The Telemedicine Demand Index and its Utility in Managing COVID-19 Case Surges

Introduction: Telemedicine was an integral component in Singapore's COVID-19 management strategy, having been deployed at a national level in a centrally-administered program whereby patients at higher risk of developing severe COVID-19 disease were proactively assigned tele-consultations, whereas those at lower risk and seen by primary care physicians could request ad hoc tele-consultations. To better plan for fluctuations in telemedicine demand during the pandemic, the Telemedicine Demand Index (TDI) was developed. Methods: Three main factors influencing telemedicine demand were considered-characteristics of the Variant of Concern, prevailing health care policies, and the population's healthcare-seeking behaviour-from which 11 coefficients were derived for the TDI formula. The number of tele-consultations demanded is the product of the TDI and the total number of new COVID-19 cases for a given period. Results: Real-world data from January 31 to March 27, 2022 were compared with TDI estimates. A total of 148,485 tele-consultations were conducted against a backdrop of 723,675 new COVID-19 cases for the period. The TDI overestimated demand by an average 11.4%. Data from March 28 to May 1, 2022 were then used to derive new TDI values and applied to a 3-week period starting May 9, 2022, following a policy change. A total of 5,560 tele-consultations were conducted against a backdrop of 77,998 new COVID-19 cases. The TDI underestimated demand by an average of 7.2%. Conclusion: The TDI shows initial promise for quickly estimating telemedicine demand at a population level. By leveraging historical data and applying some informed assumptions, it allows for the estimation of current capabilities and future requirements. There remains scope for more research to refine the TDI's constituent components, as well as its applicability in different population contexts.