Friday, 14 April 2017

Video consultations rolled out to cut hospital trips

6 public healthcare institutions in scheme that lets patients consult experts from their homes
By Linette Lai, The Straits Times, 13 Apr 2017

Patients could find themselves travelling to hospital less often once a new video call system for medical consultations clicks into gear.

The system enables patients to consult experts from the comfort of their homes, and hospitals to use their resources more effectively.

Six public healthcare institutions have agreed to join this project, including KK Women's and Children's Hospital, Tan Tock Seng Hospital, National University Hospital (NUH) and Singapore General Hospital (SGH).

Some have already started using the system, while the rest will do so by the year end. More institutions, including private ones, could come on board later. The list of services and conditions that can be addressed through video consulting could also expand.

Each institution has its own video call services. For example, SGH is focusing on speech therapy, while the Institute of Mental Health (IMH) offers psychiatric counselling.

All patients will get face-time with a doctor at their first appointment. Only those whose conditions are deemed suitable will be given the option of a video call follow-up.

"This is new, so we are moving cautiously... you do need a clinical assessment that involves face-to- face (interaction)," said Associate Professor Low Cheng Ooi, who is chief clinical informatics officer at Integrated Health Information Systems (IHiS), Singapore's healthcare technology agency.

"We can't just throw away the stethoscope and replace it with a camera," added Dr Low, who is also chief medical informatics officer at the Ministry of Health.

Still, these calls could either replace follow-up consultations or allow for more frequent check-ups.

During their video appointments, patients can log in using a smartphone application or their Web browser. The consultation will start after a check to verify their identity.

Similar "tele-medicine" projects have been carried out on a small scale by individual healthcare institutions as far back as 2005.

However, this is the first time a concerted effort has been made to get so many different centres on board. Apart from the four hospitals, two specialist centres - IMH and the National University Cancer Institute, Singapore (NCIS) - are involved in the new scheme.

Having all the groups use a single virtual platform allows for consistent implementation nationwide, said Mr Chua Chee Yong, who is director of the planning group at IHiS.

The scheme is part of the Smart Health initiative - under the broader Smart Nation drive - that aims to use technology to increase productivity and ease the burden on crowded hospitals.

"Cases are getting more complex as our population ages," said Mr Chua. "At the same time, our physical and manpower resources are also stretched. We need to find effective ways to use our limited resources."

So far, about 190 patients have been enrolled across four institutions. NCIS and NUH will get on board later this year.

The old pilot projects - which use different systems and cover areas such as ophthalmology and geriatrics - will be gradually shifted onto the new video call platform.

Unlike existing platforms, said Mr Chua, the new service allows for multi-party calls, so several medical staff can join in. It is also cheaper to scale up, and can cater to participants on mobile phone platforms, he added.

Video consultations handy for patients
Some give telemedicine the thumbs up, but others prefer to see doctors face-to-face
By Linette Lai and Selina Xu, The Straits Times, 13 Apr 2017

A few months after her son's birth, administrative worker Liu Xin realised that he had a bad case of eczema - a skin condition which causes itchiness.

She took him to KK Women's and Children's Hospital (KKH), where doctors asked if she preferred that the next consultation be done through video call via a smartphone or computer. She said yes.

"It would have caused us some trouble to take the baby to the hospital," Ms Liu, who is in her 20s, told reporters yesterday, giving the thumbs up to telemedicine.

Her six-month-old baby is one of the first patients to use the new video call system, which is being rolled out nationwide, starting with six public healthcare institutions, including KKH.

Dr Mark Koh, who heads the hospital's dermatology service, said he sees around 200 eczema patients a week, 40 of whom would be suitable for video consultations with pharmacists, who check on a patient's skin and make sure the medication is suitable. "It replaces a follow-up appointment with the doctor and saves an extra visit, especially if the eczema is well controlled," he said.

Pharmacists will help arrange for a face-to-face appointment with a doctor if they decide that the child needs one, he added.

Depending on the hospital, patients may pay for the video consultations upfront after their first face-to-face doctor's visit, and the costs could be lower than seeing a doctor face-to-face.

Mr Bruce Liang, who is chief executive of Integrated Health Information Systems and chief information officer at the Health Ministry, said that they will be monitoring patient feedback on these virtual consultations to make sure patients are comfortable with the technology.

Some, like housewife Catherine Ng, 59, have reservations. "An online consultation just won't have a human touch. In face-to-face consultations, the doctor and patient can communicate better," she said.

However, 19-year-old Lee Xin Min has no qualms about using video call technology for medical consultations, as long as the quality of care remains the same.

Said the student: "Telemedicine sounds incredibly convenient... I can arrange my time around the consultation and return immediately to what I was doing before."

Telemedicine is not a novel concept. Seven years ago, Khoo Teck Puat Hospital started a similar scheme with eight nursing homes. But in that case, a special video conferencing set was used as the technology on smartphones was not so readily available.

The success of the scheme was limited by the need for specialised hardware, said Dr James Low, a senior consultant in the hospital's geriatric medicine department. "Cabling in our hospital and the nursing homes was required when we started," he said.

But even with the constraints, he added, the ongoing scheme has helped save nursing home residents and their caregivers a trip to hospital.

Services provided and how they work
By Linette Lai, The Straits Times, 13 Apr 2017

Q How will the new video consultation system work?

• Patients make appointments after their first face-to-face consultation with a doctor. They will be sent a virtual appointment invitation link.

• On the appointment day, they log in to the video call using a smartphone app or a Web browser.

• A check to verify their identity is then done.

Q What services are provided through video calls, and what is the timeline of their rollout?

KK Women's and Children's Hospital

• When: November last year.

• What: Speech therapy, home care for children, breastfeeding consultations, pharmacy follow-up and consultation for young eczema patients.

Institute of Mental Health

• When: November last year.

• What: Psychiatric counselling and residential care nurse support.

Tan Tock Seng Hospital

• When: January.

• What: Post-stroke care, infectious diseases care, staff training at day care centres, medication counselling and refills.

Singapore General Hospital

• When: This month.

• What: Speech therapy.

National University Hospital and National University Cancer Institute, Singapore

• When: June.

• What: Post-stroke inpatient care at offsite wards, cancer patient care.

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