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The use of audio-visual technology in medical diagnosis from a distance could reduce the number of A&E hospital visits for patients. APRIL CHONG reports
Need to see your doctor? Just turn on your home computer and have a “face to face” consultation. You can also use the attached devices to measure and transmit your heart beat and blood pressure readings. That scenario is not too far off.
Telemedicine, the use of audio-visual technology to provide medical consultation, care and diagnosis from a distance, is already here. While the field is still fledgling, it is definitely growing. In his blog last week, Health Minister Khaw Boon Wan spoke about the need for more “tele-innovations” so that “health care can be better and also cheaper”.
Many clinics and hospitals are already trying out various projects in a bid to bring health care closer to patients, speed up treatment or reduce the load on acute facilities. On a basic level, hospitals now share information seamlessly through the use of the mobile phone. For example, medical scans, such as foetal and brain images, are sometimes sent between hospitals using a mobile phone through platforms such as Multimedia Messaging Service (MMS). This way, a second opinion from other doctors can be sought quickly during emergencies for faster diagnosis and treatment.
At Singapore General Hospital (SGH), tele-radiology has been in use since 2007. For example, X-rays taken at polyclinics, which may not have radiologists on hand, are transmitted via Internet to SGH for quick reporting. The radiology reports of more than 90 per cent of all the general X-rays done at the polyclinics can be ready within an hour, translating to faster treatment, said senior consultant Winston Lim, from the department of diagnostic radiology at SGH.
Khoo Teck Puat Hospital is trying to take it further and make bedside telemedicine a reality. It has been running various projects with the geriatric population for at least a decade. Last year, it tried out a teleconferencing system with St Joseph’s Home, a 140-bed nursing home located in Jurong. Such devices could reduce the
number of A&E visits for patients, saving them time and travel expenses. Also, doctors can carry out their usual weekly rounds of the nursing homes via the “tele” way, allowing them to cover more patients in a given time, said Mr Kenneth Lam, operations manager of the hospital’s geriatric medicine department. Workers at the nursing home were able to link up with doctors at the hospital when patients need medical attention. This was useful, since the doctors saw the residents only once a week.
A portable computer with an attached movable camera enabled doctors to remotely observe the elderly patients. The nurses could also perform simple physical examinations that the doctor could see. Patients were able to communicate with the doctor directly. From there, the doctor made the diagnosis and suggested treatment, all from his office chair.
Such tele-consultations prevented unnecessary hospital admissions, said the home’s nursing officer Gillian Beins. For example, one elderly woman came down with fever and pain from a leg infection. Ordinarily, she would have been sent to the hospital, since there is no resident doctor at the home. But through tele-conferencing, the doctor was able to tell that she had cellulitis, a type of skin infection, and was able to prescribe the right kind of antibiotics to the nurses in the home. Her infection subsided.
As with any technology-based trial, the project met with teething problems such as dropped signals and the computer hanging. However, these are being ironed out, with the next phase of the project getting new equipment and better Internet connectivity within the next three months, said Mr Lam. Four more nursing homes are also coming on board.
Devices that can directly transmit patient information, such as digital stethoscopes and heart telemetry equipment, may also one day become commonplace. And along this line, telemedicine has the potential to be
diffused into the homes of the elderly and disabled who live alone. Patients can take routine blood pressure and sugar level checks themselves and report the results to the doctor during the tele-conferencing.
And just as in the case of nursing homes, telemedicine can also work for people who are not sure if they need to be admitted to the hospital. “We can do a tele-triage of geriatric patients so that they do not have to make trips unnecessarily,” added Mr Lam.
Home telemedicine is gaining ground in countries such as the United States and Britain. It will be a while before costs come down and patients become comfortable enough with high-tech devices for home telemedicine to become a reality here. For now, a high-resolution camera for telemedicine purposes
could already cost thousands, said Mr Lam. But Singapore’s next-generation fibre optic network is already up and running, and it will be cheaper and easier to wire up at home then.
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