Primary Tech-Enhanced Care (PTEC): Overview of Article

• Primary Tech-Enhanced Care (PTEC) – Learn about the new model of care that enables patients with chronic conditions to self-manage with simple to use technologies and support from care team

• Scaling of PTEC Home Blood Pressure Monitoring programme – Find out how the programme is being scaled across the three healthcare clusters

• The PTEC Team – Discover the team behind PTEC

Primary Tech-Enhanced Care (PTEC): Home Blood Pressure Monitoring Programme

The Primary Tech-Enhanced Care (PTEC) Home Blood Pressure (BP) Monitoring programme aims to provide care support with easy-to use technologies that enable patients with hypertension to better self-manage their condition, and improve their health from home. The programme benefits patients who want to better manage their conditions and yet have busy lifestyles or are less ambulant as it reduces their visits to their polyclinics.

Following the positive outcomes from a one-year pilot, the MOH Office for Healthcare Transformation (MOHT) together with the National Healthcare Group Polyclinics (NHGP), SingHealth Polyclinics (SHP), National University Polyclinics (NUP) and Integrated Health Information Systems (IHiS) announced the progressive scaling of the programme to all three polyclinic clusters in Singapore.

After a one-year pilot at Ang Mo Kio Polyclinic (AMKP), the PTEC Home Blood Pressure (BP) Monitoring programme was officially rolled-out there in August 2020. The programme was also made available in Bedok Polyclinic under SingHealth Polyclinics (SHP) in October 2020 and will be rolled out at Clementi Polyclinic under National University Polyclinic (NUP). Thereafter, each cluster will implement it in the polyclinics under their care. The roll-out is expected to be completed in about three years.

“The pilot results at AMKP show that PTEC is beneficial for patients with hypertension and especially those who have uncontrolled hypertension. With regular monitoring of their own Blood Pressure levels, patients are empowered to take ownership of their own conditions. They can also continue to receive timely support from a dedicated care team with whom they have built a trusted relationship.”

Dr Valerie Teo, Family Physician,
Consultant and Deputy Head, Ang Mo Kio Polyclinic

A patient who is enrolled for the PTEC programme receives a Bluetooth-enabled home Blood Pressure (BP) device to monitor his/her BP at least once weekly. The readings are automatically transmitted through a mobile app from the smart phone to the polyclinic care team. The care team then follow-up on teleconsultations, which could involve adjustments to the patient’s medications, supported by Chatbot messages, without the patients needing to go to the polyclinics.

The PTEC Journey: Enhancing an Integrated Vital Sign Monitoring (VSM) System to record and transmit results easily from home to polyclinics

The journey between IHiS, NHGP and MOHT started in late 2018 when the three partners joined hands in search of a more scalable technology solution to provide PTEC for patients with hypertension in more polyclinics after the pilot showed positive preliminary results.

Along with MOHT and NHGP, the IHiS Telehealth team started the process by understanding the processes and needs of the team from the pilot site Ang Mo Kio Polyclinic (AMKP) and working closely with the care team and patients. The team decided to leverage on a commercial off-the-shelf vital sign monitoring (VSM) solution that IHiS has identified for the public healthcare institutions (PHIs) after careful selection.

In November 2019, the IHiS team delivered an integrated vital sign monitoring (VSM) system linking a patient Chatbot and clinician Dashboard (Task List) developed during the pilot with the Health Harmony app to provide an intuitive and easy to use solution that allowed patients to monitor their vital signs measurements at home in simple steps with the blood pressure reading automatically transmitted to the polyclinics.

“Poorly controlled high blood pressure can lead to serious problems such as stroke. The good news is there are many effective medications that can control hypertension but patients have to monitor their blood pressure regularly and adhere to their treatment. PTEC makes it convenient for patients to do so.

It helps patients to learn how to manage their conditions better and with confidence, as they have the support of their care team. Telehealth and technology-enabled home management are critical enablers. If we are able to scale these systems successfully across the primary care sector, it would benefit a significant number of patients and reduce their risk of serious complications.”

Professor Tan Chorh Chuan,
Executive Director, MOHT

Primary Tech-Enhanced Care (PTEC): Improving the Telehealth programme with a more intuitive software for users

The delivery of the integrated Vital Sign Monitoring (VSM) system for PTEC to AMKP was the first of many milestones in the PTEC journey that will test the stamina, dedication and commitment of the entire team to extend the Telehealth programme to more patients.

With Telehealth being a relatively new concept to Singapore, getting the care team and patients to be comfortable with a brand new initiative came with its challenges. Patients were comfortable with the traditional mode of consultation and manual recording of their blood pressure readings. The intervention came opportunely with the onset of the COVID-19 pandemic where patients, especially the elderly and immune-compromised, saw the benefits of substituting clinical visits with remote-monitoring and teleconsultation from home.

The team continued to seek feedback and make continuous improvements to the system. By analysing the patient enrolment workflow, IHiS developed a customised Patient Registration Portal which prepopulated and eliminated unnecessary data fields. This helped to reduce the number of steps taken to register a patient.

“We are focused on delivering value and excellent user experience to our partners. This means that we have to keep listening and evolving our solution to help them do their jobs better.”

Rino Tan, Manager,
Emerging Services – Telehealth, IHiS

Ensuring PTEC’s success through engagement and heartware

Ensuring the success of the PTEC Telehealth programme involved more than just delivering the hardware; the team addressed the heartware aspect too. As part of the change management process, IHiS and the polyclinics not only incorporated feedback of users, but also planned and conducted training programmes.

“We conducted training sessions for the care team, which included hands-on practical sessions and even role plays,” said Christophe Ng, Manager, Emerging Services –Telehealth, IHiS, who spent two weeks at the AMKP for their pilot. “The hands-on experiences gave them the confidence to embrace the new work process, and also transformed them into PTEC ambassadors to convince patients of the Telehealth programme’s benefits.”

“The new workflow was very similar to what we had been used to, thus, it is much easier for the care team to understand the process and our roles. Going through the training and demonstration of registering a patient gave us a better idea too. More importantly, when we started the enrolment of patients, IHIS and MOHT staff were on the ground in the first month to provide IT support.”

Evonne Oh, Assistant Nurse Clinician, Ang Mo Kio Polyclinic

Their effort paid off. Madam Tham Siew Yee, a retiree, is one of those who have enrolled in the PTEC programme since it was launched at AMKP. She appreciated that she is now able to transmit her readings to her care team at the polyclinic two to three times a week instead of daily manually tracking.

“It is useful and comforting to know that the reading is immediately uploaded and checked by a healthcare team behind the scenes on a regular basis. This means they don’t need to review it only in three months, or six months or at my next appointment,” she said.

Plans to scale up PTEC with enhanced Vital Sign Monitoring (VSM) system for the future

The IHiS team is mindful that the scaling of PTEC across the clusters will not be a “plug and play” model”. Even as they continue to make improvements to the integrated Vital Sign Monitoring (VSM) system, the team is working to enhance the VSM solution to prepare for scaling.

“IHiS is working closely with the public healthcare institutions to roll out more VSM pilots for the management of a range of diseases and conditions, which includes post discharge monitoring to evaluate the effectiveness of VSM in delivering better care for different diseases.”

Chua Chee Yong, Head,
Emerging Services & Capabilities Group, IHiS

The key people involved in PTEC and their roles

Different clusters use slightly different care models. In NHGP, a teamlet model is used, where the care team consists of two doctors, a care manager, and a care coordinator. They participate in identifying and offering the PTEC Telehealth programme to eligible patients, providing and maintaining continuity of care.

The care manager plays an essential role in monitoring the patients’ blood pressure readings taken from home via the Dashboard (Task List) in the polyclinic. With alerts from the Dashboard (Task List) and responses from the Chatbot, a care manager is able to take prompt action to review and titrate a patient’s medication using tele-consultation.

For example, if the Dashboard (Task List) triggers abnormal blood pressure readings that require intervention, the care manager works with the doctors to develop an action plan for the patient. The care coordinator serves as the “customer service” of the HealthTech programme.

Besides being the first contact with the patient, from recruitment to assignment and issuing instructions on the use of the equipment, the care coordinator also helps to resolve patients’ enquiries, especially when patients encounter issues at home.

PTEC enables the care team to better monitor their patients and provide support in between polyclinic visits. While telehealth cuts down on physical attendance at the clinics, the care team is still monitoring patients’ conditions, albeit remotely. This frees up some of their work and allow them to focus on patients with more urgent and complex needs.

More importantly, one of the key objectives of the PTEC HealthTech programme is to help patients increase the understanding of their health condition and give them the confidence to self-monitor and self-manage.

Our Healthcare Partners on the Benefits of PTEC

“Even as the COVID-19 situation appears to have eased somewhat in Singapore, it is still advisable for patients to observe safe distancing and avoid unnecessary crowds to minimise the risk of infection. Remote monitoring and tele-consultation can substitute some clinic visits and provide convenience to patients while ensuring safety and quality care.”

Professor Gerald Koh, Clinical Director (Future Primary Care), MOH Office for Healthcare Transformation (MOHT)

NHGP is proud to be a part of this important national initiative, from partnering MOHT to develop the blood pressure home monitoring programme to seeing it becoming a relevant and timely resource especially so during the COVID-19 pandemic. While tele-health is not new, this pandemic has accelerated the adoption of technology much faster among both healthcare providers and patients. It has spurred healthcare providers to innovate and create solutions to continue providing care for patients.

“The pandemic has provided a nudge towards greater acceptance of simple-to-use technology for patients to monitor their own health conditions and engage with providers.”

Associate Professor Chong Phui-Nah, Chief Executive Officer, National Healthcare Group Polyclinics (NHGP) & Primary Care

"Patients who enrol in PTEC will be empowered to be more active in the management of their hypertension. We feel confident that our patients and doctors alike can benefit from this HealthTech programme."

Dr Adrian Ee, Chief Executive Officer, SingHealth Polyclinics (SHP)

"We are excited to be part of this initiative, as part of our continuous efforts to deliver quality care that is centred on the patient’s needs. When we roll out this Telehealth programme to our patients, we hope that this will also enable them to self-manage their health better and more easily."

Dr Lew Yii Jen, Chief Executive Officer, National University Polyclinics (NUP)

Learn more about: Primary Tech-Enhanced Care (PTEC)