Authors (including presenting author) :
Yuk DKL(1), Lam PL(2), Ho EYL(2), Yeung W(2), Lee ISC(3), Ng WWL(1), Choi CSW(3), Leung CB(4), Hui HL(5), Tang MWS(1), Hui E(1)
Affiliation :
(1)Department of Medicine and Geriatrics, Shatin Hospital, (2)Cheshire Home, Shatin, (3)Information Technology Department, NTEC, (4)Department of Medicine and Therapeutics, Prince of Wales Hospital, (5)Information Technology and Health Informatics Department, HAHO
Introduction :
A pilot project utilising the video-conferencing feature (Skype for Business) on mobile devices (iPads) to provide telecare was commenced in Cheshire Home, Shatin (SCH) from June 2019. SCH is a 304-bed in-patient infirmary and rehabilitation unit in the New Territories East Cluster, comprising of infirmary wards for CIWL and local infirmary residents, and Chalets for moderately disabled persons. All wards are equipped with iPads since 2018. There are a total of 4 case doctors providing frontline clinical services to the unit, including one full-time doctor on-site during office hours. Full-time nurses are on shift duty round-the-clock; however there are no on-site doctors after office hours or during public holidays. After-hours off-site medical consultations are partly supported by SCH doctors, while others by on call doctors from the Department of Medicine and Geriatrics in SH. All doctors of SCH are provided with a designated iPad by the Hospital Authority (1D1P), to assist them to perform off-site clinical support to the unit after hours. The doctors' iPads are further equipped with corporate-provided 4G SIM cards, distributed via a “proof of concept (POC)” project supported by HAHO to Cluster IT. Off-site doctors could access the clinical management system (CMS) under a secured environment, including the use of IPMOE and viewing of investigation results outside the hospital. With the increasing use of Zoom as an application for telemedicine locally since the COVID-19 pandemic, together with the rather tedious internal application and installation procedures of Skype for Business, SCH has migrated from Skype to Zoom since December 2020.
Objectives :
To evaluate the level of concordance between real-time video-streams and face-to-face doctor consultations during diagnostic processes. To demonstrate that telemedicine is a useful aid in clinical situations where interactive doctor-patient consultations provide additional information to enhance diagnostic accuracy when the doctor is not on-site.
Methodology :
As an enhancement feature of the wards' and doctors' iPads, a video-conferencing (VC) software (Skype for Business) was installed with corporate accounts registered by the Hospital Authority. In the run-in phase of the pilot (June to August 2019), the on-site doctor assessed (+/- communicated with) infirmary residents in the wards through the VC software on their own iPads (with 4G SIM) for teleconsultation with the ward iPads (using hospital wifi) manipulated by ward nurses. After the teleconsultation, the doctor attended the resident face-to-face immediately, with the aim to compare the differences in diagnosis and management plans formulated via VC versus on site. Evaluation of user satisfaction of doctors, nurses and residents (if mentally capable and communicable) were performed for each episode in the pilot (run-in) phase.
Result & Outcome :
There were 30 episodes of teleconsultations in the run-in phase. The categories of consultation were diverse, including skin problems, joint swelling, gum bleeding, eye problem, chest symptom (SOB) and viewing ECGs. Degree of concordance in diagnosis was 98.3%, and that of treatment plans was 98.6%. Staff satisfaction was favourable, scoring high on “enhance case presentation by ward nurse to doctor” and “enhance patient care overall”. Among the mentally capable residents participating in 11 of these episodes, they expressed satisfaction towards “enhance realtime communications” and “enhance patient confidence in formulating appropriate diagnoses and treatment plans”. It was also observed that the average number of acute hospital transfers were reduced during the same period compared with that of previous years. Conclusion Telemedicine via iPads is a potentially safe and effective means to support off-site medical consultations in an infirmary setting. With its popularity and user-friendliness, SCH has migrated from Skype for Business to Zoom as the first-line teleconsultation tool since December 2020.
