How Singapore is using telehealth to extend care beyond hospitals

By Shirley Tay

Interview with Thomas Lew, Group Chief Data & Strategy Officer, National Healthcare Group.

Singapore is waging a war against chronic diseases. It has rolled out nationwide health campaigns to nudge citizens to healthier behaviour, imposed advertising and sales restrictions on sweetened beverages, and is now turning to telehealth.

Managing these chronic diseases starts from changing lifestyles, and telehealth can help providers extend care beyond periodic 30-minute consultations.

NHG and its member polyclinics and hospitals have turned to remote care to monitor patient health during Covid-19 lockdowns, and shift care beyond hospitals and nursing homes. GovInsider spoke to Thomas Lew, its Group Chief Data & Strategy Officer, to find out more.

The potential of telehealth

The potential of telehealth is “huge”, Lew says. Teams from Tan Tock Seng Hospital and Khoo Teck Puat hospital turned to remote consultations to monitor the health of at-risk patients during the height of Singapore’s Circuit Breaker, he says.

NHG’s member polyclinics have also used tele-sensors to monitor the condition of patients with chronic diseases, he adds. Hypertension patients, for example, can submit their blood pressure readings regularly through a Bluetooth machine.

Known as the Primary Tech Enhanced Care initiative, this was very popular among patients, said Angela Yeo, Assistant Director of the Future Primary Care programme at MOH Office for Healthcare Transformation. The office is a partner in this programme, along with other polyclinic clusters and healthtech agency IHiS.

Nurses could call patients every time their readings fluctuated abnormally, allowing for more frequent check-ins. Patients could also receive tips through SMS.

Telehealth will be effective in long-term care and help care providers continually assess patients from the comfort of their homes, Lew says.

AI for patient care

Machine learning has “tremendous potential” in healthcare, Lew says. It can help to reduce mundane operational tasks, support decision making, and improve productivity.

Staff from Tan Tock Seng Hospital and R&D agency A*STAR have developed an AI-powered tool to quickly detect abnormal chest X-rays quickly. The tool can analyse each X-ray scan within three seconds and highlight anomalies such as white patches or haziness over parts of the lungs, which may be a sign of pneumonia.

This has been used in Covid-19 screenings at the National Centre for Infectious Diseases, and allowed doctors to quickly intervene to provide treatment, The Straits Times reported.

Singapore’s National Eye Centre has also developed an AI tool to analyse eye scans and determine if there is an eye condition that points to a brain tumour or other life-threatening conditions, A*STAR wrote.

NHG supports clinicians in AI development by creating proper “test-bed environments” and analytics tools, Lew says. The National University Health System has created a similar data crunching platform known as Discovery AI, which anonymises data for the testing of AI models.

Data-driven decision making

When Singapore was battling the peak of its Covid-19 outbreak last April, NHG’s institutions had to enhance their patient management systems to meet huge demand surges, Lew says.

The group created “good decision-making tools” to support clinicians in their work, such as using analytics to safely transfer patients to step-down facilities like nursing homes. Data has also informed decisions on antibiotic prescriptions, and helped clinicians keep an eye on at-risk patients.

NHG is “sharing data nationally” to better distribute resources so patients can receive timely treatment, he says. For instance, Tan Tock Seng Hospital’s Command, Control & Communications system pooled data from sensors, emergency departments, and CCTV footage to coordinate admission, bed allocation, and locating patients during Covid-19.

“Further connectivity” of these systems will allow the group to better manage operations across its healthcare institutions, Lew says.

The group also building a population health and risk registry, known as the River of Life, Lew says. The lifestyle and clinical data gathered will enable NHG to provide services that are more customised to the healthcare cluster it serves, he adds.

In the central zone served by Tan Tock Seng Hospital, for instance, there are more residents over the age of 65. The focus will be on “taking care of them in the age of frailty”, said Dr Wong Kirk Chuan, Chief Operating Officer (Population Health) for NHG & Woodlands Health Campus, told Channel News Asia.

Training a ‘digital-native workforce’

“It is ultimately our people, and not machines, that determines the success of relationships afforded by science and circumstances,” Lew says.

NHG plans to enhance its staff’s data literacy and make them “thought-leaders” in digital health, he adds.

It is “confident” of creating a tech and data-ready workforce that still retains ethos, empathy, and critical thinking at their core. These are “foundations for the healthcare professions”, Lew emphasises.

Covid-19 has highlighted the need and potential for innovation in the healthcare system. Telehealth, AI, and data will be cornerstones in Singapore’s healthcare revolution.