Republic of the PhilippinesDepartment of Health

OFFICE OF THE SECRETARY

May20, 2021

MEMORANDUM CIRCULARNo. 2021-0045

TO

SUBJECT :

: ALL UNDERSECRETARIES, ASSISTANT SECRETARIES,DIRECTORS OF BUREAUS, REGIONAL OFFICES ANDSERVICES; EXECUTIVE DIRECTORS OF SPECIALTYHOSPITALS, AND NATIONAL NUTRITION COUNCIL;CHIEFS OF MEDICAL CENTERS, HOSPITALS, SANITARIAAND __INSTITUTES; PRESIDENT OF THE PHILIPPINEHEALTH INSURANCE CORPORATION; DIRECTORS OFPHILIPPINE NATIONAL AIDS COUNCIL AND TREATMENTAND REHABILITATION CENTERS; AND OTHERSCONCERNED

DOH-DILG-PHIC Joint Administrative Order No. 2021-0001entitled “Guidelines on the Implementation of Telemedicine in theDelivery of Individual-Based Health Services

Attached for your information and guidance is a copy of the DOH-DILG-PHIC JointAdministrative Order No. 2021-0001 entitled “Guidelines on the Implementation ofTelemedicine in the Delivery of Individual-Based Health Services” dated May 19, 2021.

Dissemination of the information to all concerned is requested.

By Authority of the Secratary of Health:

LILIBETH C. DAVID, MD, MPH, MPM, CESO IUndersecretary of HealthHealth Facilities and Infrastructure Development Team

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 local 1113, 1108, 1135Direct Line: 711-9502; 711-9503 Fax: 743-1829; 743-1786 ¢ URL: http://Awww.doh.gov.ph; e-mail: ftduque@doh.gov.ph

PhilHealthYour Partner in Health

DEPARTMENT OF HEALTHDEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

PHILIPPINE HEALTH INSURANCE CORPORATION

JOINT ADMINISTRATIVE ORDER MAY 19 2021

No. 2021-_ 0Q0

SUBJECT: Guidelines on the Implementation of Telemedicine in the Delivery ofIndividual-Based Health Services

RATIONALE

Section 19 of Republic Act (RA) No. 11223, otherwise known as the “Universal HealthCare (UHC) Act,” provides that the Department of Health (DOH), the Department of the Interiorand Local Government (DILG), the Philippine Health Insurance Corporation (PhilHealth), and thelocal governmentunits (LGUs) shall endeavor to integrate health systems into province-wide andcity-wide health systems (P/CWHS) to ensureeffective and efficient delivery of population-basedand individual-based health services, and health systems operations.

Corollary to the operationalization of this strategy, Section 18.1 of the Implementing Rulesand Regulations (IRR)of the said Act provides for remote access and delivery of individual-basedhealth services through the use of digital technologies for health. From recent events of publichealth concern such as the coronavirus disease 2019 (COVID-19) pandemic and other healththreats, one digital health technology that has been widely adopted to ensure access and deliveryof continuous, coordinated, and integrated individual-based health services and information istelemedicine.

Accordingly, this Joint Administrative Order is being issued to set the guidelines in theadoption and implementation of telemedicine in the delivery of individual-basedhealth servicesinaccordance with the rules set forth under the UHC Act.

GENERAL OBJECTIVE

This Order institutionalizes the adoption and implementation of telemedicine as an integralmodefor the delivery of individual-based health services.

ILL. SPECIFIC OBJECTIVES

A. Providethe standards and guidelines for telemedicine;B. Define the minimum investments and financing mechanisms in telemedicine; andC. Set the implementation governance that will direct, coordinate, and guide the LGUs, public

andprivate health care providers, and stakehoiders in the adoption anduse of telemedicine.

TT 1

IV.SCOPE OF APPLICATION

This Order shall apply to the implementation of telemedicine across the country; andshallcover all public and private, national and local health care providers regulated by DOH andPhilHealth, medical associations and specialty societies, pharmaceutical outlets, telemedicineservice 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 theDOH, DILG,and PhilHealth, Food and Drug Administration (FDA), Department of Informationand Communications Technology (DICT), Professional Regulation Commission (PRC), NationalPrivacy Commission (NPC), University of the Philippines Manila — National TeleHealth Center(UPM-NThC), and all others concerned.

In the case of Bangsamoro Autonomous Region for Muslim Mindanao (BARMM), theimplementation of telemedicine in the delivery of individual-based health services under theintegrated P/CWHSshall be in accordance with Article IX, Section 22 of RA11054, otherwiseknown as the “Organic Law for the BARMM” and subsequent laws and issuances. Likewise, inthe adoption by the Ministry of Health - BARMM ofits own guidelines for Telemedicine, thesame shall be consistent with the provisions of this Order and other subsequent issuances, and incoordination with the DOH.

V. DEFINITION OF TERMS

A. Asynchronous Telemedicine refers to store-and-forward” technologies where messages,images, or data are collected at one point in time and interpreted or responded to later. It alsoincludes remote patient monitoring or the direct transmission of a patient’s clinicalmeasurements from a distance to their health care provider. (US Centers for Disease Controland Prevention [CDC]; American Medical Association [AMA])

B. Health Care Providers refers to any of the following:1. Physician — all individuals authorized by law to practice medicine pursuant to RA 2382,

otherwise knownas “The Medical Act of 1959,” as amended; or2. Health facility — public or private facility or institution devoted primarily to the provision

of services for health promotion, prevention, diagnosis, treatment, rehabilitation andpalliation of individuals suffering from illness, disease, injury, disability, or deformity, orin need of medical and nursing care. It also includes temporary treatment and monitoringfacilities, and local isolation and general treatment areas that are established during eventsof public health concern.

C. Health Care Provider Networks (HCPN)refers to a group of primary to tertiary careproviders, whether public, private, or mixed, offering people-centered and comprehensive carein an integrated and coordinated manner with the primary care provider acting as the navigatorand coordinator of health care within the network, and automatically link to an apex or end-referral hospital that provides specialty care services, and performance mentoring and technicalassistance (TA) to the HCPN.

D. HomeVisit refers to a patient-health personnel contact that allows the health personnel fromthe LGU Telemedicine Operations Team to assess the patient and provide emergency care andhealth-related activities either at the patient residence, or during transit to the nearest andsuitably resourced health facility as identified during the assessment.

2

. Individual-based Health Services refer to services that can be accessed within a healthfacility or remotely that can be definitively traced backto one (1) recipient, has a limited effectat a population level and doesnotalter the underlying causeof illness such as ambulatory andin-patient care, medicines, laboratory tests, and procedures, among others.

. Integrated Health Information System (iHIS) refers to an integrated automated system forcommunication and processing of health and health-related data and reports that are neededfor operations and delivery of individual- and population-based health services, response tohealth emergencies and health events of public health concern, health policy development,decision-making, and program planning and implementation at all levels of healthcare.

. Integrated Health Information System (HIS) Module refers to a system componentof aniHIS that encapsulates code and data to implement a particular business process or service.Examples of an iHIS module are electronic health/medical records, laboratory and diagnostics,electronic prescription and dispensing, telemedicine, human resource information, etc.

. Local Government Unit (LGU) Telemedicine Operations Team refers to a group ofassigned health and non-health personnel in the LGU who prepare for and respond to anytelemedicine referral for a patient as coordinated by the referring health care provider thatprovided the telemedicine consultation. It shall be created under the Local Disaster RiskReduction and Management Office (LDRRMO), and include members from the LDRMMO,Health Systems Support Division, and Technical Management Committee of theProvincial/City Health Office (P/CHO), and provincial/city hospital.

Pharmaceutical outlets refer to entities licensed by appropriate government agencies, andwhich are involved in compounding and/or dispensing and selling of pharmaceutical productsdirectly to patients or end-users. This includes institutional pharmacy, Retail Outlet for Non-Prescription Drugs (RONPD), pharmacy/drugstore/farmacia/botica, and hospital pharmacy.

Regional Telemedicine Coordination Team refers to a group of assigned health andinformation and communications technology (ICT) personnel from the DOH Centerfor HealthDevelopment, Regional Offices of the DILG and PhilHealth, and the designated apexhospital(s) of an HCPN, among others, who shall provide administrative, coordination, TA orsupport, resolve technical and/or operational issues and problems, and conduct performancemonitoring of telemedicine service operations at the LGU, in coordination with the LGUTelemedicine Operations Team.

. Standards Conformance and Interoperability Validation (SCIV) refers to the process ofconfirmation of conformance with national health data standards for interoperability, andcompliance with rules on processing and submission of health and health-related data andreports both at the local and national levels of an iHIS and/or any eHealth solution.

. Synchronous Telemedicine refers to real-time telephone or live audio-video communicationthat connects physicians and patients in different locations via smartphone, tablet, or computer.In this telemedicine modality, involved individuals are simultaneously present for theimmediate exchange of information, as in the case of videoconferencing. (CUS CDC; WHO)

. 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 theexchangeofvalid information for diagnosis, treatment and prevention of disease and injuries,

research and evaluation, and for the continuing education of health care providers, all in theinterests of advancing the health of individuals and their communities. (WHO)

N. Telemedicine Referral refers to the mechanism by which a health care provider officially andappropriately coordinates and transfers the management of a patient requiring home visit,and/or emergency care in a suitably resourced health facility, as identified through the

’ telemedicine consultation, to the LGU Telemedicine Operations Team, and refers the patientback to the concerned health care provider, or their assigned primary care provider.

O. Telemedicine Providers refer to a telemedicine company that satisfactorily met all therequirements for provision, engagement or contracting of telemedicine services for LGUsbased on the standards and guidelines, pursuant to this Order and any subsequent issuances.

P. Validated module refers to an iHIS module that passed the software standards conformanceand interoperability validation of the DOH, PhilHealth, and DICT as to the minimum scope,standards, and level of functionality.

VI.GENERAL GUIDELINES

A. The provinces, highly urbanized cities (HUCs), and independent componentcities (ICCs) thatcommitted to integrate their local health systems shall adopt and implement telemedicinetechnologies in the delivery of individual-based health services within their defined catchmentarea that will require:1, Organizing telemedicine services within their health care provider networks (HCPN);2. 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;

3. Promoting telemedicine among their constituents to ensure steady demand for theseservices;

4. Providing the necessary infrastructure and other operational requirements to accommodatetheir current needs; and

5. Issuing policies, but not limited to, ordinances to ensure budgetary support.

B. The implementation of telemedicine in the delivery of individual-based health services shallbe 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.

VIL SPECIFIC GUIDELINES

A. Organization of LGU Telemedicine Services1. The provinces, HUCs, and ICCs shall establish integrated and coordinated LGU

telemedicine services, within one (1) year from the effectivity of this Order, that referenceand complementthe (a) service delivery design of HCPN as provided under DOH AO No.2020-0019, and (b) service classification of individual-based health services as providedunder DOH AO No. 2020-0040. Cost for the organization of LGU telemedicine servicesshall be charged using their own administrative funds.

2. At the minimum, the LGU telemedicine services shall be characterized by the following:a. Adoption and routine use of telemedicine among health care providers. All health care

providers that are part of the HCPN, including their apex hospital, shall adopt andtransition to the routine use of telemedicine in the delivery of individual-based healthservices for their catchment population as part of their business operations in accordancewith their service capability and standard service delivery protocols.

. Establishment of an LGU telemedicine operations team. All HCPN shall organize anLGUtelemedicine operations team, which shall be subsumed under each LDRMMO, thatshall prepare for and respond to any telemedicine referral to and from any health careprovider within the HCPN based on standard protocols, and collaborate with the RegionalTelemedicine Coordination Team for provision of any TA and performance monitoring.

. Telemedicine service capability profiling. All HCPN shall determine, provide andregularly monitor the services, human resources, equipment, infrastructure, and otherqualifying requirements of all health care providers and members of the LGUtelemedicine operations team in the implementation of LGU telemedicine services basedon minimum uniform standards set by DOH, DILG, and PhilHealth.

i. The telemedicine service capability profile for health care providers shall form partof the annual Health Facility Profiling of DOH and PhilHealth.

ii. Details on the service capability, specific telemedicine services being provided, clinichours, and contact information shall be included in the directory that shall be postedin each health facility, and likewise disseminated to all health care providers and theLGU telemedicine operations team within the HCPN. Accordingly, changes orupdates in the directory shall be communicated to all concerned.

iii. All HCPNs shall maintain a directory of the LGU telemedicine operations team withscheduling assignments of personnel, contact details, and availability of resources(e.g. ambulance, patient transport vehicles, etc.) that shall be disseminated and madeaccessible to all health care providers.

. Demand generation and communication. All HCPNsshall develop and implement anadaptable communication strategy for demand generation for telemedicine inconsideration of the population and local context. This communication strategy shall formpart of the health information management/ICT development component of the LocalInvestment Plan for Health (LIPH) for P/CWHS.In developing the strategy, a criticalconsideration is that the catchment population are well informed and assured of access totelemedicine at all levels of health care utilization.

. Telemedicine referral. All HCPN shall establish a functional telemedicine referral systemwith the following minimum process capabilities:

i. Process Capability 1: Health care providers shall be able to directly coordinate andrefer patients that require a non-emergency but higher or specialized level of care (e.g.from primary to secondary care) to another health care provider with the servicecapability;

ii. Process Capability 2: Health care providers that are providing secondary, tertiary andspecialized levels of care shall be able to provide asynchronous telemedicine forassistance to another health care provider, and/or refer back patients to their assignedprimary care provider;

s |

iti. Process Capability 3:- Health care providers shall be able to coordinate and refer to the designated LGU

telemedicine operations team patients that require home visit and/or emergencycare to the nearest and suitably resourced health facility;

- The LGU telemedicine operations team shall be able to receive and respond totelemedicine referrals from any health care provider within its catchment areabased on standard protocols, and provide feedback and back-referral to the healthcare provider, and/orits assigned primary care provider;

- Health care providers shall be able to track and monitor telemedicine responseactivities rendered to the patient by the designated LGU telemedicine operationsteam, and receive feedback from the team;

iv. Process Capability 4: All HCPN shall implement a standard protocol forcommunication for telemedicine referrals with all health care providers and the LGU

telemedicine operations team implementing standardized communication tools andforms that are transformed into electronic reports using their iHIS:- Health care providers shall be able to document the telemedicine consultation, and

issue electronic clinical abstract, consultation summary, prescription, and referralforms, and generate reports;

- The LGU telemedicine operations team shall be able to receive a telemedicinereferral from any health care provider, document the telemedicine responseactivities, submit a telemedicine response report and back-referral to the healthcare provider, and/or its assigned primary care provider, and generate reports; and

v. Process Capability 5: All HCPN, particularly its componenthealth facilities and LGUtelemedicine operations team, shall implement strong, reasonable, and appropriateorganizational, physical, and technical security measures and standards for personaldata protection as set by NPC and the DICT in the collection and processing ofpersonal health information and management of privileged communication fortelemedicine services, and shall uphold andprotect at all times the data privacy rightsof every patient or individual who will consult through telemedicine.

f. LGU telemedicine service operations. All HCPN shall standardize their telemedicineservice operations in their catchment area to include the following minimumrequirements:

i. All HCPN shall: (1) develop and implement an LGU telemedicine service strategyand plan that shall be subsumed under the health information management/ICTdevelopment component of the LIPH for P/CWHS, following the standards set by theDOH, DILG, and PhilHealth; (2) develop and implement localized telemedicineservice protocols that take into account the catchment population, local context, andavailable resources; and (3) issue policies relating to budget support and operations.

ii. All HCPN, as led by the P/CHO andits apex hospital, shall regularly implementcapacity building and mentoring activities of all health care providers and membersof the LGU telemedicine operations team on appropriate use of telemedicine andresponse activities, localized standard protocols, and other relevant guidelines suchas on enterprise architecture, ICT service management, data management, dataprivacy, and cybersecurity, and ensure the availability of resources (e.g. humanresources, ICT equipment and infrastructure, ambulance, patient transport vehicles,etc.) to guarantee quality provision of telemedicine services.

6}

tii.

Iv.

AN health care provider operations shall include the following:A designated telemedicine workstation;A directory of scheduling assignments for individual health care providers, clinichours, and contact information within their health facility;A directory of other health care providers and LGU telemedicine operations teamwithin the HCPN, service capability of health care providers, operating hours, andcontact information;A stable internet connection with appropriate bandwidth speed;Communication devices: landline, mobile phone with camera, tablet, laptop ordesktop computer (i.e. consider the use of dual monitors and high definitionwebcam positioned at eye level);Noise-canceling headphones, speakers, and microphones;Secure, privacy-enhancing and non-public-facing videoconferencing orcommunication software/facility that is interoperable to an electronic iHIS; and

An electronic iHIS with the following validated modules that conform and complywith the minimum uniform standards set by the DOH, DILG, and PhilHealth:= 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, andPhilHealth;

= Referral system managementfor referral of patients to/by another health careprovider or to the LGU telemedicine operations team, tracking and monitoringof telemedicine response activities, and receipt of telemedicine response report;and

= PhilHealth electronic claims processing and provider payment for processing andsubmission of telemedicine claims to PhilHealth.

The LGU telemedicine operations team shall include the following:A designated telemedicine workstation;A directory of health care providers within the HCPN, service capability,telemedicine services being provided, clinic hours, and contact information;A directory of scheduling assignments of the LGU telemedicine operations teampersonnel and contact information;A stable internet connection with appropriate bandwidth speed;Communication device: landline, mobile phone with or without camera, hand-held

two-wayradios, tablet, laptop or desktop computer;Noise-canceling headphones, speakers, and microphones;Secure, privacy-enhancing and non-public-facing videoconferencing orcommunication software/facility that is integrated to the electronic LGUtelemedicine referral system;An electronic integrated LGU telemedicine referral system for receiving andmanaging telemedicine referrals, recording, processing and tracking oftelemedicine response activities, generation of telemedicine reports and back-referrals to a health care provider, and/or its assigned primary care provider, andsubmission of telemedicine reports to DOH, DILG, and PhilHealth through theRegional Telemedicine Coordination Team. The referral system shall conform andcomply with the minimum uniform standards set by the DOH, DILG, andPhilHealth; andAmbulance, transport vehicles, and other logistical requirements.| 4

Details on the telemedicine reports to be submitted to DOH, DILG, and PhilHealth byhealth care providers and the LGU telemedicine operations team shall be provided in asupplemental issuance to this Order.

B. Practice of Telemedicine1. Only licensed physicians shall be allowed to practice telemedicine, pursuant to this Order.

a. The practice of telemedicine shall follow the standards of practice of medicine as definedunder RA 2382, otherwise known as “The Medical Act of 1959,” and its ImplementingRules and Regulations (IRR), the Philippine Medical Association (PMA) Codeof Ethicsand other applicable policies and guidelines, taking into account the absence of physicalcontact.

b. All licensed physicians practicing telemedicine shall uphold the same standards of careas in a face-to-face consultation but within the intrinsic limitations of telemedicine.

2. The use of telemedicine by licensed physicians in the delivery of individual-based healthservices for their catchment population shall be appropriate and sufficient as per context.All licensed physicians shall exercise their professional judgment to decide whether the useof telemedicine is appropriate in a given situation and the specific conditions of theindividual patient.a, Telemedicine shall be used when a health care provider is physically inaccessible (e.g.

such as during events of public health concern with community quarantine in effect,among others), in the management of chronic health conditions, or follow-upconsultations with existing patients.

b. First-time consultations, emergency and serious conditions where emergency care isneeded, or anytime that face-to-face assessment and physical contact are warranted,should not be managed using telemedicine.

3. The practice of telemedicine by licensed physicians shall be governed by the followingprinciples:a. The patient-physician relationship shall be founded on mutual trust and respect in which

they both identify themselves reliably during a telemedicine consultation. Telemedicineconsultation should not be anonymous. Both patient and the licensed physician should beable to know, verify, and confirm each other’s identity at the start of the telemedicineconsultation.

b. Proper informed consent must be obtained from the patient prior to any collection ofpersonal data and the offering of any telemedicine service regardlessif it is a first-timeconsultation or a follow-up consultation.

Consent shall be evidenced by written, electronic or recorded means, and shall containall the necessary information regarding the features of the telemedicine consultation thatshall be fully discussed with the patient, which includes, but not limited to, the following:i. How telemedicine works, including the services to be provided, activities within the

consultation, expected benefits, and billing and insurance,if any;ii. Limitations of telemedicine, including risk of technology failures, and service

limitations;iii. Manner of processing of personal health information, including submission to public

health authorities such as DOH, DILG, and PhilHealth for health policy, planning andresearch purposes;

iv. Privacy and data protection and cybersecurity measures and concerns;

ogy V5

v. LGU telemedicine referral protocol; andvi. Documentation of the patient consent.

c. The patient-physician relationship shall be based on full knowledge of the patient’smedical history and a physical examination given the circumstancesofa lack of physicalcontact (i.e. by virtual physical exam only).i. Licensed physicians shall use their professional discretion to gather the type and extent

of patient information required to be able to exercise properclinical judgment. Onlythe type and extent of patient information necessary to render a medical diagnosis andto giver proper medical assistance shall be gathered from the patient.

ii. If the physical examination is necessary for the consultation, the licensed physicianshould not proceed until a physical examination can be arranged through a face-to-face consultation. Wherever necessary, depending on his/her professional judgment,the licensed physician shall be responsible for the coordination of care, following thelocalized LGU telemedicine referral protocol.

d. The patient-physician relationship shal! respect both patient and physician autonomy.i. The licensed physician can choose not to proceed with the telemedicine consultation

at any time as guided by both law andethics. At any step, the licensed physician canrefer or request for a face-to-face consultation.

ii. At any stage, the patient has the right to choose to discontinue the telemedicineconsultation.

e. The right to privacy of health information shall be protected at all times.i. All licensed physicians providing telemedicine services shall uphold the data privacy

rights of patients, and shall provide the mechanismsfor the patients for the effectiveexercise of these rights.

ii, The processing of health information of patients consulting through telemedicine shallbe in accordance with the privacy and data protection requirements provided underRA 10173, otherwise known as the “Data Privacy Act of 2012,” its IRR and otherrelevant issuances from the NPC, and shall adhere to the principles of transparency,legitimate purpose, proportionality, and accountability.

f. The principle of privileged communication betweenthe licensed physician and the patientshall be observedatall times.i. Video or audio recording of the telemedicine consultation without the consent of both

the licensed physician and the patient shall not be allowed.ii. The protection of privileged communication between the licensed physician and the

patient for telemedicine shall be adhered at all times in accordance with the privacyand data protection requirements provided under RA 10173, otherwise known as the“Data Privacy Act of 2012,” its IRR and other relevant issuances from the NPC, andother existing or applicable laws, rules, and regulations.

4. Minimum health services to be provided using telemedicine shall include medical diagnosis,health advice and counseling, issuance of electronic prescription, and/or referral, if needed.

5. The nature of individual-based health services and information that shall be provided by alicensed physician through telemedicine shall be based on its service capability, the modeof consultation (i.e. video, audio, or text), the purpose of consultation (i.e. first-timeconsultation vs. follow-up consultation), the timing of consultation (i.e. synchronous or

“Wd 4

asynchronous), the persons involved(i.e. patient and/or caregiver to a licensed physician vs.a licensed physician to another licensed physician vs. a licensed physician to the LGUtelemedicine operations team), the specific conditions of the individual patient, andlocalized standard telemedicine service protocol.

. All telemedicine consultations by licensed physicians shall have proper documentations,which includes, but notlimited to the following:a. 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;

Telemedicine platform or communication or videoconferencing software used; and. Patient’s feedback about the telemedicine consultation/experience.

Mmonos

Likewise, all licensed physicians whose services were sought through telemedicine shallmaintain all patient’s health records as appropriate using their electronic integrated healthinformation system as provided by DOH or third-party providers. Details on theimplementation and maintenance of an iHIS shall be provided in a separate issuance.

. All telemedicine consultations by licensed physicians shall include a patient feedbackmechanism that encourages and facilitates patients (and family members or othercompanions) to provide feedback on the quality of the telemedicine consultation/experience,which enable refinement and improvementof future telemedicine consultations.

. The issuance of electronic consultation documents by licensed physicians shall be governedby the following rules:a. All licensed physicians shall be authorized to issue electronic consultation documents

such as electronic clinical abstract, consultation summary, prescription, and/or referral orback-referral forms, pursuantto this Order by issuing it via email or any other alternativemodes considered electronic document acceptable under RA 8792, otherwise known asthe “Electronic Commerce Act of 2000.”

b. All licensed physicians shall recognize and deem equivalent the electronic consultationdocumentissued by other health care providers to a written consultation documentforallintents and purposes, in accordance with RA 2382, otherwise known as the “The MedicalAct of 1959”, RA 9711, otherwise known as the “FDA Act of 2009,” and other existingor applicable laws, rules and regulations.

c. All electronic clinical abstract, consultation summary, and/or referral or back-referralformsshall contain all details similarly contained in a written consultation document ofthe same, and those additional items provided under Section VI.B.5 ofthis Order.

d. All licensed physicians shall issue a separate electronic prescription for all antibiotics,anti-infectives, and/or anti-viral preparations.

e. All electronic prescriptions shall contain the name of the patient to whom the medicinesor drugs are prescribed, the name of the medicines and/or drugs prescribed, the dosageand all other pertinent details similarly contained in a written prescription.

f. All electronic consultation documents shall contain a digital signature, name, licensenumber, Professional Tax Receipt (PTR), if applicable of the issuing licensed physician.

g. All licensed physicians who made use of electronic consultation documents shall keeprecords of all electronic consultations documents issued, pursuant to this Order.

WO |p

9. The dispensing of medicines pursuant to an electronic prescription shall be governed by thefollowing rules, and pursuant to RA 9711, otherwise known as the “FDA Act of 2009,” andRA 10918, otherwise known as the “Philippine Pharmacy Act:”a. All pharmaceutical outlets shall recognize the validity and effectivity of the electronic

prescriptions issued by the licensed physician.i. Prescription containing antibiotics, anti-infectives, and/or antiviral preparations shall

only be valid within one (1) weekafter its issuance.ii. Prescription for other medicines not covered above shall only be valid within 60 days

after its issuance.b. All pharmaceutical outlets shall strictly dispense drugs as prescribed by the electronic

prescription and the latter shall be deemed equivalent to a written prescription forallintents and purposes. The pharmacists may however verify the prescription with thelicensed physicians when necessary to determine its authenticity and accuracy.

c. All pharmaceutical outlets shall not require the actual presence of the patient to whomthe medicines or drugs prescribed before dispensing the needed drugs. A duly authorizedrepresentative may purchase the said drugs on behalf ofthe latter. In the event that thepatient is a Senior Citizen (SC) and/or Persons with Disability (PWD), the followingshould be presented together with the electronic prescription prior to the dispensing ofthe needed drugs:i, A letter of authorization duly signed by the patient; and

li. Identification card as an SC and/or PWD.

C. Development of Code of Ethics and Clinical Practice Guidelines (CPG) for Telemedicine1. The DOH, PRC, and UPM-NThC, in collaboration with medical associations, specialty

societies, patient groups, and other stakeholders, shall develop a Code of Ethics and CPGfor telemedicine that shall standardize and guideall licensed physicians in the practice anduse of telemedicine, and shall be released as a separate issuance.

. In the interim, the practice and use of telemedicine by licensed physicians shall be governedby the standards and guidelines issued under this Order and any subsequent issuances, andpursuant to RA 2382, otherwise known as “The Medical Act of 1959,” and otherexisting orapplicable laws, rules and regulations until such time that the Code of Ethics and CPG aredeveloped and approved as national practice guidelines.

D. Implementation of Certification Program for Telemedicine1. The DOH, PRC, and UPM-NThcC, in collaboration with medical associations and specialty

societies, shall implementa certification program on good clinical practice of telemedicinefor licensed physicians based on approved Code of Ethics and CPG and other relatedguidelines, and pursuant to RA 2382, otherwise known as “The Medical Act of 1959,” andother existing or applicable laws, rules and regulations. Details of which shall be providedin a separate issuance.

. The goodclinical practice certificate for telemedicine shall form part of the credentials forthe certification ofprimary care providers, and the renewal of license of physicians assignedto practice telemedicine within their HCPN, or intend to practice telemedicine as part oftheir continuing professional development (CPD) requirements.

. In the interim, capacity building and mentoring activities of health care providers on practiceand use of telemedicine shall be initiated by each HCPN, as led by its P/CHO andits apexhospital, with assistance from DOH, DILG, PhilHealth, and UPM-NTHhC, following thestandards and guidelines issued under this Order and any subsequentissuances, and pursuantto RA 2382, otherwise known as “The Medical Act of 1959,” and other existing or

TT 4

applicable laws, rules and regulations until such time that the certification program fortelemedicine is established.

E. Verification of License and Credentials of Physicians1, Verification of license and credentials of health care providers shall form part of the system

functionalities of the National Health Workforce Registry (NHWR) that shall be developedby the DOH and PRC. Details of which shall be provided in a separate issuance.

. Inthe interim, any patient or individual whois consulting through telemedicine may performonline license verification of physicians either by name or license number byvisiting thefollowing weblink: Attps://online2.pre.gov.ph/Verification until such time that the NHWRis implemented.

F. Contracting of Third-Party Telemedicine Providers1, Contracting of third-party telemedicine providers by HCPN orany ofits component health

facility for the remote delivery of individual-based health services shall be allowed, providedthat these third-party telemedicine providers have conformed and complied with minimumuniform standards on human resources, enterprise architecture, ICT service management,data management, data privacy, cybersecurity, and other qualifying requirements for LGUtelemedicine services set by the DOH, DILG, and PhiiHealth prior to on-boarding of theirservices. Details on the evaluation mechanism of third-party telemedicine providers shall beprovidedin a separate issuance by DOH, DILG, and PhilHealth.

. Health care provider networks or any of its componenthealth facility shall shoulderall costsrelated to the engagement of a third-party telemedicine provider using their ownadministrative funds.

. A Memorandum of Agreement (MOA), Service Level Agreement (SLA), contract, or itsequivalent between the HCPN andthe third-party telemedicine provider shall be legal andbinding only to the contracting parties. The DOH, DILG, and/or PhilHealth shall not beresponsible norheld liable for any action of the third-party telemedicine provider with regardto its engagement with the HCPN, or vice-versa that may result in any damage, loss, orinjury to any or both parties.

G. Financing Mechanism1. PhilHealth, in coordination with DOH, shal! implement a telemedicine benefit package and

reimbursement mechanism for health care providers, which shall be issued as a separatepolicy. Likewise, the DOH, UPM-NThC, medical associations, and specialty societies shallissue a handbook on recommended rates for telemedicine services.

. At the minimum, consultation rates for telemedicine services of health care providers shallreference and be based on the standardized claims rate of PhilHealth, and the recommendedrates from medical associations and specialty societies, among others.

. In the interim, health care providers shall charge consultation fee that is appropriate,reasonable, and commensurate with the telemedicine services provided, and in accordancewith RA 2382, otherwise known as the “Medical Act of 1959,” RA 10699, otherwise knownas the “National Athletes and Coaches Benefits and Incentives Act,” and other existing orapplicable laws, rules, and regulations.

H. Implementation Governance1. The Secretaries of the DOH and DILG, and the President and Chief Executive Officer

(PCEO) of PhilHealth, in consultation and coordination with interagency eHealth partnersand concerned stakeholders, shall provide overall policy directions and oversight relating tothe implementation of telemedicine in the delivery of individual-based health services.

“77 ]1

2. The DOH, DILG,and PhilHealth shall create a Telemedicine Sub-Working Group (SWG)that, under the policy and strategic guidance of the interagency National eHealth TechnicalWorking Group (NEHTWG), shall:a. Develop the strategies, standards and guidelines on telemedicine;b. Establish support mechanisms;c. Oversee the provision of TA on (i) developmentof localized telemedicine strategy, plans

and protocols, (ii) capacity building activities, (iii) evaluation of third-party telemedicineproviders, and (iv) monitoring and evaluation of the implementation/presence of LGUtelemedicine services characteristics;

d. Conduct researches to constantly improve the implementation of telemedicine in thedelivery of individual-based health services.

Details on the composition and terms of operations of the Telemedicine SWG shall beprovided in an appropriate personnel order.

3. The National eHealth Program Management Office (NEHPMO)at the DOH — KnowledgeManagement and Information Technology Service (KMITS) shall serve as the overalltechnical and administrative secretariat on all matters relating to the implementation oftelemedicine in the delivery of individual-based health services, in accordance with thepolicy directions from the Secretaries of DOH and DILG and PhilHealth PCEO as informedthrough the NEHTWGand Telemedicine SWG.

4. The DOH, DILG, and PhilHealth shall also create an interagency Regional TelemedicineCoordination Team that shall provide administrative, coordination, TA or support, includingresolution of technical and other operational issues and/or problems, lead the evaluation ofthird-party telemedicine providers, with the assistance of KMITS, and conduct performancemonitoring of telemedicine service operations of the LGU within their jurisdiction, incoordination with the LGU Telemedicine Operations Team. Appropriate personnel ordersshall also be issued to this effect.

I. Performance Monitoring1. Regular monitoring shall be conducted by the Regional Telemedicine Coordination Team,

together with KMITS and the LGU Telemedicine Operations Team, using an agreedmethod, tools, and performance indicators as provided under the local health systemsmaturity model and related telemedicine scorecard that shall be issued as separate guidelinesby DOH, DILG, and PhilHealth.

2. Monitoring results shall serve as basis for annual advisory updates that shall be jointly issuedby DOH, DILG, and PhilHealth every January of the succeeding year.

J. Evaluation1. An evaluation of the telemedicine implementation shall be performed every two (2) years

by the Telemedicine SWG with the assistance of the NEHTWG.2. Policy and programmatic updates shall be issued every January of the following year.

VIIL. ROLES AND RESPONSIBILITIES

A. Department of Health (DOH) shall:1. Provide policy directions and oversight, together with DILG and PhilHealth, in

collaboration with FDA, DICT, PRC, NPC, UPM-NThC, LGUs, medical associations,

“TT,

specialty societies, patient groups, and other relevant stakeholders, on theinstitutionalization and implementation of telemedicine services in the delivery ofindividual-based health services;

2. Develop strategies, standards, and guidelines on the implementation of telemedicine, incollaboration with DILG, PhilHealth, FDA, DICT, PRC, NPC, UPM-NThC, medicalassociations, specialty societies, and other relevant stakeholders:a. Knowledge Management and Information Technology Service (KMITS) — data

standards, integration and interoperability of health information sytems and services,ICT infrastructure and service management, and TA on (i) development of localizedtelemedicine strategy, plans and protocols, (ii) capacity-building, (iii) evaluation ofthird-party telemedicine providers, and (iv) monitoring of the implementation/presenceof LGU telemedicine services characteristics;

b. Health Facility Development Bureau (HFDB) — telemedicine process and servicecapabilities for HCPN and its component health facilities as aligned with DOH AO2020-0019 and the Philippine Health Facility Development Plan (PHFDP);

c. Health Facilities and Services Regulatory Bureau (HFSRB) — regulation and licensingof appropriate health facilities for telemedicine;

d. Disease Prevention and Control Bureau (DPCB) — Code of Ethics, and CPG;e. Health Human Resource Development Bureau (HHRDB) — NHWR;f. Bureau of Local Health Systems Development (BLHSD) — appropriate LHS

mechanismsto be established through LGU;g. Health Emergency Management Bureau (HEMB) — managementof health emergency

referrals using telemedicine;3. Establish coordination and support mechanisms for TA and performance monitoring with

the Regional Telemedicine Coordination Team, and LGU Telemedicine Operations Teamthrough the Field Implementation and Coordination Team (FICT);

4, Facilitate the conduct of capacity-building and mentoring activities through KMITS andRegional Telemedicine Coordination Team, in coordination with HHRDB for capacity-building needs, provision oftraining syllabus and other related TA;

5. Lead the monitoring and evaluation of the implementation/presence of LGU telemedicineservices characteristics through KMITS and the Regional Telemedicine CoordinationTeam, in coordination with the LGU Telemedicine Operations Team;

6. Designate personnel from KMITS, HFDB, HFSRB, DPCB, HHRDB, BLHSD, HEMBand FICT whowill be part of the Telemedicine SWG;and

7. Designated personnel from the CHDs who will be part of the Regional TelemedicineCoordination Team.

. Department of the Interior and Local Government (DILG)shall:1. Make available support mechanisms, such as policies and coordination channels for TA,

to facilitate the institutionalization and implementation of telemedicine services in thedelivery of individual-based health services within P/CWHSbased on the standards andguidelines as stipulated in this Order and any subsequent updates or changes hereto;

. Assist the DOH in defining the LGU telemedicine process and service capabilities;

. Co-lead with DOHin the monitoring and evaluation of the implementation/presence ofLGU telemedicine services characteristics through the Regional TelemedicineCoordination Team; and

4, Designate personnel who will be part of the Telemedicine SWG and RegionalTelemedicine Coordination Team, respectively.

14 1

Ww

Ne

C. Philippine Heaith Insurance Corporation (PhilHealth) shall:1,

2.

Formulate guidelines on telemedicine benefit package and reimbursement mechanism forhealth care providers, in coordination with DOH;Assist the DOH and DILG in the provision of TA, particularly on monitoring andevaluation of the implementation/presence of LGU telemedicine services characteristicsthrough the Regional Telemedicine Coordination Team;

. Conduct financing-related researches on telemedicine; and

. Designate personnel who will be part of the Telemedicine SWG and RegionalTelemedicine Coordination Team, respectively.

. Food and Drug Administration (FDA) shall:1. Formulate guidelines on electronic prescription and dispensing of medicines based on the

2.electronic prescription issued by a licensed physician, in coordination with DOH; andDesignate personnel who will be part of the Telemedicine SWG.

Professional Regulation Commission (PRC)shall:1. Co-lead with DOH and UPM-NThCin the development of the Code of Ethics, CPG, and

certification program for telemedicine in collaboration with medical associations,specialty societies, patient groups, and other relevant stakeholders;

. Co-lead with DOH in the development and implementation of the National HealthWorkforce Registry, which includes system functionality on license and credentialverification for health care providers;

. Designate personnel who will be part of the Telemedicine SWG; and

. Assist the DOH, DILG,and PhilHealth in the provision of TA, and facilitating capacity-building and policy development initiatives.

University of the Philippines Manila through the National TeleHealth Center (UPM-NThC)shall:1.

Ah

WwW

Co-lead with DOH and PRC in the development of the Code of Ethics, CPG, andcertification program for telemedicine, in collaboration with medical associations,specialty societies, patient groups, and other relevant stakeholders;

. Co-lead with DOH in the development of a handbook on recommended rates fortelemedicine services, in collaboration with medical associations, specialty societies;

. Designate personnel who will be part of the Telemedicine SWG;

. Conduct operational researches on telemedicine; and =’

. Assist the DOH, DILG, and PhilHealth in the provision of TA, and facilitating capacity-building and policy development initiatives.

Department of Information and Communications Technology (DICT)shall:1. Recommend ICT policies and standards, together with DOH, DILG, and PhilHealth, in

the implementation of telemedicine, particularly in terms of ICT infrastructure andservices, and related technologies;

. Assist the DOH, DILG, PhilHealth, and LGUs in the management of the end-to-endprocess and systern integration and interoperability of LGU telemedicine services;

. Facilitate and ensure the continuous provision of ICT infrastructure and cybersecurityservices to integrated health information systems on telemedicine, referral systemmanagement, and PhilHealth electronic claims processing and provider payment, andintegrated LGU telemedicine referral systems, among others, to LGUs;

. Designate personnel who will be part of the Telemedicine SWG;

5. Administer vulnerability assessment and penetration testing (VAPT)of integrated healthinformation systems and telemedicine referral system, and monitor compliance based ontest results and recommendations through the Cybersecurity Bureau;

6. Provide monthly VAPT monitoring and compliance reports to the Telemedicine SWG;and

7. Assist the DOH, DILG, and PhilHealth in the provision of TA, andfacilitating capacity-building and policy development initiatives.

- National Privacy Commission (NPC) shall:1. Recommend data privacy policies and standards, together with DOH, DILG, and

PhilHealth, in the implementation of telemedicine;2. Designate personnel whowill be part of the Telemedicine SWG;3. Administer the data privacy requirements for integrated health information systems on

telemedicine, referral system management, and PhilHealth electronic claims processingand provider payment, and integrated LGU telemedicine referral systems, and monitorcompliance through the Compliance and Monitoring Division (CMD);

4. Provide monthly data privacy monitoring and compliance reports to the TelemedicineSWG; and

5. Assist the DOH, DILG, and PhilHealth in the provision of TA, and facilitating capacity-building and policy development initiatives.

Local Government Units (LGUs) shall:1. Lead and ensure the adoption and implementation of telemedicine services within their

P/CWHS based on the standards and guidelines as stipulated in this Order and anysubsequent updates or changes hereto;

2. Provide the needed resources, investments, and support mechanisms to facilitate theinstitutionalization and seamless implementation of telemedicine services within theirP/CWHS;

3. Ensure proper complementation of efforts at the local level;4. Create an LGU Telemedicine Operations Team that will collaborate with the Regional

Telemedicine Coordination Team in the implementation of telemedicine services withintheir P/-CWHS;

5. Assist KMITS and the Regional Telemedicine Coordination Team in the monitoring ofthe implementation/presence of LGU telemedicine services characteristics;

6. Ensure efficient generation and monthly submission of implementation’s progress statusto the Regional Telemedicine Coordination Team through the LGU TelemedicineOperations Team;

7. Act as both personal information controller and processor, and ensure the security,integrity, confidentiality, and availability of telemedicine data being collected, processed,maintained, transmitted or exchanged through their integrated health information systemsand LGU telemedicine referral systems, uphold the rights of the data subjects, adhere togeneral data privacy principles, and observe the requirements for lawful processing,pursuant to RA 10173, otherwise known as the Data Privacy Act of 2012, and otherexisting or applicable laws, rules, and regulations;

8. Comply with existing or applicable laws, rules and regulations on contracting third-partytelemedicine providers, if applicable;

9. Report technical and other operational issues, concerns, and/or problems that may arise inthe implementation of telemedicine services to the Regional Telemedicine CoordinationTeam for appropriate action; and

16 \

10. Provide relevant inputs and feedback to further improve the adoption and implementationof telemedicine services at the local level.

- Medical Associations and Specialty Societies shall:1. Assist the DOH, PRC, and UPM-NThCin the development of the Code of Ethics, CPG,

and certification program for telemedicine;2. Assist the DOH and UPM-NTHC inthe developmentof a handbook on recommended rates

for telemedicine services;3. Designate personnel who will be part of the Telemedicine SWG; and4. Assist the DOH, DILG, and PhilHealth in the provision of TA, and facilitating capacity-

building and policy development initiatives.

Patient Groupsshall:1. Provide relevant inputs to the DOH, PRC, and UPM-NThCin the development of the

Codeof Ethics and CPG for telemedicine;2. Designate personnel who will be part of the Telemedicine SWG; and3. Assist the DOH, DILG, and PhilHealth in the provision of TA, and facilitating capacity-

building and policy development initiatives.

- Health Care Providers shall:1. Adopt and use telemedicine in the delivery of individual-based health services for their

catchment population, and comply with standards and guidelines on the practice and useof telemedicine, including the minimum implementation requirements as stipulated in thisOrder and any subsequent updates or changes hereto, and pursuant to RA 2382, otherwiseknownas “The Medical Act of 1959,” and RA 9711, otherwise known as the “FDA Actof 2009,” and other existing or applicable laws, rules, and regulations;

2. Ensure efficient generation and monthly submission of implementation’s progress statusto the Regional Telemedicine Coordination Team through the LGU TelemedicineOperations Team;

3. Act as personal information controller, and ensure the security, integrity, confidentiality,and availability of telemedicine data being collected, processed, maintained, transmittedor exchanged through their integrated health information systems, uphold the rights of thedata subjects, adhere to general data privacy principles, and observe the requirements forlawful processing, pursuant to RA 10173, otherwise known as the Data Privacy Act of2012, and other existing or applicable laws, rules, and regulations;

4. Report technical and other operational issues, concerns, and/or problems that mayarise inthe implementation of telemedicine services to the LGU Telemedicine Operations Teamand/or Regional Telemedicine Coordination Team for appropriate action; and

5. Provide relevant inputs and feedback to further improve the adoption and implementationof telemedicine services at the locallevel.

. Pharmaceutical outlets shall dispense medicines pursuant to an electronic prescriptionbased on the standards and guidelines as stipulated in this Order and any subsequent updatesor changes hereto, and pursuant to RA 9711, otherwise known as the “FDA Act of 2009,”and RA 10918, otherwise knownas the “Philippine Pharmacy Act.”

. Third-Party Telemedicine Providers shall:1. Comply with existing or applicable laws, rules and regulations on government

procurement, or public-private-parmership, or any similar contracting arrangement,

ad17

whichever is applicable, when engaging with LGUs for the provision of telemedicineservices;

2. Comply with standards and guidelines on the provision of telemedicine services to LGUsor any of its component health care provider, including the minimum implementationrequirements as stipulated in this Order and any subsequent updates or changes hereto;

3. Ensure efficient generation and monthly submission of implementation’s progress statusto the Regional Telemedicine Coordination Team through the LGU TelemedicineOperations Team; and

4. Act as both personal information controller and processor, and ensure the security,integrity, confidentiality, and availability of telemedicine data being collected, processed,maintained, transmitted or exchanged through their integrated health information systems,uphold the rights of the data subjects, adhere to general data privacy principles, andobserve the requirements for lawful processing, pursuant to RA 10173, otherwise knownas the Data Privacy Act of 2012, and other applicable laws, rules, and regulations.

O. Data Subjects (Patients and Family Members/Other Companions) shail:1. Ownerofthe data from the telemedicine consultation;2. Disclose truthful and accurate information regarding their health condition to the licensed

physician; and3. Observe and comply with the licensed physician’s post-telemedicine consultation

instructions.

P. Inter-Agency National eHealth Technical Working Group (NEHTWG) shallassist theTelemedicine Sub-Working Groupin the alignment, planning, organization, implementation,monitoring, and evaluation of policies, standards, and activities for the implementation ofLGU telemedicine services in accordance with the policy directions of the Secretaries of theDOH and DILG, and PCEO of PhilHealth.

IX. VIOLATIONS AND COMPLAINTS

Violations and complaints, the procedure for addressing the same, including the proper bodyhaving authority in such cases and possible sanctions that may be imposed shall be in accordance withlaws and rules such as, but not limited to:

Sections 22-29 of RA 2382 (The Medical Act of 1959) and the PMA CodeofEthics;Sections 10-15 of RA 9711(FDA Act of 2009) andother relevant issuances from FDA;Article VI, Section 44 and Article VII, Section 45-46 of RA 10918 (Philippine PharmacyAct);Rule XII, Section 51 and Rule XIIL, Sections 52-65 ofRA 10173 (Data Privacy Act of 2012)and other relevant issuances from NPC;Article 2176 of the Civil Code;Article 365 of the Revised Penal Code; andAll other laws, as applicable.

Qmm

9

ODD

X. BUDGET REQUIREMENTS

The DOH, DILG, and PhilHealth shall separately allocate funds and provide counterpartresources necessary and appropriate to the overall and regularly funded functions of each agency forthe proper implementation of this Order. Each agency shall secure the Commission on Audit’s PostAudit review over any andall transactions related hereto.

is}

XI. TRANSITORY PROVISION

Within one (1) year from the effectivity of this policy, all responsible DOH, DILG andPhilHealth offices shall release new, updated, or supplemental issuances, and operationalize theprovisions ofthis issuance.

XI. REPEALING CLAUSE

This Order hereby rescinds DOH and NPC Joint Memorandum Circular (JMC) 2020-0001dated 28 March 2020, DOH and NPC JMC 2020-0003 dated 14 April 2020, and DOH and UP ManilaJMC 2020-0001 dated 08 June 2020.

XII. SEPARABILITY CLAUSE

In the event that any provision or part of this Joint Administrative Order is declaredunauthorized or rendered invalid by any Court of Law or competent authority, those provisions notaffected by such declaration shall remain valid and in force.

XIV. EFFECTIVITY

This Joint Administrative Order shall take effect after fifteen (15) days following its completepublication in a newspaper of general circulation and upon filing three (3) certified copies to theUniversity of the Philippines Law Center.

a, ANO

Secretary AtDepartmentofthe Interior and Local Government

DU

A CIE RRAN, CPA,)President and Chief Executive Officer Bee ae

Philippine Health Insurance Corporation uc-osee asg720211474

19

Annex A. Minimum Implementation Requirements on LGU Telemedicine Services

Implementation Criteria Minimum Requirements for Means ofVerificationArea Compliance

1. Human Adequate number of| J. Individual Health Care| 1. Individual Health CareResources qualified, trained and Provider Provider

competent staff to ensure a. Duly licensed physicians a. Signed order orappropriate, efficient and that are regularly trained appointment lettereffective use of on appropriate use of hiring dedicatedtelemedicine in the delivery telemedicine and licensed physiciansof individual-based health provision of response that will provideservices within the activities telemedicinecatchmentarea. b. Dedicated ICT personnel consultations, and

ICT personnelb. Health care provider

directory on‘ telemedicine services

2. LGU Telemedicine LGU TelemedicineOperations Team Operations Teama. Duly licensed physicians a. Signed order or

that are regularly trained appointment letteron appropriate use of hiring licensedtelemedicine and physicians that willprovision of response provide telemedicineactivities consultations, health

b. Duly licensed/certified emergencyhealth emergency operations personnel,operations personnel and ICT personnel

c. Dedicated ICT personnel b. LGU Directory ontelemedicine serviceoperations

2. Enterprise Enabling local policies,|1. Policies, standards and\1J1. Policies, standards andArchitecture|guidelines, and standards for idelines guidelines

telemedicine a. LGU telemedicine a. Approved healthimplementation are issued. service strategy and plan information

b. Localized telemedicine management/ICTservice protocols development plan

c. Policies relating to with section onbudget support and telemedicine serviceoperations strategy and plan in

the LIPHb. Approved and

disseminatedlocalizedtelemedicine serviceprotocols

c. Approved policiesand ordinancesrelating to

Tq.

The process capabilities,data, technology, servicerequirements, andenvironment are completeand complied with to ensurelong-term fit and viability oftelemedicine services.

2. Individual Health CareProvidera. Fully-functional

electronic integratedhealth informationsystem with modules ontelemedicine, referralsystem management, andPhilHealth—electronicclaims processing andprovider payment asevidenced by capacity todemonstrate

—_—required

functionalities.b. Compliance with

national health datastandards ontelemedicine as providedunder this Order and anysubsequent issuances.

c. iHIS) modules havepassed the DOH,PhilHealth, and DICTStandards Conformanceand InteroperabilityValidation (SCIV) forapplication software asprovided in the releasedissuance from the DOH,PhilHealth, and DICT.

3. LGU TelemedicineOperations Teama. Fully-functional

electronic integratedLGU telemedicinereferral system asevidenced by capacity todemonstrate requiredfunctionalities.

b. Compliancenational health datastandards ontelemedicine as providedunderthis Order and anysubsequent issuances.

with

telemedicine budgetsupport andoperations

2. Individual Health CareProvidera. Fully-functional

electronic integratedhealth informationsystem withvalidated modules ontelemedicine, referralsystem management,and PhilHealthelectronic claimsprocessing andprovider payment

b. DOH,—~PhilHealth,and DICT-issuedSCIV Certificate

3. LGU TelemedicineOperations Team¢* Fully-functional

electronicintegratedtelemedicinereferral system

LGU

3. ICT Service|The minimum ICT|Minimum ICT equipment,|Inventory of ICTManagement|equipment, service,|service, infrastructure and|equipment, service,

infrastructure, and support|support requirements for|infrastructure and supportrequirements for|telemedicine are operationally|requirements fortelemedicine as provided|adequate and available. telemedicine operationsunder this Order and anysubsequent issuances are|Contingency plan in case of|Contingency planadequate, available,|equipment breakdown/continuously monitored,|malfunction and

__service

and provided as needed. interruption.

Required ICT systems and|Minimum ICT systems and| Fully-functional, integratedservices ate end-to-end|services for telemedicine are|and interoperable ICTprocess and system|fully-functional, integrated,|systems and services forintegrated and interoperable|and interoperable as evidenced|LGU telemedicine services.with each other. by capacity to demonstrate

functionality for integratedand coordinated LGUtelemedicine services.

4. Data Conformance and|Minimum telemedicine data|Quality of submittedManagement{|compliance with minimum|and reports are electronically|telemedicine reports

data and reportorial|encoded and processed instandards. accordance with prescribed

coding standards andreporting/submissionfrequency, among others.

5. Data Privacy|All processing of personal| 1. With designated Data|1.NPC certificates ofdata under the LGU Protection Officer registration of the DPOtelemedicine services|2. Implemented ICT systems and data processingremain confidential, secured for LGU telemedicine systemsand protected. services are registered to|2. Privacy impact

NPC as data processing assessment reportsystems 3. Privacy manual

3. Implemented 4. Privacy noticeorganizational, physical,|5. Signed Non-Disclosureand technical security| Agreements (NDA) ofmeasures for personal data human resourcesprotection involved in the

implementation of LGUtelemedicine services

6. Monthly data privacymonitoring andcompliance report

6. Cybersecurity|All processing of|1. With designated|1. DICT-issued certificatetelemedicine data through Cybersecurity Officer. of registration ofimplemented ICT systems,|2. Compliance with the cybersecurity officer, orincluding all application vulnerability assessment signed order designatingprogramming interfaces and penetration testing or appointment letter(API), and other technical (VAPT) of the hiring cybersecurity

officer.

“Yd, |

processes, are secured fromend-to-end.

Cybersecurity Bureau ofthe DICT.

2.

. Monthly

. Monthly

DICT-CybersecurityBureau-issued certificateof VAPTcompliance/clearance.

VAPTmonitoring andcompliance report

report onpercent of securityincidents and personaldata breaches detectedand responded to in atimely manner

7. OtherQualifyingRequirements

Theseadditionalrequirements thatshall apply iftelemedicineservices will becontracted to athird-partytelemedicineprovider by anLGU.

are

Contracting or engaging athird-party telemedicineprovider is in accordancewith existing or applicablelaws, rules, and regulationson government procurementor public-privatepartnership, whichever isapplicable.

Minimum compliancedocuments are available andduly certified.

. Certified true copy ofsigned MOA, SLAs,contractTelemedicine programprofileTelemedicine platform,including data andsolutions architecture,and ict servicemanagement documentHealth human resourcerecruitment andmanagement protocolTelemedicineconsultation protocolData privacy andcybersecurity measuresRisk and issuemanagement protocolData managementprotocolMarketing protocol

"TY 1

Annex B. Guidelines on the Practice and Use of Telemedicine

1. Setting up a Telemedicine Workstation for Health Care Providers

one

es. Ensure room is quiet, interruption-free, secure, and private with adequate lighting.. Test webcam before every visit.. Wear headphones forbetter audio, if available.. Test every speaker and microphone before every visit.

Learn about the platform or software that will be used for the telemedicine consultation.Alwaystest ahead ofthe visit, download, or install any updated needed.

Tr

pr

dg

rh Check internet speed.. Turn off other web applications and notifications.. Angle the screen so no one can walk by and see the consultation.

Wear samelevel of professional attire as in face-to-face consultation.Avoid visual distractions such as busy patterned shirts, messy desks, food and drinks, photosand posters on background wail.

k. No virtual background.

2. Choosing the Right Telemedicine Platforma. All health care providers shall exercise their professional autonomyand discretion on the best

platform to use for telemedicine taking into account what is appropriate and adequate todeliver proper care, and as provided by existing laws and regulations on privacy and dataprotection, among others.

b. In choosing the right telemedicine platform, consider the following:i.

li.

iii.iv.

Vv.

vi.

The platform is supportable across all devices (e.g. laptop/desktop computer or tablet,etc.), and can be integrated to a new iHIS telemedicine module, or interoperable with anexisting iHIS telemedicine module.The quality of service with the use of the platform is equal or better than face-to-faceconsultation,The platform allows for remote patient monitoring, and clinical validation.The webside manners are properly observed and addressed whenusing the platform.The platform is as easy as possible for patients to access and use, and for the physician tomanipulate its features and present oneself appropriately to the patient.The platform is secure, privacy-enhancing and non-public facing.

t3. Webside Manners during a Telemedicine Consultationa. Greeting

L

ii.iii.

iv.

Introduce self and your role. Ask patient to introduce himself/herself and family membersor other companions in the room, if assisted.Confirm with patient that s/he can see and hear you clearly.Acknowledge the use of the new technology. Normalize any discomfort with the use ofthe platform.Demonstrate confidence in the technology and reason for use. Include instructions onwhatto do in case of disconnection.

b. Maintaining Etiquettei.

ii.iii,iv.

Vv.

Be aware of one’s actions since these will be magnified on camera. Sit fully upright.Do notfidget, scratch, play with your hair, or touch your face.Disable picture-in-picture function.Look directly at the camera. This can be perceived by the patient as making eye contact.Position video window of patient’s imageat the top of your screen below the webcam.

oy |

vi. Explain and narrate all your actions.

c. Empathy & Communicationi. Speak slowly and clearly. Pause longer between statements to allow for transmission

delay.ii. Type into the chat windowto reiterate instructions or next steps.

iii. Check in frequently to elicit reactions and confirm understanding.iv. Use non-verbal cues even on virtual visits: Smile often. Use a warm tone of voice.v. Increase the frequency of empathetic statements to show that you are listening.

vi. Inform the patient when occupied such as when writing notes or looking at radiologicimagesor laboratory results.

vii. Summarize and clarify questions in case of delay or signal interference.viii. In case of disconnection during video consultations, inform the patient how to continue

the consultation.

4. Conducting Virtual Physical Examination. Take a thorough medical history.. Have a keen eye for observing the patient’s condition.. Consider what can be examined while going through the Review of Systems.. Partner with the patient or his/her companion to gain valuable clinical insight.

i. Using home monitor, request patient or relative to take vital signs.ii. Request a family member orrelative to conduct palpation maneuvers orassist in physical

examination while giving instructions.e. Take advantage of available technology. Sharing of photos or videos that are difficult to

visualize on webcam.

a0

Oo

Pp

Organ System Examination(s) on the patients and/or special maneuversConstitutional ® Vital signs (heart rate, respiratory rate; if available, temperature,

blood pressure, weight)e General appearance (ill/well appearing, (un)comfortable,

fatigued, attentive, distracted, disheveled/unkept)Eyes « Appearance of conjunctiva andlids (lid droop, crusting/exudate,

conjunctival injection)¢ Appearance of pupils (equal, round, extraocular eye

movements)e Assessment of vision (seeing double)

Ears, Nose, Mouth,|e« External appearance ofthe ears and nose (scars, lesions,and Throat masses)

e Assessmentof hearing (able to hear, asks to repeat questions)e Inspection of lips, mouth, teeth and gums (color, condition of

mucosa)e Gross inspection of throat (tonsillar enlargement, exudate)e Appearance of face (symmetric, appropriate movement of

mouth, no drooling or labial flattening, ability to raise eyebrow,frown/smile, close eyes, show upper lower teeth, puff outcheeks)

e Pain or tenderness when patient palpates sinuses or ears

Note: may use oral cancer self-exam.

“Ig "

Neck External appearance of the neck (overall appearance, symmetry,tracheal position, gross evidence of lymphadenopathy, jugularvenous distention)Gross movement (degrees of flexion anterior, posterior andlaterally)

Respiratory Assessmentof respiratory effort (intercostal retractions, use ofaccessory muscles, diaphragmatic movement, pursed lipbreathing, speaking in full sentences or limited due to shortnessof breath)Audible wheezing

e Presence and nature of cough (frequent, occasional, wet, dry,coarse)

Note: may use COPD assessment test questionnaires.Cardiovascular Presence and nature of edema in extremities (pitting, weeping)

Capillary refillTemperature of extremities per patient/other measure

Chest Inspection of the breasts (similar, nipple discharge)Chest wall or costochondral tenderness with self-palpation

Abdomen Examination of the abdomenTenderness on self-palpationLocalization of pain

Musculoskeletal Examination of gait and station (stands with/without use ofarms to push off chair; steady gait, broad, narrowed based)Inspection of digits and nails (capillary refill, clubbing,cyanosis, inflammatory conditions, petechiae, pallor)Extremity exam may include: alignment, symmetry, defects,tenderness on self-palpation; range of motion, pain contracture;muscle strength and tone (flaccid, cogwheel, spastic), atrophy,abnormal movements; presence and nature of edema,temperature

Skin Rashes, lesions, ulcers, cracking, fissures, mottling, petechiae,cyanosis, diaphoresis

Neurologic Dermatomal distribution of numbness or painExamination of sensation (by touch or pin)

Genitourinary Testicular self-examinationPsychiatric Orientation to time, place, and person

Recent and remote memoryMood and affectPressured speechMoodlability (crying, laughing)

Hematologic,Lymphatic,

Immunologic

Mobility and firmness of lumps and bumps

Adapted from1. Showalter, G. (30 March 2020). TeleHealth Physical Exam. Loengard A., Findley, J. (Eds). Retrieved from: https://caravanhealth.com.2. Medical Informatics Unit, College of Medicine, University of the Philippines Manila. Preparing for Teleconsultation: Guidance for Filipino

Clinicians and their Patients.

5. Recommended Telemedicine Consultation Process Flow

Before TelemedicineConsultation cS During Telemedicine

Consultation = After TelemedicineConsultation

e Prepare technical set upof the telemedicineworkstation.

« Determine if the patientis suitable for a certaintelemedicine service.Normalize anydiscomfort with thetelemedicine platform,if any.

¢ Prepare the patient’sprevious healthrecords, if applicable.

e Ensure that bothsignal/audio/video areclear on both thepatient’s andphysician’s side.

e Give introductions.Family members orother companionpresent should also beintroduced.

e Set expectations andsecure consent.

e Determine mutuallyagreeable agendaitems.

e Explain to the patienthow you will get theinformation you needfor diagnosis and planof management.

e Conduct your historytaking and virtualphysical examination.

e Obtain patientfeedback.

Summarize key points and askfor clarifications. Have thepatient repeat back what theyunderstood.Explain plan for laboratoriesand ancillaries.Explaininstructions.Arrange for a face-to-facefollow-up consultation, orgive instructions to go to thenearest health facility in caseof worsening symptoms oremergencies post-telemedicine consultation.Ask if the patientcomfortable withtelemedicine set-up.Give a clear sign to the patientthat the consultation is comingto an end. Thank the patient.Complete the documentation.

ePrescription

wasthe

® Email the patient a password-protected file of a summary onwhat was discussed during thetelemedicine consultation. Apassword-protectedprescription can also beincluded, if applicable.

Adapted from:® Medical Informatics Unit, College of Medicine, University of the Philippines Manila. Teleconsultation: Guide for Filipino Clinicians.

“OO |)

References:

. American Association of Neurology. Telemedicine and COVID19 Implementation Guide. Accessed on 11 May 2020 and 8 February2021.American Medical Association. (2020). TeleHealth Implementation Playbook. Accessed on 11 May 2020 and 8 February 2021.Ansary, A. M., Martinez, J. N., & Scott, J. D. (2019). The virtual physical exam in the 21st century. Journal of Telemedicine andTelecare. Retrieved from https://doi.org/10.1177/1357633X 19878330 on 11 May 2020 and 8 February 2021.Board of Governors — Medical Council of India. (25 March 2020). Telemedicine Practice Guidelines: Enabling Registered MedicalPractitioners to Provide Healthcare using Telemedicine. Retrieved from www.mohfw.gov.in/pdf/Telemedicine.pdf on 11 May 2020and 8 February 2021.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.R., Pillejera, J.G.A., and Rosales, N.R. (21 April 2020). Teleconsultation: Guidance for Filipino Clinicians. Medical InformaticsUnit, College of Medicine, University of the Philippines Manila. Accessed on 11 May 2020 and 8 February 2021.Isip-Tan, .T., Marcelo, A.B., Yoshida, A.S., Pillejera, J.G.A., Traboco, L., and Dahildahil, R. (19 May 2020). Guidance forAssessing Telemedicine Vendors. Medical Informatics Unit, College of Medicine, University of the Philippines Manila. Accessedon 22 May 2020 and 8 February 2021.Isip-Tan, I.T., Marcelo, A.B., Dahildahil, R., Magno, A. DL., Traboco, L., Pillejera, J.G.A., Yu, J.M., Fong, M., Guzman, A., Tan-Ong, M., and Tiongson, N. (3 June 2020). Telemedicine: Guidance on Navigating Ethical and Legal Implications. MedicalInformatics Unit, College of Medicine, University of the Philippines Manila. Accessed on 7 June 2020 and 8 February 2021.Isip-Tan, I.T., Marcelo, A.B., Sarmiento,F. I!I, Traboco, L., Fong, M., Dahildahil, R., Guzman, A., Tiongson, N., Herber, J.M., Ong,M.. (21 April 2020). Telemedicine: Guidance for Filipino Physicians. Medical Informatics Unit, College of Medicine, University ofthe Philippines Manila. Accessed on 11 May 2020 and 8 February 2021.Isip-Tan, 1.T., Fong, M., Traboco, L., Tan-Ong, M., Magno, A., Guzman, A., Yu, J.M., Herber, J.M., Dahildahil, R., and Rosales,N.R. (8 May 2020). Preparing for Teleconsultation: Guidance for Filipino Clinicians and their Patients. Medical Informatics Unit,College of Medicine, University of the Philippines Manila. Accessed on 22 May 2020 and 8 February 2021.

. Patdu, Ivy D. (19 March 2020). Privacy should not be an obstacle to telemedicine. Newsbytes.PH. Retrieved fromhttp://newsbytes.ph/2020/03/patdu-privacy-should-not-be-an-obstacle-to-telemedicine/.

. Patdu, .D. and Tenorio, A.S. (2016). Establishing the Legal Framework of Telehealth in the Philippines. Acta Medica Philippina:Vol. 5 No. 4. Retrieved from https://www.actamedicaphilippina.org/api/v | /articles/6850-establishing-the-legal-framework-of-telehealth-in-the-philippines.pdf on 23 February 2021.

. Sanofi SA. eHandbook Highlights of Indian Telemedicine Guidelines & Tenets of Telemedicine in Diabetes.

. Sarmiento, R.F.R. (4 May 2020). Webinar 1: Telemedicinein the Philippines.

. Sarmiento, R.F.R. (6 May 2020). Webinar 2: Setting up your Telemedicine Practice.Sarmiento, R.F.R. (8 May 2020). Webinar 3: Incorporating the New Normal in your Practice.

. Schowalter G, (30 March 2020). Telehealth Physical Exam. Loengard A. Findley, J. (Eds.). Retrieved from: caravanhealth.com.World Medical Association (WMA). (22 October 2018). WMA Statement on the Ethics of Telemedicine. Retrieved from

www.wma.net/policies-post/wma-statement-on-the-ethics-of-telemedicine/ on 11 May 2020 and 8 February 2021.

ay |