會長通訊:現在是時候談論“遠程醫療”了 | President's Message:It is time to talk on “Telemedicine”

HKDU⠀ Published at 2020-10-15

現在是時候談論“遠程醫療”了

On 5 Oct 2020, Site Visit at Simulation training Centre at The Hong Kong Children's Hospital 於2020年10月5日,到香港兒童醫院的模擬培訓中心探訪

 

On 5 Oct 2020, photo taken with Dr. Chan Hin Bill, Supervisor of HKCH Simulation training Centre at Simulation training Centre of The Hong Kong Children's Hospital 於2020年10月5日,香港兒童醫院模擬培訓中心Child Sim主管陳衍標醫生 在香港兒童醫院的模擬培訓中心合照

 

 

我在2020 年9 月22 日西醫工會的網絡醫學研討會上對各會員說,由於2019 冠狀病毒病不會在短期內消失,因此本會的醫學延續進修活動將會繼續透過Zoom 和面書進行直播。根據我們食物及衞生局局長的說法,2019冠狀病毒的疫苗要到2021 年冬季才能在香港使用。因此,我們將盡最大努力在未來2 年內為會員盡可能組織更多的網上醫學延續進修活動。


隨著我們於2020 年9 月27 日在九龍彌敦道363-373 號恆成大廈803 至 804 室西醫工會新辦公室的裝修工程開始,我們希望新辦公室能於2020 年11 月上旬開始投入服務。本會非常感謝各會員和朋友的慷慨捐助,新辦公室將擁有更大的空間,約600 平方尺的聚會場所,場地可容納30 人。我們將會安裝適當的視聽設備及器材為會員組織更多活動,包括網絡研討會。


隨著冬季的蒞臨,流感和2019 冠狀病毒病將在社區中傳播漫延,我們應該依靠衞生防護中心提供的有關每種病毒的本地監測數據。各會員應該認識到,流感和2019 冠狀病毒病的症狀相似並重疊,但兩者同時感染的例子已有記錄在案。唯一的區別是嗅覺及味覺衰退是感染新冠病毒的特有癥狀。我們必須注意,地塞米松被看作是救治2019 冠狀病毒病重症病人的一大突破,但皮質類固醇實際上會延長流感病毒的複制。我們應該鼓勵所有市民在這個冬天進行流感疫苗接種。


隨著2019冠狀病毒病全球大流行,一些會員已經實踐了某種程度遠程醫療,我在2020年9月14日通過ZOOM在施政報告諮詢會議上向林鄭月娥女士亦強調了這一點。

 

遠程醫療和患者管理

 

我說隨著人工智能、大數據、雲端和網絡安全技術的爆炸性增長,基於傳感器的硬件的成功研發,從而以更低的價格改進了功能以及智能設備與Internet Plus 計劃的無縫集成,現在是在2019 冠狀病毒大流行期間實施遠程醫療和患者管理的最佳時機。

 

人工智能和大數據技術可幫助醫生在短的時間內從大量數據中獲得見解。雲和網絡安全技術允許這種轉換以經過認證的安全方式發生在連接到網上的任何地方。將其與MEWS 之類的系統相結合,使醫生能夠更詳細地管理患者,並減輕他們本來就繁重的工作量,而又不犧牲其護理質量。

 

因此,除了通過我們針對高風險群組的教育和疫苗接種舉措,促進了我們先前在預防醫學方面的成就之外。我們建議香港的下一次醫療改革應著重於通過遠程醫療和患者管理加強預防藥物和早期疾病管理,在醫生與病人的關係上,診症將不再局限於單向性的病人求診,而是持續、主動及協作的醫療護理,以期及早找出病患並作出診治。在公共醫療的層上,配以類似「改良早期預警評分」(MEWS) 的長期自動化監察和評估系統、政府將會更有效率地按病者的風險及需要而作出資源調配。

 

政府可以推行什麼方針在香港開展遠程醫療和患者管理?

 

在推行方面,政府應該考慮通過各社區裡的「診所醫生」,從自己的病人名單中,選取和登記有需要及合適參加「遠程患者管理」計劃的病人,並負責教育這些病人正確的使用方法,幫助他們取得「居家協作診治」的成效。此舉將會是,通過社區「診所醫生」網絡,來實踐「把資源投放於病人端」(Hospital Decentralization)的施政方法;將會為正在面對沉重壓力的公共醫療系統,帶來一定的舒緩作用。

 

另外政府可以從兩方面提供撥款:

1「. 病人端」- 資助合適參加「遠程患者管理」計劃者,購買經「診所醫生」或合資格組織認可的醫療器具,以及支付相關的診治計劃和醫療雲端平台服務費用;

2「. 診所醫生端」- 資助參加「遠程患者管理」計劃的診所,提升「醫學資訊科技」的設備和知識,為落實「互聯網+ 醫療」在香港社會上的推行做好準備。

 

2019 冠狀病毒病導致許多患者接受遠程醫療,現在是政府將遠程醫療制度化並將遠程醫療和患者管理納入香港醫療體系的時候了。


作為第一步,本會幹事會已經成立了一個遠程醫療工作小組來研究相關問題。在2019 冠狀病毒病大流行之前,遠程醫療在香港並沒有像其他國家(例如美國和英國)那樣廣泛被使用和實踐。在2019 冠狀病毒病大流行之後,患者和醫生對遠程醫療越來越適應。


這項改革應為醫療服務提供者將高質量的遠程醫療納入其實踐創造機會及條件,並明確規定專業遠程醫療的最低要求,其中包括:


1. 為最低標準作出指引,要求醫生在斷症前需要先取得適時及合乎醫療級別的重要醫療數據;


2. 定下網絡安全標準,包括儲存及分柝醫療數據的平台保安。如美國的《健康保險流通與責任法案》(HIPAA) ;


3. 規範用作互聯網診症的「醫療器具」的準確度及安全性。如國家藥品監督管理局(NMPA) 和美國食品藥品管理局(FDA) 的醫療器械認證。


您的意見對這個重要的議題是非常需要的!

 

楊超發醫生


It is time to talk on “Telemedicine”

 

I spoke to our members in the HKDU webinar on 22nd September 2020 that since the COVID-19 would not go away soon, our CME activities will still be organized through the internet by Zoom and Facebook live. According to our Secretary for Food and Health, the vaccine for COVID-19 will not be available in Hong Kong till winter of 2021. As such, we shall try our very best to organize as many e-CMEs as possible for our members in the coming 2 years.

With the start of decoration of our new HKDU ofce in Rooms 803 – 804, Hang Shing Building, 363-373 Nathan Road, Kowloon on 27th September 2020, we would expect our new HKDU ofce to operate in early November 2020. Many thanks to the generous donations from our members and friends, we shall have a meeting place of around 600 square feet which can accommodate 30 persons. We shall be installing appropriate audiovisual equipment to cater for our members’ activities including webinars.

With the coming of winter time, influenza and COVID-19 will be co-circulating in the community, we should rely on the local surveillance data about each virus from the Centre for Health Protection. We should be aware that not only do influenza and COVID-19 have overlapping signs and symptoms, but co-infection with both with similar picture has been documented. The only difference is loss of smell and loss of taste which has not been reported with influenza virus infection. We must take note that dexamethasone is recommended for severe COVID-19 infection in hospitalized patients, but corticosteroids actually prolong viral replication in influenza. We should encourage all citizens to take up influenza vaccination in this winter.

With the prevalence of COVID-19 pandemic, some of our members have practiced some kind of telemedicine which I have stressed in our presentation to Mrs. Carrie Lam on 14th September 2020 in the Policy Address consultative meeting through ZOOM. Telemedicine and Remote Patient Monitoring I said that with the explosive growth of Articial Intelligence (AI), Big Data,Cloud, and cybersecurity technology; successful R&D of sensor-based hardware leading to improved functionality at lower price; and seamless integration of smart devices with Internet Plus initiatives, now is the best time to implement Remote Patient Monitoring (RPM) in the midst of COVID-19 pandemic.

AI and Big Data technologies help doctors generate insights from an enormous amount of data within a very short time. Cloud and cybersecurity technologies allow this transformation to happen anywhere connected to the internet in a certied secure manner. Combining this with other systems would open up the capability of doctors to monitor patients in greater detail, and to alleviate their already strenuous workload without sacricing their care quality.

As such, we would suggest Hong Kong's next healthcare reform should focus on enhancing preventive medicine and early disease management with RPM, in furtherance to our previous accomplishment in promoting preventive medicine via education and vaccination initiatives to the highrisk demographics. On the patient-doctor level, RPM has the potential to transform the current one-way, discrete and transactional patient-doctor interaction to a continuous, interactive, and collaborative healthcare experience. It would help doctors and patients build a much closer relationship whereby health issues could be identified and treated at earlier stages. On the public health level, RPM would help allocate medical resources more effectively, by incorporating systems like the Modified Early Warning Score to prioritize the need for doctors’ intervention.

 

What can the Government do to launch Remote Patient Monitoring in Hong Kong?

 

To implement RPM in Hong Kong, the government should involve the active participation of community doctors. The doctors would review their own patient list, select patients who are suitable for participation in the RPM program and invite them to register for the program. The doctors would be responsible for educating these patients on the correct usage of the monitoring devices, and for providing "Home-based collaborative diagnosis and treatment" on an ongoing basis. At the macro level, this would effectively lead to the realization of "Hospital Decentralization" through the involvement of a network of community doctors. It would certainly bring relief to the already overloaded public healthcare system.

In addition, the government should also provide incentives and funding in the following ways:

1. On the patient's end: subsidize those who are eligible for participation in the RPM program, help purchase medical devices approved by community doctors or qualied organizations, and help pay for related diagnosis and treatment plans and medical cloud platform services;

2. On Community Doctor's end: subsidize clinics participating in the RPM program to upgrade their equipment and to provide knowledge training in "Medical Information Technology", with a view to preparing them for the ultimate implementation of "Internet + Healthcare" in Hong Kong.

COVID-19 has caused many patients to adopt telemedicine and it is time for the government to institutionalize telemedicine and incorporate RPM into Hong Kong's healthcare system.

As a rst step, our Council has formed a Task Force on Telemedicine to look into the issue. Prior to COVID-19 pandemic, telemedicine is not as widely used and practised in Hong Kong as in other countries such as the US and the UK. In the wake of COVID-19 pandemic, patients and doctors became a lot more acceptive to the using of telemedicine.

 

The reform should pave the way for healthcare providers to integrate highquality telemedicine into their practice and clearly state the minimum requirement for professional telemedicine, which includes:

1. Dening the minimum standard of practice. Doctors should, at the very least, have access to timely and clinical grade vital signals before he/she is to make a diagnosis;

2. Stating the minimum cybersecurity requirement for the video consultation platform and the digital platform where the patient’s data are stored and analyzed, e.g. the US HIPAA Healthcare Cybersecurity Compliance;

3. Imposing certain minimum safety certification requirements on the devices, e.g. FDA/CFDA.

 

Your input is much needed in this important topic!

 

Dr. Yeung Chiu Fat Henry