Written by  2016-07-18

Uberising of health services

(2 votes)

Recently, I have been approached by start-ups, governmental, private agencies, tech coy on this topic of Uberising of health services. 

 

Well, first things first, go for the more traditional source of uber, somebody or anybody please do a Uber for ambulances to transport bed ridden patients or for special vehicles transporting patients in wheelchairs. There, I said it. The last I have heard, there have been discussion on such efforts being planned so it is good.

On to health services: As a active player for home and remote health services, there is definitely a role in uberising emergent health services. Those routine, long term relationship kind of services will need such supplementation for the coverage to be complete and functional. So what are the scope and the forms of these uberising there is? 

I do home based services and uberising of emergent care is possible, but the services should be properly scoped and clients should have an agreement and understanding of the limitations for such services. Funding will definitely be of issue such these form of services are probably all private right now and will not be covered under any insurance. It will be out of pocket expenses. For a MEANS tested and MEDIFUNDED patient, it will be free for them to go back to acute hospital for any emergent situation, even for just a emergency NGT change!

So who will use this form of health services and why?

Let us start with the most basic care giver services. Most commonly, (in fact just today), one of my patient’s family was asking me where to find a nanny service for the grandma, just for perhaps 2 to 3 hours to allow the usual caregiver (domestic helper) to go off duty. Care for this patient is really simple, just transferring her, routine hygiene care and perhaps companionship. She is eating orally with mince diet, which can be prepared before hand.  There are such services known as senior home help, run by charities, social enterprise and private provider. Right now, I would ask family to go to the private providers to ask for help, but as demand for this sort of services are high and such private services are really being handicapped by MOM restrictions, the request for urgent elder sitting might not be successful frequently. Uberisation of such services can help, either pool in all the providers to see who have spare capacity that day and that hour, or engage another group of caregivers totally out of this pool which sign up with this Uber App.  My patient’s daughter can then receive the services promptly.

The issue of getting Uberised care giver is perhaps 2 fold. On the provider or Uber side, how are they proposing to justify the standards for their care workers? Are they properly trained and by who, for example tube feeding techniques, transfer procedures and hygiene management. On the other site, can Uberised care giver service protect their own caregivers? Who are these clients, are they dangerous for a petite lady carer to go into the home? Is the client violent from psychotic depression or having paranoial symptoms of dementia?

Then we come to the charges, is it standardised for the entire services or each caregiver signing up charges differently based on their skills and experiences?

There are such caregiving courses, run by various charity organisations in Singapore. Perhaps, that can be the certification ground and also the source of manpower for this kind of app. Unfortunately, Lotus Eldercare Academy graduate will not be directly available here in Singapore.

Going higher up, nursing and therapy services. Therapy services are not likely to be required urgently so the market for Uberisation of therapist might not be practical. But for the completeness of the APP, there is no harm perhaps including such services.

Urgent nursing services are plainly procedure based and can be scoped rather easily. Why would family require an urgent nurse visit? Either one of the tubes (nasogastric, urinary catheter, PEG) dislodge or gotten pulled out by agitated patients; to review newly onset wounds or do wound dressings; and perhaps other more specialised procedures not being mentioned.  The certification part is easy, but skill level and comfort zone of each nurse differs. I was suggesting a refresher course for nurses doing home care for procedures to perhaps boost their confident and competency levels before they are being hired if they have not been keeping current with some of the procedures.

Similarly, to enlarge the pool, the Uber app should engage all the charity organisations, social enterprises and private nursing agencies providing such services to increase the total numbers if possible. Dangers are same as for caregivers; work place safety is still a question mark when nurse visits the family. I did have an agitated caregiver once going psychotic and took out a knife to try and stab my nurse many years back.

Lastly, urgent medical support. To me, there are only 2 things for anyone to need urgent home care consults. Urgent home care and Housecall is slightly different. Housecalls can be made to ambulant and rich persons who just want the services of GP coming to the home for treatment instead of going to the nearby GP for treatment. Issues which with a MC rest will solve usually. Urgent home medical visit involves bed or house bound patients with are very dependent and frail. Most of the time it either involves

1.     Signing of Certificate of Cause of Death

2.     Urgent medical consult for infections (which may or may not be life threatening), delirium like agitation or food refusal, worsening of organ failures like congestive cardiac failures or hepatic encephalopathies, emergent medical conditions like ischemic foot with gangrene, myocardial infarctions, strokes and seizures.

Point 1 is commonly the cause requiring urgent medical review. Point 2 can be a simple flu virus to life-threatening conditions.  Depending on the medical services provided, it is often a decision for end of life care at home or more active treatment back in acute hospital for more serious conditions. It also depends on how much resource the doctor can provide, from labs service to intravenous antibiotics to hospital-like services to the home. It is very difficult to scope as different doctors have different capacity and resources.  It will be difficult for any organisation to anticipate the requirements and scope for the services. A medical director should be in place to scope out all the medical service if such an uberisation of urgent medical care is to be done. There is no end for medical service and perhaps even an ICU level of care can be provided at home if there are such resources from the willing family. In fact, a tele-medical services should be inline with such uberisation of medical service to screen and advise. That will be more cost effective and for the very near future!

Read 1486 times Last modified on Saturday, 17 September 2016 16:09

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