with desktops or PCs available. Laptops are
mentioned but are rarely used.
Note: There are six anonymized participants in this table (A, B, C, D, E, F)

113
URBAN HEALTH PROJECT 2022
FIG. 5.4 Urban Healthcare Project (2022): Telemed Launching
IN PHOTO: Telemedicine implementers assisting patients in preparation for their telemedicine consultation.
Photo taken November 07, 2022 at Parañaque City Health Office.
114
TABLE 5.4 Analysis of the 3 Stakeholder Interviews Conducted during the Urban Health Project
in Parañaque City (2022)
INTERVIEW
1. Have you In summary, these healthcare practitioners have varying levels of experience
ever used with telemedicine.
telemedicine
services in › Participant G has embraced telemedicine during the pandemic, utilizing
your practice? informal methods and transitioning to more structured training with
iClinicSys.
› Participant H has also used telemedicine informally for various types of

consultations and inquiries.
› In contrast, Participant I appears to have limited familiarity with

telemedicine practices.
2. Do you have In summary, Participant G uses messaging platforms for telemedicine

an existing consultations, Participant H has a fixed schedule of operations that may impact
telemedicine telemedicine availability, and Participant I appears to have limited familiarity
program in with telemedicine practices in their facility.
your facility?
› Participant G mentions that they primarily use messaging platforms like
Facebook Messenger for telemedicine consultations. The response time
depends on how quickly patients complete questionnaires, with an average
duration of about 15 minutes. They note that the use of telemedicine varies
depending on the patient’s response time and the complexity of their
questions. Scheduling and availability are also factors that influence their
telemedicine services.
› Participant H outlines their operational schedule from 8 am to 5 pm,

Monday through Friday, with different services offered on various days.
They indicate that their operations already follow this schedule, and they
also mention having a caravan. It seems that their commitment to other
services might affect their telemedicine availability.
› Participant I states that they are not familiar with telemedicine.
3. What are In summary, these healthcare facilities offer a range of medical services, often
the usual with a focus on preventive and primary care. Some services are government-
services offered subsidized and free for patients, while others may involve additional charges.
by your facility? Additionally, the facilities accommodate patients from outside their immediate
area, demonstrating a commitment to providing essential healthcare services
to a broader community.
› Participant G emphasizes that the consultations provided at their facility

are free, as they are government-subsidized. Patients don’t incur charges
for these services. Additionally, some patients are willing to pay for services
like massage, and inquiries can be made through messaging.
115
INTERVIEW
› Participant H describes a range of consultations, with a focus on non-

communicable diseases (NCDs) and maintenance prescriptions. They also
mention services related to dengue, nutrition, maternal care, and vaccines.
Their workload is influenced by technical aspects and documentation.
› Participant I discusses the provision of medical assistance for services not

available within the center, such as CT scans, chemotherapy, blood-typing,
and pap smears. They mention that the majority of the barangay’s budget
is allocated for these services. Even patients from outside Sto Niño receive
vaccinations. Although the supply is intended for Sto Niño residents, they
still cater to outsiders without significant negative consequences.
4. What are the The usual patient demographics at these healthcare facilities encompass
usual patient a diverse range of ages, from infants to senior citizens. Patients come from
demographics? various income brackets, with a focus on individuals in lower to mid-lower
income groups. The facilities also provide a wide range of services, including
those tailored to pregnant women, children, working-class individuals, and
senior citizens.
› Participant G mentions seeing around 18 patients per day post-pandemic

but does not provide specific demographic details for these checkups. They
note a wide age range, from infants to seniors, and indicate that patients in
lower to mid-lower income brackets frequently seek maintenance medicines
and immunizations.
› Participant H estimates about 20 consultations per day, with patients seeking

various services, including animal bites, fever, dengue testing, immunizations,
prenatals, maintenance, and family planning. They mention that most
patients availing their services come from mission or depressed areas.
› Participant I can accommodate up to 30 pregnant women and sees varying

numbers of patients for prenatal care, ranging from 20 to 35 patients.
They also note the presence of teenage pregnancies and mention that the
majority of patients seeking consultation are young children aged 2-7 years
old, as well as senior citizens.
5. As a All three healthcare providers generally prioritize on-site (face-to-face) consultations

healthcare for a more comprehensive assessment of patients. While they recognize the value
provider, what of telemedicine in certain scenarios, they emphasize the importance of physical
is your current examination and direct observation, particularly for accurate diagnosis and
outlook for assessment of symptoms. Telemedicine is seen as an option for patients who may
telemedicine? face logistical challenges in accessing healthcare services.
› Participant G expresses a preference for face-to-face consultations,

highlighting the limitations of telemedicine. They emphasize that certain
aspects of patient assessment, like physical exams, cannot be effectively
conducted online. While acknowledging the usefulness of telemedicine in
some cases, they believe that face-to-face consultations provide a more
comprehensive and accurate diagnosis.
116
INTERVIEW
› Participant H mentions that their current practice is primarily face-to-face,

especially for services like prenatal care and immunization, which require
physical assessments. They do see potential for virtual consultations in
other areas, such as tuberculosis programs and postpartum check-ups.
However, they stress the importance of direct observation and physical
assessment, particularly for cases involving skin lesions.
› Participant I strongly prefers face-to-face consultations to assess patients

properly. They highlight the limitations of relying solely on history and mention
that symptoms and visual cues can be missed in virtual consultations. They
suggest that telemedicine may be more suitable for patients who live far
away or need frequent follow-ups.
6. What These healthcare facilities face challenges related to internet connectivity

telemedicine and express the need for stronger and more reliable internet connections.
infrastructure There’s also a consensus on the importance of dedicated personnel and
is currently in standardized processes to ensure the effective and sustainable implementation
place in of telemedicine programs.
your facility?
› Participant G describes having two Wi-Fi modems, with varying internet

speeds between the first and second floors. They note that the internet
can become slow when many users are online. They also mention having
several devices, including laptops, tablets, and desktops, assigned to staff
members for telemedicine use during their 8 am to 5 pm operations.
› Participant H highlights the need for additional manpower to support the

implementation of new telemedicine programs, especially outside the regular
working hours. They emphasize the challenges related to connectivity and
slow internet, stating that many health centers, including the city hall and
most barangay health centers, experience intermittent internet connections.
They express the need for stronger internet connectivity and describe their
use of smartphones, PCs, iPads, and laptops for telemedicine consultations
and data management.
› Participant I echoes the need for multitasking due to the variety of services
offered at the health center. They emphasize the importance of having
dedicated personnel for telemedicine to better focus on the various
programs. They mention their involvement in various administrative
tasks, data entry, and technical aspects of making the telemedicine
program sustainable. They also note the availability of free Wi-Fi and a
PLDT internet line, although the latter was temporarily disrupted due to
nearby construction.
Note: There are three anonymized participants in this table (G, H, I)

117
D. RESULTS
For the Urban Health Project (2022), the team budget allocation and close finance-project team
was able to serve over 360 community members, coordination ensured financial stability.
trained 40 personnel, conducted 1 outreach event,
established 3 model sites with telemedicine Despite our small team, we relied on each other,
services. In terms of equipment, 5 laptops were promoted open communication and showed our
provided; 3 laptops for the project sites (1 each commitment. Internally, we also aimed to hold
barangay), 1 for CHO, and 1 for Health Promotions several huddles per week to keep everyone in the
Office (HEPO) each with respective laptop bags loop. This synergy enabled us to stick to our project
and a dedicated mice. timeline and meet every milestone that would
have been much harder otherwise.
The Urban Health Project (2023) has so far helped
at least 248 patients, trained at least 50 personnel, In addition, positive feedback and testimonials
conducted 1 outreach event, and established 6 from satisfied patients and doctors helped us
model sites with telemedicine services. In terms reenergize and reinforced our focus on why we
of equipment, we have turned over an additional are doing this.
6 laptops (1 each for barangay) plus 1 computer
monitor for CHO and 1 mounting kit for the
monitor. We have also provided headphones WHAT COULD HAVE WORKED BETTER
with a microphone for better communications for
each project site in addition to the laptop bags A general sentiment from the team is that a longer
and mouse. project timeline might have allowed for more
comprehensive groundwork and preparation.
We recommended to provide at least 2 laptops Additionally, the timing of our implementation
per barangay as the ideal set up of telemedicine project coincided with other priorities and
would be having 1 laptop in the health center and commitments from within the target sites, which
1 in an identified remote hub accessible to the vast divided the focus and manpower available to help.
majority of the constituents who have difficulty
getting to the health centers. Enhancing communication channels with the
barangay stakeholders could have eased
The provision of printers is not part of the project challenges in addressing concerns. Although
scope but it would be ideal to have one unit per a stronger and more active engagement from
telemedicine hub/station for accessible printing of within the barangay stakeholders themselves is
medical records, including e-prescriptions. also welcome.
From within our team, we also recognize the

WHAT WENT WELL importance of setting realistic deadlines and
ensuring an equitable distribution of the workload.
Overall, our implementation thrived thanks to solid As we grappled with a lot of logistical challenges,
teamwork and resourceful planning. we also could have maximized the use of the
telemedicine platform.
Funding and guidance from the WHO Philippines
set us on the right path and we established Of the many opportunities we experienced, the
bimonthly check-ins on our progress. Efficient following are significant:
118
TABLE 5.1 Opportunity Highlights in the Urban Health Project Implementation
OPPORTUNIT Y DISCUSSION
Poor Timing Some target sites had prior commitments or different priorities than ours,
which made it challenging to coordinate. Moreover, with an upcoming election
campaign period and ongoing internal activities like outreach projects, the
timing was less than ideal.
Our constraint was the project’s time sensitivity, which necessitated us to

proceed with the implementation despite these challenges. Should we be
able to do it differently, we would first attempt to communicate with project
sites early, and understand their priorities and current calendars to identify
potential conflicts. This proactive approach would provide us with the time
needed to develop a more comprehensive plan.
Limited support There is an expectation that as project implementers, we should be

from the LGU responsible for addressing all challenges that arise during the project.
However, our reliance on donor funds limits our ability to address challenges
comprehensively. Proactive engagement and a sufficient workforce to fulfill
requests must also come from the LGU. Without support and prioritization,
the chance of success diminishes.
Patients and Resistance to adopting new workflows is a common expectation.

doctors have no
incentive to use In the same situation as with the LGU however, for an independent team
telemedicine with limited support or operating on a budget, not all solutions may be
readily available and straightforward. Cooperation from stakeholders,
including both patients and healthcare providers, is essential to make such
changes successful.
For Patients:
Patients are accustomed to receiving healthcare services by physically
commuting to health facilities. The idea of receiving healthcare remotely
may seem intimidating, confusing, or burdensome in terms of time and
commitment. Even if telemedicine offers convenience, time-saving benefits,
and cost-efficiency, patients may find it challenging to adapt, especially
when there’s no incentive to use telemedicine.
Additionally, there’s an expectation that everything should be provided, from

necessary equipment to setting up internet infrastructure. Though we were
able to donate laptop units to healthcare providers, the equipment to be used
by patients was out of our scope.
For Doctors:
Among healthcare providers, there are those who are forward-thinking and
genuinely committed to community well-being. There are also those who
view their work as a routine job, focusing on immediate, day-to-day tasks.
Both approaches are acceptable and have their merits. However, challenges
arise when healthcare providers are unwilling or unable (due to factors like
overwork or understaffing) to change up their routine and consider the long-
119
OPPORTUNIT Y DISCUSSION
term benefits of telemedicine, which is a problem that is commonly observed

in the latter subgroup of healthcare providers.
Effective progress in telemedicine implementation requires the commitment of

all parties involved, including the government, implementers, and healthcare
facilities, working together collaboratively.
Work redundancy The present situation in LGUs mandates the use of an official EMR/EHR. This
requirement adds to the paperwork that is still relied upon in cases where the
official platform is inaccessible or non-functional.
Introducing new ‘unofficial’ telemedicine platforms, even if they offer

enhanced features and usability, inevitably leads to redundancy in work due
to incompatibility with the existing official platform. While we were aware of
this issue and attempted to implement some workarounds, certain aspects
of redundancy were unavoidable.
Failure to optimize The tight timeline and the many project commitments we wanted to deliver led
the utilization of to a loss of focus on the most critical aspect. After setting up the telemedicine
the telemedicine platform, we neglected to monitor and promote its use until late in the project,
platform relying on the assumption that users would independently adopt it.
Medication In the validation of this roadmap, one of our target implementation sites,
logistics Brgy. Sto Niño mentions that the dispensing of medicine after a telemedicine
consultation should be standardized. During the project, the approach was
that the Barangay Health Worker (BHW) will visit the area where the patient
lives then give the prescribed medication.
In an ideal setting, the LGU telemedicine operations team from the LDRRMO
would be responsible to handle the logistics of this request.
OUTREACH COMPONENT:
A NOTE FOR TELEMEDICINE IMPLEMENTERS
In the two outreaches we performed, there was scheduling, and managing pre- and post-
more utilization of the telemedicine platform on the encounter data in outreach contexts such as the
former (Telemed Launching, 2022) outreach rather use case for the first outreach. However, we do
than the latter (Libreng Tuli, Konsulta, Atbp., 2023). not recommend it for fast-paced operations when
This is because the former was more aligned with time is limited (second outreach). In such cases,
the intended use case of synchronous telemedicine an asynchronous framework characterized by
while the other was not. performing the necessary actions on-site then
later updating the database through combining
We found that telemedicine is most effective telemedicine with paper-based tracking is
for tasks like patient registration, appointment advisable.
120
Based on our experience, we recommend the 3. Implement E-Prescriptions: Consider

following best practices: using electronic prescriptions for patient
convenience, particularly for those at risk of
1. Prioritize Team Preparedness and Flexibility: losing physical copies.
Ensure your team is well-prepared and
punctual while fostering adaptability to handle 4. Enhance On-Site Management: Develop
unexpected challenges. Include food in the strategies to better handle the challenges
budget and allocate resources for providing posed by a large on-site presence, including
meals to volunteers and staff to maintain their noise, heat, impatience, and patient
energy and morale throughout the outreach conflicts. This may involve crowd control
event, contributing to its overall success. measures, shaded waiting areas, and clear
communication to manage expectations.
2. Engage Volunteers and Local Communities:
Collaborate with volunteers and local 5. Improve Event Promotion: Strengthen
communities to manage disruptions and event promotion by collaborating closely
enhance event efficiency. Encourage better with the host barangay and utilizing various
leadership and coordination within the host channels, including social media, posters, and
barangay. This could involve training and community meetings. Establish patient trust
capacity building for local leaders to ensure by clearly communicating procedures and
efficient facilitation of events. providing information in advance, enabling a
streamlined facilitation process and efficient
resource allocation.
5.3 Recommendation for Policy Makers

FIG. 5.5 Discussions on Telemedicine
IN PHOTO: SeeYouDoc Cofounder Arnulfo Rosario Jr. MD leads a Group Activity from the Sustainability Planning for the
Urban Health Projects Workshop. Photo taken on September 14, 2023 at the Sequioa Hotel.
121
Telemedicine as a subpiece of telehealth is a game In our Stakeholder Interviews, we found that the
changer in modern healthcare. As an archipelagic difficulties encountered by LGUs and healthcare
nation, this allows remote health to be attainable providers in adhering to telemedicine protocols do
through various applications of mHealth and not solely rest on behavioral factors. In fact, our
eHealth strategies. Telemedicine has wide direct communication underscores the recurring
applications for LGU use in terms of disaster-related issues of understaffing and the burden of excessive
events (e.g. earthquakes, floods, conflagrations) workloads faced by healthcare professionals.
and not just in various levels of health care. Often, they lack manpower so it’s hard to criticize
imperfect or even non-implementation. It appears
The current health and technology sectors have, that however much they appreciate telemedicine
more broadly, succeeded in demonstrating the and its use case, it is their situation that stops them
usability and feasibility of telehealth solutions. from taking the next step without support.
However, much work needs to be done in the
areas of Governance and Foundations to fully Meanwhile, it is also essential to note that there exist
maximize the potentials of Telehealth Solutions, deficiencies, even at the level of the implementing
and facilitate Change and Adoption among the agencies themselves. These deficiencies include
various concerned stakeholders (Fernandez- the still missing critical infrastructure components
Marcelo, 2021). Be that as it may, eHealth along such as the presence of the Telemedicine SWG,
with its subparts (telehealth, EMR, HIS, etc) is the development of the telemedicine scorecard,
confronted with great challenge of leadership and the financial frameworks such as PhilHealth’s
and governance. This must be addressed by both plan for telemedicine reimbursements.
the national agencies and local governments.
Leaders of governance (health executives) must On one hand, one could argue that the issue
be properly certified in the implementation of a with LGUs is the proper use of their budget
sound, practical and sustainable eHealth solution and allocation of additional manpower. On the
in a local government like a telemedicine platform other hand, government agencies responsible
(Marcelo, A. et al., 2022). The local leadership must for implementation could redirect their focus
close the gap of need by providing necessary steps towards supporting the existing guidelines
to create an atmosphere for national appreciation instead of constantly issuing new ones without
and allocation. The road to a full telemedicine adequate support. There exists a clear disconnect
implementation might be a long process from somewhere, of which may even require a probe by
where we are today. But this project will hopefully relevant authorities. However that falls beyond the
serve as the first step to a national enlightenment scope of our current project.
of need in the promotion of a standardized
telehealth structure. One fundamental assumption is that the absence of
formal legislation governing telemedicine practice
It is widely acknowledged that there exists a in the Philippines worsens these challenges. This,
considerable disparity in healthcare accessibility along with factors such as legislation requiring
and quality among various LGUs and healthcare case studies as a prerequisite, limited demand
facilities. This issue has even been recognized generation for strong case studies, the absence of
in the DOH Administrative Order 2022-0018: a clear model facility for generating telemedicine
Development and Utilization of the Omnibus demand, and telemedicine being one item among
Health Guidelines per Lifestage: many healthcare priorities, creates a perpetual
cycle resembling a ‘chicken and egg’ problem.
Cognizant of the numerous policies Without a law in place, adherence remains

on individual-based and population- optional, and the loop remains open.
based health services that the DOH
has issued in the past decades, there The way forward is for telemedicine champions to
have been challenges in the adoption, take decisive steps, confront the challenges head-
implementation, and utilization by on, and relentlessly refine the telemedicine system
the LGUs and government and non- until it attains to the level of stability and excellence
government health care providers in terms we aspire to achieve. We ask for steps to be taken
of health systems planning and service to incentivize these champions and support them
delivery (DOH, 2022). however much we can.
122
Annexes
123
Annex 1A:
Recommended Telemedicine Consultation Process Flow
TELEMEDICINE CONSULTATION GUIDE
BEFORE DURING AF TER
1. Prepare technical set 1. Determine 1. Summarize key points and

up of the telemedicine mutually agreeable ask for clarifications. Have
workstation, see agenda items. the patient repeat back what
Annex 1C: Preparing they understood.
for the Telemedicine 2. Explain to the patient
Consultation. how you will get the 2. Explain plan for laboratories
information you need and ancillaries.
2. Determine if the for diagnosis and plan
patient is suitable for of management. 3. Explain ePrescription
a certain telemedicine instructions.
service. Normalize any 3. Conduct your history
discomfort with the taking and virtual 4. Arrange for a face-to-face
telemedicine platform, physical examination. follow-up consultation, or
if any. give instructions to go to
4. Obtain patient the nearest health facility in
3. Prepare the patient’s feedback. case of worsening symptoms
previous medical or emergencies post-
records, if applicable. telemedicine consultation.
4. Ensure that both 5. Ask if the patient was

signal/audio/video comfortable with the
are clear on both telemedicine set-up.
the patient’s and
physician’s side. 6. Give a clear sign to the patient
that the consultation is coming
5. Give introductions. to an end. Thank the patient.
Family members or
other companions 7. Complete the documentation.
present should also be
introduced. 8. Email the patient a password-
protected file of a summary on
6. Set expectations and what was discussed during
secure consent. the telemedicine consultation.
A password-protected
prescription can also be
included, if applicable.
Note: Adapted from the DOH-DILG-PHIC (2021) Annex B.5

124
Annex 1B:
Principles of Telemedicine Practice
Section VII. B.3 of the JAO 2021-0001 details the iii. Manner of processing of personal health
specific principles that governs the practice of information, including submission to
telemedicine by licensed physicians: public health authorities such as DOH,
DILG, and PhilHealth for health policy,
1. Patient-physician relationships shall be planning and research purposes;
founded on mutual trust and respect.
iv. Privacy and data protection and
a. The patient-physician relationship shall cybersecurity measures and concerns;
be founded on mutual trust and respect
in which they both identify themselves v. LGU telemedicine referral protocol; and
reliably during a telemedicine consultation.
Telemedicine consultation should not be vi. Documentation of the patient’s consent.
anonymous. Both patient and the licensed
physician should be able to know, verify,
and confirm each other’s identity at the 3. Telemedicine shall be based on full
start of the telemedicine consultation. knowledge of the patient’s medical
history and virtual examination.
2. Informed consent must be obtained from a. The patient-physician relationship shall be

the patient. based on full knowledge of the patient’s
medical history and a physical examination
a. Proper informed consent must be obtained given the circumstances of a lack of physical
from the patient prior to any collection contact (i.e. by virtual physical exam only).
of personal data and the offering of any
telemedicine service regardless if it is a first- i. Licensed physicians shall use their
time consultation or a follow-up consultation. professional discretion to gather the
type and extent of patient information
b. Consent shall be evidenced by written, required to be able to exercise proper
electronic or recorded means, and shall clinical judgment. Only the type and
contain all the necessary information extent of patient information necessary
regarding the features of the telemedicine to render a medical diagnosis and to
consultation that shall be fully discussed give proper medical assistance shall be
with the patient, which includes, but not gathered from the patient.
limited to, the following:
ii. If the physical examination is necessary
i. How telemedicine works, including the for the consultation, the licensed
services to be provided, activities within physician should not proceed until a
the consultation, expected benefits, and physical examination can be arranged
billing and insurance, if any; through a face-to-face consultation.
Wherever necessary, depending on his/
ii. Limitations of telemedicine, including her professional judgment, the licensed
risk of technology failures, and service physician shall be responsible for the
limitations; coordination of care, following the localized
LGU telemedicine referral protocol.
125
4. Both patient and physician have the choice c. The processing of health information of
to discontinue telemedicine at any time. patients consulting through telemedicine
shall be in accordance with the privacy and
a. The patient-physician relationship shall data protection requirements provided under
respect both patient and physician autonomy. RA 10173, otherwise known as the “Data
Privacy Act of 2012,” its IRR and other relevant
b. The licensed physician can choose not to issuances from the NPC, and shall adhere
proceed with the telemedicine consultation to the principles of transparency, legitimate
at any time as guided by both law and ethics. purpose, proportionality, and accountability.
At any step, the licensed physician can refer
or request for a face-to-face consultation.
6. The principle of privileged communication
c. At any stage, the patient has the right to between the licensed physician and the
choose to discontinue the telemedicine patient shall be observed at all times.
consultation.
a. Video or audio recording of the telemedicine
consultation without the consent of both
5. Privacy of health data shall be protected at the licensed physician and the patient shall
all times. not be allowed.
a. The right to privacy of health information b. The protection of privileged communication

shall be protected at all times. between the licensed physician and the
patient for telemedicine shall be adhered at
b. All licensed physicians providing all times in accordance with the privacy and
telemedicine services shall uphold the data data protection requirements provided under
privacy rights of patients, and shall provide RA 10173, otherwise known as the “Data
the mechanisms for the patients for the Privacy Act of 2012,” its IRR and other relevant
effective exercise of these rights. issuances from the NPC, and other existing or
applicable laws, rules, and regulations.
Note: Adapted from the DOH-DILG-PHIC (2021) Section VII. B.3

126
Annex 1C:
Preparing for the Telemedicine Consultation
1. Setting up the Telemedicine Workstation 3. Maintaining Etiquette

a. Ensure the room is quiet, interruption-free, a. Be aware of one’s actions since these will
secure, and private with adequate lighting. be magnified on camera. Sit fully upright.
b. Test equipment (i.e. webcam, speaker and b. Do not fidget, scratch, play with your hair,
microphone, etc.) before every visit. or touch your face.
c. Wear headphones for better audio, c. Disable picture-in-picture function

if available. (if available).
d. Be knowledgeable about the platform or d. Look directly at the camera. This can
software that will be used for the telemedicine be perceived by the patient as making
consultation. Always test ahead of the visit. eye contact.
Download or install any updates as needed.
e. Position video window of patient’s image at
e. Check internet connection. the top of your screen below the webcam.
f. Turn off other web applications f. Explain and narrate all your actions.
and notifications.
g. Angle the screen so no one can walk by 4. Empathy & Communication

and see the consultation. a. Speak slowly and clearly. Pause longer
between statements to allow for
h. Wear the same level of professional attire transmission delay (if present).
as in face-to-face consultation. Avoid visual
distractions such as busy patterned shirts, b. Type into the chat window to reiterate
messy desks, food and drinks, photos and instructions or next steps.
posters on the background/wall.
c. Check in frequently to elicit reactions and
i. No virtual background. confirm understanding.
d. Use non-verbal cues even on virtual visits:

2. Greeting Smile often. Use a warm tone of voice.
a. Introduce yourself and your role. Ask the
patient to introduce themselves as well as e. Increase the frequency of empathetic
any family members or other companions in statements to show that you are listening.
the room, if assisted.
f. Inform the patient when occupied such as
b. Confirm with the patient that they can see when writing notes or looking at radiologic
and hear you clearly. images of laboratory results.
c. Acknowledge the use of the new technology. g. Summarize and clarify questions in case of
Normalize any discomfort with the use of delay or signal interference.
the platform.
d. Demonstrate confidence in the technology In case of disconnection during video

and reason for use. Include instructions on consultations, inform the patient on how to
what to do in case of disconnection. continue with the consultation.
Note: Adapted from the DOH-DILG-PHIC (2021) Annex B.1,3

127
Annex 1D:
Determining Internet Bandwidth Speed
The UP Manila College of Medicine - Health The number of simultaneous users is a crucial
Informatics unit has created a recommended consideration. Ideally, a minimum of 2 Mbps per
internet bandwidth guide for healthcare provider user is recommended for HD720p resolution
facilities in the context of telemedicine. and a frame rate of 30 fps. It must be noted
SINGLE BRGY / RURAL SMALL

PHYSICIAN HEALTH PHYSICIAN
PRACTICE CLINIC PRACTICE
Internet bandwidth 2 mbps 2 to 6 mbps 4 to 8 mbps
Max no. of physicians 1 1-3 2-4
Supports practical
/ clinical / hospital YES YES YES
management functions,
email, and web browsing
Allows for concurrent

use of high-quality video YES YES YES
consultations and EHR1 or (including CHITSa)
EMR2, if any
Capable of real-time NO NO NO
image transfer
Possible use of HD video YES YES YES

consultations
Enables non-continuous YES YES YES

remote monitoring
128
that estimating bandwidth requirements can be the speed and quality of the internet connection,
affected not just by number of concurrent users or one may use internet speed testing sites, such as
devices, but also location, real-time transactions, https://www.speedtest.net/ (Isip-tan, I. T., et al.,
hardware, storage technology. In order to estimate 2020a, p. 12).
CLINIC / LARGE ACADEMIC /

NURSING HOME PHYSICIAN HOSPITAL LARGE MEDICAL
PRACTICE CENTER
10 mbps 10 to 50 mbps 100 mbps 1000 mbps
<5 < 25 < 50 < 500
YES YES YES YES
YES YES YES YES
NO YES YES YES
YES YES YES YES
YES YES YES YES
Note: Adapted from Office of the National Coordinator for Health Information Technology and Lazar, I,
Search Unified Communications as cited in Isip-tan, I. T., et al., 2020a, p. 13
a
Community Health Information Tracking System (CHITS)
129
Annex 2A:
Telemedicine Implementation Feasibility Assessment Form
This form can serve as a supplementary document Annex 2B: LGU Telemedicine Implementation
when conducting Stakeholder Interviews. Its Checklist, to guide you in the next steps of the
objective is to document the telemedicine readiness implementation phases.
of a specific facility. Use this in conjunction with
Continues to the next page.
130
Telemedicine Implementation Feasibility

Assessment Form
Facility Name:
HCPN (Healthcare Provider Network), write N/A if none:
Address:
Date of Assessment:
Adapted from the Telehealth Implementation Playbook by the American Medical Association (2022) and the Maryland Healthcare
Commission Telemedicine Readiness Assessment Tool accessible via http://mhcctelehealthtool.herokuapp.com
131
Facility Profile
This will be used in determining the technical requirements for creating the virtual facility.
1. Who are the key personnel in this facility?
2. What is the operational hours of this facility?
3. What are the services offered and its corresponding window hours?
4. How many departments does this facility have?
Try to create a rank system with the most patient traffic.

132
5. How many a) doctors b) nurses c) other Allied Health Professionals as applicable
(e.g. pharmacists, dentists, medtech, etc.) and d) BHWs or volunteers are actively involved
in running the facility at a given time?
6. What is the average no. of patients handled by the entire facility per day?
7. Does the facility have an existing telemedicine system (e.g. text-based, video calls, etc.)?
How does it work?
8. Does the facility currently use an Electronic Health Records (EHR) system?
133
Core Readiness
The information gathered here will be used in assessing the needs vs the telemedicine
readiness of the facility.
1. Are there significant logistical challenges (e.g. distance, transportation, schedule conflict
etc.) observed from patients that often hinder their ability to receive uninterrupted
healthcare services?
2. On a daily basis, do the majority of patients frequently inquire about the details of the
facility services, such as when, where, and how they are provided? Do you believe the
patients of the facility might find value in having online access to this information?
3. Are there increasing instances where patients express a need for services to have
extended hours or be offered after hours (i.e. evenings or weekends)?

134
4. Has the facility already identified patient groups that can benefit from some form of
telemedicine such as: appointment scheduling for PWDs or the elderly, virtual consultation
for chronic illness monitoring, online counseling and education, etc.?
5. How does the facility address these issues currently?
6. Do most patients in this facility have access to smartphones and the internet?
7. OPTIONAL What is their Telemedicine Readiness Score?
(The higher the score, the closer the facility is to telemedicine preparedness).
Get the ADB Readiness Assessment Tool & Questionnaire here
https://www.adb.org/sites/default/files/publication/677181/idhpacific-resource1.docx
135
Discussion
Use this section to open a discussion with the IT & security, finance and legal teams for the early assessment
on the feasibility of the telemedicine implementation. Additionally, questions for the telemedicine platform
(if it’s a separate entity) are provided.
MARKET ANALYSIS
1. Facility
a. How great is the demand for a digitized version of the services offered in the facility?
b. Will there be competition from other facilities to look out for once we go digital?
TECHNICAL FEASIBILITY
1. Platform
a. Can the platform ensure data security?
b. Does the platform support video-conferencing?
c. Does the platform have Electronic Health Records (EHR) capability?
d. Can the platform integrate with existing healthcare systems already in use within the facility?
e. How easy will it be to use by healthcare providers?
2. Facility
a. Is there tech personnel readily available on-site for help with installation and basic troubleshooting
on top of their current workload?
FINANCIAL FEASIBILITY
1. Platform
a. How much will the initial setup cost?
b. How much will be the regular upkeep (e.g. subscription, maintenance, etc.)?
2. Facility
a. Does the facility have proper funding or enough revenue streams to sustain the telemedicine
operation? If not, what will be the solution?
b. Does the facility have any existing, visible or hidden, operational expenses that can hinder
the implementation?
136
OPERATIONAL & ORGANIZATIONAL FEASIBILITY
1. Platform
a. Will the platform provide training sessions for onboarded personnel?
2. Facility
a. How will the facility support the added workload of the telemedicine operation?
b. Does the facility currently face staffing/workforce challenges?
c. What additional skills or resources are currently lacking to run the telemedicine operation?
LEGAL AND REGULATORY COMPLIANCE & RISK ANALYSIS
1. Platform
a. Will there be continued support for fixing software bugs and improving user experience?
b. Will there be continued support for promoting patient acceptance and education on the use
of telemedicine?
c. How is the platform protecting sensitive information?
d. How will the platform handle a data breach?
2. Facilities
a. Is the facility able to easily get support from the city leadership in terms of funding, ordinances, or
operational needs (e.g. referrals, etc.)?
TIMELINE AND MILESTONES
1. Facility
a. When is the best time to start this operation?
b. Can we afford to delay this telemedicine implementation?
c. Can we afford to not delay?

138
Annex 2B:
LGU Telemedicine Implementation Checklist
This visual checklist is meant as a quick reference item. More information for each step is available in
for determining the next step in your telemedicine Chapter 2: Telemedicine Steps to Implementation
implementation. It is important to follow this guide & Sustainability of this guide.
in sequence and check-off as you go over each
From the upcoming Telemedicine Roadmap for Philippine Local Government Units (WHO PHIL, 2023)
140
From the upcoming Telemedicine Roadmap for Philippine Local Government Units (WHO PHIL, 2023)
141
Annex 2C:
Sample Telemedicine Ordinance
In Section VI. A. of the JAO 2021-0001, the DOH- A template for drafting your own LGU telemedicine
DILG-PHIC mentions the possibility of “Issuing ordinance is provided. We recommend using this
policies, but not limited to, ordinances to ensure as a foundation and customizing it further based
budgetary support.” on your circumstances.

142
REPUBLIC OF THE PHILIPPINES

SANGGUNIANG PANLUNGSOD
CITY OF
City Council
PROPOSED ORDINANCE
Ordinance No.
The Sangguniang Panlungsod of the (name of LGU) ,

on motion of (name of ordinance authors)
AN ORDINANCE ESTABLISHING TELEMEDICINE SERVICES IN ,

PROVIDING FUNDS THEREOF
WHEREAS, the 1987 Constitution specifically Article II, Section 15 declares that “The State shall
protect and promote the right to health of the people and instill health consciousness among them;”
WHEREAS, Article XIII, Section 11 of the same Constitution also provides that “The State shall
adopt an integrated and comprehensive approach to health development which shall endeavor to make
essential goods, health and other social services available to all the people at affordable cost. There shall
be priority for the needs of the underprivileged, sick, elderly, disabled, women, and children. XXX;”
WHEREAS, in a 2018 journal published by the World Health Organization (WHO) entitled The
Philippines Health System Review, it was discovered that amidst widespread efforts to improve the
healthcare service delivery in the country, there persist regional and socioeconomic disparities in its
availability and accessibility. These include, among others: a maldistribution of infrastructure and human
resources across the different regions, with a bias towards Metro Manila and major cities; the increased
likelihood of health care professionals to find employment overseas than to find incentive to stay in the
country; governance and implementation challenges that continue to impact the utilization of the health
budget, and as an example, more than 50% of the total health spending was discovered to be out of pocket;
WHEREAS, in early 2020, the Philippines was placed in a State of National Emergency for a period
of six months “unless earlier lifted or extended as circumstances may warrant” through Proclamation No.
929 following the rising threat to life and livelihood of the Filipino people caused by the coronavirus disease
health crisis, known in our history as the COVID-19 pandemic;
WHEREAS Section 19 of Republic Act (RA) No. 11223 enacted on July 23, 2018, otherwise known
as the “Universal Health Care (UHC) Act,” provides that the Department of Health (DOH), the Department of
the Interior and Local Government (DILG), the Philippine Health Insurance Corporation (PhilHealth), and the
local government units (LGUs)shall endeavor to integrate health systems into province-wide and city-wide
health systems (P/CWHS) to ensure effective and efficient delivery of population-based and individual-
based health services, and health systems operations;
143
WHEREAS, on May 19, 2021, the DOH, the DILG, and PhilHealth issued Joint Administrative
Order (JAO) No. 2021-0001 entitled “Guidelines on the Implementation of Telemedicine in the Delivery of
Individual-Based Health Services” to set the guidelines in the adoption and implementation of telemedicine
in the delivery of individual-based health services in accordance with the rules set forth under the UHC Act;
WHEREAS, as of writing today, there is no official legislation for the practice of telemedicine and
the JAO 2021-0001 remains our current telemedicine policy in terms of standards and guidelines, and
implementation requirements;
WHEREAS, Section VII. A. of the aforementioned JAO states that “The provinces, HUCs, and ICCs
shall establish integrated and coordinated LGU telemedicine services, within one (1) year from the effectivity
of this Order, that reference and complement the (a) service delivery design of HCPN as provided under
DOH AO No. 2020-0019, and (b) service classification of individual-based health services as provided
under DOH AO No. 2020-0040.” And that “Cost for the organization of LGU telemedicine services shall be
charged using their own administrative funds.”
WHEREAS, in preparation of similar calamities as the COVID-19 health crisis, it is crucial for our
primary health institutions such as the (name of hospital/facility) to be available and adopt the use
of telemedicine;
WHEREAS, the use of telemedicine helps overcome distance and geographic barriers as well
as a consequential tool necessary for adjusting to the new normal by providing clinical healthcare from
a distance.
WHEREAS, it is within the power of the (name of LGU) government to enact this measure
pursuant to Section 16 of R.A. 7160, otherwise known as the Local Government Code of 1991, which
provides for the general welfare clause mandating the city government to ensure and support, among
other things, XXX, promote health and safety, XXX;”
WHEREAS, pursuant to the aforecited power of the local government unit to pass measures to
promote the general welfare and in conjunction with the issuances made by the Department of Health,
Department of Interior and Local Government, PhilHealth, National Privacy Commission, Philippine Medical
Association, and the University of the Philippines Manila, it is of necessity to pass this measure to enhance
and promote the people’s right to health through the establishment of telemedicine services to provide free
and accessible telemedicine services to patients requiring quality health care from certified and licensed
doctors, overcoming physical barriers and calamities;
NOW THEREFORE:
BE IT ORDAINED, AS IT IS HEREBY ORDAINED, the Sangguniang Panlungsod of the (name

of LGU) , in a regular session assembled that:
SECTION 1. TITLE. — This Ordinance shall be known as the “Telemedicine Implementation and
Sustainability Ordinance in the (name of LGU) .”
SECTION 2. POLICY OBJECTIVES. — In order to carry out a) the declared State policy on
the protection and promotion of the right to health of the people and in adopting an integrated and
144
comprehensive approach to health development which shall endeavor to make essential goods, health
and other social services available to all the people at affordable cost and the preferential treatment for
the needs of the underprivileged, sick, and elderly, b) the telemedicine guidelines to implementation as
defined by the DOH, the DILG, and PhilHealth on the Joint Administrative Order (JAO) No. 2021-0001
entitled “Guidelines on the Implementation of Telemedicine in the Delivery of Individual-Based Health
Services” which was made in accordance with the rules set forth under the Universal Healthcare Act,
this ordinance seeks to:
2.1 Establish a system of telemedicine services in the (name of hospital/facility) and

City Health Department to maximize the use of technology in healthcare settings to
connect health care providers with (name of LGU) residents especially those who
are geographically situated in remote or underserved communities, or those who cannot
afford the services of a private healthcare institutions but continue to seek life-prolonging
maintenance medical services for their illness but suffer from mobility restrictions, etc.;
2.2 Improve health outcomes by increasing patient’s access to health services given the
gap or shortage of healthcare professionals and overcome the lack of health facilities
especially in remote areas or in unserved or underserved communities;
2.3 Prepare and equip our health facilities and empower our patients to use telemedicine
as a viable health care option for continued access to medical care and support patients
in the self-management of their health conditions in the post-pandemic scenario that
telemedicine shall become an important part of our new normal.
SECTION 3. DEFINITION OF TERMS. — For purposes of this Ordinance, the terms used adopts
the definitions set within the DOH-DILG-PHIC Joint Administrative Order 2021-0001 Guidelines on the
Implementation of Telemedicine in the Delivery of Individual-Based Health Services.
The following terms shall mean:
1. Telemedicine “refers to the delivery of health care services, where distance is a critical factor, by
all health care professionals using information and communication technologies for the exchange
of valid information for diagnosis, treatment and prevention of disease and injuries, research
and evaluation, and for the continuing education of health care providers, all in the interests of
advancing the health of individuals and their communities (World Health Organization definition)”
2. JAO 2021-0001 is a shortened reference to the DOH-DILG-PHIC Joint Administrative Order

2021-0001 entitled “Guidelines on the Implementation of Telemedicine in the Delivery of
Individual-Based Health Services”
3. (**add or remove as needed**)
SECTION 4. ESTABLISHMENT OF TELEMEDICINE SERVICES FOR ALL BARANGAYS — All Rural/

Barangay Health Units within the jurisdiction of the (name of LGU) LGU and City Health Department
are to adopt and implement telemedicine services as an integral mode for the delivery of individual-based
health services and strive to comply with the minimum telemedicine set-up and requirements set forth in
Section VI-VII of the JAO 2021-0001 which is the latest telemedicine policy to date recognized by the DOH,
pending official legislation. All R/BHUS will be part of the Primary Care Provider Network (PCPN) under
the (name of LGU) Healthcare Provider Network (HCPN). The (name of LGU) shall allocate an
annual budget to provide the means for enabling telemedicine offered within the HCPN as a step towards
Universal Healthcare.
145
SECTION 5. ESTABLISHMENT OF AN ‘LGU TELEMEDICINE OPERATIONS TEAM’ —

The (name of LGU) HCPN will be supported by an LGU Telemedicine Operations team, “which
shall be subsumed under the Local Disaster Risk Reduction and Management Office (LDRRMO), that
shall prepare for and respond to any telemedicine referral to and from any health care provider within
the HCPN based on standard protocols” as set forth in Section VII of the JAO 2021-0001. A telemedicine
response could be in the form of transporting a patient to a physical health facility, purchase and
delivery of medicines, coordination for laboratory and diagnostics depending on the capacity of the
LGU as explained by the DOH in Module 9 Lecture 3: Implementing Telemedicine (retrieved September
12, 2022 from DOH-KMITS). It shall comprise a team from the Provincial/City Health Office (healthcare-
focused) and Local Disaster Risk Reduction and Management Office (logistics-focused).
SECTION 6. APPOINTMENT OF MINIMUM HEALTH CARE PROVIDERS FOR TELEMEDICINE

SERVICES — The (name of hospital/facility) must strive to maintain a minimum population of
doctors and nurses so as not to compromise the quality of care provided to patients. Each BHU will use
their best judgment and discretion to allocate the correct number of manpower for operations. At minimum,
there shall be at least 2 physicians and 2 nurses working on rotation that will maintain the telemedicine
operation throughout their operational hours.
SECTION 7. APPROPRIATIONS. — There shall be appropriated a yearly amount of budget,

recommended PHP 5M for up to 15 BHUs and 1 LGU Operations team) to be charged against the
general fund for the implementation of this ordinance.
SECTION 8. SEPARABILITY CLAUSE. — Should any part or parts of this Ordinance shall be
declared invalid or unconstitutional, the other parts not so declared shall remain in force and effect.
SECTION 9. REPEALING CLAUSE. — Any existing ordinance or any of its provisions, which are
inconsistent with this Ordinance, shall be deemed repealed, amended or modified accordingly.
SECTION 10. EFFECTIVITY CLAUSE. – This Ordinance shall take effect 15 days after its publication
in a newspaper of local circulation.
Name
Author, [Role]
146
Annex 2D:
Sample Budget Proposal for the Telemedicine Ordinance
in Parañaque City
This budget proposal was submitted to the For transparency, this budget breakdown
Parañaque City Health Office as part of the provides a clear view of the expected inclusions
sustainability efforts to uphold the telehealth within the budget range. This should be used
implementation initiated through the Urban Health to support the establishment of a telemedicine
Projects and sustain the momentum. ordinance in your LGU, as detailed in Chapter
2, Step 12: Scale, and Annex 2C Sample
Telemedicine Ordinance of this guide.
ITEM COST
TELEMEDICINE PLATFORM (1 YEAR) PHP 2.9M
Platform & Bandwidth
› 1 Medical Network owner (PARQ CHO/future LGU Telemedicine

Operations Team),
Inclusive
› 16 Virtual Facilities (1 per brgy);
» Up to 3 free Virtual Clinics per facility
› Add-ons: +1 facility (PHP 5000), +1 clinic (PHP 1,000) / per month
Professional Services
› Custom website & hosting,

Inclusive
› Telemedicine platform maintenance
› Technical & customer support
SeeYouDoc (MA) Analytics Inclusive
CLINICAL WORKFORCE (1 YEAR) PHP 2.1M

147
ITEM COST
Care Team (Primary Facility)*
› Nurse (PHP 100)
› Primary Doctor (PHP 300) PHP 1,320,000.00
› Specialist Doctor (PHP 500)
* Incentive-basis: Paid per completed telemedicine consultation
LGU Telemedicine Operations Team (CHO)*
› 2 Telemedicine Staff (PHP 15,000.00)

PHP 840,000.00
› CHO Head Incentive (PHP 40,000.00)
* Salary-basis: Fixed pay on a monthly basis
TOTAL ANNUAL COST (12 MOS) PHP 5M
Note: From SeeYouDoc
Based on Parañaque City’s total barangay count (16). Key Assumption: Each barangay will have a maximum of 3 clinics per
facility, with an estimated 250 telemedicine patients per month for each facility.
This budget covers the 1) telemedicine platform › We also propose the creation of a salaried
subscription costs and 2) the necessary manpower position within the LGU telemedicine
expenses for its operation. operations, facilitating oversight by the CHO
across the HCPN.
Notably, we’ve observed a recurring challenge
with manpower in our target sites. » While the ideal setup involves 24/7
monitoring, an initial approach with a
› Within the primary facility, we aim to address shifting schedule and two employees can
this issue by introducing incentives to any suffice. This can be later improved as more
available healthcare worker that can assist or demand is generated.
complete a telemedicine consultation.
Note that the starting point of 5M PHP does not
» This means any available nurse / physician, include initial equipment sourcing. In the case of
even from another clinic can assist the Parañaque, we were able to enhance their existing
operation and be paid with the incentive. equipment with laptop donations. Similarly,
telemedicine equipment in your LGU may already
» A separate budget is allocated for each of exist or can be procured second-hand or at low
the 16 barangays. cost. We advise adjusting this budget accordingly,
per your community’s specific needs.
148
Annex 4A:
SeeYouDoc MA Analytics
The following images are screenshots of the SeeYouDoc MA in action.
SeeYouDoc MA Dashboard Page
Note: From SeeYouDoc (MA) Analytics

149
SeeYouDoc MA Appointments Page

150
SeeYouDoc MA Demographics Page

151
SeeYouDoc MA Customer Ratings Page

154
References
1 Adeleye, O., Carvalho, M., Halm, M., Eshofonie, A., Rosario, A.J., Awosika-Olumo,
D., (2007). Using Syndromic Data to Investigate Gastrointestinal Illness
Associated with Water Quality Complaints in Houston. ResearchGate.
https://www.researchgate.net/publication/278667564_Using_Syndromic_
Data_to_Investigate_Gastrointestinal_Illness_Associated_with_Water_Quality_
Complaints_in_Houston
2 Asia Development Bank (2021) Digital Health Implementation Guide for the Pacific.
https://www.adb.org/publications/implementing-digital-health-pacific-guide
DOI: http://dx.doi.org/10.22617/TIM210178-2
3 American Medical Association ®. AMA (2022) Digital Health Implementation
Playbook Series: Telehealth Implementation Playbook.
https://www.ama-assn.org/practice-management/digital/telehealth-
implementation-playbook-overview
4 Caryl, C. J. (1997). Malpractice and other legal issues preventing the development
of telemedicine. PubMed.
https://pubmed.ncbi.nlm.nih.gov/10182029/
5 CNN Philippines (2016, February 20). More islands, more fun in PH. Retrieved
September 09. 2023 from https://web.archive.org/web/20180620024729/
http://cnnphilippines.com/videos/2016/02/20/More-islands-more-fun-in-PH.html
155
6 Dayrit, M.M., Lagrada, L.P., Picazo, O.F., Pons, M.C. & Villaverde, M.C. (2018).
The Philippines health system review. Health Systems in Transition, 8 (2),
World Health Organization. Regional Office for South-East Asia.
https://apps.who.int/iris/handle/10665/274579.
License: CC BY-NC-SA 3.0 IGO
7 Del Castillo, N. G., Gerolaga, P., Amoranto, A., Del Castillo, V., & Rosario, A. J. (2022).
Telemedicine use and satisfaction among Filipinos during the COVID-19
Pandemic. Journal of the International Society for Telemedicine and EHealth, 10,
e6 (1-10). https://journals.ukzn.ac.za/index.php/JISfTeH/article/view/2829
https://doi.org/10.29086/JISfTeH.10.e6
8 DEPARTMENT OF HEALTH (DOH) (2022a). ADMINISTRATIVE ORDER NO. 2022 - 0018:
Dissemination of the Omnibus Health Guidelines per Lifestage.
https://drive.google.com/file/d/13e5rZITUSU3VMKEfNKqWiaFJCl12Kmoo/
view?usp=drive_link
9 DEPARTMENT OF HEALTH (DOH) (2022b). DEPARTMENT CIRCULAR NO. 2022 - 0344:
Dissemination of the Omnibus Health Guidelines per Lifestage.
https://drive.google.com/drive/
folders/1HABGZLjykDs5mpaq6MZJ8LkyZ4OK3ubc?usp=drive_link
10 DEPARTMENT OF HEALTH (DOH), DEPARTMENT OF THE INTERIOR AND LOCAL
GOVERNMENT (DILG), PHILIPPINE HEALTH INSURANCE CORPORATION
(PHIC). (2021). JOINT ADMINISTRATIVE ORDER 2021-0001: Guidelines on the
Implementation of Telemedicine in the Delivery of Individual-Based
Health Services. https://dmas.doh.gov.ph:8083/Rest/GetFile?id=688848

156
11 DEPARTMENT OF HEALTH (DOH), DEPARTMENT OF BUDGET AND MANAGEMENT
(DBM), DEPARTMENT OF FINANCE (DOF), DEPARTMENT OF THE
INTERIOR & LOCAL GOVERNMENT (DILG), PHILHEALTH (PHIC). (2021).
JOINT MEMORANDUM CIRCULAR 2021-0001: Guidelines on the Allocation,
Utilization, And Monitoring of, And Accountability for, the Special Health Fund.
https://www.dbm.gov.ph/wp-content/uploads/Issuances/2021/Joint-
Memorandum-Circular/JMC-2021-0001_Guidelines-on-SHF.pdf
12 DEPARTMENT OF FINANCE INSURANCE COMMISSION (May 16, 2022) LIST OF
HEALTH MAINTENANCE ORGANIZATIONS WITH CERTIFICATES OF AUTHORITY
ISSUED BY THE INSURANCE COMMISSION FOR LICENSE YEAR 2019-2023 As of
29 April 2022. https://www.insurance.gov.ph/wp-content/uploads/2022/05/List-of-
HMOs-with-CA-29-Apr-2022.pdf
13 DEPARTMENT OF HEALTH (DOH), NATIONAL PRIVACY COMMISSION (NPC), (2020a)
Joint Memorandum Circular 2020-0001: Guidelines on the Use of Telemedicine
in COVID-19 Response.
https://privacy.gov.ph/wp-content/uploads/2020/10/DOH-mc2020-0016.pdf
14 DEPARTMENT OF HEALTH (DOH), NATIONAL PRIVACY COMMISSION (NPC),
(2020b) Joint Memorandum Circular 2020-0003: Guidelines on the Monitoring
and Evaluation (M&E) of the Use of Telemedicine in COVID-19 Response.
https://privacy.gov.ph/wp-content/uploads/2021/11/MC2020-0024-1.pdf
15 DOST-PCHRD | Philippine Council for Health Research and Development. (n.d.).
DOST-PCHRD to support 3 Filipino startups for health R&D.
https://www.pchrd.dost.gov.ph/news_and_updates/dost-pchrd-to-support-3-
filipino-startups-for-health-rd/
157
16 DOST-PCHRD | Philippine Council for Health Research and Development. (n.d.).
SeeYouDoc Analytics.
https://www.pchrd.dost.gov.ph/heartnovation/seeyoudoc-analytics/
17 Fernandez-Marcelo, P. G. (2021), Beyond COVID-19: Telehealth for universal health
care: guiding principles and recommendations for a parallel and stepwise
approach to local and nationwide implementation. Operations and Legal
Research and Modelling on the Implementation of Telehealth Services within
the Universal Health Care (UHC) Vision. Unpublished manuscript
18 Ghia C. J., Ved, J. K., Jha R. K. (2013) Benefits of Telemedicine and Barriers to its Effective
Implementation in Rural India: A Multicentric E-Survey. IMSEAR.
https://pesquisa.bvsalud.org/portal/resource/pt/sea-157474?lang=enl
19 Isip-tan, I. T., Marcelo A. B., Sarmiento F. III, Traboco L., Fong, M., Dahildahil, R., Guzman,
A., Tiongson N., Herber, J. M., Tan-Ong, M., UP College of Medicine. (2020a).
TELEMEDICINE: GUIDANCE FOR PHYSICIANS IN THE PHILIPPINES.
https://drive.google.com/drive/folders/1XqagEbnWBFmwcQFSra8sBvdyHl1QzLnh
20 Isip-tan, I. T., Marcelo A. B., Traboco L., Yu, J. M., Tiongson, N., Tan-Ong, M., Fong, M.,
Guzman, A., Herber, J. M., Sarmiento, R. F., Pillejera, J. G. A., Rosales, N. R., UP College
of Medicine. (2020b). TELECONSULTATION: GUIDANCE FOR FILIPINO CLINICIANS.
21 Isip-tan, I. T., Fong, M., Tan-Ong, M., Magno, A., Guzman, A., Yu, J. M., Herber,
J. M., Dahildahil, R., Rosales, N. R., UP College of Medicine. (2020c) PREPARING FOR
TELECONSULTATION: GUIDANCE FOR FILIPINO CLINICIANS AND THEIR PATIENTS.
158
22 Isip-tan, I. T., Marcelo, A. B., Yoshida A. S., Pillejera, J. G., Traboco, L., Dahildahil, R., UP
College of Medicine. (2020d) GUIDANCE FOR ASSESSING TELEMEDICINE VENDORS.
23 Isip-tan, I. T., Marcelo, A. B., Dahildahil, R., Magno, A. DL., Traboco, L., Traboco, L.,
Pillejera, J. G., Yu, J. M., Fong, M., Guzman, A., Tan-Ong, M., Tiongson, N.,
UP College of Medicine. (2020e) TELEMEDICINE: GUIDANCE ON NAVIGATING
ETHICAL AND LEGAL IMPLICATIONS.
24 Katz, H. P., Kaltsounis, D., Halloran, L., & Mondor, M. (2008). Patient safety and telephone
medicine : some lessons from closed claim case review. Journal of general internal
medicine, 23(5), 517–522. https://doi.org/10.1007/s11606-007-0491-y
25 Khan, A. N., Griffith, S. P., Moore, C., Russell, D., Rosario, A. C., & Bertolli, J. (2006).
Standardizing laboratory data by mapping to LOINC. Journal of the American
Medical Informatics Association, 13(3), 353–355.
https://doi.org/10.1197/jamia.m1935
26 Letigio, D. (2021, September 10). Cebu City Council passes telemedicine ordinance.
INQUIRER.net. Retrieved September 14. 2023 from
https://cebudailynews.inquirer.net/399181/cebu-city-council-passes-
telemedicine-ordinance
27 Litvak, M., Miller K., Boyle, T., Bedenbaugh, R., Smith, C., Meguerdichian, D., Reisman, D.,
Biddinger, P., Licurse, A., Goralnick, E. (2022). Telemedicine Use in Disasters: A
Scoping Review. PubMed. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8442996/
PMID: 33750505 PMCID: PMC8442996 DOI: 10.1017/dmp.2020.473

159
28 Luna, F. (2020). First confirmed nCoV death outside China is in Philippines.
Philstar Global. Retrieved October 02, 2023 from
https://www.philstar.com/headlines/2020/02/02/1989762/first-confirmed-ncov-
death-outside-china-philippines
29 Martins, J. (2023, April 15). How to Write SMART Goals (And Why they Matter) [2023]
• Asana. Asana. Retrieved September 14. 2023 from
https://asana.com/resources/smart-goals
30 Marcelo, A., Pascual, K. C., Udayasankaran, J. G., Allaudin, F. S., & Kijsanayotin, B.
(2022). A framework for regional health information systems interoperability:
The Asia eHealth Information Network (AeHIN) experience. In Elsevier eBooks
(pp. 399–414).
https://doi.org/10.1016/b978-0-12-823413-6.00005-7
31 Moody, A. (2022, August 18). World’s Busiest Roads. GoShorty Short Term Vehicle
Insurance. https://goshorty.co.uk/blog/worlds-busiest-roads/ as cited in Philstar.
com (2022, September, 8). Manila is the world’s 8th city with longest hours
spent in traffic — study. Retrieved September 14, 2023 from
https://www.philstar.com/business/2022/09/08/2208311/manila-worlds-8th-
city-longest-hours-spent-traffic-study
32 National eHealth Program (n.d.). National EHealth Context (Overview). Retrieved
September 14, 2023 from https://ehealth.doh.gov.ph/index.php/faq#openModal9
33 National Privacy Commission (NPC). (2012). Republic Act 10173 - Data Privacy Act
of 2012. Retrieved Oct 6, 2023 from https://privacy.gov.ph/data-privacy-act/#w1

160
34 Orion Health (2020). What is HL7 and why does healthcare need it? Orion Health.
Retrieved October 02, 2023 from
https://orionhealth.com/global/blog/what-is-hl7-and-why-does-healthcare-need-it#
35 PAGASA (n.d.). Tropical Cyclone Information. Retrieved September 11, 2023 from
https://www.pagasa.dost.gov.ph/climate/tropical-cyclone-information
36 PBBM lifts State of Public Health Emergency throughout PH due to COVID-19.
(2023, July 22). Presidential Communications Office | Office of the President of the
Philippines. https://pco.gov.ph/news_releases/pbbm-lifts-state-of-public-health-
emergency-throughout-ph-due-to-COVID-19/
37 PhilHealth (2023). Joint Memorandum Circular 2023-0013: Implementing Guidelines for
the PhilHealth Konsultasyong Sulit at Tama (PhilHealth Konsulta) Package
(Revision 2). https://www.philhealth.gov.ph/circulars/2023/PC2023-0013.pdf
38 Philippine Statistics Authority | Republic of the Philippines (2021, July 7) 2020 Census
of Population and Housing (2020 CPH) Population Counts Declared Official by
the President.
https://psa.gov.ph/content/2020-census-population-and-housing-2020-cph-
population-counts-declared-official-president
39 Rosario, A. J., Amoranto, A. J. P., Capada, R. G. H., Santos-Fabia, A. D. F., Marcelo,
P. G. F.. (2023) Evaluation of the Design and Development of the HeLe
Newborn Hearing Screening Tele-Audiology Systems for the Philippines.
Acta Medica Philippina.
https://actamedicaphilippina.upm.edu.ph/index.php/acta/article/view/5392
161
40 Rosario, A. J., Bertolli, J., Khan, A.N., Cheek, J.E., Shelby, L., LeVeen, E.,
Peterson, D., Holck, P., Davis, S. (2004) The ID Web Project: Improving Care
and Surveillance Using the Internet.
https://scholar.google.com.ph/citations?view_op=view_
citation&hl=en&user=fQcUvxgAAAAJ&citation_for_
view=fQcUvxgAAAAJ:9yKSN-GCB0IC
41 Stumpf, S. H., Zalunardo, R. R., Chen, R. J.. (2002) Barriers to telemedicine
implementation. Usually it’s not technology issues that undermine a
project — it’s everything else. PubMed.
https://pubmed.ncbi.nlm.nih.gov/12827765/
PMID: 12827765
42 World Health Organization (WHO) (n.d.) Technical Assistance for the Implementation
and coordination of the Urban Health Project Year 3 in Valenzuela and
Parañaque. United Nations Global Marketplace. Retrieved October 5, 2023
from https://www.ungm.org/Public/Notice/193155

Telemedicine Roadmap For Philippine LGUs

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Telemedicine Roadmap For Philippine LGUs

Uploaded by

Copyright:

Available Formats

Telemedicine

In collaboration with the

Quote from the

Already, I have seen many milestones achieved with

ADHD Attention Deficit Hyperactivity Disorder

ADB Asia Development Bank

BARMM Bangsamoro Autonomous Region for Muslim Mindanao

BAA Business Associate Agreement

BHW Barangay Health Worker

BNS Barangay Nutrition Specialist

CAHPS Consumer Assessment of Healthcare Providers and Systems

CCMC Cebu City Medical Center

CDC US Center for Disease Control and Prevention

CHD City Health Department

CHITS Community Health Information Tracking System

CHO City Health Officer

CPG Clinical Practice Guidelines

CPH Census of Population and Housing

CSO Civil Society Organizations

CWHS City Wide Health Systems

DBM Department of Budget & Management

DICT Department of Information and Communications Technology

DILG Department of Interior and Local Government

DOF Department of Finance

DOI Digital Object Identifier

DOST Department of Science and Technology

DPA Data Privacy Act RA 10173

DSL Digital Subscriber Line

EHR Electronic Health Records

ECQ Enhanced Community Quarantine

FDA Food & Drug Administration

GAA General Appropriations Action

HCPN Health Care Provider Networks

HEPO Health Promotions Office

ICU Intensive Care Unit

ICT Information and Communications Technology

IHIS Integrated Health Information System

IRR Implementing Rules and Regulations

IATF Inter-Agency Task Force

IARTCT Inter-Agency Regional Telemedicine Coordination Team

JAO DOH-DILG-PHIC Guidelines on the Implementation of Telemedicine

in the Delivery of Individual-Based Health Services

KOFIH Korea Foundation for International Healthcare

KMITS Knowledge Management and Information Technology Service

KPI Key Performance Indicators

LIPH Local Investment Plan for Health

LDRRMO Local Disaster Risk Reduction Management Office

LOINC Logical Observation Identifiers Names and Codes

LGU Local Government Unit

MA SeeYouDoc (MA) Analytics

MHO Municipal Health Officer

MN SeeYouDoc (MN) Medical Network

MOA Memorandum of Agreement

NEHTWG National eHealth Technical Working Group

NEHPMO National eHealth Program Management Office

NGA National Government Agencies

NTC National Telecommunications Commission

NPC National Privacy Commission

OHG Omnibus Health Guidelines

PAPO Philippine Alliance of Patient Organizations

PBBM President Bongbong Marcos

PAGASA Philippine Atmospheric, Geophysical and Astronomical Services Administration

PCPN Primary Care Provider Network