A stretched workforce has long been a problem even before COVID-19, although we cannot deny that the pandemic has only worsened the situation. Pregnancy care, like other areas of medicine, has not been spared. While institutions have regularly promised that the obstetrics ward would not be compromised by the pandemic, expecting mothers and care providers alike have felt the impact of shifting priorities.
Hospitals, patients, and maternity care providers are overwhelmed, and it’s not at all surprising that poorer outcomes stem from the situation. Last month, an inquest about the death of Wynter Sophia Andrews shortly after birth at Queen’s Medical Centre tragically presented how overworked and understaffed midwives can jeopardise patient safety.
The torch of hope is turned toward new technologies, such as remote monitoring, to offer a practical solution. Hospital Insights Asia sits down with Amrish Nair, Co-Founder and CEO of Biorithm, a medical device company specialising in digitalisation of maternity care in Singapore, to discuss how remote monitoring can complement and support hospital operations and patient experience.
A paradigm shift
Interest has spiked for the general “telehealth” sector since the pandemic. We have seen this across Asia with telemedicine, tele-ICUs, and command centres taking stage. Biorithm observes the same increasing interest for their remote fetal monitoring solution, as hospitals and patients realise that remote care incorporating fetal monitoring can aid midwives and doctors to deliver care more efficiently.
Delivering care beyond the confines of the hospital has become a reality with advances in devices and software, as well as telecommunications. “We’ve always had the basic assumption that people need to go into hospitals to get healthcare,” Amrish explains. “Now is a great time to shift that paradigm from the hospital as a building which we go to for healthcare, to hospital as a building which manages information to create better health for everyone.”
Understanding how hospital visits can be complemented with remote monitoring can significantly reduce staff workload, Amrish stresses. For example, pregnant mothers, especially those with high-risk conditions, have an intensive visit schedule during their last trimester, some of which are purely for blood pressure and fetal heart rate monitoring. “And understanding how we could safely bring these back to the home, whilst complimenting them with in-patient visits, would mean a possibly reduced number of visits into the hospital, which could then reduce the workload in-hospital for not just clinicians and midwives but a whole stretch of hospital staff who deal with patients,” explains Amrish.
Maternity care providers, obstetricians, and other hospital staff will then be able to safely shift tasks such as monitoring to the patient and better perform key functions that require in-hospital settings – all the while managing their remote patients through advanced data platforms, a set-up that still generates revenue even if the patient is not present in the hospital. Essentially, they will be able to complete more work in less time, which ultimately translates to higher patient satisfaction and a more sustainable health system. “What it does is help with managing rising costs,” Amrish asserts.
Always about patients
Patients also benefit from the integration of remote monitoring into their care by way of better healthcare experience and empowerment. It’s important that patients are given choices in healthcare, says Amrish. If patients want to come in to see their doctor, they should be able to. If they don’t want to or aren’t able to do so, they should be given the option to perform some tasks at home which could possibly reduce the number of visits.
It presents the opportunity for patients to be simultaneously more autonomous and more involved in their healthcare, which improves patient experience in terms of convenience as well as empowerment. Monitoring their own baby’s heart rate under care team supervision, for instance, provides better patient experience to pregnant mothers. Given patients spend 99% of their time outside of the hospital, it is prudent that fetal and maternal well-being are also assessed during this period. Amrish compares it to understanding an unfolding story through snapshots in time versus a full motion picture. With remote monitoring devices, fetal and maternal well-being can be assessed with greater frequency, allowing midwives and clinicians to trend information and spot anomalies.
This is welcome news for care providers who can now collect data they previously did not have access to, thereby allowing them better insights about the patient’s condition and enabling them to better detect signs of early complication. This is a core part of Biorithm’s belief: “Pregnancy is a time when the emotional and physical care of the pregnant woman has been shown to have a significant impact on mother and baby outcomes. By identifying maternal and fetal health conditions early in pregnancy and reducing them, we can have a positive impact on the outcomes for the child as well as the mother.”
Furthermore, during COVID-19, there was a reduction of antenatal visits in some countries due to a combination of hospital restrictions and pregnant mothers’ anxiety for their and their babies’ safety. This isn’t ideal as pregnancies require time-sensitive care. And if patients did decide to visit, they felt personal touch had been lost in some cases due to COVID distancing and safety measures. This can’t be helped during the pandemic, but it forces hospitals and care providers to rethink how the pregnancy journey could be improved in the new normal.
Remote monitoring can change this outlook on the healthcare experience. An ECG-based fetal monitoring solution, for instance, allows pregnant mothers to check their baby’s heart rate and general condition and send that data to a care provider, at a frequency set by the clinician, for review without having to leave their homes. Care is delivered without distance or infection risk as a hurdle, accessibility is increased for patients, and care providers maintain a high quality of care. Understanding that a part of pregnancy care can be safely delivered at home allows for innovative hospitals to offer new services.
Proven safety and accuracy
As hospitals begin to consider adopting remote monitoring into their practices, Amrish recommends focusing on three main considerations: patient safety and performance, cybersecurity and data management, and the fit into the existing workflow. Hospitals require change management whenever a certain part of the operation is altered, including technology. Doctors, management, and patients may have reservations whenever a new device is introduced.
While this has its warrant, Amrish affirms that medical technology is a heavily regulated industry. In contrast to unregulated areas such as wellness and some digital health products, medical technologies, like Biorithm’s remote monitoring solution, are first assessed and approved by the health ministries and other relevant agencies before being introduced to the market.
“All the claims that we make would be very much pertaining to what has been proven and what has been shown to the regulators; that’s how we can prove that we are safe,” says Amrish. In other scenarios where the remote monitoring technology cannot be used, companies like Biorithm make sure the details are clearly articulated to the care providers.
Necessity is the main driver for change. The struggle with providing access to efficient care outside of the hospital leads to innovative healthcare developments like remote monitoring solutions. Patients get to enjoy a more involved healthcare experience and the quality of care will no longer be compromised due to overworked staff.
Founded by doctors and engineers, Biorithm is a medical device company spun off from Nanyang Technological University Singapore (NTU).
Forging new frontiers in pregnancy care, Biorithm has developed cutting edge analytic software together with an easy to use medical-grade abdominal ECG wearable designed for remote monitoring of maternal & fetal physiological parameters. Our unique solution allows accurate and advanced remote monitoring of a wide range of vital pregnancy data, empowering patient and clinicians to identify early signs of maternal-fetal complication for timely intervention while reducing the cost of care.