Telehealth In Singapore

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Telehealth In Singapore
Dr Wong Chiang Yin 2nd Vice President Singapore
Medical Association
10th MASEAN Conference, Phnom Penh, Cambodia, 15
to 18 Nov 2001
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Telehealth in Singapore
Overview

• Introduction to Telehealth
• Telehealth Infrastructure
• Telehealth Concerns
• Telehealth Projects in Singapore
• Vision of Healthcare beyond 2001
• Take Home Messages

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Telehealth in Singapore
Introduction to Telehealth
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Telehealth in Singapore
Definition of Telehealth
The interaction of an individual - consumer,
patient, caregiver or professional - with or
through an electronic device or communication
technology to access or transmit health
information, or to receive or provide guidance
and support on a health-related issue. (Eng
Gustafson, 1999)
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Telehealth in Singapore
Telehealth Infrastructure

• Advances in key communication and information
  technologies include wireless technology,
  integrated computer telephony, improved
  audio-visual conferencing, speech recognition,
  digital TV, collaborative tools, network
  bandwidth, and imaging technology.

• Broadband infrastructure level of high capacity
  networks and switches, based on Asynchronous
  Transfer Mode (ATM) switching technology capable
  of speeds up to 622Mbps. Two operators Singapore
  Telecom (SingTel) and Singapore Cable Vision
  (SCV).

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Telehealth in Singapore
Telehealth Infrastructure (contd)

• Singapore One national initiative aims to
  deliver a new level of interactive, multimedia
  applications and services to homes, businesses
  and schools throughout Singapore.

• Singaren a high bandwidth network which
  connects research laboratories and universities,
  and is connected to the United States and Canada
  at 14Mbps. Connection to Europe over a
  transatlantic high-speed connection. Allows
  Singapore research centres to collaborate with US
  and European scientists.

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Telehealth in Singapore
Telehealth Concerns

• Deterioration of the doctor-patient relationship
  due to lack of face-to-face communication,
  diagnosis, and treatment. At the very core,
  healthcare is still a high-touch profession.

• Overwhelming emails from patients and families.
• Information and advice patients get from the
  Internet can be biased, incorrect, and harmful.

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Telehealth in Singapore
Telehealth Concerns (contd)

• Difference between privacy and confidentiality
• Patient confidentiality
• Hacking of databases
• Unauthorised access and illegal use of patient
  information

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Telehealth in Singapore
Addressing the Concerns

• New Singapore Medical Council (SMC) Guidelines
  (to be released)
• Patient education guidance from doctors on how
  to distinguish between reliable and unreliable
  medical information.
• Doctors have a continual responsibility towards
  patients that patient information will not be
  compromised in any way.
• Should there be electronic medical records in
  place, security systems should have good
  encryption and authentication measures in place
  to prevent unauthorised intrusion.

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Telehealth in Singapore
Addressing the Concerns

• Singapore Medical Council (SMC)
  Guidelines (to be released)
• Prohibits doctors from dispensing medical advice
  electronically unless a) a previous
  doctor-patient relationship exists (i.e. old
  patient) b) there is another doctor at the
  other end with the patient
• Incumbent on the doctor to ensure that standard
  of care is not compromised despite limitations of
  telemedicine (e.g. no palpation possible),

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Telehealth in Singapore
Case Presentations of Telehealth Initiatives in
Singapore
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Telehealth in Singapore
National Heart Centre Live Course

• Annual "Live Course in Cardiovascular
  Intervention teleconferencing event in
  Singapore.
• Leading cardiac interventionists throughout the
  Asia-Pacific countries participate in the course
  as invited speakers or operators together with
  the leaders from Europe and America.
• Objective is to share experiences and introduce
  new techniques to increase the level of
  healthcare delivery to patients.
• "Ninth Live Demonstration Course in Coronary
  Intervention" was between Singapore and Paris,
  17 - 19 January 2000.

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Telehealth in Singapore
Singapore General Hospital Teleconference
Medicine

• Holds regular teleconferences with Stanford
  University Hospital and various medical centres.
• Most difficult Siamese twin separation todate.
  The Nepalese twins, Jamuna and Ganga Shrestha,
  were connected at the tops of their heads and
  shared the same brain cavity. Long distance
  collaboration SGH Neurosurgeon was able to
  discuss complex questions with Dr Benjamin Carson
  of Johns Hopkins Baltimore.

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Telehealth in Singapore
Ministry of Health Collaborators

• Hospital Emergency Ambulance Link (HEAL) by
  MOH, NCB, SCDF, SGH essential patient
  demographic information, ECG transmission,
  pertinent medical condition transmitted from
  ambulances to Hospital Emergency Department.
  Speeds up delivery of emergency care for
  patients.

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Telehealth in Singapore
Singapore National Eye Centre OphthWeb

• Ophthalmic electronic medical record that can be
  accessed locally and globally via the Internet.
• Provides secure multimedia patient data to
  doctors, patients, and healthcare providers at
  any time and in any place.
• Patients have secured access to their own
  medical records in the convenience of their homes
  or during any health emergency at any time or
  place around the world. Benefits low cost and
  convenience.
• Collaborators Kent Ridge Digital Laboratories
  Singapore, Chinese University of Hong Kong.

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Telehealth in Singapore
Singapore Armed Forces Patient Care Enhancement
System

• Electronic Patient Records SAF has gone totally
  paperless. All military personnel's medical
  records are stored electronically for rapid
  clinical diagnosis and treatment.
• Successful model for possible nationwide
  implementation.
• The two major hospital clusters in Singapore are
  looking into the implementation of electronic
  medical records to increase efficiency in
  healthcare delivery.

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Telehealth in Singapore
A Vision of Healthcare in Singapore Beyond Year
2001
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Telehealth in Singapore
Vision of Healthcare

• Information technology offers the best
  opportunity to make healthcare less expensive,
  more efficient, of higher quality, and more
  patient-centric.

• The amount of information sharing and
  collaboration among practitioners will increase,
  to improve on healthcare delivery for patients.
• More emphasis will be placed on wellness and
  prevention as a means of decreasing treatment
  needs. IT will come in useful as a tool for
  patient education.

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Telehealth in Singapore
Vision of Healthcare (contd)

• Non-intrusive computer systems will capture
  relevant information and store the results in a
  secure, life-long record. The data will be made
  available for patient care, collaborations,
  research, administration, and policy making.

• Patients will be encouraged to be more involved
  in health matters. More healthcare information
  will be made more readily available through IT
  tools and infrastructure.

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Telehealth in Singapore
Take Home Messages

• It is important to recognise that the Internet
  is an extremely powerful innovation that has and
  will continue to shape the healthcare industry in
  the years to some.
• Doctors are starting to catch on this wave of
  digital empowerment.
• It will certainly enhance the ability for
  doctors to care for their patients and ultimately
  add value to their practices.
• The challenge now is to make it easy for every
  doctor to come on board.