Is the Philippines ready for mHealth (mobile health)?

Healthcare in the Philippines continues to face a lot of challenges. Foremost among these are inadequate medical facilities and infrastructure, high cost of healthcare, and lack of medical professionals. The country also faces high mortality rates from diseases that, in developed countries, is readily prevented or controlled, such as heart disease, cancer, diabetes complications, and infectious diseases. Being an archipelago also does not help because it leads to many underserved, remote regions where medical professionals are scarce, probably even nonexistent.

Can technology help our healthcare situation?

Pru Life UK is hoping to promote better health and wellness among Filipinos using technological innovations. It recently commissioned Quisumbing Torres, a top Philippine law firm, to look into the potential for mHealth (or mobile health) apps as a way to make health more accessible and affordable to Filipinos. They saw that many Filipinos have no access to proper healthcare, especially those in remote and far-flung areas but almost everyone has access to a mobile phone. So why not use that access to bring mHealth to them.

What is mHealth?

For purposes of the white paper, this was defined as including “the use of applications accessible through mobile wireless technology (i.e., mobile phones, tablets, laptops) for healthcare in general”. These applications may cover the following services:

• booking appointments with healthcare practitioners (HCPs)
• online consultations with HCPs
• electronic prescriptions of medicines (e-prescription)
• navigating physical locations of hospitals and clinics
• ordering medicines online
• recording and accessing patient diagnoses and information
• tracking and recording daily diet and health lifestyle information
• employing artificial intelligence (AI) to provide personalized health services (e.g., chatbots)
• accessing medical insurance information, products, and services (including filing and processing of claims)

 

Benefits of Mobile Digital Health to the Philippines

If done right, there are many benefits to digital health. People are empowered to make better decisions regarding their own health because they are provided more options and information.

In developing countries like the Philippines, where there is a lack of physical infrastructure, people depend largely on mobile telecommunications. mHealth is meant to use this mobile range to extend the reach of healthcare facilities, Those in remote and impoverished areas are given access to healthcare through their mobiles even if there is no immediate presence of an HCP or access to medical facilities. In our country, where doctor-patient ratio is 1:1,000 (much lower than the average in developed countries) and most HCPs are concentrated in urban areas, mHealth applications can serve as the bridge of information.

By focusing on prevention by allowing mHealth apps to provide information about regular exercise and proper nutrition, as well as addressing risk factors of non-communicable diseases, it is hoped that the costs of healthcare would go down.

mHealth also serves as an engagement tool. System-generated SMS can be used to disseminate health messages. It can also enhance patient engagement by matching patient needs with doctor capabilities and allowing personalized communication through the mobile applications.

The State of mHealth in Other Countries

In the United States, for example, a survey showed that almost 83% of physicians in the United States are already using mHealth applications to provide patient care. A study by Wolters Kluwer Health shows that 72% of physicians access drug information from smartphones, 63% access medical research from tablets, and 44% communicate with nurses and other staff through smartphones (see infographic below). What is even more interesting in this infographic is the growing use of smartphones and tablets in communicating with patients and accessing their medical records and other patient data.

The result of the independent study conducted by Quisumbing Torres is a pioneering whitepaper titled “Mobile Digital Health in the Philippines“. This white paper examines the readiness of the country’s regulatory framework to support mHealth. It also proposes solutions to integrate mHealth as part of current reforms in healthcare in the Philippines.

Here are the challenges and recommendations based on the white paper:

Challenges in the Philippine Healthcare Landscape

The problem we face in the Philippines is that developments in technology have far outpaced the enactment of laws relevant to the use and regulation of these technologies. The current legal and regulatory framework in the Philippines is such that mHealth’s operations are still restricted by obsolete regulations.

1. Barrier to entry for foreign investments

According to the Securities and Exchange Commission (SEC), a foreign online platform that offers for sale or is engaged in the selling of content and services over the internet to account holders in the Philippines is considered as doing business in the Philippines even though its activities, employees, properties, and servers are located outside the Philippines. Under this definition, many of the current mHealth applications that are operated from abroad may qualify as doing business in the Philippines and as such, would necessitate getting all the necessary licenses and business permits a company usually needs to operate in the Philippines. They would also be subject to the foreign ownership restrictions.

2. Confusing and outdated regulatory framework

The confusing and outdated regulatory framework makes for active provisions that are no longer relevant or outdated when we consider the features of mHealth applications. Here are some:

Practice of profession – Under current regulations, the practice of medicine is limited to individuals licensed to practice the profession. Thus, mHealth applications cannot contain healthcare information that provide diagnosis, treat, or prescribe any remedy for any condition; otherwise, it will be deemed engaged in a medical profession and that is not allowed. mHealth applications can only “engage medical professionals as independent contractors, and use the mHealth platform to connect the patients directly to these professionals, who may then provide the diagnosis, treatment, and prescription, and answer questions in a clinical context.”

Value-Added Services – A service may be considered “value-added services (VAS)” if these are provided directly to the Philippine general public and are provided for a fee. Regulation would then fall under the National Telecommunication Commission (NTC) much the same way that NTC regulates public utilities by limiting foreign equity to 40% and requiring registration as VAS providers with the NTC. Since mHealth applications are likely to charge a fee, they would fall under the definition of VAS. This poses an obstacle if mHealth services are provided from abroad and the companies are foreign-owned.

Medical Devices – While the Philippines is already a signatory to the 2014 ASEAN Agreement on Medical Device Directive which defines a medical device and includes software intended to diagnose and treat illnesses, the Food and Drug Administration (FDA) still has to issue guidelines to allow current stakeholders of physical and traditional medical devices to transition to the new registration requirements. Until those guidelines are issued, only those enumerated in orders issued by the DOH require registration and mHealth applications are not registrable.

Practice of Pharmacy – The Pharmacy Act regulates the dispensing of medicines, interpreting prescriptions, preparing, packaging, labeling, recordkeeping, dose calculations, and counselling or giving information related to pharmaceutical products, with or without a prescription or medication order. A virtual pharmacy without a licensed physical outlet is not allowed. That means online ordering and delivery, as well as a mobile pharmacy requires prior application and approval by the FDA.

Electronic payments (E-payments) – Lastly, it is likely that mHealth apps will integrate e-payments into its functions. This will make the operators subject to regulations of the Bangko Sentral ng Pilipinas (BSP) as they may be considered to facilitate remittance activities. If the mHealth operator engages in an activity that will be construed to be a remittance activity, it will have to register with the BSP as a remittance and transfer company (RTC).

3. Consumer protection and e-commerce regulations

While the broad definition of the Consumer Act of the Philippines, as well as the e-Commerce Act, consider mHealth applications as a consumer product and cover transactions executed through mHealth applications, there are still gray areas not addressed. The study cites as example, the case of an mHealth operator not being the seller of the products and services offered through the app, making it unclear who shall be required to comply with the requirements and be held liable for any violation.

4. Data privacy issues

Since the mHealth apps will generally require its users to give out personal information and will also collect sensitive health information, the provisions of the Data Privacy Act will apply. There is a need for regulations tailored specifically to mHealth applications.

Recommendations to clear the path for mHealth

The white paper makes the following recommendations:

• Formulate rules and regulations that will set concrete and practical tests to determine whether the operator or provider of mHealth platforms or applications is doing business in the Philippines –
• Clarify foreign equity restrictions to ensure that mHealth operators would not be deemed as engaging in mass media, advertising, or providing value-added services
• Introduce clear guidelines that will allow mobile consultation with medical professionals and online dispensing and selling of medicines
• Issue a unified and harmonized set of regulations providing for the guidelines for digital health in general and mHealth platforms and applications in particular
• Issue specific privacy guidelines covering the organizational, physical, system, and technical aspects of mHealth applications to reduce their risk of unauthorized use, processing, or access of personal data
• Offer tax and other incentives for mHealth operators to introduce the innovation in the Philippines
• Integrate the data gathered and processed by mHealth applications into the health information system mandated under the Universal Health Care Act

 

So, is the Philippines prepared for mHealth applications?

Probably not right now. There is a lot of preparation ahead to lay the groundwork. Stakeholders who want to bring mHealth applications into the Philippines have their work cut out for them. It won’t be easy. But with political will and cooperation of all stakeholders, it could be done.

Champions will be needed in both houses of Congress who will thoroughly study how to modify and integrate existing laws that currently restrict the operation of mHealth applications and sponsor the necessary bills to modify them.

The public will need to be educated on the benefits of mHealth and scale it by bringing into the ecosystem as many medical professionals, HMOs, insurance companies, and banks as possible.

Medical accountability has to be ironed out since doctor-patient relationship is now virtual.

Cybersecurity and privacy issues have to be addressed since different operators now process and have access to critical and sensitive personal and health information.

A win-win business model has to be worked out where mHealth applications’ fees are affordable to the sectors that most need to avail of mHealth while remaining profitable for the mHealth operators.

We may still be years away from a true mHealth ecosystem in the country but I am happy to see companies like Pru Life UK already looking ahead and preparing for such a time. I hope they will be able to get support from government and the private sectors needed to make this happen.