Telehealth gaining traction, though ethical and legal issues persist

SINGAPORE — Telemedicine is gaining more ground in Singapore, from progress seen in hospital programmes to new platforms coming online for patients to seek out and book healthcare professionals.

Some of these latest developments were shared yesterday at the TeleMedicine – Future of Healthcare session at the biennial Singapore-Malaysia Congress of Medicine hosted by the Academy of Medicine, Singapore.

Telehealth programmes help medical professionals to monitor patients and their conditions remotely, often through wireless medical devices in their homes. Such a programme at the National University Hospital (NUH), now caters for around 3,000 people. These include post-heart-attack patients and heart patients who have just started on insulin.

The Outpatient Telehealth Initiative has helped patients — such as those with heart failure — since 2014, and about 50 to 60 are joining the programme every month.

Some patients are required, for example, to measure their weight daily.

“If a patient suddenly gains weight, that means he’s about to go into heart failure,” said Associate Professor James Yip, National University Health System’s chief medical information officer and senior consultant at the Department of Cardiology, National University Heart Centre. “The main thing is to pick up events at home which you would otherwise not know if you saw the patient only in clinics, say once a month or once in a few months.”

When it comes to web media tools, a Malaysian healthcare platform called BookDoc helps patients find medical professionals, including doctors, specialists and dentists.

Users can also download a mobile app.

Launched in 2015, BookDoc is now available in Singapore, Malaysia, Hong Kong and Thailand.

“Globally, no platform out there has done what we’ve done,” said its founder Chevy Beh. “We’ve integrated with the whole (system of) thinking of the patient’s journey.”

Once a user has made a booking, he or she can find other online services he needs for his consultation.

This includes navigation tools such as Google Maps, or transport services such as Grab and Uber, to reach a clinic.

The platform also allows users to sync their fitness trackers such as Apple Health, S Health, Fitbit and Jawbone so that they can track their average steps per day and earn rewards every month from retail partners.

A recent feature of the app, Health Info, keeps users updated on the latest health tips.

“You can check by country all the news ... anything you want to read, it’s all in there,” said Mr Beh.

With telemedicine’s growth in the healthcare industry, however, ethical and legal issues could crop up, one medical professional said at yesterday’s session.

“(The issues) are not new, but they do amplify some of the existing challenges we’ve been thinking about but have yet to resolve in a comprehensive way,” said Dr Calvin Ho, assistant professor at the Yong Loo Lin School of Medicine’s Centre for Biomedical Ethics.

“For instance, protecting privacy and confidentiality is not new, but telemedicine could make it an even greater concern, since a lot more data will now be collected and used.”

Dr Ho also said that telemedicine “presents regulatory concerns about product liability and safety”.

In September last year, the Health Sciences Authority proposed regulatory guidelines for telehealth devices. Public consultation has been completed, and a review is under way.

Dr Ho noted that a telehealth device would be under the HSA’s regulatory control if it is to be used for medical purposes, but not if it is deemed to be for lifestyle purposes.

“Whether all telehealth devices would neatly fall within one category but not the other is still very much a discussion topic,” he added.

“It will be interesting to see how the HSA’s finalised guidelines will shape up.”