Video Consultations for Non-emergency Acute Conditions at All Polyclinics

14 Mr David Hoe asked the Coordinating Minister for Social Policies and Minister for Health (a) whether all polyclinics currently offer video consultations for non-emergency acute conditions in a primary care setting; (b) if not, whether there are plans for polyclinics not offering such telemedicine services to introduce them; and (c) if so, what are the expected timelines for implementation in these polyclinics.

The Senior Minister of State for Health (Dr Koh Poh Koon) (for the Coordinating Minister for Social Policies and Minister for Health): Sir, the video consultations at polyclinics are generally limited to patients who had previously attended in-person at the polyclinic and for specific indications, such as follow-up of minor acute conditions, to review test results or to monitor patient's recovery. This ensures adequate clinical evaluation of medical conditions. Where clinically appropriate, such appointments will be arranged by the polyclinic.

At the point of teleconsultation, if new or worsening conditions are identified, the video consultation will not proceed and the patient will be advised to seek an in-person consultation instead.

Teleconsultations for common acute symptoms like cough and cold with accompanying medical certificate issuance are not typically offered because these are already well-provided for by private sector players. And while SingHealth Polyclinics currently offers this service under a cluster-run pilot, there are no immediate plans for a broad-based expansion across all polyclinics.

Mr Speaker: Mr Hoe.

Mr David Hoe (Jurong East-Bukit Batok): I thank the Senior Minister of State for his response. I have three supplementary questions.

I understand that telemedicine is suitable in certain circumstances and as of today, SingHealth serve the East side with telemedicine for acute conditions. I would like to just clarify again whether the Government would consider expanding to the two other health clusters serving in the West side of Singapore and also the Central region of Singapore.

My second question is, if we do expand, what is the Ministry of Health's (MOH's) view on the services that the polyclinics will provide? Would it be similar or different to the private telemedicine? If so, what are the principles that guide this decision?

Finally, on eligibility, currently today for SingHealth Polyclinics, a patient has to be at least 18 years old. Whereas in the private teleconsultation, they have different thresholds. Can I understand what is the rationale and are there plans for a more consistent guideline nation-wide for the minimum age to access tele-consultation?

Dr Koh Poh Koon: Mr Speaker, I thank the Member for his three clarifications.

On his first question regarding services provided at three polyclinics, let me just clarify with him that actually all three polyclinic clusters currently do offer video consultation for follow-up of acute conditions. In other words, not for the first consultation, but for follow-up care. As I explained in my earlier reply, it really is to provide a good assessment of the patient's condition so that there is some assurance in terms of the quality of follow-up care through the tele-consultation means, in which the doctors may not be able to examine the patient. So, it is really to just risk stratify and make sure that even while we offer convenience for the patients, their care is not compromised.

And SingHealth Polyclinics, while they also offer acute video consultation for the first attendance, as I said earlier, this is still under a pilot and there are currently no plans to expand this. Typically, the polyclinics will have to take into account their own resourcing and the needs of the patients. So, they are now, at the moment, for the other polyclinics in the other two clusters, they are now focusing their resources on chronic disease management, which includes telehealth for chronic diseases as well. So, it is offered, but to a more conscribed group of patients and not for acute conditions as a first presentation.

The second clarification on the differences between what we provide at the polyclinics and the private sector, well, the polyclinics are guided by how best to meet the needs of their patients, while ensuring good care, at the same time, is provided in a safe and efficient manner. MOH is monitoring the progress of the pilot by SingHealth Polyclinics and we will take lessons from that and see whether there is a scope for us to implement it more widely, and also to learn from it and see how it reflects or complements what the private sector is already currently providing.

His third clarification on the age criteria, SingHealth Polyclinics in the pilot project has a cut-off age of 18 years old, but this is based on the polyclinic's definition of what is deemed as a child and what is deemed as an adult. So, this may be different from what the other clinics are using, and given the nature of this pilot being an early attempt to look at how it can be used for acute conditions, SingHealth is taking this 18-years-old cut-off as a more cautious approach to ensure that only adults are included in the testing of this service.

In terms of guidelines, there are circulars issued by the Ministry to the service providers regarding how they should use telehealth services and how they should structure those services. But it will be quite difficult for us to provide a very prescriptive, line by line guideline for every possible condition out there. So, in general, we issue guidelines to give broad guidance and to make sure that providers assess patients' suitability for telehealth holistically, including their condition, their age, their ability to communicate using telehealth, like say, through a video conference.

At the same time, we think that the providers should be given enough latitude to exercise their own judgement, because even while doing a telehealth, video consultation for a supposed simple condition at presentation, if the provider detects something that is somewhat more sinister and perhaps needing more evaluation, they should actually get the person to attend in-person and make a thorough evaluation with an examination, for example. There are times also where in telehealth consultations, the person may say there is no pain. But when you look at the person on the video, he obviously is not looking too good. That is why judgement is still needed even in providing convenience.

Ultimately, what we want is to make sure that whatever guidelines we give to our providers, we are not conscribing and constraining their ability to make the right judgement. All healthcare providers, typically doctors, are trained to picked up conditions that they may have to be cautious about. Ultimately, the bottom line is this: you can offer convenience, but that should not replace the need for patient safety and making sure that you discharge your duties in a professional way, looking at patient safety and outcome as a key priority.