Taiwan Today

PHOTOS BY CHANG SU-CHING

Telecare is keeping the elderly and the chronically ill out of large hospitals by monitoring them in their communities and homes.

“Can I have the medicine for colds? I have my prescription right here,” says a woman pushing open the door of the Health Care Convenience Center located at Cheng Kong Collective Housing in Taipei City. The woman, Zhuang Mei-yue, who suffers from frequent colds, and her husband are members of the Telehealth Pilot Project, a telecare development program begun by the government in 2007. “Every day I come here to have my blood pressure measured and if I have any questions or doubts about my diet, I can also ask the nutritionists here,” she says.

The Telehealth Pilot Project relies on the digital transmission of medical data collected from patients in community health centers, private homes and nursing homes. Zhuang is one of the some 220 patients using the services of the Health Care Convenience Center at Cheng Kong. “On weekdays, this center is normally full of elderly patients, who mostly visit to have their blood pressure, blood glucose and blood lipid levels measured,” says Zeng Huei-mei, a registered nurse at the community center. Zeng is an employee of the Hua Chih Group, a privately owned medical company that operates a clinic and pharmacy. After the levels are measured, center staffers, which include two nurses and two volunteers, upload the results of the tests to Hua Chih, where doctors and other healthcare professionals monitor and analyze them.

The Telehealth Pilot Project was launched to explore the benefits of providing telecare services, particularly to members of Taiwan’s increasingly aging population. One of the benefits of the telecare program is that it makes health resources available close to patients’ homes, which is particularly important to less mobile patients such as the elderly. “Since the project has been launched, senior citizens no longer need to journey to big hospitals far away from their homes,” says Shi Zhong-sheng, the head of Qunying Village in Taipei’s Da-an District, where Cheng Kong Collective Housing is located.

Providing adequate healthcare for seniors is a growing concern in Taiwan, as the population of those aged 65 and older accounted for 10.4 percent of the island’s total population at the end of 2008, compared to 9.9 percent in 2006, according to the Ministry of the Interior. The elderly make up 15 percent of all residents of Cheng Kong, which was formerly a residential community for retired military personnel and their families. “Senior citizens often have health problems, and that makes any trip a big one for them,” Shi says.

The village head also notes that seniors often face chronic illnesses rather than acute health problems, and as a result require frequent but less intensive care. Hence, nurses and volunteers at the Health Care Convenience Center at Cheng Kong Collective Housing collect patients’ medical data, while doctors at Hua Chih review the data and guide overall treatment. Doctors in the Department of Family Medicine at Taipei Medical University Hospital are also available to consult with the patients via a live teleconference if necessary. The result is that through telecare, the seniors receive care without having to travel outside their community. From the government’s point of view, telecare can also help to reduce healthcare costs and facilitate the more effective deployment of healthcare personnel.

Monitoring Medications

The Health Care Convenience Center  also offers a medication home delivery service, although patients must first visit a doctor in person to obtain a prescription. The medications are provided to patients free of charge by He-kan Pharmacy, a company in the Hua Chih Group, through the National Health Insurance scheme.

Since most of the center’s members are seniors who live alone, nurse Zeng Huei-mei spends a lot of time monitoring medication intake, if there are no family members who can do so. “It’s essential that the elderly don’t stop taking their medicine,” she says. To keep track of the patients and their medications, Zeng classifies prescriptions according to the names of patients who have already received their medicine, the time it was delivered and the prescribing hospital and department. She even provides a note indicating when patients need to return to pick up more medicine. “Because we track their medications, the patients no longer forget whether they’ve taken their medicine or not,” Zeng says.

On the other hand, Zeng notes, there are also times that patients overdo it with their medications. “One time, an elderly man came to the pharmacy, arguing that he hadn’t received his medicine yet,” she says. “However, I found his signature in my notebook showing that he had.” To find out what happened to the drugs, the nurse went to the patient’s house, where she discovered that he was taking drugs prescribed by five separate hospitals to control his high blood pressure. “He had been going to different hospitals that don’t coordinate their medical records,” she explains. With Zeng’s help, however, all of the drugs the patient had collected were sorted out and the patient was put on a more appropriate medication regimen.

Consultations and health education are other services provided by the Health Care Convenience Center. Once a week, pharmacists and nutritionists from Taipei Medical University Hospital visit the center to offer advice about medications, diet and nutrition. Every Thursday and Friday, the center also broadcasts instructional videos to educate residents about diabetes, menopause and healthy living habits. “These things are all part of the center’s basic mission—to promote members’ health,” Zeng says.

That mission seems to be having a positive impact at Cheng Kong Collective Housing, with the percentage of elderly patients receiving regular blood pressure checks rising from 53.8 percent at the beginning of the project to 81.9 percent in 2008, according to a survey conducted by Wan Fang Hospital at the end of that year. The survey also showed that the percentage of telecare members who required hospitalization dropped from 6.11 percent at the project’s start to 2.12 percent in the same timeframe.

While the Health Care Convenience Center at Cheng Kong represents a community-based approach to telecare, Wan Fang Hospital’s Telecare Service Center—another part of the government’s Telehealth Pilot Project—functions according to a home-based model. Participants in the project come from 50 households located in the Wenshan District of Taipei City and include those with disabilities or chronic illnesses such as high blood pressure and heart disease. The pilot project is scheduled to run until the end of this year.

Health TV

Each of these patients is provided a device capable of measuring both blood pressure and blood glucose, along with a television set-top box that functions as a computer capable of uploading the test results to the Telecare Service Center. With the box connected to a television, patients can easily upload the information by using a remote control. “Since most of the users are elderly people that have difficulty using computers, the box and the measuring device are both designed to be used easily,” says Marc Hsu, a neurosurgeon at Wan Fang Hospital and a member of one of the groups leading the Telehealth Pilot Project.

Every day, after members upload their blood pressure and glucose readings, registered nurses at the Wan Fang Telecare Service Center analyze them. If dangerously high blood pressure levels are found or members do not upload their readings, healthcare professionals follow up with the patients by phone.

Chung Chi-wen, a participant in the Telehealth Pilot Project, says that since his family joined the plan, his 94-year-old father receives ’round-the-clock care via the system. The personal healthcare aide Chung hired to take care of his father is off duty at night, he says, but his father’s vital health information can be uploaded and analyzed by technicians at any time.

Initially, however, providing such home care services did not always run smoothly. “We found that not every applicant had a computer or Internet connection at home,” Wan Fang Hospital’s Hsu says. To help residents install the required software and connect to the Internet, the hospital set up a group comprised of network technicians from Chunghwa Telecom Co., Ltd., specialists from the company providing the software for the set-top box and registered nurses from the hospital. As a result, Hsu says the project has seen consistent improvement over the two years it has operated, with members becoming better at operating the monitoring and data uploading devices and hospitals becoming more efficient at analyzing and acting on patient data.

The project faced another challenge when the installation of network access points and software stretched to two months. Hsu says that the companies and organizations in the group “didn’t always communicate with each other very well, and it happened sometimes that a key person was missing at a scheduled time.” Therefore, he suggests that future telecare projects should be managed by private businesses, with hospitals refocusing on their core mission of taking care of patients.

The Big Picture

The fundamental services of telecare projects are provided by the information technology (IT) and telecommunication industries, companies producing medical equipment and healthcare professionals. Taiwan’s innate strength in these areas makes it well positioned to develop the telecare industry. “Taiwan is at the leading edge of these four industries around the world,” says Huang Tung-liang, secretary-general of the Telecare Industry Alliance Taiwan. Taiwan is well known for its IT industry and has also become a major international supplier of medical devices like digital blood pressure monitors, thermometers and blood glucose monitoring systems. Taiwan’s exports of digital blood pressure monitors, for example, were the second highest in the world in 2005, according to the Industrial Technology Research Institute.

Currently, there are seven privately run enterprises in the alliance and 12 hospitals in Taiwan that provide telecare services under different operating models. Pilot projects such as Wan Fang Hospital’s Telecare Service Center have shown the potential benefits and pitfalls of the various telecare systems. “The Telehealth Pilot Project is like testing the water,” Huang says. “Through the project, the government can identify which telecare model may encounter more difficulties than other models when operated.” Huang believes that employing telecare services at institutions such as nursing homes may prove to be the best model, as the diagnostic equipment at such institutions is operated by trained professionals, whereas home care members operate it themselves.

Selecting the most effective model is important, but Huang believes the greatest challenge faced by private companies providing telecare services is learning how to combine the characteristics of the service industry with the technical abilities of the medical profession. Without reaching a high standard of customer service, Huang adds, the companies will have a hard time competing with hospitals. Retraining medical professionals working for the companies is not an easy task, however. “It’s like telling medical personnel wearing scrub suits that they have to wait on customers,” he says. “It’s the most difficult staff training job in the industry.”

The large concentration of hospitals and clinics in Taiwan poses another challenge to the development of the telecare industry, Wan Fang Hospital’s Marc Hsu points out. “People might question why they should use telecare services if they have convenient access to a nearby hospital,” he says. Huang agrees, but notes that the current pilot telecare projects are focused on urban areas in northern Taiwan, where hospitals proliferate. The real benefits of telecare services may be realized when they are applied in rural areas in the future, he says.

In the final analysis, telecare services are not designed to compete with hospitals, but rather to fill an important niche in the healthcare system. As Qunying Village head Shi Zhong-sheng says, telecare services are designed to offer care to those who need it while also allowing them to maintain their independence in their own homes. Moreover, for many elderly members of the community, just the fact that they are able to share their concerns and fears with people who have time to listen can mean a lot, he says.

Write to Vicky Huang at powery18@mail.gio.gov.tw