"There is an urgent need for personalised and precision medicine to help the elderly population age with the least disease burden," says Prof Chan.

"...Companies and users alike are getting more interested in monitoring personal health and even safety," says Javier Boon (seated), with Boon Swan Mui (Director).

"I believe that Singapore would do well to train more healthcare professionals in the design, evaluation and implementation of new care models, says Mr Koo.

ROUNDTABLE PARTICIPANTS

Associate Professor Chan Yew Weng, Senior Consultant, Department of Anaesthesiology, Singapore General Hospital

Mr Javier Boon, co-founder of BitCare

Mr Julian Koo, co-founder and CEO of Jaga-Me

Moderator: Chia Yan Min, The Business Times

HEALTHCARE systems across the world - including Singapore - are grappling with ageing populations, higher levels of chronic diseases and the escalating cost of care. These challenges are made more acute by a shortage of healthcare professionals and caregivers.

To meet growing needs, the industry needs to develop new models of healthcare - hence the growing interest in innovative technologies such as remote healthcare monitoring. Such services allow the monitoring of patients outside of conventional clinic or hospital settings, giving them more time at home as well as alleviating caregiver fatigue and reducing the burden on the healthcare system as a whole.

The Business Times brings together an expert panel to discuss the rise of remote healthcare monitoring in Singapore. All three panellists will be taking part in this year's Medical Fair Asia as exhibitors or speakers.

Question: Why is there a growing need for community healthcare and remote healthcare monitoring in Singapore?

Prof Chan: Singapore has a fast ageing population. By the year 2030, we will have more than 900,000 Singapore residents who will be 65 years and above. The majority of these elderly residents will have homes in our Housing Board flats. And at least 10 per cent, or 90,000, of them will be staying alone.

To put these figures into perspective, our first satellite town in Singapore, Queenstown, has an estimated HDB resident population of only 82,800 living in 31,504 HDB flat units (as at March 2017). In 12 years, we will have 90,000 elderly folks living alone in 90,000 HDB flat units.

These exclude elderly caregivers staying with another elderly care-receiver. With most of these elderly citizens suffering from at least one or more of common chronic medical conditions (such as hypertension, diabetes mellitus and hyperlipidemia), it is inevitable that elder-healthcare and elder-support-care will move from our established hospital and step-down care environment into our housing board flat units.

New and innovative community healthcare models using remote healthcare monitoring will definitely grow to meet this demand.

Question: Tell us more about how your remote healthcare monitoring solutions help address some of the pain points.

Mr Boon: When I visited my late grandmother in the hospital, she would complain that it was very difficult to communicate with and get prompt attention from the healthcare staff.

The majority of nurse call systems used by Singapore hospitals and healthcare wards were technology that is more than 20 years old. This spurred us to come up with a more savvy and interactive digital system.

Our solution benefits nursing and healthcare staff the most, as they are the ones providing round-the-clock services to patients. Since there can never be enough nurses to go around for every patient, patients often feel that when he/she calls for a nurse, it can take a long time for the nurses to get to them, or they have to make repeated calls to ensure a nurse tends to them quicker.

Our system solves this by integrating a digital two-way audio call. Nurses can pick up the call through a touchscreen nurse station terminal, or wherever they are in the ward via our newly launched mobile app. This will inform them of what the patients need. They can also let patients know that they will be attended to soon. This allows the nurses to prioritise the patient's needs and the nurses can assure multiple patients that they will be attended to, all while still assisting another patient.

Studies were done on similar solutions and were found to greatly reduce alarm fatigue, while increasing efficacy and productivity of the nurses.

We set up BitCare in 2017 to supply our nurse call system to hospices, nursing homes and hospitals. We started as a father and son team and now have two other staff.

Mr Koo: Jaga-Me is a digital healthcare platform that enables access to on-demand healthcare in homes and communities. Through our web and mobile app platform, Jaga-Me facilitates the delivery of healthcare services and medical goods to patients at home.

The fundamental idea of Jaga-Me is to transform the traditional model of healthcare - from one that is designed to "deliver" patients to "where the care is" - to a healthcare system that is decentralised, and can deliver care to where the patient chooses.

Through Jaga-Me, healthcare professionals (JagaPros) work flexible hours by taking up micro-jobs through our platform.

Our technology has helped reduce the waiting time for home healthcare services by ten- fold, and we've served over a thousand patients through our platform.

Not only does the Jaga-Me platform perform the role of matching supply and demand, it also serves as a health data cloud so that a patient can be cared for seamlessly throughout their journey. This means that reports can be viewed and shared among members of a care team, allowing them to remotely manage a patient's needs, both online and offline.

We were founded in 2015, and are now a 15-person team with the mission to enable access to quality healthcare at home, through a global community care network.

Question: How do you see demand for remote healthcare monitoring services evolving in the coming years?

Mr Koo: Telemedicine via tele-consults have become extremely pervasive. Almost every physician group has a teleconsultation system, or is in the midst of implementing one.

Telemonitoring is still nascent, despite the increase in the availability of off-the-shelf devices that can provide medical- and wellness-grade readings. One key reason is the challenge in integrating the monitoring workflows into the clinic's current patient management process.

Not only are there few patient management programs outside the clinic or hospital, but there has yet to be a payor ecosystem for government and insurers to fund this care model.

Prof Chan: The need for more community nurses and eldercare trained maids to help our seniors age comfortably in their neighborhood will slowly evolve towards the adjunct use of communication robots with artificial intelligence to help the elderly cope with loneliness and depression like in Japan.

Today, most services look after the physical and medical needs of our elderly residents, but these will evolve to include the psychological and mental well-being needs of the individual.

With time, post- surgery rehabilitation and recovery will be moved from the hospitals and day care centres into our individual homes with communication robots encouraging individualised physiotherapy modules to be performed; reminding them the time to sleep, to take medication, and to engage in social conversation and games.

Mr Boon: Based on recent trends in the market and exhibitions, companies and users alike are getting more interested in monitoring personal health and even safety. With such technology getting more affordable, users are able to keep a keen eye on their current health condition and treat any illnesses before it's too late.

Future demand would likely skew towards private home monitoring services especially for the elderly and individuals with special needs.

In anticipation of this, we have remote monitoring services products in the pipeline (including wearables and apps that can link to healthcare service providers or family members).

Question: What are some of the challenges involved in rolling out such solutions in Singapore?

Mr Koo: The adoption of remote monitoring for the management of healthcare delivery will largely be driven by healthcare professionals, as an extension of the work that they do in the clinic. However, the challenge lies in that clinicians need ready-to-use solutions that have been clinically tested and endorsed by the hospital. Such standardisation of devices and data streams has yet to be achieved.

In addition, we are more conscious than ever of the security of health data. This situation could potentially dissuade patients from reporting this data digitally, as well as increase the number of hurdles healthcare and technology providers have to jump through before they can implement a solution.

Mr Boon: Most of our potential customers ask: "Do you have any project references in Singapore?"

Being a startup company, we are often turned away before given a chance to even demonstrate our solutions. Some clients are also reluctant to adopt new and current technology and would stick to dated "tried and tested" systems, unless encouraged by their bosses.

One consultant for a hospital even asked if we had the cheapest and simplest "single push button" nurse call, which rings when the patient pushes a button.

Prof Chan: There is an urgent need for personalised and precision medicine to help the elderly population age with the least disease burden. This requires the ethical use of individual genetic testing and electronic population health records to target inherent disease risks in each individual citizen (such as cancer, Alzheimer's disease, strokes and cardiovascular disorders) before the diseases surface with directed early lifestyle changes, medication and even preventive surgeries. Our society needs to embrace these new possibilities in exchange for total individual confidentiality and autonomy.

Question: What steps should be taken to improve take-up of these solutions?

Mr Koo: I believe the authorities have taken the right steps to facilitate innovation in healthcare, by investing in research and innovation capabilities (eg innovation teams within hospitals), and even a regulatory sandbox to trial and incubate new care delivery models which rest in a regulatory grey areas.

Building on this foundation, I believe that our innovation efforts need to be focused on well-defined outcomes for our health system, in a way that enables Singaporeans to receive quality care at good value. For example, considering the manpower shortages we face, how can we reduce the number of nurses needed from seven per 1,000 residents to three?

I am often approached with technologically advanced solutions, which are sadly designed without a value-based mindset.

Secondly, I believe that Singapore would do well to train more healthcare professionals in the design, evaluation and implementation of new care models. This expertise and exposure will help them partner engineers and technologists to bring these solutions to market more quickly, without compromising the quality of care.

Prof Chan: Public education and consultation in the fields of multidisciplinary medical innovation, technology innovation, financial innovation and end of life comfort care will make ageing well in our HDB homes a sustainable reality.