UPMedWebinar on Telehealth

1. Current Gaps in Telehealth
and How to Address Them
Alvin B. Marcelo, MD

2. Disclosures
Executive director, Asia eHealth Information Network
Professor, University of the Philippines Manila (on leave)
Chief Information Officer, St. Luke’s Medical Center

3. Outline
What is telehealth?
Why is telehealth relevant now?
The ABCs of Telehealth
Challenges with Philippine Telehealth and how to address them

4. Guidance
bit.ly/upmiutelemed2020

5. What is telehealth?

6. Telehealth and the COVID-19 pandemic

14. A component-based perspective of telehealth
sender
receiver
message

15. A time-based perspective of telehealth
Before During After

16. ABCs of Telemedicine
Actors
Agreement
Bridge
Connectivity
Content
Continuity of care

17. Actors
Patient
Doctors
Other health professionals
Relatives and caregivers
Coordinator

18. Agreement
Consent

19. Bridge
The technology platform agreed upon by all actors
- Videoconferencing
- SMS, instant messaging
- Email
- Phone

20. Connectivity
Technology
- Broadband
- Email
- SMS
- Instant messaging

21. Content
What transpires between actors during the telehealth session
- Registration (identifying the patient)
- Diagnosis and treatment
- Education
- Follow-up

22. Continuity of care
Access to patient’s longitudinal record

23. Challenges and How to Address Them

24. Actors: Doctors
Lack of knowledge with use of technology
Lack of clinical experience
Lack of confidence
Solution: capacity-building; integration of
telehealth in health professions education

25. Actors: Patient
Identity (for new patients)
Lack of knowledge with telehealth technology
Reluctance
Incomplete understanding of instructions
Solution:
● confirm identity using at least two parameters
● handhold patients before/during/after telehealth
sessions

26. Actors: Relatives and caregivers
Unable to adequately represent the patient/understand history
Lack of experience with physical examination
Privacy breach
Solutions:
● full disclosure of relationship
● consent given by patient for their participation
● compliance to conditions of consent (no
recording)

27. Actors: other health professionals
Lack of training
Lack of tools
Solution: capacity-building; integration of
telehealth in health professions education

28. Actors: coordinators
Errors in identification
Mismatching of patient and doctor
Misrepresentation of doctor’s capabilities
Privacy breach
Solution: capacity-building

29. Agreements
Most doctors do not obtain signed informed consent
Solution:
Use consent templates
Embed into workflow
Sample: https://www.aap.org/en-
us/_layouts/15/WopiFrame.aspx?sourcedoc=/en-
us/Documents/Telehealth%20Consent_FINAL.docx&action=default

30. Bridge: communications platform
SMS email
instant
messaging
voice video
Signal-to-noise ratio

31. Bridge: digital tools
Stethoscope
Ophthalmoscopes
Otoscopes
ECG
Sphygmomanometer
Tongue depressor with camera
Spirometers
Ultrasound
Colposcope
Thermometer

32. Connectivity
Slowest connectivity segment determines the bridge technology
No/slow Internet
No cellular signal
Solution:
Use government Internet facilities

33. Content
Telehealth sessions cannot match face-to-face due to limited capability for
complete physical examination
Inability to perform complete physical examination
Solution:
● Capacity-building (risk awareness on limitation of
technology)
● Use of digital tools
● Integration of telehealth in health professions
education
● Development of telehealth checklists by
professional societies

34. Continuity of care
Despite the abundance of digital solutions (tools, software, connectivity), patient
care is still fragmented.
Patient data are in silos and doctors have no visibility on the patient’s full record.
Telehealth alone is not enough. Electronic medical records (EMRs) play a major
role in continuity of care within a clinic/institution but also has potential for
population/public health
Solution: electronic medical records;
shared clinical abstracts/discharge
summaries

35. The Greatest Challenge of Telehealth
Accepting new patients the first time via telehealth (no initial face-to-face meeting)
How to confirm identity and perform complete P.E.
Solutions:
● Consent
● Use identity services or face-value
● Limit to patients referred by known
colleagues (ideally while at their clinic)

36. Summary 1
The ABC's helps us remember the people, processes and technologies involved in
telehealth
Most challenges and shortcomings exist even with face-to-face interactions but
telehealth can amplify them
Telehealth introduces more risks compared to face-to-face. Telehealth
practitioners should be aware of them and should ensure that patients receive
their benefits without being harmed.
The country is missing out on the opportunity for universal health coverage
through appropriate use of telehealth. Keep monitoring DOH and Philhealth
telehealth policies to ensure you are using the right technology.