Commentary: The future of healthcare in Singapore looks like a hospital without walls
During the pandemic, digital and remote care were shown to be viable alternatives to in-person medical visits. Imagine a hospital without walls as the future, says Dr Huang Weiting from the National Heart Centre Singapore.
SINGAPORE: Anyone who’s had to deal with medical visits will tell you how long and frustrating the wait can feel - from triage in the Emergency Department or follow-up appointments, to routine screening or test results at the outpatient clinic.
Why not take the wait out of hospitals and into the comfort of our homes or in a clinic closer to home? We already have the tools for remote monitoring of patient vital signs and telemedicine to provide care and advice.
Patients who need chronic care, such as for diabetes or ongoing heart issues, can have a healthcare professional regularly checking in on their blood pressure virtually. Those who are recovering from hospital care can be discharged to recuperate at home while staying under the watchful eye of professionals via wearable sensors that measure heart rates or blood pressure.
The COVID-19 pandemic ultimately proved to patients, medical professionals and society at large that there are other options than face-to-face consultations, and in fact that the efficiencies of digital and remote care offer a healthy alternative to the status quo.
But even if the crisis forced us to adopt telemedicine, it’s a poor way to optimise it for the future. The healthcare system will have to adapt if a hospital without walls is the care of the future.
USING HOSPITAL RESOURCES EFFICIENTLY
Healthcare of the future can sometimes sound like the stuff of science fiction, with talk of sensors, robots and artificial intelligence. But it aims to address a very real and human problem.
Singapore is not just ageing rapidly but expected to become “super-aged” by 2026 - that is, 21 per cent of our population will be aged 65 and above. Demand for healthcare services will rise in tandem.
The healthcare system will face greater strain in meeting those needs. The COVID-19 pandemic exposed its gaps and weaknesses, especially the prevalence of burnout among healthcare workers making manpower issues worse.
Any opportunity to alleviate the burden of healthcare workers and move some duties away from hospitals into clinics and home-based care warrants exploration. Caring for patients effectively and safely outside of the hospital can free up and ensure efficient use of much-needed hospital resources (such as beds, medical personnel and equipment) for those requiring more immediate or intensive support.
SHIFTING CARE BEYOND HOSPITAL WALLS
There are three key elements that need to be in place to shift care from within to beyond the hospital walls.
The first is infrastructure. Singapore, armed with foresight of the power of digital, embarked on centralising patient data over a decade ago. Today, more than 2,300 healthcare institutions participate in the National Electronic Health Record system (NEHR) which consolidates patients’ key health information from across the healthcare system.
This ensures continuity of care. Patients recently discharged from hospital will be able to continue seeing their family doctor, who will be abreast of changes in their health condition through the NEHR system. Some may even be discharged earlier: Instead of staying admitted to wait for improvements in blood test results - which can take days as organ functions take time to normalise - they can choose to go home and visit their family doctor for the blood test in a few days, who will then be able to review against in-hospital tests.
The second element is talent and education. Upskilling current talent and training new practitioners to deliver home care will require a new playbook and approach.
For example, the SingHealth cluster has been conducting research using artificial intelligence powered technology Us2.ai - a Singapore-founded health tech start-up - and found that people with no prior experience can be trained to perform accurate heart scans. With two weeks of training, people without experience were able to produce accurate readings of complete echocardiogram reports for 96 per cent of patients, in an average of about 11-and-a-half minutes compared to an hour at the hospital, not including appointment wait and travel time.
Third, shifting the centre of gravity of a nation’s entire healthcare system invariably requires substantial funding, both in rolling out new programmes and subsidising the out-of-pocket costs of participating patients to shape new behaviour.
KEEPING UP GOOD HEALTH OUTCOMES
Even as the healthcare system moves to meet population health needs that are growing beyond the capacity of hospitals, will patients embrace out-of-hospital care?
Our research found that patients consider these factors important when it comes to new ways to deliver care: Facilitating conditions (such as infrastructure, technical support and ease of access); and performance expectancy (accuracy and efficiency). Interestingly, patients also consider hedonic motivation - or the enjoyment of using the system - which can shape behaviour and usage.
Patients have gradually warmed to telemedicine apps, where they can have video consultations with doctors for simple ailments or more complex health concerns.
The Ministry of Health (MOH) has been taking gradual steps to transition from in to out-hospital care. This includes setting up the MOH Office for Healthcare Transformation, dedicated to more fundamental, system-level changes, such as providing hospital-type care in a “virtual” ward at home in a recently expanded pilot called Mobile Inpatient Care-at-Home.
Increasingly, polyclinics or general practitioner clinics organised into a Primary Care Network are tasked with outpatient care responsibilities, from follow-ups for patients discharged from the hospital or responding to the needs of at-home patients to managing more complex chronic conditions.
New technology and initiatives are paired with a rigorous evaluation programme to determine if out-hospital care can deliver good or similar outcomes compared to what’s achievable from in-hospital care, with an increase in efficiency.
Ultimately, even if Singapore is currently recognised as having a good healthcare system, we will need to keep anticipating and improving to ensure we stay so in the long run.
Clinical Assistant Professor Huang Weiting is Consultant at the National Heart Centre Singapore.
