BACKGROUND AND OBJECTIVE

The utilization of information and communications technology (ICT) to support health, known as eHealth, is a crucial enabler of universal healthcare. It is important to identify various aspects that could support or hinder eHealth, especially in limited-resource settings. This study determined the factors influencing the implementation of eHealth solutions in the Philippines, in consideration of the development process and initial outputs of the Philippine eHealth Strategic Framework and Plan 2014-2020.

The descriptive-qualitative study was conducted among 15 municipalities/cities in the Philippines, recognized as early adopters of eHealth programs. Records review of eHealth solutions and key informant interviews among stakeholders (i.e., physicians and nurses) per study site were facilitated to gather data. Using directed content analysis, contextual, process, and content factors influencing eHealth implementation in the country were synthesized.

Results showed a range of eHealth solutions in the selected facilities, majority of which involved electronic medical records. Various contextual, process, and content-related factors could serve as facilitators or barriers to eHealth implementation in the country. Particularly, contextual factors include individual characteristics (ICT experience/training, organizational commitment, readiness for change), perceived need/urgency for eHealth (provisions, policies, regulatory issues), and third-party involvement for financial/technical support. Meanwhile, process-related factors involve implementation team practices, appropriate top-down and bottom-up approaches in leader/member engagement, and resource management (ICT equipment, stable internet connection, power supply). Content-specific factors mainly include the eHealth design (complexity, adaptability to local context and service demands, interoperability or the capacity to connect or exchange information with other platforms/systems). Notably, limitations across the three dimensions could make eHealth implementation more complicated, which could lead to poor time management and resource wastage.

This study highlighted the importance of a multidimensional understanding of factors that influence the utility of eHealth in the health system. There is a need for leadership and governance, stakeholder engagement, resource and funding, implementation readiness, appropriate design of eHealth solutions, and proper training to ensure the successful implementation of eHealth in the country.

OBJECTIVE: To propose and evaluate the effectiveness of a telerehabilitation platform designed for patients with rotator cuff (RC) tears. METHODS: During the first study phase, a virtual service platform that included information on RC tear pathology, joint care, and a series of instructions regarding therapeutic exercise was designed and created. Subsequently, in the clinical phase, a quasi-experimental study was performed. The platform was tested on patients and evaluated at baseline and at 1, 2, 3, and 6 months with respect to their pain levels and functionality on the Constant-Murley (CM) scale. RESULTS: Eleven patients were included, 5 women and 6 men, with a median age of 55 years (range, 42–68 years). Pain diminished from a baseline value of 64 mm (range, 40–80 mm) to 16 mm (range, 0–30 mm) at 6 months (p<0.001). Points on the CM scale rose from a baseline value of 54 points (range, 51–66 points) to 85 points (range, 70–100 points) at 6 months (p=0.001). Functionality in daily living and work activities, movement, and strength exhibited significant changes at 6 months (p<0.05). CONCLUSION: Significant changes were observed in pain and functionality in this group of participants who used a telerehabilitation platform. To the best of our knowledge, this is the first study that included a specific program for RC tears.
Female ; Humans ; Joints ; Male ; Non-Randomized Controlled Trials as Topic ; Pathology ; Rehabilitation ; Remote Consultation ; Rotator Cuff* ; Shoulder ; Tears* ; Telemedicine ; Telerehabilitation*

Introduction: The coronavirus disease 2019 (COVID-19) pandemic prompted a shift from standard in-person consultation to non-patient contact methods such as telemedicine. To our knowledge, there was no published a priori evaluation of the telemedicine readiness and acceptance among the medical staff of the Philippine General Hospital (PGH) before implementing the institution’s telemedicine program. The lack of this vital pre-implementation step is understandable given the unprecedented crisis. However, if telemedicine programs will continue in the post-quarantine period, it is crucial to determine the facilitators and barriers to the use of telemedicine. Objective: This study determined the level of readiness and acceptance for telemedicine as an alternative method for patient consultation during the COVID-19 pandemic and post-enhanced community quarantine period among PGH medical staff (consultants, residents, fellows). Methods: The cross-sectional study was conducted from October 2020 to July 2021. Medical staff from the 16 clinical departments of the PGH were selected by systematic random sampling. Inclusion criteria included appointment as medical staff in PGH or University of the Philippines College of Medicine (UPCM), voluntary informed consent, internet access, and technical capacity to access e-mail and SurveyMonkey™. The online survey consisted of two questionnaires. It collected data on the demographic profile and outcomes of interest (e.g., telemedicine readiness and acceptance). Technological readiness was determined through the 16-item modified version of Technological Readiness Index (TRI) version 2.0, while telemedicine acceptance was determined through the modified version of the 19-item Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Descriptive and analytical statistics were performed at a 95% confidence interval. Results: The study had an 87% response rate with 205 respondents, 62% of whom were physicians in training (resident physicians and fellows). The respondents had a median age of 33 years and were mostly males. Only 19% had telemedicine experience before the pandemic. The majority (51%) learned telemedicine on their own. The most common devices used for telemedicine were mobile or smartphones (53%) and laptops (38%). The primary source of internet for telemedicine was mobile broadband (e.g., cellular data) (40%). The majority practiced telemedicine at their home or residence (51%), followed closely by the hospital or clinic (47%). The mean score of the respondents on TRI was 3.56 (very good technological readiness), and 4.00 (very good telemedicine acceptance) on UTAUT (behavioral intention to use the system). Performance expectancy (p = 0.02), effort expectancy (p = 0.03), and self-efficacy (p = 0.02) were significantly directly related to telemedicine adoption, while anxiety (p = 0.03) was significantly inversely related. Conclusion The PGH medical staff were found to have very good telemedicine readiness and acceptance. This suggests a willingness to use telemedicine during the pandemic. Further studies on the organization and technical support system of the telemedicine program in the PGH are strongly recommended. The quality and efficiency of the program will strongly influence the continued use of telemedicine by the medical staff even after the pandemic.
Health Services Administration ; Telemedicine ; Telecommunications ; Remote Consultation ; COVID-19

The coronavirus disease 2019 (COVID-19) epidemic is evolving in Latin America despite implementation of government measures. We report a familial cluster in Lima, Peru, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Two young and two middle-aged adults with a wide range of COVID-19 manifestations experienced successful management under telehealth outpatient monitoring. Telehealth monitoring was scheduled as suggested by Peruvian Ministry of Health Guidelines and was performed by a designated physician who assessed the patients and prescribed treatment. On May 14, 2020, a 25-year-old male, who worked treating COVID-19 patients, reported constitutional symptoms and tested positive for SARS-CoV-2. Clinical improvement was achieved with azithromycin and ivermectin therapy. He had been in contact with his parents (Cases 2 and 3) and his sister (Case 4). Cases 2 and 3 developed moderate pulmonary compromise requiring oxygen supplementation and pharmacological therapy, including corticosteroids and anticoagulation, under home medical assessment and telehealth monitoring. Case 4 developed mild symptoms and periorbital rash, an atypical dermatological finding. To our knowledge this represents the first report of a familial cluster with COVID-19 that was successfully managed under scheduled telehealth outpatient monitoring in Latin America.
SARS-CoV-2 ; COVID-19 ; Telemedicine ; Remote Consultation

The suspension of facility-based rehabilitation services and restricted mobility at the onslaught of the coronavirus disease 2019 (COVID-19) pandemic forced healthcare workers to explore new methods of providing patient care. This case report presents a 40-year-old female who underwent osteotomy with iliac crest bone graft and intramedullary nailing with quadricepsplasty to correct the leg length discrepancy and knee extension contracture that developed secondary to multiple bone injuries sustained in a vehicular accident 17 months before admission. The in-hospital postoperative rehabilitation was prematurely terminated due to the COVID-19 lockdown. The client was discharged with pain and swelling of the right lower limb, knee flexion of 0–25°, and an ankle plantar flexion contracture. She had moderate to severe difficulty in walking, bathing, toileting, and lower garment dressing, needing assistance to complete these tasks. Telerehabilitation was done over three months using both synchronous and asynchronous methods. Gains from the remote program were independence in all the self-care activities with no difficulty in performing them. The patient was able to return to work. Gains in knee and ankle mobility were minimal. Telerehabilitation using available technologies can be used to continue patient care amidst barriers to face-to-face rehabilitation in a low-resource country
Telerehabilitation ; Telemedicine ; COVID-19 ; Osteotomy

Background: Catalyzed by the coronavirus disease 2019 (COVID-19) pandemic that restricted non-essential travel, awareness of the value of telehealth increased among healthcare providers and consumers. Telerehabilitation, a subset of telehealth and telemedicine, refers explicitly to the remote provision of rehabilitation services. However, since the majority were new to the concept of telerehabilitation, which was commonly interchanged with other related terms (e.g., telehealth, telemedicine, teletherapy, telecare, telepractice, etc.), and relevant internationally recognized guidelines were not available pre-pandemic, many turned to online resources to learn more about it. However, such might create confusion with the terminologies. Objective: This infodemiological study aimed to examine the trends of global online interest in telehealth, telemedicine, telerehabilitation, and related search terms. The authors hypothesized an abrupt rise in stakeholders' awareness regarding the virtual method of delivering or accessing healthcare, including rehabilitation services, during the pandemic. Method: Using Google Trends™, we obtained and analyzed the trends of global online interest in telehealth, telemedicine, telerehabilitation, and other related search terms from 2004 to October 2020. Results: The frequencies of searches for “telehealth,” “telemedicine,” and “telerehabilitation” peaked in March 2020, which coincided with the lockdown in many countries, including the Philippines. The term “telehealth” was more frequently searched in western countries, while “telemedicine” was relatively common in eastern countries. Among the terms synonymous with telerehabilitation, “teletherapy” was most commonly used worldwide, with “teletherapy speech” being the most searched related topic. The Philippines had the most significant number of times the term “telerehabilitation” was searched in the past decade. Conclusion During the COVID-19 pandemic, there is an overall global demand for the acquisition of knowledge related to telehealth, telemedicine, telerehabilitation, and related search terms. Of particular interest, tele rehabilitation, however, varied in terminologies across countries, with “teletherapy” mainly being used worldwide and “telerehabilitation” being primarily searched in the Philippines. Therefore, arriving at a consensus across professional societies and operationally defining different interrelated terms could help streamline our current or future guidelines and programs.
Telemedicine ; Telerehabilitation ; COVID-19 ; Infodemiology

BACKGROUDN: Telemedicine has the potential to reform the delivery system of dermatologic health care. OBJECTIVE: The purpose of this study was to investigate the concordance and accuracy of diagnosis and the management plan of dermatologist's teleconsultation and traditional clinic-based consultation. METHODS: Eighty-eight lesions of 77 patients were examined by digital image and clinic-based consultation by one dermatologist. The reliability and accuracy of the dermatologist's diagnoses and the reliability of the management recommendations were compared. RESULTS: The concordance of diagnosis between telemedicine and clinic-based consultation showed high levels(complete agreement, 92.05%; complete + partial agreement, 97.73%). The agreement on management recommendations was variable. The diagnostic confidence and the image quality affected the agreement. CONCLUSION: The digital image consultations result in reliable diagnostic outcomes when compared with the traditional clinic-based consultaion. And it is necessary to investigate the accuracy of teledermatology and to identify clinical conditions inappropriate for teleconsultation.
Delivery of Health Care ; Dermatology* ; Diagnosis ; Humans ; Referral and Consultation ; Remote Consultation* ; Telemedicine

PURPOSE: In elderly and patients with underlying diseases, mortality rate is increased when compared to rib fractures which occurred in other patients. Because there is a shortage of emergency physicians or real-time consultation with radiologists in many countries, it is necessary to receive a formal image reading remotely from an expert. We suggested the use of iPad in X-ray reading and compared the diagnostic validity of iPad, which was highly portable, with that of liquid crystal display (LCD) monitor. METHODS: Fifty four X-ray cases of rib fracture and 54 cases without rib fracture were randomized and reviewed by 10 emergency physicians. A total of 108 cases were divided 1st to 54th and 55th to 108th. Two sessions were separated with a four-week interval. If the reviewer interpreted the 1st to 54th with iPad, they did 55th to 108th with LCD monitor. Reviewers reported the presence of rib fracture, the number of fractured ribs, and diagnostic confidence of 5-scale. RESULTS: The interobserver agreement among reviewers in LCD and iPad was 0.551, 0.524 in Fleiss-kappa value. The intraobserver agreement between tools for each reviewer was 0.410-0.859 (Mean=0.628+/-0.150). Reviewers showed sensitivity over 0.810 regardless of the tool; 0.810- 0.966 (Mean=0.879+/- 0.054) in LCD, 0.828-1.000 (Mean=0.898+/-0.052) in iPad. The specificity was 0.520- 0.860 (Mean=0.750+/-0.117) in LCD and 0.560-0.880 (Mean=0.708+/-0.111) in iPad. Therefore, remote consultation of X-ray by iPad with a specialist was possible with minimized temporal and spatial limits in the emergency room. CONCLUSION: In our study, there was no statistical difference in the diagnosis of rib fracture by X-ray via iPad or LCD. Therefore, remote consultation of X-ray by iPad with a specialist in the emergency room was possible, with temporal and spatial limits by iPad.
Aged ; Diagnosis* ; Emergencies ; Emergency Service, Hospital ; Humans ; Liquid Crystals ; Mortality ; Remote Consultation ; Rib Fractures* ; Ribs* ; Sensitivity and Specificity ; Specialization ; Teleradiology

BACKGROUND: Filipino speech-language pathologists (SLPs) can reach more persons with disabilities across 7,107 Philippine islands through telerehabilitation (also known as teletherapy, telepractice). This study described the feasibility of telerehabilitation for speech-language pathology in community-based rehabilitation in terms of appropriate information and communication technologies (ICT), stakeholder perspectives, and facilitators and barriers. METHODS: A qualitative descriptive design was employed. Participants were purposely selected as telerehabilitation stakeholders. One metropolitan-based SLP conducted remote and synchronous therapy sessions to two persons with voice disorders (52 and 65 years old) in their homes, assisted by one primary caregiver each and one community-based rehabilitation worker (CBRW). ICT observations were logged as field notes. Stakeholder perspectives were obtained through participant journals and interviews, thematically analyzed using NVIVO, and validated by participants. Facilitators and barriers were derived from data triangulation of field notes, journals, and interviews. RESULTS: The best ICT comprised of fastest wireless internet available (7.2 Mbps), MacBook™ laptop, and FaceTime™ videoconferencing application. Stakeholders had varied yet positive perspectives. The SLP focused on ICT requirements and intervention conduct. The families saw telerehabilitation benefits of cost-effectiveness and intervention effectiveness. Both SLP and the families were satisfied as telerehabilitation providers and consumers. CBRW appreciated intervention effectivity. The only barrier to telerehabilitation was low internet bandwidth. Facilitators to telerehabilitation were stronger CBR policies and SLP capacity development. CONCLUSION Telerehabilitation is feasible in speech-language pathology within communitybased rehabilitation in the Philippines, given community-appropriate ICT and positive experiences of stakeholders. It can flourish with faster internet, stronger community health policies, and empowering stakeholders.
Telerehabilitation

Pelvic sarcomas are rare malignancies that can result in extensive surgeries involving bone and soft tissue resection, which can greatly improve with rehabilitation. However, due to the restrictions brought about by the COVID-19 pandemic, the rehabilitation of patients with pelvic sarcomas was affected. Limited information is also presented in the literature regarding the rehabilitation of patients with lower extremity surgeries undergoing telerehabilitation and during a pandemic. This study presents the rehabilitation process of a 43-year-old woman diagnosed with pelvic round cell sarcoma of the right gluteal area during the COVID-19 pandemic. The patient underwent wide excision, buttockectomy and internal hemipelvectomy, and we measured outcomes using the Tinetti assessment tool (TAT) and Lower Extremity Functional Scale (LEFS). A decreased risk of falls and improved functional performance were recorded using the TAT and LEFS respectively. Telerehabilitation was noted to have a good satisfaction rate among the patient and health workers. Telerehabilitation may be an effective alternative to face-to-face therapy during the COVID-19 pandemic. More studies are needed to look into the conduct of telerehabilitation intervention among patients with bone and soft tissue surgeries.
Telerehabilitation