On April 23, 2020, Philippine General Hospital (PGH) was identified as demonstration site for the implementation of universal health care (UHC) during the COVID-19 pandemic by the Philippine Health Insurance Corporation (PhilHealth). The directive aims “to link up major tertiary hospitals to satellite clinics in order to lessen foot traffic and to ensure patients’ access to quality health services and continuity of care”.
COVID-19-related health services such as pre-hospital health concerns like disease prevention and early diagnosis; and post-discharge concerns like follow up care and detecting reinfection, stand to gain from accessible satellite clinics.
It is for all other health conditions that networked services will be game-changing. Non-COVID-19 services have largely ceased at PGH as a result of the quarantine; hence, non-COVID-19 cases are overdue for health care.
The pandemic also interrupted the UHC agenda. Like this law, the Bayanihan to Heal as One Act channeled resources to health systems, but only to prop them up for the crisis. The UHC Act aimed to rectify deeper and more chronic problems, now compounded with an ever-present danger and cost multiplier that is COVID-19.
A program proposal for networked health services is now being developed by PGH. It envisions a network of PGH satellite clinics and partnered health providers linked to the main hospital. This can help restore access to health care for PGH patients in the National Capital Region. The goal is to resume as wide a range of health services as possible for as many patients as possible without compromising COVID-19 containment.
Networked health financing is also being discussed to ensure financial accessibility for patients. It may also attract and sustain health provider partners. In the ideal scenario, a patient is prescribed medications at a PGH satellite clinic, gets the drugs at participating pharmacies, and pays only minimal to no out-of-pocket fees.
If enough patients were to enrol under the new network, PhilHealth funding could be correspondingly large under the UHC law. The network would then pay its own health providers. Until the networks are formed however, the health outcomes of PGH patients who are not being seen will deteriorate. Program proponents have therefore raised the idea of setting aside a stimulus package to ensure that the network’s initial providers and services will be covered.
Telemedicine is foreseen to be both a program enabler and an integral part of the new normal. Aided by the UP Manila National Telehealth Center and with experience gained from the Bayanihan Na! Operations Center, PGH hopes to position telehealth services not only to minimize physical contact between patients and health professionals, but also to drive efficiency. Long-distance algorithmically guided services can direct patients to the appropriate level of care while optimizing the use of human resources.
PGH satellite clinics and telemedicine will rely heavily on computerized information systems. Related efforts in these areas predating the pandemic have therefore been accelerated with a view towards integration. The Computerized Registry of Admissions and Discharges (RADISH), a homegrown platform started in 2018 was quickly expanded to accommodate outpatient record-keeping. Its younger sibling, the Computerized Audited Records Retrieval and Online Tracking (CARROT) will bridge PGH’s extensive paper-based charts to the era of e-charting.
For clinical encounters, the Department of Medicine has resumed piloting the latest version of a UP-designed electronic health record (EHR) system and connected this with plans for telemedicine. Earlier versions of this EHR have served the Diliman UP Health Service since 2017. This EHR was originally designed in 2016 for networked outpatient care by Philippine Primary Care Studies (PPCS), a UP-, DOH-, and PhilHealth-funded research program. The UP Manila National Telehealth Center provided initial software programming. DBP-Data Center Inc. provides ongoing software development and technical support.
The Department of Family and Community Medicine has signified interest and will bring its expertise to outside rotations, local government partnerships, and networked tele-enabled health professional education and practice; and to include areas where PGH patients reside.
Public health crises often expose and exacerbate issues that have plagued health systems for decades. The COVID-19 crisis is no different. It has intensified, not eliminated, the need to pursue UHC through networked health care. In becoming a COVID-19 Referral Center, PGH moved to secure the so-called third line of defense. It now marches on to more advanced frontiers in order to protect the health of all its patients.
Dr. Jose Rafael Marfori | Published in Healthscape Special COVID-19 Issue No. 3
