IBA Healthcare and Life Sciences Law Committee

Telemedicine Survey – PHILIPPINES

TELEMEDICINE: A GLOBAL APPROACH TO TRENDS AND PRACTICES

Authors: Gwyneth S Ong, Jaime S Fernandez and Marie Claudine B Bernas, Martinez
Vergara & Gonzalez Sociedad
Date of completion: 30 November 2022
LAWS AND REGULATIONS ON TELEMEDICINE

1. Is telemedicine allowed in your country? If so, how is it defined?

Telemedicine is allowed in the Philippines. DOH-DILG-PHIC Joint Administrative Order No

2021-0001 titled ‘Guidelines on the Implementation of Telemedicine in the Delivery of
Individual-Based Health Services’ (the ‘Guidelines’) adopts the definition of telemedicine
provided by the World Health Organization (WHO). Under the WHO definition, 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 the exchange of
valid information for diagnosis, treatment and prevention of disease and injuries, research
and evaluation, and for the continuing education of health care providers, all in the interests
of advancing the health of individuals and their communities’.

2. Please provide a high-level overview of the legal framework regarding telemedicine in

your country.

Telemedicine is specifically regulated by the Guidelines. However, the governing law that
regulates physicians engaged in telemedicine is the Republic Act No 2382, or the Medical Act
of 1959 and its Implementing Rules and Regulations. The Philippine Medical Association
Code of Ethics is likewise applicable.
Other laws that apply include:
 Republic Act No 8792, or the Electronic Commerce Act of 2000;
 Republic Act No 9711, or the Food and Drug Administration (FDA) Act of 2009;
 Republic Act No 10918, or the Philippine Pharmacy Act;
 Republic Act No 10173, or the Data Privacy Act of 2012 (the ‘DPA’).
The Guidelines likewise mandate the Department of Health (DOH), the Professional
Regulation Commission (PRC) and the University of the Philippines Manila – National
TeleHealth Center (UPM-NThC) to develop of a code of ethics and clinical practice guidelines
(CPG) for telemedicine that will standardise and guide all licensed physicians in the practise
and use of telemedicine, but this has not yet been issued.

3. Briefly identify the key licensing bodies for telemedicine and outline their
responsibilities.

The Guidelines provide that only licensed physicians shall be allowed to practise
telemedicine.
The licensing body for physicians is the PRC, in particular, the Board of Medical Examiners.
The board implements the provisions of the Medical Act of 1959, as amended, and ensures
that only qualified individuals are granted licences to practise medicine.
The Implementing Rules and Regulations of Republic Act No 10912, or the Continuing
Professional Development Act, provides that Continuing Professional Development, or the
inculcation of advanced knowledge, skills and values in a post-licensure specialisation or in
an inter or multidisciplinary field of study for assimilation into professional practice, self-
directed research and/or lifelong learning, is a mandatory requirement in the renewal of the
licence of physicians, among other licensed professionals. The renewal of such a licence is
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Telemedicine Survey – PHILIPPINES

required to continue practising their profession.

4. Was telemedicine authorised during the Covid-19 pandemic?

Yes, telemedicine was expressly authorised by the Guidelines during the Covid-19 pandemic.
5. Is there any possibility of the regulatory landscape being changed in the post-
pandemic scenario or has there already been a change in regulation in the post-
pandemic scenario?

Currently, the regulatory landscape is dependent, in the interim, on pre-existing rules prior to
telemedicine. With the issuance of the Guidelines, implementing agencies have been tasked
to produce updated and specific rules relating to telemedicine. Moreover, there is currently
pending legislation regarding e-health systems and service. As such, it is likely that we will
see a change in the regulatory landscape for telemedicine.
6. What types of teleservices are allowed (eg, second opinion, teleconsultation,
telediagnosis and telesurgery)?

Based on the Guidelines, the following teleservices are contemplated: (1) telemedicine
consultation; (2) virtual history taking and physical examination; (3) telediagnosis; (4)
creation of an electronic medical record; (5) provision of e-prescription instructions; (6)
issuance of electronic consultation documents; and (7) telemedicine referral. Nonetheless,
other teleservices are not expressly prohibited.
However, the Guidelines do state that first-time consultations, emergency and serious
conditions where emergency care is needed or any time that face-to-face assessment and
physical contact are warranted should not be managed using telemedicine.
7. Who can use telemedicine services? Please indicate whether only doctor-doctor or
also patient-doctor remote medical services are allowed.

Patient-doctor remote medical services are allowed. In such cases, the Guidelines provide
that telemedicine consultation cannot be anonymous. This means that ‘both patient and the
licensed physician should be able to know, verify, and confirm each other’s identity at the
start of the telemedicine consultation’.
8. Please outline the funding model for telemedicine. Is it available in your jurisdiction’s
public health system? Is telemedicine under mandatory insurance coverage? Please
indicate what legislation applies.

The Philippine Health Insurance Corporation (PhilHealth), in coordination with the DOH, will
implement a telemedicine benefit package and reimbursement mechanism for healthcare
providers, which shall be issued as a separate policy. In the interim, healthcare providers
shall charge a consultation fee that is appropriate, reasonable and commensurate with the
telemedicine services provided.
The consultation rates for telemedicine services shall be based on the standardised claims
rate of PhilHealth, and the recommended rates from medical associations and specialty
societies, among others. Claims for reimbursement may be filed for transactions and
services falling under PhilHealth coverage. The Guidelines mandate all healthcare providers
to include, among others, a PhilHealth electronic claims processing and provider payment for
the processing and submission of telemedicine claims to PhilHealth.
Currently, the Guidelines provide that telemedicine should be made available through the
public health system in some provinces, highly urbanised cities (HUCs) and independent
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component cities.
9. Please indicate whether any insurance requirements are applicable to telemedicine
service providers.

Currently, there are no insurance requirements applicable to telemedicine service providers

under the Guidelines.

REQUIREMENTS APPLICABLE TO HEALTHCARE PROFESSIONALS AND INSTITUTIONS

10. Who can practise telemedicine in your country? Please indicate whether other
healthcare professionals are authorised to provide remote health services under the
applicable rules (eg, nurses, psychologists, nutritionists and alternative health
therapy providers).

Part VII, section B (1) of the Guidelines expressly provides: ‘Only licensed physicians shall
be allowed to practise telemedicine, pursuant to this Order’.
Section 8 of the Medical Act of 1959 provides the qualifications of those who may practise
medicine: ‘No person shall engage in the practice of medicine in the Philippines unless he is
at least twenty-one years of age, has satisfactorily passed the corresponding Board
Examination, and is a holder of a valid Certificate of Registration duly issued to him by the
Board of Examiners’.
Under the same Medical Act, the practise of medicine is defined as persons:
‘(a) who shall, for compensation, fee, salary or reward in any form, paid to him directly or
through another, or even without the same, physical examine any person, and diagnose,
treat, operate or prescribe any remedy for any human disease, injury, deformity, physical,
mental or physical condition or any ailment, real or imaginary, regardless of the nature of
the remedy or treatment administered, prescribed or recommended; or (b) who shall, by
means of signs, cards, advertisements, written or printed matter, or through the radio,
television or any other means of communication, either offer or undertake by any means
or method to diagnose, treat, operate or prescribe any remedy for any human disease,
injury, deformity, physical, mental or physical condition; or (c) who shall use the title M.D.
after his name’.
Under the Guidelines, any patient or individual may perform online licence verification of
physicians either by name or licence number through the PRC website.
Notably, other healthcare professionals are not expressly covered by the telemedicine
Guidelines and the government has not issued any guidelines regarding other healthcare
service providers, such as nurses, psychologists, nutritionists and alternative health
therapies providers.

11. Are there any specific education requirements or training that healthcare
professionals need to meet or attend to provide telemedicine services?

Currently, there are no specific education requirements or training imposed on healthcare

professionals in order to provide remote health services. The minimum requirement is that
one must be a licensed physician. However, the Guidelines recommend that capacity
building and mentoring activities of HCPNs be initiated while the guidelines for the
certification programme on good clinical practice for telemedicine are being drafted.

12. Is there any registration requirement applicable to physicians that provide

telemedicine services?
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Telemedicine Survey – PHILIPPINES

There is currently no additional registration requirement applicable to physicians who provide

telemedicine services. Generally, all licensed physicians are qualified to provide telemedicine
services.

13. Please indicate whether special licenses or authorisations are mandatory for
institutional healthcare providers engaged in telemedicine services.

There is no additional registration requirement to allow physicians to provide telemedicine

services under the current Guidelines. However, the same Guidelines provides for the
implementation of a certification programme for telemedicine where the DOH, PRC, UPM-
NThC and concerned medical associations shall implement a certification programme on
good clinical practice in telemedicine for licensed physicians. The Guidelines provide that
such a certificate shall ‘form part of the credentials for the certification of primary care
providers, and the renewal of license of physicians assigned to practice telemedicine within
their HCPN, or intend to practice telemedicine as part of their continuing professional
development requirements’.

REQUIREMENTS APPLICABLE TO TELEMEDICINE SERVICES

14. Are there specific requirements applicable to the telemedicine platform?

The Guidelines do not provide for specific requirements; however, it provides the following:
‘All health care providers shall exercise their professional autonomy and discretion on the
best platform to use for telemedicine taking into account what is appropriate and
adequate to deliver proper care, and as provided by existing laws and regulations on
privacy and data protections, among others.
In choosing the right telemedicine platform, consider the following:
1. The platform is supportable across all devices (e.g. laptop/desktop computer or
tablet, etc.) and can be integrated to a new Integrated Health Information System
(iHIS) telemedicine module, or interoperable with an existing iHIS telemedicine
module.
2. The quality of service with the use of the platform is equal or better than face-to-face
consultation.
3. The platform allows for remote patient monitoring, and clinical validations.
4. The website manners are properly observed and addressed when using the platform.
5. The platform is as easy as possible for patients to access and use, and for the
physician to manipulate its features and present oneself appropriately to the patient.
6. The platform is secure, privacy-enhancing and non-public facing.’
15. Are there any requirements regarding electronic equipment and internet speed for
telemedicine services?

A stable internet connection with appropriate bandwidth is the minimum requirement

imposed by the Guidelines on telemedicine service providers. For electronic equipment, it is
recommended that the platform used by the telemedicine service provider is supported
across all devices (eg, laptop/desktop and tablet) and can be integrated into a new
Integrated Health Information System (iHIS) telemedicine module or interoperable with an
existing iHIS telemedicine module.
The Guidelines also provide that, for local government units (LGUs), the minimum
information and communication technology (ICT) equipment, service and infrastructure must
be operationally adequate and available. A contingency plan in the case of equipment
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breakdown/malfunction and service interruption must be in place.

16. Does legislation provide for specific rules concerning patients’ medical records?

Yes, under the DPA, the medical information of a person constitutes sensitive personal
information that is entitled to a higher degree of security and protection from unlawful
processing.

17. Are there geographic location requirements applicable to the provision of

telemedicine services?

During the early stages of the National Telehealth Program, a partnership between the
University of the Philippine Manila and the DOH, telemedicine was prioritised in
geographically isolated and disadvantaged areas (GIDA). Under the current Guidelines,
however, there are no geographic location requirements.

18. Does the healthcare professional need to obtain the patient’s consent to engage in
telehealth?

Yes. The Guidelines expressly provide that a healthcare professional needs to obtain the
patient’s proper informed consent before collecting any personal information and offering any
telemedicine service. Consent shall be evidenced by written, electronic or recorded means,
and shall contain all the necessary information regarding the features of the telemedicine
consultation that shall be fully discussed with the patient. These include how telemedicine
works, its limitations, the manner of processing of personal health information, and privacy
and data protection.

19. Is there any other important requirement that should be highlighted?

According to the Guidelines, all telemedicine consultations by licensed physicians shall have
proper documentation. Moreover, all telemedicine consultations by licensed physicians must
include a patient feedback mechanism. Specific rules on issuance of electronic consultation
documents and dispensing of medicines pursuant to an electronic prescription are also
outlined in the Guidelines.

DATA PRIVACY ASPECTS

20. Are there data privacy issues that should be considered for the exploitation of such a
market? If your answer is yes, please provide a short description.

Yes, because telemedicine necessarily involves the collection and processing of sensitive
personal information, this is prone to non-compliance with the DPA by the physician or the
healthcare institution, which may, in turn, result in data breaches and the exploitation of such
information.

21. Does the applicable regulation provide for criteria and requirements for the security
systems to protect the patient’s information?

Yes. According to the Guidelines, the processing of the health information of patients who
consult through the platform must be in accordance with the privacy and data protection
requirements provided under the DPA and its Implementing Rules and Regulations. In
addition to this, the Guidelines provide that the processing of patient’s information shall
adhere to the principles of transparency, legitimate purpose, proportionality and
accountability. The principle of privileged communication between a physician and patient
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was also reiterated in the guidelines.

In the minimum implementation requirements on LGU Telemedicine Services provided in the
Guidelines, it is stated that processing of personal data must remain confidential, secure and
protected. To comply with this, the telemedicine service provider must submit the following:
 National Privacy Commission (NPC) certificates of registration of the data processing
officer and data processing systems;
 privacy impact assessment report;
 privacy manual;
 privacy notice;
 signed non-disclosure agreement of human resources involved in the implantation of
LGU telemedicine services; and
 monthly data privacy monitoring and compliance report.
In addition to the above, a designated cybersecurity officer and compliance with the
vulnerability assessment and penetration testing of the Cybersecurity Bureau of the
Department of Information and Communications Technology (DICT) are also required.

22. Does the applicable regulation provide for requirements for the transfer of information
abroad?

Yes, the DPA expressly provides for extraterritorial application in the following instances:
 the act, practice or processing relates to personal information about a Philippine citizen
or a resident;
 the entity has a link with the Philippines, and the entity is processing personal information
in the Philippines or even if the processing is outside the Philippines, as long as it is
about Philippine citizens or residents such as, but not limited to, the following:
- a contract is entered into in the Philippines;
- a juridical entity is unincorporated in the Philippines but has central management
and control in the country; and
- an entity has a branch, agency, office or subsidiary in the Philippines and the
parent or affiliate of the Philippine entity has access to personal information; and
 the entity has other links to the Philippines, such as, but not limited to:
- the entity carries on business in the Philippines; and
- personal information was collected or held by an entity in the Philippines.

23. Is there any registration of databases requirement that companies must observe? Are
there requirements regarding the recording of data in the patient’s medical records?

Companies must comply with the provisions of the DPA. On the part of physicians, the
Guidelines provide that those who made use of electronic consultation documents shall keep
records thereof. In addition, all licensed physicians whose services were sought through
telemedicine shall maintain all patient’s health records as appropriate using1 their electronic
integrated health information system as provided by DOH or third-party providers

LIABILITIES

24. Please provide a high-level overview of the liability of healthcare professionals and
institutions involved in telemedicine practices.

According to the Guidelines, a healthcare professional or institution involved in telemedicine

1 The specific guidelines for this requirement are yet to be implemented.

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may be liable for:

 violation of sections 22–29 of the Medical Act of 1959;
 violation of sections 10–15 of the FDA Act of 2009;
 violation of Article VI, section 44 and Article VII, sections 45–46 of the Philippine
Pharmacy Act;
 violation of the DPA;
 quasi-delicts or torts under the Civil Code;
 reckless imprudence under the Revised Penal Code; and
 other applicable laws.
TELEMEDICINE NUMBERS AND TRENDS

25. Is there any public disclosed information concerning the use and acceptance of
telemedicine in your country?

Ad Spark PH, in its June 2020 Special Report, stated that online conversations on telehealth
and online medical consultations in the Philippines reached its peak in March 2020, during
the height of the pandemic. Since then, the topic has been steadily talked about online.
One of the telemedicine service providers in the Philippines reported a more than 100 per
cent revenue growth for 2021 and reached over one million members as of February 2022.

26. What are the perspectives and trends in relation to the matter for the next few years?
Please outline any unresolved issues, proposed changes or trends for the
telemedicine sector and briefly indicate how these may foreseeably affect medical
practice in the near future.

Telemedicine only recently entered the mainstream during the Covid-19 pandemic. The
issuance of the Guidelines was a response by the Philippine Government to regulate and
institutionalise the use of telemedicine in order to ensure the safety of patients. The
telemedicine sector can be expected to expand into a widely used healthcare service by
Filipinos.
The Guidelines state that a code of ethics and CPG for telemedicine, and certification
programme for telemedicine shall be issued by the DOH, PRC and University of the
Philippines Manila – National TeleHealth Center, in collaboration with medical associations,
specialty societies, patient groups and other stakeholders. The demand, accessibility and
efficiency of the telemedicine sector will be affected by the issuance of these regulations.
There is currently legislation pending regarding the Philippine eHealth Systems and Services
Act, which aims to attain the following objectives:
 recognise e-health as equal with other healthcare delivery methods to the extent
allowable by existing laws; and provide and support healthcare delivery, including
diagnosis, consultation, treatment, transfer of care of patient, exchange of health data
and education, especially in medically unserved and underserved GIDAs;
 utilise ICT to deliver health services that has the potential to lessen costs, improve
quality, change the conditions of practice and improve access to healthcare,
particularly in rural and other medically underserved areas;
 develop infrastructure for ICT for health to promote equitable, affordable and
universal access to health services;
 set policies and standards, and establish regulations regarding the field of e-health;
 designate national and regional centres, and networks of excellence for e-health best
practices, policy coordination and technical support for healthcare delivery; and
 facilitate the exchange of and access to secured personal health information,
including health provider sharing, and use health and medical information to improve
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care, as well as public access to relevant information for the promotion of their own
personal health.
The bill was approved on the third and final reading, but has not yet become law.