Telehealth technologies are one of the rising models that offer better possible support. The technology offers services related to health through telecommunication (Lindberg et al., 2013). This system involves with simple services such as two clinicians or health professionals discussing about a health case over telephone about serious complicated case such as performing a robotic surgery sitting at different regions of the globe. This innovation within the technological and communicating systems have supported the patients in receiving the best medical consultation staying back at their homes only (Kvedar, Coye & Everett, 2014). Therefore, the systems through which all the medical advices along with their solutions are received through phone or the internet are gaining popularity with growing technology. Singapore is introducing new systems with the progression of technology, communication based services and medical need (Van Velsen et al., 2015). Thus various studies have been conducted in Singapore with desire to visualize if the population in this country are benefitted by utilising telehealth. Any individual having a phone or with internet connection can avail the facility in case of any urgency. Telehealth system is of much importance to those patients who are chronically ill and usually requires multiple visits to the clinics due to monitor their health. These services are available in Singapore from a couple of years as the country is facing a increased growth in population, chronic disease explosion and increased population of the aging people (Tabish & Syed, 2015). Delivering these healthcare services will facilitate the old aged people in receiving nursing at home without any reason to travel far to visit the clinician. Apart from getting relief from travelling, it also minimises the travelling costs and also reduce the time that is taken by the clinicians to assess the patients (De San Miguel, Smith & Lewin 2013). Thus, there lies a significant comparison between the telehealth systems and methods conducted traditionally, as a single clinician can assess many patients within a single day (Gratch et al., 2013).
Pros and cons of telehealth in Singapore
The telehealth impacts the quality and management of the medical services in a very impressive and positive way in Singapore (Gabbrielli, 2013). Therefore this technique is spreading increasingly throughout the entire world along with Singapore itself as the patients and clinicians are quite happy with the outcome measures. In Singapore, the Ministry of Health is in charge of building the required steps in implementation of the telehealth services. They are also trying to establish this system to as many areas and regions as possible in order to make this system accessible to large extent of people (Bhowmik et al., 2013).
The positive impacts of telehealth on the health quality of the patients helps in bringing the nursing care within the home and thus the patient can enhance the access to healthcare successfully. Thus this system increases and improves the productivity of the healthcare system in Singapore (Kalpa, 2012). Telehealth also contributes in offering integrated and continuous care in order to meet the effectiveness of the healthcare needs. This system is increasing the productivity of the therapist or consultation by improving the nursing professionals as they can offer treatment and care to large patient groups (Haseltine, (2013). It also optimises the resources in order to overcome the constraints of the manpower within the healthcare community. Implementing the telehealth in every corner of the Singapore has delivered quality healthcare services to a large extent of ageing population (Tabish & Syed, 2015). It has also enabled and assisted the old aged people who cannot mobilise to age in their home environment. Apart from this, it has also minimised the patients need along with their caregivers from travelling and waiting long for getting appointments in the clinics and hospitals.
Based on this system, a setup was established named NEHR (National Electronic Health Record), which functions as a system of data exchange by storing the consolidated clinical records about each and every individual in Singapore (Sinha et al., 2012). Through this data exchange system, the clinicians and medical professionals can avail the patient’s medical history thereby helping them in making decisions and saving time required for duplicating medical tests. Thus by sharing the information an updated and complete patient record is available to the healthcare staffs throughout numerous institutions of healthcare. This helps to ensure the continuation of care, enhancing the accurate measurements of the clinical decisions and finally provide effective outcomes of care (Meier et al., 2013).
On the other hand, apart from positive impact of telehealth services, some negative impacts were also noted. The clients were not sure about whether they would like the change as a lot of them were not acquainted with computers or internet. Even the staffs of the technology were undecided if the technology would bring positive experience in the clients as it would be difficult at some points to monitor the situation in home through video conferencing and would improve the medications management (Munir et al., 2017).
In the upcoming few years, Singapore is estimated to face two major key challenges within the healthcare system. One of them is the rapid ageing of the population and the other is the crunchy manpower (Huang et al., 2015). There will be an increased life expectancy by tripling the elder citizens’ number to 900,000 by 2030. Along with the increased life expectancy, the small working base with be about as less as 2.1 working citizens aged 65 and above it (Thomas et al., 2015). Thus, to address the challenges faced, Singapore is implementing the smart technology use in order to transform the healthcare system. According to Jacqueline Poh, the managing director of the Infocomm Development Authority (IDA), they were lacking required hospital beds for taking care of the overall aging population in Singapore and thus there lies a need for aging in their own place and care should be provided in the community (Sterner, 2013). Based on these needs, the technology can be helpful in providing personalised care during the patients’ visits to the clinics. Thus the technology can play a key role for operating with excellence thereby optimising the resources of the healthcare system. At recent time, the government of the Singapore has announced a national plan costing 3 billion dollar with an aim of helping the old aged senior citizens to age well (Ngan, 2017). Different types of active aging centres will be established within the new developments of public housing within which the smart technology with telehealth system can be effectively used for the palliative care of the intermediate and long term care of the old aged people through care hubs that are centre based and through rehabilitation services. Along with this, a national innovative challenge will be formed costing approximately 200 million dollars for catalysing the aging researches and encouraging the research community in developing innovative ideas (Tabish & Syed, 2015).
Implementing telehealth in palliative care in intermediate and long term treatment in Singapore:
Clinical record of Singapore has reported that almost 48% cases of disease burden is associated with chronic illness such as high cholesterol, stroke, diabetes and hypertension which is estimated to rise to 600,000 by the beginning of 2030 (MacPherson, 2012). Thus, due to shortage of medical requirements in the hospitals, Singapore had planned to include telehealth services by helping the residents in availing the palliative care in intermediate and long term treatment from home and thus will be able to monitor their conditions of health and access medical attention whenever required. The managing director of the IDA had also said that they along with their healthcare partners are planning to set up a program of Smart Health-Assit to discover the ICT utilities in delivering care to the patients based on their comfort from home or community sectors. Thus to start the program first thing to be noted was the way of managing the chronic diseases by the use of wearable devices and sensor equipment placed within the public housings (Billings et al., 2013). After placing, the processed data from the devices would be delivered to the care providers and healthcare sectors for further processing. The model of the Smart Health-Assist program is a section of paradigm shifted from episodic, followed by healthcare reactivity to pre-emptiness and preventive healthcare. The sensors for monitoring health would be embedded in the patient’s home environment and the information recorded would be transferred to the health professionals with proper accuracy and regularity. Any information related to decline in patient’s health could be detected promptly with an early possible treatment followed by and preventive intervention by the healthcare professionals (Baig & Gholamhosseini, 2013). This early detection could help the patients in reducing their visits in the clinics, emergency departments of the hospitals along with inpatient admissions.
Personal Management of health
Apart from this, the healthcare sectors also planned to shift their goal towards the management of personal health in Singapore (Dhawan et al., 2015). This would help the citizens in managing their self health by accessing their own personal records of health and other essential information. All these facilities would be made feasible through applications from web and mobile which would effectively allow promoting of health activities and well being. The Minister for Health, Gan Kim Young, said that with this context that there was an increased desire by the population in managing their own health through a number of avenues (Haseltine, 2013). This willingness opened an opportunity to IT based health industry in considering the utility of behavioural sciences, social marketing and outreaching the public by involving the ownership of the people in their health outcomes. Thus, with an increase in healthy population, the chronic disease incidence would be minimised and finally reduce the requirement of the healthcare systems (Patel et al., 2012).
Telehealth service could also play role within the hospitals of Singapore. Telehealth based infocomm system could ease the shortfalls of manpower and enable the effective utility of resources (Liew, 2015). The managing director of the IDA said that, Singapore could exert a potential role in optimising the resources of healthcare as they had warranted optimisation. They had a huge crowd of patients in their public hospitals, thus the healthcare resources should be optimised via automation. Based on this fact, he allocated the name of Ng Teng Fong Hospital as an example. This hospital used guided vehicles in order to deliver food products and linen thereby reducing the required manpower (Yen, 2012). Hospitals had transformed into automated robotic pharmacies with automated machines for dispensing and devices to scan the overall workflow such as picking the medication, packaging, labelling them, assembling and verifying. All these advancement had proved to be a huge benefit in making the medication safer with greater accuracy and also saving the capital resources of human (Maksimovi? & Vujovi?, 2017). The resources of the healthcare could also be set free with the advent of the technology through wireless monitoring. The wearable patient devices for monitoring such as a mobile device has the potential to monitor the blood pressure, body temperature, oxygen saturation level, pulse rate and other related vital signs (Appelboom et al., 2014). The measurements recorded are transferred to the nurse’s station via Wifi facilitating close monitoring of an increased number of patients at any time thereby minimising the vulnerability of expensive emergency events. A recent study conducted in the Singapore hospitals revealed numerous critical events of deteriorating patients which enabled the caregivers in implementing interventions within a proper time (Chan et al., 2012).
Health Data Exchange Systems
Telehealth supported exchange systems of health data, the NEHR (National Electronic Health Record) was established in 2011 that functions in storing the medical records of every individual in Singapore (Zhang & Xu, 2012). Through this system the doctors could easily avail the patient’s medical history with an objective to support the patient in their decision making. Gan, the Minster for Health delivered that with the system of information sharing, the health care members could avail an updated and clear record of the patient health thereby assuring the continuous care by enhancing the accurate decisions and provide better health outcomes (Richesson et al., 2013). Immediately after the implementation, the NEHR effectively had rolled out over 796 institutes throughout the healthcare organisation and also allocated access to 18571 users to medical records (). Moreover, IDA is looking ahead to build a federated system of data exchange for improving the healthcare data of Singapore through analytics (Rudin, Tang & Bates, 2014).
According to Poh, the term smart nation corresponds to data and thus it is essential that all the data captured from the body, home, environment and hospitals are included to a good cause through an important federated model (Kobetski & Axelsson, 2012). He also said that policies are being instrumented to form federated grids and systems of data along with a data exchange for healthcare to offer the various sectors in monitoring the patients with a three-sixty degree visualisation and thus will be able to record data for researching clinically in order to provide increased healthcare solutions in the near future.
Smart Health TeleRehab
It is a telehealth model that was piloted by the Integrated health Information Systems (IHiS) and T-Rehab, which was implemented from the May 2017. This teleRehab will help the patents to recover from severe conditions such as stroke, limb amputations, deconditioning and fractures (Hondori, Khademi & Lopes, 2012). With this facility the patients can restrict to confront the physical barriers and relief their caregivers by not accompanying them to the rehabilitation centre as well as their therapists from visiting their home (Franklin & Cheville, 2015). Thus, in this way the new development of the technology through telehealth will positively affect the growth of the palliative care in intermediate and long term care in the health system of Singapore.
Aim of the project: A project proposal from a palliative care leader to seek approval from the Board of Directors in the implementation of telehealth technology for palliative care in a new nursing home.
Background: Decline in birth rates along with longer-surviving population had caused an age-shift in Singapore. It is expected that the median aged population will reach to 47 by 2030 (Swee-Hock, 2012). According to the World Health Statistics, in Singapore the life expectancy is considered to be the highest throughout the World with an average of 83 years in 201. The population in Singapore aging 65 years or above are expected to be five in one by 2030. Thus as the population ages, the patients in need of palliative care will increase respectively (Thomas et al., 2015). The major goal of palliative care is to provide relief to the patients suffering from prolonged illness and also ensures the best possible quality life of the patients (Fayers & Machin, 2013). Thus it is essential to frame the healthcare system in nursing homes in order to deliver effective care to the patients in their home environment thereby restricting the frequent admission in the hospitals and thereby reduce the treatment costs. Based on this prospect, to bring the health care services closer to them, implementing telehealth technology in the nursing home can help the seniors in managing their chronic conditions keeping the acute settings behind in Singapore (Carretero et al., 2013). Telehealth is the technology that uses digital information and communications to provide medical care, public health services and health education by linking multiple users from different locations (Lupton, 2014). This uses clinical information that is exchanged from one to another site through electronic communications in order to improve the health status of the clinic. The technology involves applications and services by two-way video use, smart phones, wireless gadgets and email (Majedi, Naeem & Anpalagan, 2016). Thus implementing telehealth services in the nursing home will remove the professional, geographic and economic barriers in delivering care by connecting the healthcare professionals, caregivers and patients through a virtual network. The services delivered by telehealth technology are cost effective, appropriate and appropriate (Free et al., 2013).
Strategic plan: Implementing the telehealth technology will benefit the patients as well as the nursing home too. Speaking about the patients, they will experience immediate benefits of this technology by accessing the healthcare team and thereby will participate in achieving their goals of healthcare (Davidson et al., 2013). Some of the benefits are enlisted here:
- Improved access: Will improve the service access to the patients and the family within real-time and will also expand the reach to the service providers. It will increase the ability of practitioners in accessing the specialized health services from other location (Mohr et al., 2013). Apart from improving the service access it will also ease the shortfalls of manpower in the nursing home.
- Cost efficiency: Telehealth technology will reduce the care cost and thereby will increase the efficiency by providing quality management of chronic illness along with on time access to service providers (Clifford & Clifton, 2012). This program will also significantly minimize the travel time.
- Improved quality: Interventions on time in the home of patients will improve the clinical outcomes and will increase the satisfaction of the patient as because of real-time connection (Thomas et al., 2014).
The following connections can be recommended in the nursing home.
- Wed-based applications: Patients will be able to download the applications that are web-based in communication purpose and monitor their health status virtually. For an example, a patient portal can be created to report the blood pressure, glucose levels or weight (de la Torre Díez et al., 2016).
- Patient monitoring in remote areas: The patient can use mobile phones or similar applications in their community or home to monitor their health. Through this they can interact with the health care facility about their health status (Kvedar, Coye & Everett, 2014). Example: Recorded health status can be transferred through the web-based application to the primary care giver.
- Store and forward: The technology will facilitate to capture video or image and store them to be accessed by the health care provider to provide virtual healthcare (Schwamm, 2014). Example: Take and store a photo of the injured area and will be accessed and reviewed by the medical team and treatment will be recommended.
There were certain challenges related to implementing telehealth technology (Taylor et al., 2015).
- Lack in availability of telehealth supporting staff and medical staff providing the service.
- Facing difficulties in using and organising the telehealth technology in terms of correctly connecting the equipment, integrating the medical information systems, and other peripheral devices supporting the telehealth interactions.
- Lack of grant funds that are limited, accessing the technical equipments and the staff can be expensive.
- Lack in availing proper guidelines, standard procedures and training workshops to use the telehealth technology and their services.
Apart from all the key challenges, this technology involves many positive impact and outcomes. With the increased need of palliative care in the growing aged population in Singapore, implementing the tehehealth technology in the new nursing home will not only benefit the organisation by easing the manpower shortage but will also help the patients with chronic illness with an effective treatment at home thereby reducing frequent admission to the hospitals and minimising travel time and costs.
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