Telemedicine guide for doctors in Singapore
What if your patients are worried about being infected by Covid-19 and thus reluctant in going out to seek medical treatments?
Undeniably, patients who are worried about the spread of the virus would feel more comfortable to see doctors online. Telemedicine thus comes to the stage.
In this article, we will provide you with an in-depth introduction to telemedicine, how it is conducted, what are the regulations for telemedicine, and how to setup telemedicine in your clinic.
What is telemedicine
The 3 types of telemedicine
How does telemedicine work
HIPAA compliant telemedicine
MOH Singapore National Telemedicine Guidelines
Telemedicine for Chronic Disease Management
How does telemedicine improve the quality of care
Risks of telemedicine and ways to mitigate
Telemedicine trends
What is telemedicine?
Telemedicine, more specifically as teleconsultation, is a form of consultation delivered mainly through video conferencing for clinical purposes, has become the ultimate solution for patients during the COVID-19 pandemic by providing quality healthcare in convenient and safe ways.
Just like how the WHO (World Health Organization) refers to telemedicine as ‘healing from a distance’, telemedicine allows the whole process of patients consulting doctors and doctors diagnosing their conditions and prescribing corresponding treatments to happen online.
Difference between Telemedicine and Telehealth
Telemedicine, although used interchangeably with “Telehealth” in the MOH National Telemedicine Guidelines (NTG), is a subset of telehealth, the umbrella term that also includes other non-clinical events like administrative meetings and physician trainings. While telemedicine refers to teleconsultation, telehealth does not refer to any specific service, but a collection of methods to improve general patient care.
The 3 types of Telemedicine
Now you know what telemedicine is. But how does it work? Here are the specific types of telemedicine to help you understand it better.
Store-and-forward Telemedicine
Store-and-forward telemedicine, or ‘asynchronous telemedicine‘, is for patients and different healthcare providers to collaborate by sharing patient medical information like medical imaging, bio-signals, and test results in a built-in, integrated and secure system while ensuring patient confidentiality. It efficiently helps all healthcare providers to review the necessary information when it is convenient for them and gives patients access to a healthcare team comprising of providers in different locations and time zones.
Remote Patient Monitoring
Remote patient monitoring is also known as self-monitoring or self-testing. The key part is using technological devices to monitor the patient’s clinical signs remotely, which is widely used in the management of chronic conditions such as heart disease, diabetes mellitus, and asthma. Cutting-edge equipment can transmit the medical data to healthcare providers automatically, allowing them to provide a better level of care and detect any earliest signs of trouble. It also greatly reduces the cost and time a patient needs to spend in the hospital.
Real-Time Interactive Telemedicine
Real-time telemedicine is also called live telemedicine, which makes it easy to have a doctor-patient interaction across time and space. It includes any real-time, two-way communications between healthcare providers and patients in ways like video conferencing and phone consultations. Assessments of medical history, basic visual examinations, psychiatric evaluations, and even ophthalmic tests can all be done via real-time telemedicine.
How Does Telemedicine Work?
By now you know what telemedicine is and the types of telemedicine. But how does the telemedicine system work? What kinds of technology allow communications between a healthcare provider at a hospital and a patient at home? How can the medical services be provided in the system?
Examples of telemedicine connections include networked programs and monitoring center links.
Networked connections link remote health clinics to larger health facilities like metropolitan hospitals, creating networks of healthcare services. The networks allow smaller clinics to outsource medical care to specialists across time and space.
Monitoring center links are for remote patient monitoring by creating a digital connection between a patient’s house and a remote monitoring facility. It allows a healthcare provider to monitor the patient’s conditions, which is very helpful for patients with chronic conditions.
Based on the programs of the system, you can offer medical services to your patients in mainly two ways, a patient portal, and virtual appointments.
As a secure system, a patient portal allows you to transmit information to your patients such as giving prescriptions and sharing test results, while virtual appointments allow you to have video conferencing consultations with your patients.
Health Insurance Portability and Accountability Act (HIPAA) Compliant Telemedicine
Some people mistakenly think that so long as the communication of electronic protected health information (ePHI) at distance is between the healthcare provider and patient, HIPAA Privacy Rule would apply.
However, the telemedicine channel used for communicating ePHI at distance also has to be HIPAA-compliant.
The HIPAA guidelines on telemedicine are within the HIPAA Security Rule as follow:
Only authorized users should have access to ePHI.
A system of secure communication should be implemented to protect the integrity of ePHI.
A system of monitoring communications containing ePHI should be implemented to prevent accidental or malicious breaches.
The first point would be met if physicians use “reasonable and appropriate safeguards” to prevent ePHI from being disclosed to any unauthorized parties. The second point means that unsecured channels of communication such as Skype and email should not be used for communicating ePHI at distance, as a healthcare organization is required to have a Business Associate Agreement (BAA) with the third party storing ePHI, which is absent in the case of Skype or Google.
Finally, according to the HIPAA guidelines on telemedicine, any system of communicating ePHI at a distance must have safety mechanisms to monitor and remotely delete the communication if necessary. The system should also have automatic log-off features if unused for a period of time.
MOH National Telemedicine Guidelines (NTG)
The NTG covers four areas: “Clinical Standards and Outcomes”, “Human Resources”, “Organisational”, and “Technology and Equipment”. It specifies that the duty and quality of care should be established and maintained in telemedicine, which “must be provided as part of a structured and well-organized system and the overall standard of care delivered by the system must not be any less compared to a service not involving Telemedicine”. It also emphasizes that patient privacy and confidentiality, as well as informed consent, must be ensured and given.
For the full guidelines, you can refer to MOH website
Telemedicine for Chronic Disease Management
In Singapore, there is an increasing prevalence of chronic diseases. According to Health Promotion Board, one in four Singaporeans aged 40 years old and above has at least one chronic disease(s), which includes diabetes, high blood pressure, high blood cholesterol, and stroke. Take diabetes as an example, the number of people with diabetes is predicted to increase from 450,000 today to one million by 2050, if left unchecked. It is clear that managing the increasing number of cases of chronic diseases has become a priority for healthcare providers.
Telemedicine thus proves to be an effective tool in chronic disease management, given its cost-effectiveness and monitoring features that widen the access to specialized care for your patients. Specific benefits of telemedicine in chronic disease management are shown below.
Increased Access to Specialised Care
Patients with a chronic condition usually suffer from mobility issues while they need specialized care for their treatment. Having to travel down to see specialists makes it hard for them to seek treatment on a regular basis. With telemedicine, however, patients can easily correspond with healthcare providers even for specialized medical care from the comfort of their own home regularly. It reduces and even eliminates travel expenses and thus greatly increases patients’ access to specialized care.
Increased Close Monitoring
Close monitoring of patients’ conditions including lifestyle changes and symptoms is key in chronic disease management.
Except for medications, patients with chronic diseases usually have to change their lifestyle like diet and exercise frequency to improve their conditions. However, changing long-term habits is not easy if patients are left on their own, which means their conditions might be worsened.
But when healthcare providers can remotely monitor patients’ conditions, they can check if the patients follow the treatment and quickly remind them to go for a walk or eat healthily, improving their chances of recovery.
Besides lifestyle changes, symptoms that may be a sign of deterioration or a new chronic condition should also be monitored. These symptoms might be seemingly insignificant or mild, and the patients might decline to consult about it given that they have to travel long distances for an in-person consultation.
But telemedicine makes instant consultations possible. Patients with chronic diseases can quickly get recommendations of changes in treatment and information of the new symptom as it appears in real-time. This allows patients to receive timely medical services that are much needed to manage chronic diseases.
Reduced Hospital Readmissions
Patients with chronic diseases account for the majority of all hospital admissions. When a healthcare provider can keep in touch with the patients and help them manage their treatment regime, the chances of a lapse in treatment and thus hospital readmissions can be reduced. This in turn also reduces the cost of healthcare.
How Does Telemedicine Improve the Quality of Care?
The benefits of telemedicine apply to not only patients with chronic disease, but also patients and doctors in general.
Increased Access to Healthcare
For patients, reduced travel expenses and the elimination of extra costs caused by medication non-adherence and unnecessary emergency visits also greatly expand their access to quality medical services of both specialized and normal care. After all, more accessible and convenient healthcare is the ultimate goal to achieve by telemedicine.
While telemedicine increases access to specialized care for patients, it also does so for primary care doctors who need to consult specialists on patient cases. For example, small hospitals without adequate radiology specialists on-site can outsource evaluation of x-rays through a telemedicine system.
Increased Patient Engagement
Telemedicine builds up the channels of instant and direct interactions between patients and healthcare providers, allowing them to connect more frequently and conveniently. This can lead to a stronger doctor-patient relationship, making the patients feel empowered and engage more to manage their own care.
Higher Quality of Patient Care
Telemedicine also makes following up with patients and monitoring their conditions easy. Healthcare providers can answer medication questions or check out patients’ lifestyle changes in a simple video conference, which leads to better care outcomes.
Risks of Telemedicine and Ways to Mitigate
While the field of telemedicine is promising and expanding exponentially, it’s facing associated risks due to practical and technological challenges.
Ongoing Policy Updates
While the technology is growing faster than the policy framework, there is uncertainty on issues like privacy protection and reimbursement that may subject to policy changes. Potential liabilities in areas such as privacy risks for patients, healthcare providers, and insurance companies, as well as risks of data leakage may thus be presented.
In Singapore, regulations of telemedicine are still under development. After a regulatory sandbox, MOH has announced that it aims to license telemedicine service in the middle of 2022 as part of the upcoming Health Services Act. This move is after the introduction of a voluntary listing of direct telemedicine service providers that are committed to meeting essential training and guidelines stipulated by MOH in February this year.
While MOH already stipulated National Telemedicine Guidelines, there are still grey areas to keep up with and more detailed guidelines and restrictions may be issued in the near future.
The best way to mitigate the risk of data leakage and potential liabilities is to choose trustworthy telemedicine systems that have integrated, secure features.
Potential Errors and Misdiagnosis
Given that healthcare providers can’t physically examine patients during teleconsultations, it’s harder to ensure a high standard of care. Just as how technology cannot always capture what the human touch can do, the possibility of misdiagnosis rises with telehealth services.
In-person patient-doctor visits with human touch are thus necessary for many circumstances. Just as stipulated in MOH National Telemedicine Guidelines, telemedicine should be incorporated in the normal workflow of clinical processes seamlessly and thus supplement these in-person visits.
At the same time, healthcare providers should also set clear standards on how to run video appointments or teleconsultation to make sure the same quality and standard of healthcare is provided as in-person consultations.
Requirement of Technical Training and Equipment
Telemedicine platforms usually require some training and equipment purchases at their phase-in stage. Exact expenses vary among different devices and systems. Costs of training primary doctors and specialists also vary. However, it is expected that much more time and expenses can be saved in a long run.
Potential Breakdown in Care Continuity
Since consumer-facing models of telemedicine provide on-demand care for patients, any patient can simply use the system to request a teleconsultation and get treatment. However, similar to a retail health movement, such a model can lead to a breakdown in care continuity as a random doctor may not fully know the patient’s whole medical history. The best approach to mitigate such risk is to use telemedicine tools that connect you with your own patients, or make seamless transfer of patient’s experiences between doctors, just like the solutions provided by UNO Technologies.
Telemedicine Pros and Cons
Telemedicine can bring plenty of benefits to a clinic. In a pandemic such as the COVID-19, it provides doctors and physicians a great way to engage their patients in a safe and convenient way.
The disadvantages and cons of telemedicine mainly surrounds data security issues, and possible misdiagnosis.
Practitioners are advised to select their TM service providers carefully, a HIPAA and MTCS compliant service provider is a must. While you should also practice good data protection and security measures within your clinic to protect your patient’s data.
Introducing UNO Clinic Management System, fully integrated, easy and safe to use. No additional software or hardware required, HIPAA and MTCS compliant. Your ideal choice of TM provider.
Telemedicine Trends
When people are stuck at home or going out for a doctor’s visit becomes risky, many of those who needed to seek medical services turned to telemedicine for diagnosis and treatment. Governments have also quickly made digital health platforms available to the general public in response to the spread of the virus.
There’s no doubt that the development of telemedicine was boosted greatly due to COVID-19. But even before the pandemic, telemedicine was nearing a turning point. In Bain’s 2019 Asia-Pacific Front Line of Healthcare survey, nearly 50% of patients expected to use digital health tools in the next five years; 91% of consumers said they would use digital health services if the costs were covered by an employer or insurance provider.
When countries start to recover from the pandemic, telemedicine will support a safe recovery while laying the foundation for a new era of care delivery by helping healthcare providers improve the quality of medical care and holding the line on rising costs.
The telemedicine industry will continue to grow, and the key is to sustain the momentum built during the pandemic.
“Once individual consumers start using digital tools, including digital healthcare tools, they continue using them. So, we fully expect that individual consumers will continue to use telemedicine as a complementary part of their medical care,” said Ms. Renée McGowan, CEO for Marcer in Asia, to CNA
How to register as a telemedicine service provider to conduct TM in your clinic
Independent Physicians, doctors, and dentists providing direct patient care may apply for telemedicine service license under the Healthcare Service Act (HCSA).
Independent practitioners wishing to register as a TM service provider must:
Complete MOH TM e-training
Have a sound and professional set of measures to provide safe TM service, and be compliant to them.
Apply to MOH here
Conclusion
All in all, the future of healthcare is digital, is doing more with less. Healthcare stakeholders who are responsive to the rising trend will definitely emerge as the front-runners on the scene. Following the trend and adapting into the current context is a good practice to stay competitive in the healthcare industry.
source:
CNA
MOH Telemedicine regulations
Bain.com