Symposium 11 - Telehealth Development and Smart Initiatives

The COVID-19 pandemic has accelerated the development and adoption of teleconsultation and technological innovations which facilitate patients' access to quality and efficient healthcare services. The increasing acceptance of the model by patients has called upon healthcare providers to rethink how the much broader scope of telehealth can be better utilised to deliver healthcare services beyond health consultation, these include allowing healthcare professionals to provide guidance on drug adherence, postoperative care, rehabilitation, health education and more.
Not only has telehealth transformed the way that healthcare is delivered, but it has also presented a new approach in empowering patients and caregivers to play a more active role in self-managing their health and in monitoring health remotely. The past few years have also seen more rapid introduction of relevant services by private care providers, with some developed in collaboration with healthtech companies. 


Outside Hong Kong, there is also an emerging trend of internet hospitals, more notably in the Mainland where online and physical hospitals are combined to provide services from health consultation to diagnosis, treatment and health management. A similar trend is also being picked up in Singapore where virtual hospitals are being piloted with a view towards alleviating stress on inpatient services and enhancing cost effectiveness. This new stream has brought about another interesting topic for both public and private hospitals in Hong Kong to contemplate.

With the collaboration of Hospital Authority Head Office (HAHO) Information Technology Team, Kowloon West Cluster (KWC) Smart Hospital Project Team took the first initiative to design eBedpanel and eVital systems, collect clinical feedback across specialties, source installation hardware, scrutinize operation flow for risk mitigation and set up the first model ward in Princess Margaret Hospital for pilot live run of eBedpanel and testing of eVital signs systems in March and June 2019 respectively. 


eVital and eBedpanel systems are corporate developed information technology (IT) systems, providing a digital platform to handle patients' vital signs data and exhibiting electronic real time display to replace paper vital signs documentation and bed-head signage showing care information to facilitate prompt patient assessment, risk alertness and care decision across disciplines. The team has spotted the great potential and advantages of the systems and decided to have mega-rollout, pursuing to smart hospital development in KWC through incurred benefit of improved patient experience and enhanced staff satisfaction in 2021-23, achieving the strategic goals of smart staff and hospitals in HAHO annual plan 2022-23.


The systems are time and cost efficient, maintaining standardization but balancing with customization in addressing special operational needs of frontline users. During COVID pandemics, systems also helped in infection control and time saving. The collaborative efforts of various stakeholders, including clinical staff, the IT Department and the Facility Management Department, were crucial to the project's success. Their commitment and support, along with management's guidance, led to the positive feedback and successful collaboration, culminating KWC the first cluster in the full completion covering approximately 4,500 beds and 120 wards and allied health sites in four acute hospitals by March 2023. Apart from patient care management, use of the systems also gained significant benefit on green management and cost saving of around 30% by two-year mega rollout.

Introduction
Community Nursing Service (CNS) has long been providing holistic community care aiming to empower patients/ carers for self-care and reduce hospital utilization. Tele-Visit, an innovative strategy of TeleHealth development in CNS, serves as an adjunct to primary mode of CNS outreach service to improve patient outcomes and experience, and reduce workforce pressure. A pilot of Tele-Visit was launched in PMH CNS and UCH CNS to evaluate its feasibility.


Objectives
1. To improve access to care
2. To offer options for patient’s choice
3. To improve clinical outcomes and patient experience
4. To better manage growing service demand


Methodology
With the support from KWC Smart Hospital Management Committee, HA Cluster General Managers (Nursing), HA Information Technology Team and Finance Team, the proposed pilot drafted by the Workgroup on TeleHealth in CNS was commenced in August 2022. The target sample size was 24 involving 12 patients for disease management on Diabetes Mellitus (DM) and Chronic Obstructive Pulmonary Disease (COPD) and 12 patients for wound management on pressure injury (PI) and leg ulcer (LU). Patients under CNS care who were clinically stable with informed consent to Tele-Visit arrangement and good compliance to treatment plan were recruited. Patients were selected by primary nurse/ team in-charge according to a set of criteria. Face-to-face home visitation and Tele-Visit were provided according to a preset schedule. Tele-Visit and patient registration was conducted via the one-stop mobile app, HA Go. 


Result & Outcome
The pilot was completed in May 2023. 6 COPD patients, 6 DM patients, 4 patients with PI and 1 patient with LU were recruited. The results were appealing in terms of user experience, pre- and post-empowerment scores, clinical parameters and hospital utilization. Aiming to achieve a better project evaluation, an extended pilot of Tele-Visit had commenced in the whole corporate CNS in October 2023.