Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

EIGHTEENTH CONGRESS
First Regular Session

HOUSE BILLNO. 4899

Introduced by Hon. John Marvin “Yul Servo” C. Nieto

EXPLANATORY NOTE

Article XIII Section 11 of the 1987 Philippine Constitution emphasizes that “The
State shall 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 utilization 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.

It is in this intention that the Philippine eHealth Systems and Services Bill is humbly
submitted and is prayed for its swift passage.

JOHN, VII ‘UL SERVO” C. NIETO


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

EIGHTEENTH CONGRESS
First Regular Session

HOUSE BILL NO. 4999

Introduced by Hon. John Marvin “Yul Servo” C. Nieto

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 I
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);

b) 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

f) 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.

c) “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 image 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.

g) “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.

1) “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.

0) “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 IT
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.

c) 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.

d) 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 III
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)

b)
°)

qd)

Establish an inter-agency and multi-sectoral National eHealth Steering
Committee

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

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 Philij

ine

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)
b)
©)
d)
e)

f
9)
h)

Secretary, Department of Science and Technology

Secretary, Department of Information and Communication Technology
Secretary, Department of Social Welfare and Development;

Secretary, Department of Interior and Local Government;

President and Chief Executive Officer, Philippine Health Insurance
Corporation;

Chancellor, University of the Philippines - Manila;

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 Association;

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

b) 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

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

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

e) 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;

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

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

h) Submit yearly assessments to Senate Committee on Health; and

i) 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) “Health informatics” refers to interdisciplinary study of the design,
development, adoption, and application of IT-based innovations in healthcare
services delivery, management, and planning'.

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

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

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

e) “Electronic Medical Record/Electronic Health Record" refers to software
systems that contains encoded form of documentation of patients’ health

information.


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

g) “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 IT system that
stores and retrieves information, improves cooperation and collaboration,
locates knowledge sources, manage repositories, and enhance knowledge
management.

1) “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 (EMR/EHR) - 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 internal 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
c) 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 VII
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;

c) 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

d) Telehealth centers should ensure regular review of human resource plans and
policies related to telehealth and telemedicine.


ARTICLE VIII
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

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
c) 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

c) 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,