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Is there a doctor on the webcam?

Bangkok hospitals introduce online consultations with new apps

Thailand's hospitals have long been using Facebook and other cyber tools to advertise themselves and their services to those seeking medical care. Incorporating technological assistance into modules that will help reduce burden on medical personnel is understandably much more difficult but both Bangkok's public and private hospitals have recently launched applications that they feel will improve patient care.

Ramathibodi Hospital has introduced an app that works like a video call and allows patients to communicate with doctors and nursing staff. Here, online consultations do away with the time-consuming process of registering at 5am and waiting hours to see a doctor for five or 10 minutes.

The service at private facilities Samitivej and BNH hospitals is much faster so their apps offer patients the possibility of calling an ambulance with GPS guidance and, for selected patients, provide nurses who act as personalised health secretaries.

One of Thailand's biggest medical school hospitals, Ramathibodi deals with thousands of patients every day. To ease the pressure on its medical staff, the hospital's skin clinic recently launched an online service where a patient can log in to consult with a nurse or their doctor via the health app www.HealthOnline.co.th.

Such consultations are designed for follow-up rather than diagnosis and treatment and provide for queries on medication as well as for updating symptoms.

Dr Somsak Tanrattanakorn, head of Ramathibodi Laser Centre says the app is helping to ease the dermatology department's log jam of cases, many of which involve patients who have questions about their medicine or symptoms.

While some of these can be handled over the phone, consultations about medication without seeing the patient's face is always a risk.

"It's a way of improving our care, of filling the communication gap between patient and doctor. Sometimes they have just minor questions after seeing a doctor," says Dr Somsak.

The health online application connects as the patient logs in. Medical records show up on screen alongside the patient's face and once the video call starts, they can upload pictures or video that allows the doctor to visualise the problem area. Photos are preferable as images from high quality cameras or mobile phone provide for better clarity than video.

"Sometimes a patient develops a rash after returning home. If they video call me through the app and show me a photo, I can give them advice on the condition. If it looks bad, they obviously they should come back to the hospital but in most cases, all that is needed is some medication and follow-up," says Dr Somsak.

The online consultation does of course have limitations, as it's only available during clinic hours. Nurses monitor the calls and answer questions regarding the patient's medication regimen as well as problems. The call is passed to the doctor if the problem is more complicated.

The app was developed by the Health Online Company, an affiliate of computer and IT giant Sahaviriya Group. Marketing manager Pakphoom Permmongkol looked closely at the facilities and decided to approach Ramathibodi Hospital's skin clinic first because it's located inside the new Somdech Phra Debaratana Medical Centre, which has the infrastructure for internet technology.

Pakphoom initially suggested a virtual clinic app that allows for online diagnosis but Dr Somsak felt a follow up procedure would be more appropriate as it allowed medical personnel to verify the caller.

The technicians at Health Online spent the next eight months developing the app, sending staff along to the clinic to observe the work and how the clinic communicated with patients. The app is now being used in both of the hospital's skin clinics and the plastic surgery department will soon introduce it to follow patients, particularly diabetics with infected chronic wounds.

The Police Hospital has also opted for the app though here it will be used by residents working at mobile units to consult their instructors.

The company, which invested almost Bt20 million in the app, is providing it free to public hospitals along with a server that records every video call and maintenance.

"It's a kind of corporate social responsibility but we also benefit by getting the data to develop new medical applications. Medical records remain totally confidential. We just study behaviour in using the technology," says Pakphoom, adding that as part of Sahaviriya, they will also benefit from selling the hardware used in running the application.

Samitvej and BNH hospitals also raised their cyber service to a higher level last month by launching the Samitivej Connect and BNH Connect apps.

For the moment, Connect is a pilot project and Dr Narintorn Suasinthon of Samitivej Sukhumvit Hospital says the app really offers a value added service. It works by allowing an ambulance to find a patient in trouble via GPS and through providing VIP patients with a well-trained nurse who's aware of their personal medical records to advise them around the clock

Only 400 patients are being invited to use the app in this initial stage and they must register with a username and password so that the hospital can personalise their health records on the app.

To date, a few of the personalised health secretaries have received calls but there have been no ambulance call outs. Conversations between the nurse and patient won't be recorded for privacy reasons but the feedback is being noted and the hospital will evaluate the application process regularly.

"We plan to launches new apps in the future. One of these will be the Samitivej application for general knowledge as well as providing health articles for free. There'll also be specific apps for pregnant women and kidney disease patients. But before we go any further, we need to evaluate the Connect app over a period of three months," says Dr Narinthorn, adding that app will narrow the communication gap between hospital and patients.

"The hospital has to adapt to the world of technology. Many patients study their disease online before coming to see a doctor, so from the application and website, we hope that Samitivej will be a priority and a good resource when they search for health articles online," he says.


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