Feature
Is remote monitoring the future of general practice?
One GP’s drive to change the way things work could pave a new path for general practice through remote patient monitoring.
Dr Kean-Seng Lim says his team’s remote monitoring of patients has prevented hospitalisations and created more efficiency in his practice.
Dr Kean-Seng Lim may be working as a GP at his practice in Sydney, but he is always connected to his patients even when they are at home.
Dr Lim and his team know when a patient’s blood pressure is spiking, their blood glucose levels, where their weight is tracking and even how their mood is at any given time, without seeing them face-to-face.
This was made possible after Dr Lim stepped outside the established conventions of general practice and into the world of software.
He would go on to develop a virtual healthcare platform, which he has since sold, which allows patients to enter their own health data through a mobile app – alerting the practice team when things get out of a safe range and facilitating early intervention.
Dr Lim says this tactic is less about what GPs do, and more about ‘how we do it’.
‘My interest has always been in exploring how can we do things better, and that’s where we measure better in terms of both clinical outcomes as well as efficiency,’ he said.
‘For me, a big part of things has been about how can we do general practice in a more effective as well as comprehensive manner and produce better outcomes at the same time.’
Although already time-poor GPs may baulk at the potential for added workload here and being inundated with messages from patients, Dr Lim has found that not to be the case, provided the right groundwork has been put in place.
‘Whether it increases the workload to any great degree or not is dependent on two things,’ he said.
‘Number one is the way the software is designed, and number two is how the team acts on whatever alerts might come through.
‘We found that this introduced whole new efficiencies in the way we manage care and in the way we do our day-to-day consultations.’
He said, on an average day, he receives about five to 10 alerts from measurements that have gone out of range and maybe one message from a patient.
‘What it does is allows us to activate the team and to assign tasks to different team members, so that alerts at different levels might either be escalated directly to the doctor or be handled by team members according to their skill sets,’ Dr Lim explained.
‘The first step to introducing remote monitoring is actually not the remote monitoring part, but the team part, because it really doesn’t work unless the team is engaged, activated and trained to be able to do it properly.’
Dr Lim was using this software pre-COVID-19, particularly in monitoring patients with chronic obstructive pulmonary disease and asthma over large parts of New South Wales when widespread bushfires increased smoke levels and created poor air quality.
‘We found it was possible to identify patients who were destabilising and then either proactively call them or message them through the application itself and also monitor very closely the responses and progress,’ he said.
Out of the 60 patients Dr Lim and his team monitored with chronic lung conditions during this time, there were no emergency department presentations and no hospital admissions.
Then COVID-19 came along and everything changed again.
‘But what it also meant was that there was an increased role for this sort of remote monitoring, and we also then had rebates available for telehealth,’ he said.
But the focus on real-time consultations in telehealth, Dr Lim said, limited ‘any innovation when it comes to remote monitoring and asynchronous consultations’.
‘We were able to still continue using the same system for many of our patients with COVID or with chronic conditions and there was an increased uptake of the software, including by some large hospital groups and health insurers,’ he said.
Overall, Dr Lim’s main motivation here was to create a new model that he hopes can influence the way general practice operates.
‘We were really trying to design the primary care system of the future and try to show a way where we can get teams to work together,’ he said.
‘Whether those teams are co-located, in the community or in the local hospital, we can coordinate around the care of a cohort of patients, and then manage them in a proactive and comprehensive manner.’
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