Page 11 - HA Convention 2016 [Abstracts (Day 1)]

Symposiums HOSPITAL AUTHORITY CONVENTION 2016

S4.2 Telemedicine in Chronic Disease Management 16:15 Convention Hall C

Telemedicine in Chronic Lung Disease in Hong Kong
Choo KL
Medicine, North District Hospital, Hong Kong

Telemedicine is the provision of healthcare to patients in the community through the use of information technologies. This can
involve data transmission (telemonitoring) or ways to improve patient access to educational tools (telehealth).

Telemonitoring

At North District Hospital (NDH), telemonitoring was initially used to provide physiological data on chronic respiratory failure
patients receiving home non-invasive ventilation (NIV). With time, pulse oximetry telemonitoring was utilised to monitor
ambulatory patients who were marginally hypoxic. This was particularly useful for continuing management of patients
discharged early into a Hospital-at-Home programme. Titration of NIV or oxygen flow settings naturally became part of
the response plan to patients deteriorated in the community. Objective data formed the basis of communication between
community and hospital healthcare providers (HCP). Moreover, caregivers of telemonitored patients became active partners
of healthcare delivery.

Telehealth Tuesday, 3 May

Various telehealth systems enable patients to participate by answering questions on symptom scores. The first generation
of patient-reported outcome tool at NDH involved the use of a locally manufactured tablet device. Through regular reporting,
chronic obstructive pulmonary disease (COPD) patients gained an increased awareness of their disease. HCP were also
alerted when patients’ symptom scores were higher than preset threshold. This then led to a timely contact with patients
by phone or home visit to initiate exacerbation management. The second generation device now incorporates automated
feedback that provides information based on symptom severity. Animated audiovisual information reinforced HCP’s advice
when patients’ symptom scores worsened.

Telerehabilitation

As part of an ambulatory pulmonary rehabilitation programme, physical activity can be telemonitored to assess patients’
compliance to exercise. Encouragement is provided via prompt audiovisual feedback and patients can be connected on a
common platform.

Closing the loop

Structured disease management algorithms, staff trained in data interpretation and a response team’s support form essential
components of a telemedicine service.

S4.3 Telemedicine in Chronic Disease Management 16:15 Convention Hall C

Telemedicine for Chronic Heart Disease in Hong Kong — Care from a Distance?
Fan K
Cardiac Medical Unit, Grantham Hospital, Hong Kong

The term “telemedicine” has a broad definition — “medicine practiced at a distance” with a wide range of telemedicine
applications applied in management of chronic diseases; either in form of information technology or delivery of clinical care.
It is not a separate medical specialty: patients’ consultations via video conferencing, transmission of still images, e-health
including patients portals, remote monitoring of vital signs, continuing medical education, and nursing call centres are all
considered part of telemedicine. Broadband internet technology has made these transmissions affordable and available to
our wider community, making this a feasible alternative to the conventional system.

Among most chronic diseases, the largest number of clinical studies and reviews on the use of telemedicine is heart
failure, which seems to have the most favourable results. Heart failure continues to be a major burden on our healthcare
system, in particular, on the cost of hospitalisation. Readmission rate and hospital length of stay are emerging as quality
markers of heart failure care. Apart from maintaining quality assurance, the disease process of heart failure per-se requires
close attention in order to prevent acute de-compensation episodes. Remote monitoring is morphing into a key disease
management strategy to optimise care for heart failure. Various mechanisms of patient monitoring at home and interventions
have been studied. These included structured telephone monitoring, monitoring with home-based portable technology,
monitoring with specially designed wearable or implantable electronic devices with specific device diagnostics. Innovative
implantable technologies for intra-cardiac haemodynamics monitoring are evolving, which potentially could offer better and
substantial parameters to monitor.

The effects of telemonitoring will most likely be better when technology is used as part of a comprehensive and integrated
care package that involves multidisciplinary programme components recommended by clinical guidelines, for example,
patient education, appropriate pharmacological treatment and psychological support. The explosion of social media and
smart phone applications is a potentially untapped resource in creating a patient centred system in future.

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