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E-consultations a boon for patients

Video calls with doctors will become common in public healthcare centres soon. This can free up doctors' time for patients who need the personal touch.


If all goes according to plan, video calls with doctors will become part and parcel of the healthcare experience in years to come.

Even so, the announcement that a national video consultation system will be rolled out in all public healthcare institutions has raised a few eyebrows.

"How is it possible for a doctor to give a systemic and rigorous assessment of a patient's condition with only a video image?" one reader wrote in to ask last month.

"If the health condition of a patient... suddenly worsens in the midst of the call, will the hospital authorities be held liable?"

His questions were echoed on social media, with people wondering whether even the most sophisticated technology can match up to a face-to-face doctor's visit.

These are valid concerns, but they miss the point. Telehealth is not for everyone - but it was never meant to be.

Pick your patients right, and it becomes a powerful tool that can make routine consultations less of a hassle for everyone involved.


Last month, healthcare technology agency Integrated Health Information Systems (IHiS) announced the new video call system, which provides a common platform for public healthcare institutions to speak with their patients virtually.

No special equipment is needed - a smartphone will do, or a computer with a Web camera and Internet access.

The new system is available at six institutions so far, comprising four hospitals, the Institute of Mental Health (IMH) and the National University Cancer Institute, Singapore. It will be rolled out to the rest later, and possibly even to the private sector.

This major shift builds on at least 12 years of tinkering with such technology but, even then, the authorities are proceeding with the utmost caution.

Video consultations are available for only a select group of patients who require certain specific services - for example, speech therapy or psychiatric counselling.

Nobody's first contact with a doctor will be on-screen.

It goes without saying that the same applies to those who require a proper physical examination. While many medical specialities may not fall under this criterion, plenty of others do.

"We can, theoretically, do the full consultation without having to touch the patient," said Dr Kelvin Ng, a consultant at IMH's community psychiatry department. "In that way, psychiatry is uniquely suitable for video consultations." Since November last year, Dr Ng and his colleagues have used video-call technology to speak with around 140 stable psychiatric patients from four residential homes.

On average, a fifth of this group would default on their visits. None have done so since the new system was introduced.

Instead, patients simply step aside from their routine activities for their appointments. Immediately afterwards, they can return to whatever they were doing before.

Apart from fewer unused appointment slots, these changes mean time saved on travelling and waiting to see the doctor. It also means that residential or nursing homes do not have to set aside scarce manpower resources for the routine task of accompanying patients to their appointments.

"This is especially significant for those residing in homes for the disabled, because they would require special transportation to ferry the patients... to the clinics," Dr Ng said.

When it comes to technology and healthcare, Singapore has a few things to be proud of.

Less than a quarter of countries surveyed by the World Health Organisation in 2015 said they had a national telehealth policy - including the United States and Singapore.

The Republic also has a nationwide system to organise everyone's virtual health records, which developed countries like the United Kingdom and Japan have not implemented.

These things are important because they mean that all public healthcare institutions are on the same page.

People moving from hospital to hospital can be assured that the healthcare institutions are held to the same standards. Their records can follow them with ease, without having to jump through virtual hoops caused by different ways of capturing information.


And yet, said Mr Ashwin Moduga, who is part of the Health Insights team at IT research firm International Data Corporation, Singapore is arguably behind the curve.

Elsewhere, such as in the US and India, video-call technology has become mainstream among private healthcare providers.

"Practo, a virtual-care company in India, has already reached a stage where they are doing online consultations in the thousands per day," Mr Moduga said.

"Such systems have not yet become popular in the public health system. However, as Singapore is largely a public-governed health system, this move could have come earlier."

After all, this national project has been more than a decade in the making. As far back as 2005, similar trials were carried out on a smaller scale by individual healthcare institutions.

Many were started because getting certain groups of patients - such as the disabled - to routine check-ups often became a time-consuming, labour-intensive process.

Services provided under these trials ranged from dermatology to geriatrics. Often, they required investment in fixed infrastructure to ensure the quality of the call.

Technology has improved since, with 4G mobile networks and state-of-the-art smartphone cameras.

One common argument against making video consultations mainstream is that older people could struggle with this new-fangled technology.

But assumptions like that sell our seniors short. Many have mastered iPads, Skype and touchscreen ATMs - albeit more slowly and with less ease than their children or grandchildren. Why should this be any different?

"I think there's a great misconception about many older people," said Mrs Rebecca George, global lead for public-sector healthcare and social services at consulting firm Deloitte. "I think that a lot more people are happier to use such systems than many might think."

For example, she said, her own parents - who are in their 80s and 90s - regularly use Skype to keep in touch with their children.

"I believe many people would choose the ease of using technology over the hassle of travelling to appointments," Mrs George said.

But what about the group of people who prefer speaking to a doctor in person - regardless of cost or the time taken?

Currently, some hospitals on the new system allow patients to choose between video and face-to-face consultations. Whether this will remain the case once the scheme has been rolled out in full is unclear.

If video consultations are indeed made compulsory across the board, it could prove a bitter pill to swallow for these people, who value the human touch above all else.

However, given how careful the authorities have been about implementing such technology on a larger scale, it seems that they are fully cognisant of the objections.

As Associate Professor Low Cheng Ooi, chief clinical informatics officer at IHiS, said: "This is new, so we are moving cautiously... We can't just throw away the stethoscope and replace it with a camera."

And this is the silver lining: If more people opt for video calls for their routine check-ups, that could hopefully mean doctors have more time to spare for patients in their clinics - where face time really matters.

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A version of this article appeared in the print edition of The Straits Times on May 04, 2017, with the headline E-consultations a boon for patients. Subscribe