The prefix “tele” comes from a Greek word that means “far off”. On the account of COVID-19, “tele” concepts have been widely used: telemedicine, teleconsultation, telehealth, and tele monitoring. For a handful of hospitals in Asia, however, these concepts have been in use since several years ago and have just been adopted more resolutely during the management of the pandemic.
Columbia Asia Hospitals have employed tele monitoring technologies for several years now. In an interview with Hospital Insights Asia, Manisha Kumar, Hospital Head and General Manager, shares how Columbia Asia Hospitals India have extensively used remote monitoring for diagnostics, in-patient care, and outpatient areas.
Tele monitoring technologies
In order to provide access to timely and quality radiologic interpretations that help in diagnosis, the hospital has a “full-fledged tele radiology setup which consolidates radiology operations across the group and works as a hub and spoke model linking all network hospitals to one radiology reporting centre for centralised 24X7 reporting and subspecialised reporting services”. Through this setup, more than 1,500 radiologic images from various hospitals in India, Southeast Asia, the Middle East, and Africa are sent over a secured virtual platform and reported by a pool of expert radiologists.
Columbia Asia Hospitals India also employed the step down ICU (Intensive Care Unit) technology that operates with a centralised monitoring system. This specific tele monitoring setup aims to manage patients who require a level down of critical care services and close monitoring at the same time. Healthcare providers like nurses, caregivers, and physicians, are able to view patients’ vital statistics, such as electrocardiogram, saturation, pulse, and heart rate, on their mobile phones at any time, thus, can review and order instructions remotely. With a centralised monitoring system through a tele-ICU and remote monitoring ICU solutions, Columbia Asia Hospitals India can maintain superior clinical outcomes while successfully managing a large number of critical care patients using the same number of resources.
As with other technologically advanced hospitals, Columbia Asia uses wearable devices, in particular patches and Bluetooth-enabled glucometer devices, for outpatient management of patients with chronic conditions. The hospital does remote monitoring for patients with diabetes and cardiovascular diseases. To illustrate, all data recorded on the glucometer wearable device will be shared with a diabetes educator who is assigned to closely monitor the patient and assist in the timely interventions and titration of insulin levels and medications. Through tele monitoring using medical wearables, healthcare providers can better manage their patients’ health on a real-time basis. Plus, doctor consultations are more meaningful and limited, allowing patients to save both time and money.
Business model for tele monitoring
Apart from helping patients, especially those in outpatient care, cut down on cost, tele monitoring can be monetised. What Columbia Asia Hospitals do is include the cost of these devices in insurance bills sent for claims. However, insurance claims are a challenge for some patients considering the insurance penetration in India is still very low. Columbia Asia Hospitals India implements an additional daily charge of the use of these remote monitoring technologies, which Kumar describes as a “comfortable bet” given the overall cost of care and hospital stay between critical care and step down setup will go down for the patient.
Meanwhile, quite a few of the tele monitoring systems pay for themselves and do not need to be charged to patients at all: the cost of the central monitoring system they use to send patients’ vital statistics to healthcare providers’ mobile phones is covered by the solution itself by justifying the number of healthcare professionals needed per patient bedside.
Choosing remote monitoring devices
The tele monitoring market is anticipated to grow particularly at a time when physical interactions are discouraged. Kumar shares the criteria followed by Columbia Asia Hospitals in employing remote monitoring devices.
First, the device should serve as a solution to a problem faced by the hospital and its patients. For instance, if a high-volume organisation is concerned about the turnaround of beds, specifically to cater to the high demand of critically and severely ill patients, a step down unit or a tele-ICU can solve the problem. Home-monitoring post-surgery and similar technologies may also be viable solutions to free up some much-needed beds.
Second, the device must be compatible with other patient monitoring equipment in use. It is equally important that the technology can be customised according to the user’s needs, and be flexible enough to be integrated into the hospital information system.
Third, the device should have a reasonable cost. Likewise, the cost must be justified by the value that the device adds to patient outcomes.
Additionally, the device should also comply with regulations in the country. In India, the regulatory environment encompassing remote consultations and monitoring has evolved over the years and especially more firmly during the COVID-19 outbreak. Fundamentally, the regulatory framework in India includes taking medical consent of the patient, using devices approved by the FDA, adhering to principles of medical ethics including protection of patient privacy and confidentiality, and ensuring data privacy.
Taking into account all the above considerations, a healthcare provider like Columbia Asia Hospitals not only ensure excellent clinical outcomes despite physical boundaries but also encourage digital revolution in the healthcare industry.