Enhancing chronic disease management through telecare - the Singapore Health Services experience

A telecare project has been established which allows outpatients to monitor their own health with the assistance of SingHealth clinicians. Communication takes place through a Web portal and/or by mobile phone text messaging (SMS). The pilot service has been used by local and overseas patients with chronic diseases such as heart failure, hypertension, renal failure, diabetes and suspected occupational asthma. Through the telecare system, which was developed in-house, clinicians can configure a personalized monitoring plan (vital signs and symptoms) for each patient and follow up with interactive charts. The patient's health data are transmitted to the telecare system by the patient or care-giver, through a Web portal or by SMS messages. If a patient's health indicators fall outside predefined thresholds, clinicians can be alerted by SMS. Patients and clinicians can also communicate through the portal. Apart from chronic disease management, the system has also been used to replace one of the regular clinic reviews for well-controlled primary care patients with hypertension and to facilitate the diagnosis of occupational asthma through monitoring peak flow values during periods at work and away from work. The responses from clinicians and patients have been favourable. Patients have benefited medically from the interventions and their quality of life has improved.