Abstract 370: First of a Kind Telehealth Implementation Study in Singapore: Methodology and Challenge to Tailor to Asian Healthcare System
Authors: Riistama Jarno , Pauws Steffen , Tesanovic Aleksandra , Cheong Jenghis , Erazo Fernando , Bruege Armin , Parkerson Sara , Chow WL , Tong S C , Ahmad Atikah Bte , Ng A , Phang A , Yap M F , Cao Y , Leong K T Gerard 
Published: March 2022

Introduction:
The Eastern Health Alliance (EHA) and Changi General Hospital (CGH), Singapore, implemented a new, localized telehealth (TH) program for heart failure (HF) patients. The first of its kind in Singapore, the program allows healthcare professionals to remotely monitor, provide clinical intervention and educate HF patients after they have been discharged.

The current long-term HF outpatient management does not allow the cardiologist to provide close monitoring of patients at home in the immediate post discharge period. Without a common platform for primary care physicians (PCP) and specialists to monitor HF patients, it is challenging for the PCPs to be involved in the post discharge care.

Currently, patient education and coaching, essential for enabling effective self-management, is mostly done in person in the outpatient setting by HF nurses. It is challenging to scale the program to cover the whole HF population.

Methods:
EHA and CGH worked with the service provider to develop a localized TH program supplementing the existing post-discharge care pathway. The program leverages on the use of tablet devices adapted to the needs of local population - 3 languages, look and feel and educational content. This is particularly important as Singapore is a multi-ethnic country where elderly patients prefer to communicate in their own native language.

TH coaching component is focused on engaging the patient in his health management. TH will enable educating and coaching patients remotely using videos and quizzes to test information retention. TH will allow time for the nurses to identify and address knowledge gaps during their interaction with the patients. The program aims to recruit a family physician to provide further clinical management advice and support.

The program addresses challenges in long-term HF management on scalability, patient engagement, safety, clinical- and cost-effectiveness. The program comprises of two phases: Phase I is used to prove patient safety of the intervention and phase II will focus on reducing the number of unplanned HF hospitalizations (primary outcome), mortality, hospital service utilisation, patient satisfaction, quality of life and disease knowledge (secondary outcomes). The outcomes are measured 12 months pre and post introduction of the program. In total, 200 patients will be enrolled to the program. Incremental cost-effectiveness of TH will be estimated against historical and additional control group without TH intervention.

Expected results:
The program is expected to reduce unplanned HF admissions and as secondary outcomes, reduce number of HF related bed days and length of stay, higher patient satisfaction and better patient HF knowledge levels, without compromising patient safety. A TH solution is expected to meet high standards in patient safety, clinical effectiveness and cost-effectiveness in Singapore.