See your doctor over a webcam

The Straits Times (23 February 2012) by Lea Wee

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Clerical officer Nancy Aw, 52, used to fork out $230 every few months to have a doctor from Khoo Teck Puat Hospital (KTPH) pay a house call on her 83-year-old mother at their four-room flat.

Alternatively, she had to take her mother to the hospital by ambulance.

Her mother, who had a stroke, is bedridden and it would be a logistical feat to take her to hospital for check-ups without an ambulance.

But under a pilot telegeriatric project by KTPH, the older woman can now be at home and have a consultation with her doctor via a portable tablet computer installed with a video-conferencing programme.

The teleconsultation, which lasts about an hour, is facilitated by a nurse from KTPH, who carries the tablet with her to Ms Aw's home.

She is also trained to do a physical examination. She then relates her findings to the consulting doctor through the camera.

The teleconsultation costs only $65, less than a third of the cost of a doctor's visit.

Ms Aw said the teleconsultation not only saves her money, but she also did not find it significantly different from a real consultation.

'I can still talk to the doctor about my mother's condition,' she said.

The KTPH project is just one of several telemedicine projects that have been piloted in hospitals here.

They are overseen by the Integrated Health Information Systems (IHiS), which was set up by the Health Ministry in 2008 to maximise the quality of health-care services through technology.

IHiS chief executive officer, Dr Chong Yoke Sin, said telemedicine, or what she calls telehealth, uses video-conferencing and online sharing of patient's data and images to allow doctors to assess and treat patients without needing them to be at the same place.

The idea of 'remote' medicine has been around for a while but recent advances, such as real-time video streaming and faster Internet bandwidth, have made this more feasible, she said.

To maintain the human connection as much as possible, we have insisted that each teleconsultation concludes with a video chat between the doctor and patient.

DR WONG HON TYM, medical director of the National Healthcare Group Eye Institute

At least three pilot projects now allow patients to have teleconsultations with specialists in hospitals from their home or neighbourhood polyclinic, as a cheaper and quicker alternative to seeing their doctors face-to-face. These sessions are facilitated by nurses or other health-care workers.

For instance, the telegeriatric project at KTPH has been a godsend for a handful of bed-bound patients like Ms Aw's mother.

A parallel project by the hospital with the St Joseph Nursing Home has saved time for doctors, who now go to the nursing home only half as often.

A third project by the National Healthcare Group Eye Institute at Tan Tock Seng Hospital enables its specialists to help their colleagues at the Hougang polyclinic manage minor eye problems, so patients do not have to make a separate trip to see a specialist.

However, those involved in these projects said the remote consultations in the community work only as long as patients are stable.

Dr Ang Yan Hoon, a senior consultant geriatrician from KTPH, said: 'If patients complain of new acute problems such as shortness of breath or abdominal pain, we will still refer them to the hospital so that more investigative tests can be done.'


As Singaporeans age and more people develop chronic diseases, telemedicine is likely to become more widely used, said Dr Chong.

And its use need not be confined to managing chronic conditions in the community.

In the hospital, it can also be used to link up with specialist centres to speed up the diagnosis and treatment of acute conditions.

Already, emergency doctors at Changi General Hospital and KTPH are treating patients with acute ischaemic stroke with a clot-busting drug.

This is done after teleconsulting neurologists from the National Neuroscience Institute (NNI), who have diagnosed the patient's condition based on scans transmitted to them.

Given its speed, teleconsultation is ideal for this condition as treatment is highly time-dependent, said NNI consultant neurologist, Dr Rajinder Singh.

A patient treated 60 minutes after his symptoms first surface is four times less likely to be disabled by the stroke than someone who is treated three hours after his symptoms appeared, he said.

In this nascent phase, however, some hurdles need to be crossed before telemedicine can be more widely practised here.

One immediate concern is its high capital and running costs.

For instance, it costs KTPH $12,000 to put in place a video-conferencing system at St Joseph Nursing Home and $800 a month to lease a dedicated line between the two institutions.

Mr Kenneth Lam, the senior operations manager of geriatric medicine at KTPH, said: 'We tried Skype and other free applications over the Internet, but the signals are not stable enough. We cannot afford to have muffled voices in a teleconsultation. Nurses need to hear instructions from the doctors clearly.'

But he expects the cost of technology to drop in time.

Other doctors say a bigger issue may be the need for national guidelines to ensure that the practice of telemedicine is safe.

Such guidelines would also protect the interests of patients and doctors.

In the end, how much telemedicine grows may depend on evidence of how effective it is.

Hospitals involved in the pilot projects are now collecting data on how remote consultations stack up against face-to-face meetings.

Early data from the National Healthcare Group Eye Institute is promising.

It found that eye specialists could detect a defined list of eye abnormalities from the images transmitted to them in a teleconsultation just as well as they could in a real-life eye examination.

Another informal survey by the institute found that about 78 per cent of 160 patients, mostly older adults, found a teleconsultation to be comparable to a real-life one and would choose it again if they had an eye problem in future.

At this point, no one sees telemedicine replacing conventional consultations, though this might change as people become more used to online interactions.

But it is difficult now to replicate the 'personal touch and handshake' in a virtual visit, said Dr Wong Hon Tym, the institute's medical director.

He said: 'To maintain the human connection as much as possible, we have insisted that each teleconsultation concludes with a video chat between the doctor and patient.'

Still, he noted, there are advantages, such as the convenience it affords, that people might come to like.

'For some patients, this is likely to be a welcome alternative to the queues at crowded eye clinics,' he said.

Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.