Republic of the Philippines
HOUSE OF REPRESENTATIVES

Quezon City, Metro Manila
SEVENTEENTH CONGRESS,

House{Bill No. 4630

INTRODUCED BY Hon. John Marvin “Yul Servo” Nieto and
Hon. Edward Vera Perez Maceda

EXPLANATORY NOTE

Article XIll Section 11 of the 1987 Philippine Constitution emphasizes that “The State shail adopt an integrated
and comprehensive approach to health development which shall endeavor to make essential goods, health
and other social services available to all the people at affordable cost. There shall be priority for the needs of
the underprivileged sick, elderly, disabled, women, and children. The State shall endeavor to provide free
medical care to paupers.”

Further, Article XIV Section 12 provides that “The State shall regulate the transfer and promote the adaptation
of technology from all sources for the national benefit. It shall encourage the widest participation of private
groups, local governments, and community-based organizations in the generation and-utiization of science
and technology.”

Harmonizing the two (2) provisions, the use of appropriate Information Communications Technology (ICT) is
seen as a cost-efficient solution in coming up with an integrated and comprehensive approach to health
development

Issues on access, availability, equity, patient rights, electronic medical data and health information exchange,
among others are encapsulated in the proposed Philippine eHealth Systems and Services Bill

Medical consultations may be done online through an accredited eHealth provider, which indirectly reduces
out-of-pocket expenditures of patients such as travel fare from any health providers and other incidental
expenses such as food and accommodation. On the other side, medical records will be readily made available,
which can be analyzed by researchers and used by policymakers in crafting rules and regulations.

itis in this intention that the Philippine eHealth Systems and Services Bill is humbly submitted and is prayed for

its swift passage,
Y
Avera Perez Maceda
tive, 4% District of Manila

re S
in “YyfServo”™
e, 3 lfftrict of Manila Rep!



Republic of the Philippines
HOUSE OF REPRESENTATIVES

Quezon City, Metro Manila

SEVENTEENTH CONGRESS

Houta No. 4630

INTRODUCED BY Hon. John Marvin “Yul Servo” Nieto and
Hon. Edward Vera Perez Maceda

AN ACT
ESTABLISHING PHILIPPINE eHEALTH SYSTEM AND SERVICES IN THE DELIVERY OF HEALTH
SERVICES WITH THE USE OF INFORMATION AND COMMUNICATIONS TECHNOLOGY IN THE
PHILIPPINES AND APPROPRIATING FUNDS THEREOF

Be it enacted by the Senate and the House of Representatives of the Congress of the Philippines in session
assembled:

ARTICLE | *
GENERAL PROVISIONS

SECTION 1. Short Title - This Act shall be known as the “Philippine eHealth Systems and Services Act”

SECTION 2. Declaration of Policy ~ The State shall protect and promote the right to health of the people and
instill health consciousness among, them. Hence, it is the intent of the Legislature to institutionalize a system of
providing wide access and quality health care services through electronic means using Information and
‘Communication Technologies (ICT) or eHealth resulting in improved health outcomes for every Filipino

SECTION 3. Objectives - The eHealth Act shall provide a policy framework and establish a National eHealth
System that will direct and regulate the practice of eHealth in the Philippines.

The Philippine eHealth Systems and Services shall be comprehensive, integrative, sustainable, measurable,
synchronized, interoperable, and progressive based on best practices, and shall facilitate inter-agency and
inter-sectoral coordination at various level of governance covering both the public and private sectors, It shall

a) recognize eHealth as equal with other health care delivery methods to the extent allowable by existing
laws, provide and support health care delivery, including diagnosis, consultation, treatment, transfer of
care of patient, exchange of health data and education, especially in medically unserved and
underserved or geographically isolated and disadvantaged areas (GIDA);

) utilize information and communication technology (ICT) to deliver health services which has the
potential to lessen costs, improve quality, change the conditions of practice, and improve access to
health care, particularly in rural and other medically underserved areas;

©) develop infrastructure for ICT for health to promote equitable, affordable, and universal access to health
services;

4) set policies and standards, and establish regulations regarding field of eHealth;

e) designate national and regional centers and networks of excellence for eHealth best practices, policy
coordination, and technical support for healthcare delivery; and

) facilitate the exchange and access to secured personal health information, including health providers
sharing and use health and medical information to improve care as well as public access to relevant
information for the promotion of their own personal health

SECTION 4. Definition — For the purpose of this Act the following definition shall apply:


a) “Act” refers to the Philippine eHealth Systems and Services Act

b) “Distant Site” refers to the site where a health care provider is located while providing these services
Via telecommunication systems.

©) “Electronic health or eHealth” refers to the use of cost-effective and secure information
communication technology for health.

d) “Geographically Isolated and Disadvantaged Areas (GIDAs)” refer to communities with
marginalized population physically and socio-economically separated from the mainstream society and
characterized by: a. Physical factors such as those isolated due to distance, weather conditions and
transportation difficulties (island, upland, lowland, landlocked, hard to reach and unserved/underserved
communities); and b. Socio-economic factors such as high poverty incidence, presence of vulnerable
sector, communities in or recovering from situation of crisis or armed conflict.

e) “Information and Communications Technology” refers to the following:

1, Compressed digital interactive video, audio, or data transmission;

2. Real-time synchronous video or web-conferencing communications;

3. Secure web-based communication

4, Still mage capture or asynchronous store and forward; and

5. Modern smart medical devise use for diagnosis and health care services.

f) “Institutional Healthcare Provider” refers an organization or institution that provides
health care and related services, including but not limited to the provision of inpatient and
outpatient care, diagnostic or therapeutic services, laboratory services, medicinal drugs, nursing care,
assisted living, elderly care and housing, including retirement communities, and equipment used or
useful for the provision of healthcare and related services.

@) “Originating site” refers to the site where the patient is located at the time of provision of health care
services through telecommunication systems.

h) “Professional Healthcare Provider” refers to the healthcare practitioner or license individual, which
includes medical doctors, nurses, pharmacist, physical therapist, and midwives, who provides
healthcare within the scope of his profession license.

i) “Licensable Healthcare Professionals” refer to health care professionals applying for the license to
practice telehealth services

j) “eHealth Practitioner” refers to any health care provider

k) “eHealth Center” refers to health agency involve in a Telehealth System.

\) “eHealth systems” refers to an organized and structure application of eHealth, integrated in the
regular workflow of health care facilities

m) “Telehealth” means the delivery of health related services and information via telecommunication
technology. It encompasses preventive, promotive, curative, and palliative aspects.

n) “Telemedicine” means the use of telecommunication technology to provide health care services from a
distance; focuses more on the curative/treatment aspect.

©) “Unserved and underserved areas” refer to communities such as those isolated due to distant,
physical terrain, poverty, or lack of transportation and social services, as well as those in situation of
disaster, crisis, and armed conflict.

SECTION 5. Scope of the Act - The act covers all existing eHealth practitioner, institution, entities, services
and related applications in both public and private. It shall not alter the scope of practice of any health care
provider or authorize delivery of health care services in a setting or in a manner not authorized by law. It shall
cover all other eHealth solutions and services including relevant standard equipment in the field of health and
ancillary services that uses ICT and are complementary to existing minimum modalities or standards of health
care and other access to information.

ARTICLE Il
eHEALTH SYSTEMS’ COMPONENTS

SECTION 6. The eHealth Components — The following components are the building blocks that shall be put
in place to realize the national eHealth vision and allow the eHealth outcomes to be achieved:

a) Leadership and Governance — Directs and coordinates eHealth activities at all levels like hospitals
and health care providers. Critical areas of governance are management of the eHealth agenda,


stakeholders’ engagement, strategic architecture, clinical safety, management and operation,
‘monitoring and evaluation, and policy oversight.

b) eHealth Services/Solutions — Required services and applications to enable widespread access to
health care services, health information, health reports, health care activities, and securely share and
exchange patient's information in support to health system goals. These address the needs of the
various stakeholders like individuals, health care providers, managers, officials, and others.

©) Standards and Interoperability — Defines standards of eHealth systems and services, and promotes
and enables exchange of health information across geographical and health sector boundaries through
use of common standards on data structure, terminologies, and messaging. The implementation of
software certification or accreditation where eHealth solutions must comply in order to be certified as
able to exchange health information shall ensure compliance to eHealth data standards for
interoperability.

4) Policy, and Compliance - Formulation of the required policies, guidelines and compliance
mechanisms to support the attainment of the quality and acceptable eHealth systems and services.

e) Infrastructure — Establishes and supports the ICT and medical base to enable provision of eHealth
services and health information exchange to enable sharing of health information across geographical
and health sector boundaries, and implementation of innovative ways to deliver health services and
information.

f) Human Resources ~ Workforce or professionals that develop, operate, uses or implement the national
eHealth environment such as the health workers who will be using eHealth in their line of works, health
care providers, information and communication technology workers, and others.

9) Strategy and investment — Schemes and outlay that are needed to develop, operate and sustain the
eHealth Systems and Services. These components support the development of a strategy and plans to
serve as guide in the implementation of the eHealth agenda. Investment refers to the funding or amount
needed for executing the strategies and plans.

ARTICLE Ill
LEADERSHIP AND GOVERNANCE.

SECTION 7. Lead Agency — The Department of Health (DOH) shall be the lead agency in implementing this
Act. For the purpose of achieving the objectives of the Act, the DOH shall:
a) Establish an inter-agency and multi-sectoral National eHealth Steering Committee
b) Spearhead the establishment of a National eHealth System and Service
¢) Coordinate with the Department of Science and Technology (DOST), the Department of Information
and Communication Technology Office (DICT) and the Philippine Council for Health Research and
Development (DOST-PCHRD), Philippine Health Insurance Corporation (PhilHealth), University of the
Philippines — National Telehealth Center (UPM-NTHC), Medical and Paramedical Specialty Societies,
Boards and Associations , Professional Regulation Commission (PRC) and various health services
providers and facilities including the academe and patient groups, and other stakeholder; and
d) Create or identify an office to coordinate the development and implementation of a National eHealth
System and Services among agencies concerned and provide direction and guidance to all DOH
offices and attached agencies including the local government units and the private sector.

SECTION 8. National eHealth Steering Committee — To ensure the implementation of this Act and to serve
as an executive body of the Philippine eHealth System and Services (PNeHSS), the National eHealth Steering
Committee shall be created and made an integral part of the DOH. The composition of the Steering Committee
shall be as follows:

Chair: Secretary, Department of Health

Members:

a) Secretary, Department of Science and Technology

b) Secretary, Department of information and Communication Technology

©) Secretary, Department of Social Welfare and Development;

d) Secretary, Department of interior and Local Government;

e) President and Chief Executive Officer, Philippine Health Insurance Corporation;

) Chancellor, University of the Philippines — Manila;

9) Commissioner, Professional Regulatory Commission


‘Commissioner, Commission on Higher Education
Commissioner, National Privacy Commission
Commissioner, National Anti-Poverty Commission
President, Philippine Hospital Association;
President, Philippine Medical Association:
President, Philippines Nurses Associatio
President, Philippine Pharmacists Association;

‘A representative from the Association of Municipal Health Officers/PHO/CHO; and
Two (2) representatives from a duly organized patient group.

Members of the Committee shall be appointed by the President of the Philippines and shall serve for three (3)
years for a maximum of two (2) consecutive terms, unless recalled, replaced or resigned from office. The
Committee shall exercise the following function:

a)
b)
°)
dq)
e)
i)
9)

h)
i)

Establish eHealth policies, standards, regulations, and ethical frameworks pertinent to use, practice
and provision of eHealth services;

Direct and coordinate the eHealth system and services. at the national level and ensures alignment of
the system and services with the overall health goals of the government

Spearhead the activities that promote eHealth awareness and engages the participation of
stakeholders;

Formulate responsive plans and strategies for the development of a national eHealth environment in
coordination with major stakeholders and affected sectors;

Set and develop policies and programs for the further advancement of eHealth, and impose
necessary regulatory mechanisms including penalties upon hearing and deciding on cases;

Create Technical Working Group, other Committees, and Experts Group to assist in the development
of the eHealth Projects

Create or identify the Telehealth Licensing and Regulatory mechanisms and body to implement
these;

Submit yearly assessments to Senate Committee on Health; and

Convene at least twice a year.

ARTICLE IV
eHEALTH SERVICES AND SOLUTIONS

SECTION 9. Service and Application- the National eHealth System shall provide tangible means for
enabling services and systems including access to, and exchange and management of information and content
for the general public, patients, providers, insurance, and others which may be supplied by government or
private businesses.

SECTION 10. Scope of eHealth Services and solutions — eHealth is an umbrella term that covers the
following areas.

a)
b)
°)
dq)
e)
9)

“Health informatics” refers to interdisciplinary study of the design, development, adoption, and
application of IT-based innovations in healthcare services delivery, management, and planning}.
“Telehealth” means the delivery of health related services and information via telecommunication
technology. It encompasses preventive, promotive, curative, and palliative aspects.

“Telemedicine” means the use of telecommunication technology to provide health care services from a
distance; focuses more on the curative/treatment aspect.

“Electronic learning or eLearning” refers to learning utilizing electronic technologies to access
educational curriculum outside of a traditional classroom’.

“Electronic Medical Record/Electronic Health Record” refers to software systems that contains
encoded form of documentation of patients’ health information.

“Electronic prescription or ePrescription” refers to an electronic generation of a physician's
prescription, transmission and filling of medical prescription.

“Virtual healthcare teams” refer to professionals who collaborate and share information on patients
with digital equipment.


h) “Mobile health or mHealth” refers to medical and public health practice supported by mobile devices,
such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other
wireless devices.”

i) “Social media for eHealth” refers to the opportunities for the healthcare industry to engage with
patients and healthcare professionals through online communications channels dedicated to
community-based input, interaction, content-sharing and collaboration.

j) “Health Information Exchange” refers to the solution which enables data sharing and exchange
between health care providers and facilities, and support access to the patient's record across
providers in many geographic areas of the country

k) “Knowledge Management system” refers to any kind of ITsystemthat stores and
retrieves information, improves cooperation and collaboration, locates knowledge sources, manage
repositories, and enhance knowledge management.

|) “Patient Self Education about Healthcare” refers to the patient's use of internet through personal
computers or mobile devices to research on medical and/or pharmacological information, treatment
options, or search for health care facilities available in their area.

SECTION 11. Telehealth and Telemedicine Services - Telehealth is an approach of providing health care
services and public health with the use of ICT to enable the diagnosis, consultation, treatment, education, care
management, and self-management of patients at a distance from health care providers. However, it shall not
be understood to modify the scope of medical practice or any health care provider or authorize the delivery of
health care service in a setting or manner not otherwise authorize by the law.

SECTION 12. Electronic Medical/Health Record (EMRIEHR) — All data in EMR/EHR shall be considered
protected health data and shall be governed by established rules for access, authentications, storage and
auditing, and transmittal.

SECTION 12.1. Disclosure — Disclosure of and accessibility to protected data in EMR/EHR shall be
limited and standardized following international and local rules and regulation. Patients may secure a
copy of their EMR/EHR upon request and shall provide informed consent if their EMR/EHR is shared
with third parties except when these are processed for the production of aggregate health statistics, for
social health insurance claims based on established guidelines, for public health emergency concerns
and national security.

SECTION 12.2, Covered Entities — covered entities may disclose protected health information to law
enforcement officials performing their official duties and responsibilities as required by existing national
and local laws and with proper order from duly concerned bodies.

SECTION 13. Standards of Care — The Standards of Care to be provided shall be based on established
clinical or service guidelines and services given must be the same regardless of whether a healthcare provider
provides healthcare services in person or electronically. The primary accountable for the healthcare delivery
shall be the attending physician.

eHealth shall not replace health care providers providing services in person or relegate them to less important
role in the delivery of healthcare. The fundamental healthcare provider-patient relationship is not only to be
preserved but also augmented and enhanced.

ARTICLE V
STANDARDS AND INTEROPERABILITY

eHealth systems and services can potentially transform healthcare through mobile health delivery,
personalized medicine, and social media eHealth applications. Reaching the potential for advancements in e-
health will only be achieved through information and communication technology standards efforts that facilitate
interoperability among systems and devices, of the developing world, and leverage existing ubiquitous
technologies such as social media applications and mobile devices.

SECTION 14. Standards — Standards shall be introduced and imposed to facilitate interoperability among
systems and devices, provide unqualified privacy and security and to address the unique needs. This must be


complied with by various providers, centers, and systems developers to enable consistent and accurate
collection, and exchange of health’ information across health systems and services. The appropriate
Committee as may be defined in this Act shall define and regularly update, and impose standards for
interoperability among various eHealth systems and services and shall ensure wide dissemination for easy
access of all concerned .

SECTION 15. Interoperability framework ~ The eHealth interoperability shall be defined and must be in
consonance to national eGovernment interoperability framework and established intemal standards

SECTION 16. Secure Health Information Exchange (HIE) - The DOH, DOST, DICT and PhilHealth shall
establish a secured health information exchange using a common trust framework and a common set of rules
which serves as the foundation for electronic information exchange across geographical and health-sector
boundaries. The HIE includes the physical infrastructure, standards, core services, and applications that will
strengthen the national eHealth environment.

SECTION 17. Establishment and Accreditation of eHealth Centers and eHealth Practitioners - The Act
shall ensure that telehealth centers are strategically organized across the country within three (3) years
upon enactment of this law to ensure that telehealth practitioners are sufficiently equipped with skills for the
ethical safe practice of telehealth. Regional Telehealth Centers shall be established. No telehealth center
shall be allowed to operate unless it has been duly accredited based on the standards set forth by the DOH.
The Department of Health shall be the lead agency for the accreditation for the facilities as Telehealth centers,
whereas the Professional Regulatory Commission shall be the lead agency for the accreditation of the
Telehealth Practitioners in close coordination with the National eHealth Steering Committee. Practitioner shall
be accredited by the PhilHealth for reimbursement purposes. A Telehealth Center shall have the following
minimum requirements:

a) Equipped with the needed ICT applications suitable for telehealth in the country;

b) Be supervised and staffed by trained personnel; and

©) Undergo periodic unannounced inspection by the DOH in order to evaluate and ensure quality

telehealth center performance.

ARTICLE VI
INFRASTRUCTURE

SECTION 18. ICT Infrastructure ~ The required ICT infrastructure to implement eHealth system and services
shall conform to the national ICT infrastructure plan and standards

SECTION 19. Medical devices and eHealth solutions — Software platform that connects existing or new
medical devices and gateways shall be defined and regulated to ensure seamless data transfers based on
established industry and national standards and standardization of EHR/EMR

SECTION 20. Telehealth Centers Database — All telehealth centers and originating sites shall coordinate with
DOH for consolidation of pertinent databases. DOH shall maintain and manage a national database for
consults on clinical cases as well as health and medical education exchanges.

SECTION 21. National Health Databases and Data warehouse - The DOH shall spearhead the
maintenance and management of a secured and protected national health database and national health data
warehouse or defined shared EMR/EHR and of consultations on clinical cases as well as health and medical
education exchanges and other eHealth applications.

ARTICLE Vil
HUMAN RESOURCES

SECTION 22. Human Resources ICT Competencies — Minimum ICT or eHealth competencies shall be
established and imposed to medical and paramedical professionals practicing eHealth, and be part of the
medical and allied medical curricula.


SECTION 23. Capability Building Plans & Policies — Human resource plans and policies shall be fully taken
into account any unique human resource and operations requirement involved in delivering Telehealth and
Telemedicine. The following are to be considered:
a) Licensable health care professionals must hold a valid Philippine license based on the requirement of
the Professional Regulation Commission (PRC);
b) Appropriate policies concerning cases wherein a licensed telehealth practitioner in the Philippines
intending to provide telehealth services to patient in another country should be in place;
¢) In any event, a telehealth center should have policies and procedures to ensure that all relevant staff
have the appropriate competencies to practice safe telehealth services; and
4d) Telehealth centers should ensure regular review of human resource plans and policies related to
telehealth and telemedicine.

ARTICLE VII
STRATEGY AND INVESTMENT

SECTION 24. eHealth Strategic Framework — The DOH shall spearhead the development and monitoring of
strategic framework and plans to serve to guide the implementation eHealth Systems and Services.

SECTION 25. Monitoring & Evaluation System - establishment of a robust metric for monitoring and
evaluation for eHealth to assess and analyze the impact of eHealth systems and services.

SECTION 26. Appropriation — The amount necessary to carry out the provisions of this Act shall be included
in the General Appropriation of the year following its enactment into a law thereafter.

SECTION 27. Financing eHealth Services — Financing for applicable eHealth services by PhilHealth and
other partners, as defined by the National eHealth Steering Committee 7.

SECTION 28. Private Sector participation — The government shall encourage private sector's investment on
eHealth systems and services subject to existing laws and regulation through the appropriate government
agencies and must be compliant to the established national eHealth systems and services.

ARTICLE IX
RESEARCH AND DEVELOPMENT

SECTION 29. Research and Development ~ The DOH, in coordination with DOST and DICT, the specialty
societies and boards, the academe, and other research institutions shall regularly endeavor to evaluate
existing tools and technologies used for eHealth to ensure the cost efficiency, appropriateness, safety and
equality of services provided to the patients in particular, and the health sector in general towards this end, It
shall:
a) Develop the Research Agenda
b) Establish centers of excellence for eHealth research that will endeavor to produce high quality research
on distance learning for basic and continuing professional education; and
©) Provide access to current specialized, accredited knowledge for clinical care, public health, other health
research publications and databases.

SECTION 30. Funding Source for Research Development - The research budget shall not exceed 5% of
the funding sources of the following government agencies:

a) Department of Health;

b) Department of Science and Technology; and

©) Department of Information and Communication Technology.

ARTICLE X
FINAL PROVISIONS

SECTION 31. Rules and Regulation — Within ninety (120) days from the approval of this Act, the Secretary of
Health, after consultation with the DOST, DICT, University of the Philippines - Manila, PhilHealth, CHED,


medical and paramedical associations and societies and other stakeholders, shall promulgate the rules and
regulations implementing the provisions of this Act.

SECTION 32. Separability — If any part or provision of this Act shall be declared or held to be unconstitutional
or invalid, other provisions hereof which are not affected thereby shall continue to be in full force and effect.

SECTION 33. Repealing Clause ~ All general and special laws, decrees, executive orders, proclamations and
administrative regulation, or any parts thereof which are inconsistent with this Act are hereby repealed,
amended or modified accordingly,

SECTION 34. Effectivity — This act shall take effect fifteen (15) days after publication in the Official Gazette or
a newspaper of general circulation.

Approved,