NUS PRIME (Zubin)

Education
Clinical Care
Research
Presenter:
Dr. Zubin J Daruwalla
MBBCh (Hons), BAO, MRCSI, MCh (Orth), MMed I
(Orth)
Resident, Department of Orthopaedic Surgery
zubin_jimmy_daruwalla@nuhs.edu.sg
The Application and Advantages of a Telehealth Platform
to Medical Education
NUS – Priority Research In Medical Education
6th
April 2015

Its 3am and you’re the resident on call…
OR
You’re the consultant on call and your resident calls you about a case in the
emergency department…
“This is a young male involved in a polytrauma situation…..”
“There is an open wound over the left tibia, I think I see bone coming
out but I’m not sure….”
“The wound is over the medial aspect of the leg…”
A CLASSIC SITUATION

WOULDN’T YOU RATHER HAVE A PICTURE AND
MAYBE X-RAYS TO FURTHER ASSESS THE SITUATION?
A PICTURE IS WORTH A THOUSAND WORDS

TECHNOLOGY MAKES IT EASIER

A BREACH OF PATIENT PRIVACY

•A secure messaging system
•Easy to use
•Quick and responsive with minimal lag
•High quality picture/video transmission
WHAT DO WE NEED?

Started out as my quality improvement project…

High impact factor publication…
JMIR Mhealth Uhealth. 2014 Jun 5;2(2):e28. doi: 10.2196/mhealth.3303.
The Application of Telemedicine in Orthopedic Surgery in Singapore: A Pilot
Study on a Secure, Mobile Telehealth Application and Messaging Platform.

• Private but government-incubated healthcare startup
• Integrated triad
– Secure communications
– Patient diary
– Virtual teleconsults via live video conferencing (Wi-Fi / Internet)
INTRODUCTION

METHODS

• Prospective cohort study
• Aims
– To assess staff satisfaction and the effects of the implementation of an
alternative secure messaging system
METHODS

• Participants
– Orthopaedic Surgery Program Director
– Orthopaedic Surgery Program Coordinator
– Trauma Consultant (Core Faculty)
– All Orthopaedic Surgery Residents (16)
– Non-orthopaedic residents in NUH (6)
• Verbal consent taken from all subjects
METHODS

• N = 25 (23 males, 2 females, average age 32 years)
• Follow up = 6 weeks
• Questionnaire at end of follow up
METHODS

SECURE MESSAGING
USER INTERFACE

CASE DISCUSSION WITH
RADIOLOGIAL IMAGES

CASE DISCUSSION WITH
CLINICAL PHOTO IN CASE OF
EMERGENCY DEPARTMENT REFERRAL

PRE-OPERATIVE DISCUSSION

• 1) MyDoc should replace current systems of peer-to-peer communications
platforms
– Strongly agreed = 76%
– Agreed = 16%
– Neutral = 8%
RESULTS

• 2) Quality of images transmitted via MyDoc
– Excellent = 88%
– Good = 8%
– Fair = 4%
RESULTS

• 3) Quality of videos and sounds transmitted via MyDoc
– Excellent = 100%
RESULTS

• 4) Communication was easy amongst users with them being comfortable for
use on daily basis
– Strongly Agreed/ Agreed = 92%
– Neutral = 8%
RESULTS

• 5) MyDoc should be made available to inpatients and outpatients to
potentially lessen clinic loads and provide a secure manner which patients
can communicate with their primary teams
– Yes = 80%
– Neutral = 12%
– No = 8%
RESULTS

• 6) Telerounding may have advantages, especially when on weekends as a
supplement to normal rounds
– Yes = 88%
– Neutral = 8%
– No = 4%
RESULTS

• 7) Telerounding may help residents adhere to the number of hours they are
allowed to be onsite in the hospital
– Yes = 88%
– Neutral = 8%
– No = 4%
RESULTS

• Many current applications are unsecure
• We are at risk of violating healthcare privacy acts
• Diagnosis can be made through history alone in 90% of cases with
remaining 10% often made after physical examination
• Pivotal role of communication in the art of medicine
DISCUSSION - ADVANTAGES

• Need for reliable wireless network or good internet connection
• Speed of transmission of information slightly slower than some other
commercial apps
DISCUSSION - DISADVANTAGES

• Regional teleconsults for specialist referral
• Clinical outreach in the setting of trauma
• Supervision in the operating room
• Providing both patient and parent reassurance in paediatric orthopaedics
• Outpatient department consults (wound reviews, follow ups, etc.)
• Weekend ward rounds
DISCUSSION – POTENTIAL USES

• Telehealth expected to grow six-fold by 2017
– May be a remedy for chronic hospital admissions
• Excellent results in terms of acceptance and satisfaction
• May downsize operational costs and may help reduce resident onsite
working hours
• Safe and secure system that complies with a number of healthcare acts
• “I have a dream…” -> …a globally-linked orthopaedic community
CONCLUSIONS

Now, what if I wanted to add to this dream?

• Regional teleconsults for specialist referral
• Clinical outreach in the setting of trauma
• Supervision in the operating room
• Providing both patient and parent reassurance in paediatric orthopaedics
• Outpatient department consults (wound reviews, follow ups, etc.)
• Weekend ward rounds
• MEDICAL EDUCATION
DISCUSSION – POTENTIAL USES

• MEDICAL EDUCATION
– Clinical case discussions for students
• “Ortho Pearls”
– First time all ~ 300 students able to be on a single group
» Very positive feedback…
FURTHER POTENTIAL USES…

A PICTURE IS WORTH A THOUSAND WORDS

Did a bit of research…

WHAT HAS MYDOC ACHIEVED THUS FAR…?
• Closed first round of funding with backing from SPRING
• MDA-grant
• Finalist in IBM biz spark
• Publication in 4.7 impact factor journal
• List of reputable clients, including Guardian
• Liaised with hospitals, MOH and SMC
• Collaboration with Duke-NUS and Prof. Thiru

Spoke to a few people…

Spaced education…

WHAT ELSE IS MYDOC HOPING TO ACHIEVE…?
…Collaboration with NUS YLL SOM starting with
Title of Abstract: A Medical Student Population-Based Study on Spaced Education using
Singapore’s First Secure, Mobile Telehealth Application and Messaging Platform
and the Importance of Raising Awareness of the Personal Data Protection Act.
Authors/Dept/Institution: Zubin J Daruwalla, Moses Loh, Naresh Kumar, Chaoyan Dong

• All 240 individuals responded to the questionnaire
• 66% considered MyDoc a secure communication platform among medical
professionals, 6% disagreed and 28% stated they were unsure
• 64% felt using MyDoc as a secure messaging platform is better than using
current messaging systems and that it be implemented medical school wide
in order to ensure the highest security standards and comply with the PDPA
with 6% disagreeing and 30% neither agreeing nor disagreeing
• On being asked if they could easily communicate with their peers and
seniors using the MyDoc secure messaging platform, 57% agreed, 23%
neither agreed nor disagreed, 17% disagreed and 3% strongly disagreed
MEDICAL EDUCATION STUDY RESULTS

• While 58% were aware of and familiar with the PDPA of Singapore and its
medico legal implications prior to the study, all remaining students (100;
42%) attributed their subsequent awareness to this study
• 38% did not feel MyDoc facilitated them learning in orthopaedic surgery
while 22% said they felt it did and 40% said they felt that perhaps it did
• In terms of the usefulness of clinical case discussions, 51% found them to
be useful or very useful while 10% did not and 39% answered neutrally

• The quality of the images was found to be poor by one student (0.004%), fair
by 41 students (17%), good by 100 students (42%), very good by 63
students (26%) and excellent by 35 students (15%)
• In asking what role the clinical case discussions played in comparison to the
students’ current modes of education, 208 (87%) felt it should
complement current modes while 32 (13%) felt there was no role

• 50% agreed or strongly agreed that MyDoc was user friendly while 32%
were unsure, 14% disagreed and 4% strongly disagreed
• On being asked if they felt using MyDoc to communicate with faculty or their
seniors would help build a stronger mentor-mentee relationship, 155 (65%)
felt it would, 61 (25%) stated possibly and 24 (10%) felt it would not
• Ninety-six students (40%) responded that they would recommend MyDoc to
others, 37 (40%) said they would not and 107 (45%) said they might

Of a total of 300 third-year students, 240 (80%) voluntarily engaged themselves
with MyDoc. Over a six-week period, 27467 individual messages were sent
between the students, equating to 654 per day. For group messages, a total of
19751 were sent, equating to 470 per day.

IRB?!

Met a few more people…

WHAT ELSE IS MYDOC HOPING TO ACHIEVE…?
• 24/7 student mentorship and/or avenue for specialty advice…
• Replace or enhance current interactive sessions
• Specialty groups for clinical years
• Case based discussions for pre-clinical years
• Focus on basic sciences behind diseases so even clinical year students
benefit with the pre-clinical students
• 700 people using it at same time should be aim (potentially 1500)

WHERE DO WE STAND CURRENTLY…?
• LIFT grant
• Journal of Medical Education or alternative journal

Thank you
for your attention!
zubin_jimmy_daruwalla@nuhs.edu.sg

NUS PRIME (Zubin)

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