Remote monitoring devices can improve quality of care

Dr James Yip, Group Chief Medical Informatics Officer of NUHS, Singapore, recognises the increasing demand for remote monitoring and the role of diagnostic devices in improving quality of care in hospitals.

The Consumer Technology Association recently found that 2 in 3 physicians strongly intend to use remote patient monitoring technology in the future. Doctors reveal that this technology will positively impact patient outcomes, compliance rates, and patients’ ownership of their health.

At the National University Health System (NUHS) in Singapore, remote monitoring devices have been in use since 2015. When the COVID-19 happened, however, this demand grew as patients were understandably hesitant to make hospital visits. Dr James Yip, Group Chief Medical Informatics Officer at NUHS, says that the technology NUHS employs is classified under a special branch of telemedicine called remote monitoring or vital signs monitoring that allows a non-doctor staff to monitor long-term health conditions at home.

What they look like at NUHS

Some of these remote monitoring technologies include Bluetooth blood pressure sets, POCT (point-of-care testing) blood glucose monitors, and weighing scales, which NUHS charges patients about S$70 per month (inclusive of government subsidies) for use. Since these technologies only monitor blood pressure, sugar levels, and weight, NUHS is also looking into adopting other wearable monitoring devices like POCT stethoscopes for asthma and chronic obstructive pulmonary disease (COPD) for heart failure, home blood diagnostics for fertility treatments, and wearable rings for depression and dementia care.

“The end goal of using these remote monitoring devices is the improvement of quality of care without the need for physical visits. Through the years, NUHS has seen improvement in patients’ Hba1c for diabetics, reduction of heart failure visits, and improvement in ACE inhibitor titration in a randomised controlled trial for post-attack heart patients,” Dr Yip remarks.

Nigel, 61, a diabetic, reviews his experience using blood glucose monitor: “It has been a revolution in convenience, offering a quick and easy way to know my glucose levels.”

Challenges along the way

However, the introduction of such devices in hospitals did not come easy due to user acceptance (both provider and patients) and existing regulations for telemedicine.

Oftentimes, doctors find using such devices stressful as the data received from patients at home can be quite overwhelming to manage on a daily basis. As such, nurses are trained, received certification for each monitoring device to manage specific conditions patients, and assigned to help enrol patients for this programme. “We then train them to follow a clinical protocol to help the patients titrate medication doses and give advice,” Dr Yip adds. The nurses are also assigned a doctor champion to help them with difficult cases.

Hence, change management is of utmost importance for these wearable monitoring devices to be successfully utilised in the healthcare industry. Dr Yip believes that showcasing good outcomes from the use of these devices, in particular better blood pressure and sugar control, high patient satisfaction rate, and a reduction of admissions from heart failure, helps facilitate change management with clinicians.

Taking into consideration the patients’ perspective, NUHS acknowledges that the elderly might find using these technologies difficult. As such, the organisation has made sure that the platform is kept simple and straightforward so that patients will only need to turn the device on and press a button, eliminating the need to enter data into desktops, tablets, or apps. Patients are also required to pass a simple test on device usage before they can be enrolled for home monitoring.

On another note, the regulatory environment also has an impact on the use of remote monitoring and diagnostic devices. In Singapore’s National Telehealth Guidelines, for instance, teleconsultations are advised for repeat-visit patients. During the COVID-19 pandemic, first-visit consultations have been allowed for primary care and selected specialist consultations, though the regulation still permits the cancellation of these teleconsultations when a doctor deems virtual care unsuitable for a particular case. Likewise, doctors doing teleconsultations are subject to the same accountabilities and standards of care that govern traditional in-person consultations. Furthermore, Singapore also requires doctors to undergo a two-hour online training course before being certified to conduct teleconsultations in the island-state.

Projections show that the wearable technology market will grow to $150 billion by 2027, taking into account its use in healthcare. With more healthcare organisations recognising the advantage of online diagnosis and monitoring, telemedicine could very well be stepping up its role in the future of healthcare.