Unboxing the RxBox

| Written by Jo. Florendo B. Lontoc

In the UP Diliman infirmary, an annual physical exam means you go for the required tests from one department to another, falling in line for each test. Then you wait hours or days, going back to the same venues, for the results, before being finally ready for a doctor’s assessment of your general state of health.

The process is stressful and drawn out, but you’re more or less assured that all bases are covered. In a rural health facility, the situation is worse. All the equipment it will most likely have will be thermometers, stethoscopes, sphygmomanometers, weighing scales, and for expectant mothers, speculums.

The staff can tell you if you have fever, the state of your heartbeat, your blood pressure, your weight. If you’re expecting, they’ll tell you if the baby’s heartbeat is OK, and if you’re close to giving birth.

But don’t expect to get exact figures about a whole lot of other important things. They can only estimate the level of oxygen in your blood, which helps detect lung and cardiovascular problems. The staff will have difficulty measuring the fetus’s heart rate at critical times of the pregnancy and delivery, and the strength of a mother’s uterine contractions during labor and delivery, which indicates distress of the mother and the baby.

For such exact measurements, you would have to go to a better-equipped polyclinic in town, which is probably half a day’s travel away for most Filipinos.

That’s why the RxBox is a game-changer. It’s a life-saving invention of UP, in a box which combines several diagnostic devices for common medical problems, computerizing results, and electronically transmitting data.

The writer is fitted with a pulse oximeter and blood pressure monitor, as Dr. Alvin Marcelo, former director of the National Telehealth Center, and Dr. Portia Grace Marcelo, RxBox project leader, explain how the setup works, during the UP Knowledge Festival in April 2016. (Photo by Misael Bacani, UP MPRO)

Doctors, health workers, physicists, computer scientists, and electrical and electronics engineers helped put this box together. This handheld machine has a blood pressure monitor, a pulse oximeter, an electrocardiogram (ECG), a fetal heart monitor and a maternal tocometer with fetal movement marker, and a temperature sensor—all built around a touch-screen tablet. Because it’s modular, it can be integrated with more devices in the future.

The RxBox can make many measurements in one sitting and can transmit them as a mobile and Internet device. Where there might be no doctors present, the health worker can make the measurements and send the results via telemedicine to a doctor who can respond immediately on remote. The potentials for faster and cheaper health services are obvious.

The tablet stores and transmits not only diagnostic results, but electronic medical records as well. With CHITS or the Community Health Information Tracking System—another homegrown and prizewinning UP Manila technological breakthrough—health workers need not pore over paper files to get to patients’ medical records.

You give all public health facilities mobile or Internet access and this device, and public health recording goes automatic. For this purpose, the configuration of the CHITS data sets has been aligned with the datasets of the Department of Health (DOH) and the Philippine Health Insurance Corp. (PhilHealth). Organized mass-based data will improve public health policy and planning.

The tablet also has built-in data to help users make sense of measurements, which makes it useful as a medical training device.

Telehealth involves the patient being attended to by the health worker, the worker referring his or her case to doctors and institutions, and the encoding of data for public health information and planning, all using networked devices. Through the leadership of UP’s National Telehealth Center (NTHC), telehealth has been a pillar in the modernization of the country’s health care system since 2004. Foremost among its tools is the RxBox.

“When you think about telehealth and telemedicine, think about a long-running health program that is likewise research and service by the University. It’s continually being improved with technologies being tested with the people—frontline health workers—so that we can find the best ways to improve access to health care and achieve better equity in health,” says Dr. Portia Marcelo, lead RxBox investigator.

The RxBox was originally conceptualized for emergency cases at the Philippine General Hospital (PGH). The idea was for the first responders to be able to provide the hospital staff real-time information on the clinical status of the patient before he or she arrived at the hospital—alerting the staff to the personnel and equipment needed.

RxBox Program in Cabucgayan, Biliran in the Philippines (Photo from telehealth.ph)
RxBox Program in Cabucgayan, Biliran in the Philippines (Photo from telehealth.ph)

The RxBox prototype was conceptualized as early as 2007 by Dr. Alvin Marcelo, then NTHC director, and Dr. Luis Sison of the UP Diliman College of Engineering. It is one of the first “emerging disciplines” projects of UP to have reached national policy levels.

Beginning from scratch, the device, CHITS, and telehealth underwent several iterations or versions through the years. Deployment to 169 rural health units refined the RxBox to its current design.

The RxBox now enables the National Telehealth Service Program (NTSP) being directed by a National E-Health Steering Committee, which was formed as part of UP’s advocacy for governance of e-health initiatives in the country.

Led by the DOH and the Department of Science and Technology, with the Department of Information and Communications Technology, the Commission on Higher Education, PhilHealth, and UP Manila, the committee is bent on scaling up the deployment of RxBox under the NTSP.

“The RxBox 1,000 project has been launched and will deploy these technologies to a thousand of the country’s 3,500 towns. The poorest of the poor municipalities are our priority,” Dr. Portia Marcelo says.

With widespread use and confidence, bigger demand is expected. Making an industry out of the RxBox will no longer be far-fetched. The manufacture of a thousand units in one go, for full deployment early next year, will be proof of the viability of commercialization.

This could be the country’s gift of innovation for national industrialization, and health care in the world, according to Marcelo. And as a UP product, RxBox emerged out of UP’s mandate to serve the country’s poor and underserved masses, which is perhaps its greatest value added.