Perseverance, teamwork, a “can-do” attitude, coupled with a sense of urgency to find solutions amid an evolving pandemic, have led to the development of novel technologies in the past year.

Within the few months after COVID-19 hit our shores, SingHealth institutions and teams rallied together to design, build, and deploy smart solutions to address challenges faced by patients and healthcare staff during the pandemic.

Dr Charlene Liew, Deputy Chief Medical Informatics Officer and Consultant, Diagnostic Radiology, Changi General Hospital (CGH), said the pandemic catalysed the widespread adoption and acceptance of digital technology in all sectors, with healthcare being no exception.

“When COVID-19 evolved rapidly across the world, we knew that we had to leverage new technologies, such as artificial intelligence (AI) and analytics, to develop tools that can be swiftly deployed, and enable teams to find new ways to combat the virus and manage the situation efficiently — for example, the use of AI in vaccine development and diagnostic tests so that they could be accelerated to address the pandemic,” said Dr Liew, who is also Director of Innovation, SingHealth Duke-NUS Radiological Sciences Academic Clinical Programme.

Harnessing AI

Dr Liew is part of the CGH team that developed an AI predictive tool to determine the likelihood of whether a patient has mild or severe pneumonia, based on chest x-ray images. Named Community- Acquired Pneumonia and COVID-19 Artificial Intelligence Predictive Engine (CAPE), this system alerts doctors to pneumonia patients who are likely to become critically ill.

<<Trained using more than 3,000 chest x-ray lung images and 200,000 data points including lab results and clinical history as a basis, CAPE is a predictive tool used to determine the likelihood of whether a patient has mild or severe pneumonia.>>

As pneumonia is one of the main causes of deterioration in COVID-19 patients, the ability to quickly predict its degree of severity is paramount. Together with the Integrated Health Information System (IHiS) team, CAPE was developed in four months.

“One main advantage of using AI as a predictive tool is that the risk of patients requiring critical care can be calculated almost instantaneously. Doctors at the emergency department and wards can receive an early warning for possible clinical deterioration, and prescribe the appropriate measures to improve patient outcomes,” said Dr Liew.

Robots on the frontline

In a world of social distancing, how can healthcare staff safely and effectively care for and interact with patients while mitigating risks of viral transmission?

Meet the robots that have been on the frontlines of the COVID-19 battle, “SwabBot” and “temi”.

Clinicians from National Cancer Centre Singapore (NCCS), Singapore General Hospital (SGH), and Duke-NUS Medical School worked with Biobot Surgical Pte Ltd, a local medical robotics technology company, to develop the first-of-its-kind fully patient-controlled nasal swab robot. Nasal swab is still the gold standard method of gathering specimens for COVID-19 tests.

Led by Dr Rena Dharmawan, Consultant Surgeon, Department of Head & Neck Surgery, Division of Surgery & Surgical Oncology, SGH and NCCS, the project was initiated in April 2020 and a working prototype was made available within just six weeks.

SwabBot is a made-in-Singapore robot that can automatically complete a nasal swab test in just 20 seconds, which is faster and more comfortable compared to a manual swab test. It also reduces swabbers’ risk of exposure to the virus and standardises the technique, which leads to a consistent swab done on every patient.

<<Individuals use their chin to activate the SwabBot to perform nasal swabbing. A swab stick extends safely and gently through the nose to the back of the nasal cavity. It has an in-built safety feature, where the swab stick retracts when a resistance is encountered.>>

Mr Sean Woon, a 22-year old volunteer in the clinical trial, said, “Compared to my past experience with manual swabbing, the process with SwabBot was faster and more comfortable.”

Amid the pandemic, remote-controlled robots called “temi” were also deployed at the SingHealth-managed Community Care Facility at Singapore Expo and at SingHealth Community Hospitals (SCH).

While initially purposed for conducting teleconsultations to minimise healthcare workers’ face-to-face interactions with COVID-19 patients, the versatile robot has also been used in other innovative ways to care for patients.

Temi has been used to deliver medications and assist social workers in tele-counselling with patients. It has even served as an exercise and dance “instructor” in wards where patients could follow videos of exercise and dance routines, said Clinical Assistant Professor Luke Low Sher Guan, Chief Medical Informatics Officer, SCH, and Director, Medical at Sengkang Community Hospital (SKCH).

<<Temi can be deployed to patients’ bedsides for non-urgent needs, act as a live translator for patients who speak different languages, deliver medications to patients, and facilitate tele-counselling sessions.>>

Prepared for shortages

Among the most severe complications of COVID-19 is respiratory failure, where ventilators are required to support the breathing needs of affected patients.

“During the pandemic, many countries and hospitals saw a lack of life-saving ventilators.

Should Singapore experience a surge in severe COVID-19 cases with respiratory failure, we were concerned that it could be a challenge to secure the supply of ventilators and train healthcare professionals to manage large volumes of patients on ventilators,” said Associate Professor Derrick Chan, Director of KK Research Centre, KK Women’s and Children’s Hospital (KKH), and Deputy Director, SingHealth Medical Technology Office (MTO).

With this in mind, clinician-innovators from KKH, SGH, CGH and Sengkang General Hospital (SKH), in collaboration with SingHealth MTO and industry partners, created their own ventilator prototype — the SG-Inspire (SinGapore Invasive/ non-invasive support for effective respiration), which was meant to supplement the supply of ventilators in Singapore, should the need arise.

<<SG-Inspire is an innovative ventilator prototype developed to support COVID-19 patients requiring breathing support. Photo: The Straits Times © Singapore Press Holdings Limited>>

The project started in March 2020 and a working prototype was ready by end-July 2020. Since then, the team has received multiple enquiries locally and overseas for the production of SG-Inspire, and is in discussions with the respective industries. SG-Inspire costs five times less than that of conventional ventilators and uses readily available components, which means that it can be scaled up and mass produced swiftly to handle the pandemic.

Overcoming challenges

Perseverance and a focus on patient care was what kept the clinician-innovators going, despite trying circumstances, such as the limited knowledge of the virus, and having to manage the rising number of cases and evolving situation.

For the SG-Inspire team, lockdowns in many countries around the world resulted in limited options in the supply of components. To overcome this, they used a supply-to-design approach, choosing only available and suitable components that could be used for the design of SG-Inspire, so that it could be mass produced without any component supply issues.

“A compelling unmet need is always the basis of any useful innovation. This fostered a sense of mission in the team which, together with professionalism and proactiveness, were key drivers of our team’s efforts. We worked round the clock to bring this to fruition,” said Prof Chan.

Beyond COVID-19

These technological innovations will stay relevant in supporting healthcare teams, even beyond COVID-19.

The CAPE team is looking to integrate data from electronic medical records and further improve the accuracy of the tool with clinical data from hospitals, including SGH and SKH.

“Besides COVID-19, CAPE can be applied to all forms of community-acquired pneumonia. It can also be calibrated to potentially identify and predict the severity of respiratory infections globally to plan for an increase in inpatient and critical care support. In areas where healthcare resources are limited, CAPE can enable prioritisation of resources so that patients can receive appropriate and timely care,” said Dr Jessica Quah, Consultant, Respiratory & Critical Care Medicine, CGH.

Likewise, SG-Inspire has the potential to be used beyond Singapore’s shores, in resource-limited settings such as developing countries.

“This would mitigate what is currently a preventable tragedy of children and adults suffering and dying due to a lack of suitable equipment and skills,” said Prof Chan.

Meanwhile, temi robots are still being used as assistants in some SCH to keep patients meaningfully occupied with the entertainment functions and to look out for them.

Prof Low believes many of these advances in technology will be here to stay and be part of a new normal in healthcare processes.

“But we are also mindful that robots cannot completely replace humans in healthcare. Having the human touch in patient care is important because we need that bond with our patients to provide them with the much needed emotional support of comfort and reassurance as they heal,” he said.