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Vol 20, No. 06, June 2016   |   Issue PDF view/purchase
How Technology Helps in Care Coordination: Telehealth?
Fernando Erazo
Head of Healthcare Informatics, Solutions & Services
Philips ASEAN Pacific

Fernando Erazo is the Business Leader for Philips Healthcare Informatics, Solutions and Services (HISS) in ASEAN & Pacific and a member of Philips Health Systems regional leadership team. His business portfolio in ASEAN & Pacific includes electronic medical record (EMR), picture archiving and communication system (PACS), cardiology informatics and advanced visualisation – these are Philips Healthcare IT solutions, some ranked best in class, with decades of proven value especially in radiology, cardiology and oncology clinical domains.

Fernando believes that information without action is inadequate and nowhere more poignantly so than in healthcare where there is a growing boom of data. He has a key interest in trying to bring about changes in the healthcare industry by focusing on three main aspects.

First, leverage data from a growing array of technologies, professional diagnostic modalities and patient-owned devices that generate ever more information from structured, unstructured, deeper, broader and denser data-sets.

Second, collect data from bigger and better stratified populations – citizens, consumers demanding higher quality services at acceptable cost to address growing needs of increasingly complex and more elderly patients.

Lastly, analyse data from inside and outside of the hospital by connecting care wherever it happens: especially in lower cost settings, including the home.

Fernando’s role at Philips is to partner health systems to securely connect relevant data in a seamless and clinically-responsible way (both on-premises and in the cloud). His main aim is to make healthcare data actionable, valuable for diagnostic or treatment decisions by integrating data into clinical workflows. Fernando and his team help CIOs to manage the data explosion by addressing all data sources today (across all care settings, including the home) as well as innovating the next frontier, by integrating digital pathology and genomics data, to name a few. Fernando believes in unlocking data to provide the bigger picture of a patient’s (and entire population’s) health. Philips is leading this transformation, as data powers new models of personalised care, from prevention to treatment, all the way to recovery and long-term care.

Fernando holds a double-degree in Physics & Computer Science from Knox College in Illinois, United States, as well as a Masters’ of Science in Software Engineering from Groningen University, Netherlands.

  • What is Philips’ future plan and commitment in terms of digital health in Singapore?

    Philips’ vision is to improve the lives of three billion people a year by 2025. We understand that Asia’s healthcare industry is facing several challenges and pressures today, including an ageing population, rising chronic diseases and lack of hospital beds. We believe that technology and digital health will play a fundamental role in addressing these challenges in the region, as well as in Singapore.

    Therefore, we aim to continue developing and advancing our healthcare solutions, as well as to build a robust digital health ecosystem to serve the needs of a growing and ageing population in Asia. Our new regional headquarters, the Philips APAC Centre – opening in May – will help us to achieve this through our world-class facilities for customers, partners and employees to come together to collaborate, design and develop innovations to capture the Healthcare Technology opportunities together.

    Beyond continuing to design and develop meaningful solutions that will help people live healthier lives, we are also committed to fuelling the growth of innovative digital health industry. To strengthen our commitment, we are collaborating with Singapore organisations by enabling access to Philips experts, our ecosystem of healthcare solutions and our extensive global network. In January this year, for example, we signed a Memorandum of Understanding with the Singapore Economic Development Board to jointly invest in select, high-potential digital health companies from around the world especially in the area of Population Health Management, and to develop Singapore’s workforce to further strengthen the country’s position as the leading medical hub in Asia.

  • How Philips Singapore delivers effective telehealth program in an effective way in terms of cost and quality of care coordination?

    It is our aim to deliver quality care coordination and cost effective programs and solutions to clinicians and individuals. We are already helping over one hundred patients with complex and debilitating conditions like Heart Failure, to live more fulfilling and safer lives with self-monitoring at home. In 2014 we partnered with Eastern Health Alliance and Changi General Hospital to launch their first-ever longitudinal telehealth program in Singapore. The pilot program was launched to support patients proactively over a 12 month period, with a dedicated, remote clinical team that connects to patients living at home through the Philips telehealth platform. Our vision is to scale such programs nation-wide and across many other disease spaces, not just for complex heart conditions.

    In addition, here in Singapore we are also designing new programs to improve the lives of people in countries with less comprehensive health systems. In Indonesia, for example, we launched the Mobile Obstetrics Monitoring (MOM) program in January. This scalable smartphone-based digital health service is designed to identify mothers-to-be who are at high risk of pregnancy-related complications and help reduce maternal mortality rates. The pilot had over 650 pregnancies within the program. Not a single woman died from preventable causes related to pregnancy and childbirth through early monitoring and risk stratification. In Singapore and elsewhere, our mission is to deliver new models of care that allow patients to receive help earlier.

Dr. Michael J. Breslow
Vice President of Clinical Research and Development,
Philips Hospital to Home
Dr. Michael J. Breslow, M.D., FCCM, is Vice President and head of research and product innovation for Philips Healthcare's Hospital-to-Home (H2H) organisation. Prior to joining Philips, Dr. Breslow co-founded VISICU, Inc., a technology/service company providing innovative solutions for ICU care. Following Philips' acquisition of VISICU, he led research and product marketing for the Philips Enterprise Patient Informatics Solutions business, which included VISICU, Emergin and the IntelliVue Clinical Information Portfolio. In this role he was responsible for product strategy and development activities for US and international markets.

In 2012, Dr. Breslow assumed his current role, leading the development of innovative, highly efficient inpatient and outpatient solutions that enable health systems to improve clinical outcomes and reduce costs for high risk, high cost populations. Dr Breslow has overseen the growth of Philip’s H2H offerings from monitoring ICU operations, to monitoring of general wards, specialist clinics, and to providing care coordination and telehealth services to patients at home. Dr Breslow is a recognised leader in driving forward the vision to enable patients with multiple chronic diseases to age in the comfort of their homes. His role has been instrumental in projects at cutting-edge hospitals like Banner Health and Mercy Virtual, which have implemented full suites of telehealth-enabled care coordination services across the healthcare spectrum.

Dr Breslow also directs the H2H research programs, including the eICU Research Institute that utilises data from more than 2 million eICU Program patients to support academic research, advance the understanding of critical care and drive technical and clinical innovations.

Prior to founding VISICU, Dr. Breslow was associate professor of anesthesia, internal medicine, and surgery at the Johns Hopkins University School of Medicine. During his time at Hopkins, Dr. Breslow directed the Surgical Intensive Care Unit and was head of the Division of Critical Care Medicine. He had a productive research career, receiving funding from the National Institutes of Health and the American Heart Association. His research focused on peri-operative problems and mechanisms responsible for trauma-related complications. He has served on the Scientific Advisory Boards of the Association of University Anesthesiologists and the American Society of Critical Care Anesthesiologists, and on the Critical Care Committee of the American Society of Anesthesiologists. He has been an associate editor of the journals Critical Care Medicine and Anesthesiology.

Dr. Breslow was a magna cum laude graduate of Harvard University in 1972, with a B.A. degree in biochemistry. He graduated in 1976 from the Tufts University School of Medicine and went on to residency training in internal medicine and anesthesiology at Michael Reese Hospital and Massachusetts General Hospital, respectively.

  • Can you briefly describe the current state of the telehealth system in the United States? What are the challenges?

    The USA is adopting telehealth faster and in more meaningful ways than anywhere else in the world. Health systems there are shown to have effectively improved clinical outcomes for patients (with more proactive care) and have improved efficiency for providers. Under the Affordable Care Act (often referred to as Obamacare), providers are starting to manage the whole care picture of entire patient populations – extending care to the home makes perfect sense, so you see telehealth taking a leading role.

    Take the program at Banner Health as an example. The program has been operational for approximately 2 years. They currently have more than 500 patients under care. Major outcomes include a roughly 30% decrease in healthcare costs (15% when program costs are included), a 45% decrease in hospitalisations, and high patient satisfaction.

    While implementing the program, the major challenges encountered were to aggregate all relevant information about new enrolees and to rapidly assemble a complete picture of their needs. In addition, it takes effort to change established behaviours of healthcare providers, specifically when moving to team-based care. This requires a level of communication, standardisation and trust that does not come naturally.

  • Most elder people have reservations with healthcare that involves IT technology. How would it be beneficial for the elderly if they avail of this telehealth service?

    You would be surprised that elderly people in the USA share much in common with elderly people in Singapore: above all, they fear being a burden on their family members. They dislike unnecessary medical appointments and prolonged hospital stays – which telehealth helps them avoid. We have also seen that seniors are quite keen to adopt technologies that deliver clear benefits to them and their families. That said, it’s not a one-size-fits-all solution. There are patients better fit and keener to use these means.

    The key to increase the uptake of technology among elder people is to keep the technology simple and easy to use. And to invest time in helping them to get comfortable with these tools. Most importantly, the member must see value in the tool. For example, a sense of safety as a result of being looked at regularly, easier communication with care givers and the healthcare team, access to education, or feedback on how they are doing.

  • How many telehealth programs have been launched in the United States? Do you think this similar model is workable in Singapore?

    Again, there isn’t a single approach to telehealth. Even in the USA there are a myriad of telehealth programs and we at Philips support hundreds of programs nation-wide, each with tailored solutions to support different groups of patients and their individual needs. Additionally, one must also consider the health systems (i.e. the provider’s perspective): in Singapore, we are aware of clinical collaboration models, hierarchy and culture levers among clinicians one must never ignore. These are factors we take into account when defining locally relevant clinical programs for Singaporean patients and clinicians. We see a bright future for telehealth-enabled care in Singapore.

Prof Lim Yee Wei
Associate Professor, NUS Saw Swee Hock School of Public Health

Associate Professor Lim is a primary care physician and health policy researcher at the at the NUS Saw Swee Hock School of Public Health. His work encompasses two areas: the first is the design and evaluation of health systems in developed and developing countries, and the second is in the area of social innovations in health. Examples of projects in the first area include policy recommendations for the development of healthcare systems in Kurdistan and Qatar; and development of public health preparedness programs for Mekong Delta countries to tackle pandemic flu. He co-led a multi-million dollar Bill & Melinda Gates Foundation project to determine the future of diagnostic platforms for infectious diseases in developing countries resulting in a series of papers that were published in Nature and formed the basis for the Foundation’s Grand Challenges grant call. In 2014, he led an APEC funded initiative to build capacity in health technology assessment for Asia-Pacific countries, including the examination of funding options for public health programs. The second area of his work explores the role of social innovation in health in Singapore and developing countries. Examples of projects include the development and evaluation of a new model of integrated community-based model of holistic care for vulnerable elderly (with Tsao Foundation, Singapore); case studies of Kopernik and John Fawcett Foundation, which both use innovative funding methods to provide public health services to last mile populations in Indonesia and other parts of the world; and with HelpMeSee, to develop and evaluate an innovative approach to cataract surgery training and delivery involving independent private non-physician practitioners serving underserved areas in developing countries.

Associate Professor Lim has co-led the NUS Improvement of Healthcare in Asia (NIHA) Leadership Development Program since 2011. The program trains senior healthcare leaders from the public, private and NGO sectors of Asia-Pacific countries in leadership and health policy development and implementation. He has conducted health policy and leadership training for senior healthcare leaders for Brunei’s Ministry of Health in 2013.

  • Singapore is one of the countries with aging population and rising chronic diseases. How does Singapore monitor and care for the chronically ill patients now?

    Currently, chronic diseases in Singapore are managed heterogeneously. Patients are getting their care primarily from specialists in hospitals, and that a significant number of patients are getting their care within government-run polyclinics. Patient monitoring is generally based on human contact, less use of technology and telehealth.

    Comparatively speaking we see fewer patients go to GP for care of their chronic diseases, such as diabetes. The monitoring of patients with chronic diseases is very much driven by physicians or the healthcare teams, but less by self-monitoring or self-care.

    But what will change is that with the Government’s health system agenda, patients are encouraged to self-care and self-monitor their health conditions. The system will start to rely more on private GPs to provide care for patients with chronic diseases in order to move patients away from specialist care of hospitals. Also the government is encouraging more community based program, such as having allied health professionals to conduct home visits of patients.

  • How is the telehealth program carried out in Singapore? Are there any challenges to launch telehealth in Singapore or in other Asian countries?

    The infrastructure in Singapore is improving. The use of National Electronic Health Records, and the popularity of smart phones in our country which provides a platform to increase the use of mobile health and telehealth technology, are examples of such improvement.

    Challenges in Singapore

    The difficulties are coming from customising the mobile health or telehealth programs. For example, a lot of older people are not as tech-savvy as younger generation and they are much used to getting care from physicians directly. We will have to educate a generation who are used to getting their care in clinics and hospitals, to use different platforms and technology, such as skype teleconferencing, as a way to manage their chronic diseases and to receive their care. So these are the challenges but they are not unmanageable. We just have to help the patients to be familiar with the new technology and what it can offer.

    The healthcare system also faces challenges in implementing telehealth. With increasing use of telehealth, doctors in hospitals or polyclinics have to change the way they offer their care. Instead of face-to-face consultation, they may see their patients via teleconferencing or skype, and may also receive texts from their patients to ask questions or report their progress. They will also use tablets and iPad to look at patients’ results; and administer care through home care and rehabilitative care via telehealth platforms. Therefore, with all the technology advancements it is not just the patients but also the health providers who have to adjust themselves to the new platform of patient care. The change in patient monitoring model requires time to develop required knowledge and confidence.

    There are other system issues that need to be looked at, such as financing. In the macro system, physicians are remunerated by the number of patients they see in a physically location. With the implementation of telehealth, we will need to consider changing the way how doctors are being paid.

    Challenges in other countries

    As for other countries, the big urban cities such as Manila, Jakarta and Bangkok, they may have better chance of developing telehealth compared with the rural areas of their countries. As they have better connectivity between patients and doctors in healthcare institution, better internet infrastructure.

    While it is more challenging to apply telehealth in rural areas, mobile health may be more implementable in these regions as the use of mobile phones has become very important and popular. People use mobile phone to exchange information and to conduct day-to-day tasks such as banking. In light of these facts, mobile health can become an important part of developing countries and more so than using institution-based telehealth platform which we see in developed countries.

    For developing countries in Asia, the major challenge of implementing telehealth is financing – it is hard to finance telehealth if a country is facing socio-economic challenges such as lack of health literacy, or insufficient access to good private healthcare. That being said, the challenge itself can also be an opportunity. We can rethink the telehealth models that we see in Singapore and other more developed urban centres, and to improve some of these technology platforms in order to reach the population.

  • As it is always daunting to start, what approach do you think we should use to persuade older patients who are not IT literate to give telehealth a try?

    We will need to make the platform more culturally appropriate. For example, we can create platforms for non-English speaking patients by using their first language, such as Malay or Chinese, in telehealth platforms.

    The other way is to change expectation of older patients who are used to see their doctors in clinics. We have to convince them that they can have interaction with the health system remotely and reassure them that the quality of care would be equally great even though they are not physically seeing their healthcare professionals in a clinic setting.

    Although changing their mindset may not be easy, we can improve the telehealth uptake of the older patients by peer influence, i.e. to show successful cases of other elderly patients in managing their chronic illnesses. We also need to enhance elderly patients’ confidence in using technology such as iPad, mobile phone, and devices at home to monitor their health parameters, e.g. ECG and blood pressure.

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