Video Consultation Services at SingHealth Polyclinics
In July 2020, SingHealth Polyclinics rolled out video consultation for patients with chronic diseases such as diabetes and hypertension at all eight of its polyclinics. From then to July 2021, more than 7,000 video consultation sessions were conducted, with encouraging increase in the number of video consultation sessions monthly.
Based on feedback from 409 patients between May and July 2021, 93% had sufficient information and guidance provided before the video consultation session. 95% found the arrangement of appointments to be convenient. Another survey earlier in the year showed that 81% reported that they saved at least one hour from not having to travel to the polyclinic, which helps to save cost for patients as well. 96% would likely use teleconsultation in future, and 92% believed that the experience was comparable to a face-to-face consultation.
Evaluation of clinical effectiveness of video consultation showed favourable outcomes. Riding on the momentum, SingHealth Polyclinics intends to widen the application of video consultation to other chronic diseases, such as asthma, stroke and chronic kidney disease. To optimise resources, they are exploring setting up a centralised “Telemedicine Hub”, which will operate from a single location to serve all SingHealth Polyclinics patients.
Vital Signs Monitoring at SingHealth Community Nurse Post
An even more recent example is the deployment of VSM earlier this year at SingHealth’s Community Nurse Posts (CNP) located at Senior Activity Centres (SAC), to enable elderly residents with hypertension to self-measure their blood pressure (BP) regularly, and take charge of their health conditions. Recognising that these seniors can be empowered to measure and manage their BP with guided messages, SingHealth Community Nurses have introduced VSM Kiosks at 20 out of the 68 CNPs by end of June 2021.
The workflow is as such:
- SingHealth Community Nurses would first identify suitable residents with hypertension or suspected hypertension under their care, and coach them on how to manage their health conditions and self-measure their BP at the VSM Kiosk.
- Nurses would also educate residents on abnormal symptoms to look out for and to proactively seek help if required. Residents would then scan their IC and measure their BP at the kiosk weekly.
- The kiosk, equipped with a blood pressure monitor connected to an iPad running the VSM Platform (Health Discovery Plus), will inform these seniors if their BP readings are low, normal or high, and advise the next steps to take.
- If there are continuous abnormal readings, HD+ Dashboard (developed by IHiS), would trigger threshold alerts to the nurses for timely intervention.
- The BP readings are also displayed real-time in SingHealth’s Electronic Medical Record (EMR) to enable nurses to better manage the residents’ care, enable care continuity and facilitate information sharing with other care providers.
Between February to June 2021, 150 residents have been enrolled. Out of 33 residents who responded to a survey, 73% felt that VSM kiosks are useful to help them better manage their hypertension, while 64% would continue to measure their blood pressure using the kiosks. An analysis of 53 seniors enrolled in the pilot found that all of them achieved an average 3% reduction in their systolic BP one month after weekly self-monitoring.
Related article: Health Discovery: Empowering COVID-19 Patients at CCFs
Video Consultation Services at National Heart Centre Singapore
The National Heart Centre Singapore (NHCS), a specialty centre under SingHealth, started providing video consultation services in February 2020 and saw increased uptake when COVID-19 restrictions started in April 2020. Between April to December 2020, 931 video consultation sessions were conducted.
Their exclusion criteria for patient suitability for video consultation are:
- New Referrals
- High Cardiac Risk Patients
- No Face-to-Face Consult in the Last One Year
- Communication Issues
The results were positive. More than 90% of patients felt that video consultation improved their access to healthcare, and more than 90% also trusted the quality of service. Overall, 93% were satisfied with the experience. A clinical safety audit of all 931 cases showed that only 2 patients, or 0.2% of cases, had unscheduled readmissions to the hospital within 30 days.
An audit established that these two cases could not have been reasonably prevented even with a physical consultation. This metric demonstrates appropriate patient selection for teleconsultation, thereby ensuring robust clinical safety standards.
The analysis also showed that the no-show rate of 7.3% for video consultation was lower than the 14.2% no show rate of face-to-face consultation. This translates into institutional time savings of a few hours a day, or hundreds of hours a year, depending on the number of patients. Patients also saved an average of $34 - $36 by using video consultation over face-to-face consultation.
