A “ New-normal ” order caused by COVID-19 pandemic has brought many changes to our world . Many new trends are already underway as the global economy are being accelerated by the impact of the pandemic . With the amplification of these trends , the future of work has arrived faster as every sector including healthcare are thinking out of the box for non-conventional methods to solve problems . One of the paradigms shifts in medical fraternity is a realization that telemedicine is applicable , acceptable and has great potential to provide rapid , safe and equally high-quality care to patients compared to conventional walk-in consultations .

A new model of healthcare delivery emerges with more emphasis on in-home primary care and telehealth services . Remote care or telehealth services which were already used in emergencies , crisis and routine care previously has gathered wider utilization during this pandemic period .

Telehealth services have now been used for large-scale screening and triaging of patients prior to their visit to hospital in China . A central strategy for health care surge is “ forward triaging ” – the sorting of patients before they arrive to the Emergency Department . Telemedicine allows patient to be efficiently screened . It is both patient-centered and conducive to those who are self-quarantined . It also protects patients , healthcare providers and community from exposure . It can allow physicians and patients to communicate 24 / 7 , using smartphones or webcam-enabled computers . Presence of respiratory symptoms and detailed travel and exposure histories are easily obtained . Automated screening algorithms and local epidemiologic information can be integrated to standardize screening and make clinical decision across providers .

There is an immense role of telehealth services in primary healthcare . It enables patient to seek their family physician ’ s advice about non-emergency problems . It offers convenience to patients and practitioners by obviating the necessity for a physical visit to get medical advice or treatment . It is cost-effective and safer in comparison to the conventional process of waiting to see a doctor in the clinic . It allows doctors to provide continuous care to their patients and is value-added service specifically for patients who can ’ t travel to the hospital due to certain circumstances .

Community paramedicine or mobile integrated health care programs may also allow patients to be treated in their homes , with higher level medical support provided virtually . Telemedical oversight by physicians via teleconsultations and doorstep drug delivery may reduce the need for transportation to hospital . For sicker patients , physician may even deploy a mobile home health care unit to patients to conduct home-based testing and treatment . Those patients that require in-patient care will be directed to the most appropriate center . This will potentially allow patients to bypass clinics and Emergency Department to be placed directly in hospital bed , reducing exposure to healthcare workers and other patients .

Some patients with mild symptoms can be treated at their own home to reduce their exposure . Technologies to support telehealth such as wearable devices , biosensors that measures vital signs can be integrated into establishing a smart home to monitor them . Smart homes with environmental and biosensors are interconnected using 5G technology can monitor patient health and send messages to responsible clinicians when emergency situations are detected It is highly likely that a significant portion of medical services will remain telehealth-based post COVID-19 , especially the remote monitoring and management of non-emergencies patients as it provides higher convenience and better patient-centered care thus partially addressing the healthcare system flow rate and capacity challenges . To realize the long-term benefit of telehealth , organizations need to collaborate and learn what work well . Hospital administrators needs to find solutions to create buy-in from reluctant physician and patients as many older age groups may not feel comfortable with new technology . Government need to play a huge role to support the health technology industry in developing and testing novel telehealth solutions that are simultaneously safe and affordable to patients . This is done by creating platforms for multi related industries to work with health care professionals . While telemedicine promises to grow rapidly over the next decade and has clear benefits , it still poses some technical and practical problems for healthcare providers . The great thing about telehealth and its use during the pandemic is that it actually became a good proof that it is possible to move towards this new ecosystem without sacrificing patient safety and health care quality . The burden of care imposed on patients and their families must be considered , but new knowledge coupled with self-health responsibilities can be empowering for both clinicians and patients .

Emergency Pysician

Dr Billy Yeoh Chen Wye

MD ( USM ), MMED ( UM )