Technology Extends Care Beyond Hospital Walls

Singapore, August 3, 2016

NCS Continuous Care Management
A  typical cardiac acute care scenario would see an elderly person like 75-year-old Mr Chan who has diabetes, suffer a sudden onset of myocardial infarction and then undergo coronary intervention. Before being sent home to recuperate, the hospital can set up a care plan for him and specify his daily tasks that include continuous monitoring of clinical condition, medication, exercise and diet compliance, and daily physical assessment. 
This allows Mr Chan to recuperate at his home where his disease progression is tracked to enable early intervention in the event of deterioration. This is an example of how smart technology can boost patient engagement to manage chronic disease, extending the reach of the care provider into the home of patients.
The world faces a growing ageing population. The global share of older people (aged 60 years or over) increased from 9.2% in 1990 to 11.7% in 2013 and will continue to grow as a proportion of the world population, reaching 21.1% by 2050, according to the United Nations. 
In Singapore, the number of seniors aged over 65 years will more than double from 430,000 today to over 900,000 in 2030. By then, 1 in 5 Singaporeans will be 65 and above as compared to 1 in 9 today. The combination of a shortage of healthcare resources and an ageing population coupled with the rising trend of chronic illnesses, growing healthcare costs and a strained healthcare system are drivers for innovations in the healthcare industry. What is needed? 
New cost-effective healthcare delivery models that use technology to manage healthcare quality and costs. This would include the use of home monitoring and tracking applications that reduce the need for hospitalisation, the use of sensing technologies to alert care provider when medical attention is needed, or Internet video conferencing capabilities to allow patients to interface with a medical personnel without having to set foot in a clinic or hospital. 
A Patient-Centred Model for Home Care 
NCS believes that technology can help provide continuous care, or patient-centred home care. This would include the early detection and treatment of diseases to halt or slow its progress while encouraging personal strategies to prevent recurrence, and implement homebased care plans to return people to their original health and prevent long-term problems. 
The NCS Continuous Care Management (CCM) solution can benefit three main groups of patients:
Newly discharged patients from acute care who require continuous monitoring to ensure smooth recuperation.
Patients who require chronic disease management such as those with diabetes who require daily monitoring.
Elderly patients who live alone and require care monitoring due to factors such as senility, frailty, proneness to fall, etc.
NCS CCM enables patients and elderly to follow through clinician-defined daily care plan to monitor their health, wellness and compliance to medication, diet and exercise, and use telehealth technologies to measure patients/elderly clinical conditions and send health data to care providers. Care managers are enabled with an easy-to-read, intuitive dashboard on patients’ conditions which can prompt auto alerts about clinical anomalies by analysing patients’ clinical and daily living data. This allows for early intervention to prevent further deterioration.
Patients and elderly are further supported by an online care community through advice, education and mutual/moral support, while being able to access essential information and services to care for their health. CCM goes beyond tracking the physical well-being of a patient, and is designed around three holistic aspects of well-being:
Physical: Track the patient’s vital signs through telehealth and monitoring devices.
Behavioural: Use analytics to unveil patterns so as to allow for a more individualised patient-centred response.
Psychological: Provide the patient with support as well as goals to keep him/her engaged and motivated.
Quality Care At Home 
Back to Mr Chan, whose care plan specifies the devices used to monitor his vital signs and care plan compliance, which includes wearable ECG, sensor mat for heart and breathing rate, daily blood pressure monitoring, a panic button, medication pill box, motion sensor and a glucometer. His Care Manager (CM) at the hospital had also set various parameters for alerts and specified the course of action when vital signs are detected to be out of range.
The CM can use the Care Manager Dashboard to review the vital signs of several patients that he/she is tracking. On a typical day at home, Mr Chan uses the CCM Patient Dashboard to  access his care plan. Lying in bed, the Smart Mat monitors his sleep patterns and can alert the CM if Mr Chan has been in bed for too long. Then the CM can give Mr Chan a call to understand his condition.
When Mr Chan is up, he turns on the Android tablet where he is greeted by the Care Plan Dashboard, on which he selects My Care Plan which takes him through his daily tasks. These include the medication to take, a reminder to measure his blood pressure and glucose, and to exercise.
A week later, Mr Chan is alone at home, slips and falls in the toilet. If he is conscious, he can press a panic button that is a wearable pendant to send an alert. However, if he is unconscious, the sensors in the toilet detect a person lying motionless on the floor, and a smart algorithm will confirm a fall has taken place in the toilet by interpreting the information from the sensors. Both the CM and Mr Chan’s son will receive alerts on their mobiles.
When the CM and Mr Chan’s son attempt to communicate with Mr Chan through the speaker system in the toilet and receive no response, they confer and decide to send for an ambulance. The son arrives in time to open the door and check on his father, when the ambulance arrives and brings Mr Chan to the hospital.
The use of sensors placed strategically in Mr Chan’s home can allow the CM to track his well-being. For instance, activation of sensors on the fridge, kitchen door, and kitchen tap can suggest that he has entered the kitchen to have his breakfast, and washed up after breakfast. Such tracking of activities is important to ensure that Mr Chan has not skipped breakfast to prevent his blood sugars from falling after diabetes medication.
In summary, healthcare technology like sensors, analytics, and care management solutions can be leveraged to collect valuable patient data so as to provide actionable insights. With the challenges of a rapidly ageing population, there is significant potential to reduce cost and enhance the healthcare delivery for the ageing population.
Thought Leader:
Chan Kah Choon
Sales Director, Healthcare,
Commercial Large Enterprise