Bringing Healthcare Services to the Elderly Using Telemedicine: Khoo Teck Puat, Singapore

Rationale / Objectives

Singapore’s population is aging at one of the highest rates in the world. Elderly patients suffering from multiple conditions require ongoing and complex care. Weekly visits previously made by doctors from Khoo Teck Puat Hospital (KTPH) to St. Joseph’s Home (a nursing home) were costly and time-consuming; as was transporting patients to the hospital. Moreover, the physical presence of a doctor was often unnecessary for treatment. The organizations involved wanted to reduce the burden of providing healthcare services to the elderly by enabling remote consultations.

Project/Program Description & Major Achievements

A telegeriatric system was implemented, involving a dedicated video link connecting KTPH with the nursing home. A camera, microphone and monitor mounted on a trolley were wheeled to the patient’s bedside at the nursing home. Alternatively, a teleconsultation room at St. Joseph’s was fitted with the same equipment for use with patients of higher mobility. A similar setup was installed at KTPH for use by the consulting doctor. A specially trained nurse aided the remotely located doctor in examining the patient. There was a significant reduction in emergency department admissions from St. Joseph’s Home. The planned extension of the program will encompass a total of four nursing homes. After a year, there were over 148 teleconsultations.

Lessons Learned

By receiving healthcare services at the nursing home, rather than at the hospital, patients experienced less stress and disruption to their lives. The training received by nurses who used the telegeriatric system was considered a valuable investment, as it provided them with enhanced medical knowledge and enabled them to function more effectively in all aspects of their jobs. Connectivity issues existed, and often led to repeated confirmation and clarification of instructions. It is expected that inevitable technological improvements will reduce connection dropouts and improve doctors’ visual capabilities. Telegeriatric systems display high scalability, and enable doctors’ expertise to be distributed over an area not limited to their physical location; this is particularly beneficial during crises. Although implementation costs were high, net savings are expected.

Further Description

With support provided by the Agency for Integrated Care, this pilot was implemented in 2010, and involved one of the country’s best known nursing homes – St. Joseph’s Home. Due to the sensitive nature of medical consultations, a secure and dedicated line had to be established between St. Joseph’s and KTPH. The onsite nurse obtained consent from the patient, measured blood pressure and vital signs, and transmitted the patient’s history and other information to KTPH. The camera’s zoom capabilities allowed close-up inspection of the patient when needed. The nurses had to be specially trained in conducting physical examinations, as they were “the doctor’s hands”. This training was accomplished in 24 modules. The consultation form completed by the doctor was sent to the nursing home for their records.

Major Achievements

Metric Result Additional Detail
Number of tele-consultations Over 148 After one year   1