Amin, H. et al.: Planning the Development of the Singapore National Health Portal This slideshow, presented at Medicine 2.0’08 , Sept 4/5 th , 2008, in Toronto, was uploaded on behalf of the presenter by the Medicine 2.0 team Do not miss the next Medicine 2.0 congress on 17/18th Sept 2009 ( www.medicine20congress.com ) Order Audio Recordings (mp3) of Medicine 2.0’08 presentations at http://www.medicine20congress.com/mp3.php

This slideshow, presented at Medicine 2.0’08 , Sept 4/5 th , 2008, in Toronto, was uploaded on behalf of the presenter by the Medicine 2.0 team

Do not miss the next Medicine 2.0 congress on 17/18th Sept 2009 ( www.medicine20congress.com )

Order Audio Recordings (mp3) of Medicine 2.0’08 presentations at http://www.medicine20congress.com/mp3.php

PLANNING THE DEVELOPMENT OF THE SINGAPORE NATIONAL HEALTH PORTAL 04 September 2008 MEDICINE 2.0 CONGRESS Handy Amin, Active Health Management Dr Shyamala Thilagaratnam, Active Health Management Dr Andy Tan, Active Health Management Low Sau Chan, Chief Information Officer's Office Tan Ping Ping, Chief Information Officer's Office

All About Singapore

An island city-state in Southeast Asia >15,000 km from Toronto Land area of 700 km 2 Geographic Location Maps courtesy of The World Factbook

An island city-state in Southeast Asia

>15,000 km from Toronto

Land area of 700 km 2

The People of Singapore Vibrant global city; thriving centre of commerce Multi-ethnic resident population of >3.6 million Chinese 76.8% Malay 13.9% Indian 7.9% Others 1.4% Total population of <4.6 million Images courtesy of the Singapore Tourism Board

Vibrant global city; thriving centre of commerce

Multi-ethnic resident population of >3.6 million

Chinese 76.8%

Malay 13.9%

Indian 7.9%

Others 1.4%

Total population of <4.6 million

Things to do in Singapore Images courtesy of the Singapore Tourism Board

Singapore’s Healthcare System

Individual responsibility towards healthy living & medical expenses Affordable basic healthcare Subsidised medical services at public hospitals and clinics Principle of “co-payment” Medisave Medishield Medifund Eldershield S$ 7.6 billion or 3.8% of GDP on healthcare (2005) Singapore’s Health Philosophy

Individual responsibility towards healthy living & medical expenses

Affordable basic healthcare

Subsidised medical services at public hospitals and clinics

Principle of “co-payment”

Medisave

Medishield

Medifund

Eldershield

S$ 7.6 billion or 3.8% of GDP on healthcare (2005)

Medisave (1984) National medical savings scheme (6.5% - 9% of monthly salary) Personal or immediate family's hospitalization, day surgery and certain outpatient expenses Medishield (1990) Low cost catastrophic illness insurance scheme Operates on a co-payment and deductible system Medifund (1993) Endowment fund set to help needy Singaporeans Eldershield Affordable severe disability insurance scheme Healthcare Finance Schemes

Medisave (1984)

National medical savings scheme (6.5% - 9% of monthly salary)

Personal or immediate family's hospitalization, day surgery and certain outpatient expenses

Medishield (1990)

Low cost catastrophic illness insurance scheme

Operates on a co-payment and deductible system

Medifund (1993)

Endowment fund set to help needy Singaporeans

Eldershield

Affordable severe disability insurance scheme

Primary care (outpatient) 80% public – 18 polyclinics 20% private – Over 2,000 General Practitioners (GPs) Acute care (inpatient) 20% public – 7 public hospitals, 9 specialty centres / institutes 80% private – 13 private hospitals 2 public healthcare clusters National Healthcare Group (NHG) 9 polyclinics, 4 hospitals, 4 specialty centres / institute Singapore Health Services (SingHealth) 9 polyclinics, 3 hospitals, 5 specialty centres Public Versus Private Healthcare

Primary care (outpatient)

80% public – 18 polyclinics

20% private – Over 2,000 General Practitioners (GPs)

Acute care (inpatient)

20% public – 7 public hospitals, 9 specialty centres / institutes

80% private – 13 private hospitals

2 public healthcare clusters

National Healthcare Group (NHG)

9 polyclinics, 4 hospitals, 4 specialty centres / institute

Singapore Health Services (SingHealth)

9 polyclinics, 3 hospitals, 5 specialty centres

Reasons for a National Health Portal

Health Promotion Board (HPB) Established on April 1, 2001 Vision A nation of healthy and fit Singaporeans Mission Statement We will be a centre of excellence for health promotion. With our partners, we create a supportive environment, and provide health education and preventive health services to empower every Singaporean to attain the best possible health throughout life. The Health Promotion Board

Health Promotion Board (HPB)

Established on April 1, 2001

Vision

A nation of healthy and fit Singaporeans

Mission Statement

We will be a centre of excellence for health promotion. With our partners, we create a supportive environment, and provide health education and preventive health services to empower every Singaporean to attain the best possible health throughout life.

The HPB Strategic Framework Web Unhealthy & aware of health conditions (patients) Unhealthy & not aware of health conditions Approach Life Cycle Nutrition Smoking Control Physical Activity Positive Mental Health Targeted Interventions Early detection Chronic Disease Management Patient Education/Empowerment Building Bridges to our Partners Exploit IT Maximally Research & Strategic Planning ADOLESCENTS ADULTS ELDERLY CHILDREN At-risk groups People of Singapore Healthy Unhealthy Schools Healthcare Workplaces Community Industry

The Chronic Disease Challenge

Promote the concept of Active (& Individualised) Health Management (AHM) Empower Singaporeans to actively manage their own health Provide relevant resources and tools to support AHM Active Health Management

Promote the concept of Active (& Individualised) Health Management (AHM)

Empower Singaporeans to actively manage their own health

Provide relevant resources and tools to support AHM

Reduce medical costs Change medical encounters from episodic to continuous Enable prevention and early detection of illnesses Enable provision of quality healthcare services based on individual needs and requirements Objectives of AHM

Reduce medical costs

Change medical encounters from episodic to continuous

Enable prevention and early detection of illnesses

Enable provision of quality healthcare services based on individual needs and requirements

Exploiting IT, E nabling AHM

National Health Portal (NHP) Personal Health Record (PHR) Health education resources Personalised health management tools Health Risk Assessment (HRA) Behavioural Health Intervention Programmes (BHIP) Health Trackers Collaborative disease management between patient and care providers Exploiting IT, E nabling AHM

National Health Portal (NHP)

Personal Health Record (PHR)

Health education resources

Personalised health management tools

Health Risk Assessment (HRA)

Behavioural Health Intervention Programmes (BHIP)

Health Trackers

Collaborative disease management between patient and care providers

The National Health Portal Project

The NHP Taskforce Drive development and implementation of NHP Comprising of representatives from various stakeholders: HPB Health Clusters (SingHealth, NHG) Ministry of Health (MOH) Healthcare professional organisations (e.g.. College of Family Physicians of Singapore) Infocomm Development Authority (IDA) Healthcare Cluster Feasibility study Global review of health portals Dialogues / focus groups with stakeholder representatives Conceptualising the NHP

The NHP Taskforce

Drive development and implementation of NHP

Comprising of representatives from various stakeholders:

HPB

Health Clusters (SingHealth, NHG)

Ministry of Health (MOH)

Healthcare professional organisations (e.g.. College of Family Physicians of Singapore)

Infocomm Development Authority (IDA) Healthcare Cluster

Feasibility study

Global review of health portals

Dialogues / focus groups with stakeholder representatives

“ A unified web portal for empowering individuals and their care-givers with health/medical information and preventive/monitoring tools for personalised health management so as to achieve better health outcomes.” The NHP Vision

“ A unified web portal for empowering individuals and their care-givers with health/medical information and preventive/monitoring tools for personalised health management so as to achieve better health outcomes.”

NHP Project – Phase 1

Phase 1- 2008 to 2009 Internet National Health Portal HPB User Public Clinicians Laboratories MSB Personal Health Info Health Screening Results Self-entered Personal Health Info Laboratory Systems Hospital Systems

Functionalities / Features: PHR Self-entered records; no integration with Electronic Health Records (EHR) Lab results from Integrated Screening Programme (ISP) Drug allergies from Critical Medical Information Store (CMIS) Health management tools HRA Weight Management BHIP Smoking Cessation BHIP Diabetes Management BHIP Health Trackers Clinician Access to PHR Public healthcare sector Interfaces Interface with clusters’ events calendar & eventshub.sg Interface with CPF for Medisave / Medishield / Eldershield information Phase 1- 2008 to 2009

Functionalities / Features:

PHR

Self-entered records; no integration with Electronic Health Records (EHR)

Lab results from Integrated Screening Programme (ISP)

Drug allergies from Critical Medical Information Store (CMIS)

Health management tools

HRA

Weight Management BHIP

Smoking Cessation BHIP

Diabetes Management BHIP

Health Trackers

Clinician Access to PHR

Public healthcare sector

Interfaces

Interface with clusters’ events calendar & eventshub.sg

Interface with CPF for Medisave / Medishield / Eldershield information

Conditions Family history Allergies Food Environmental Drug (Critical Medical Information Store, CMIS) Lab tests Results from Integrated Screening Programme (ISP) Contact information Print PHR Summary Print In Case of Emergency (ICE) Card Phase 1 PHR Features

Conditions

Family history

Allergies

Food

Environmental

Drug (Critical Medical Information Store, CMIS)

Lab tests

Results from Integrated Screening Programme (ISP)

Contact information

Print PHR Summary

Print In Case of Emergency (ICE) Card

Concept of tailoring More tailored, more engaging, more effective HRA BHIPs Weight Management Smoking Cessation Diabetes Management Health Trackers Phase 1 Health Management Tools

Concept of tailoring

More tailored, more engaging, more effective

HRA

BHIPs

Weight Management

Smoking Cessation

Diabetes Management

Health Trackers

Phase 1 Health Management Tools Low Tailored Story Tailoring Variable Used In This Case: + Gender

Phase 1 Health Management Tools High Tailored Story Tailoring Variables Used In This Case: + Age + Gender + Ethnicity + Marital status + Smoking status of spouse + Child in home + Physically active + Number of cigarettes smoked + Job status + Barrier + Social support

Health Trackers Weight / BMI Blood Pressure Blood Sugar (fasting and non-fasting) Smoking Nutrition Physical Activity Hemoglobin A1c Phase 1 Health Management Tools

Health Trackers

Weight / BMI

Blood Pressure

Blood Sugar (fasting and non-fasting)

Smoking

Nutrition

Physical Activity

Hemoglobin A1c

Appointment Booking Interface with clusters’ appointment systems Calendar of events Interface with clusters’ events calendar & eventshub.sg Health education resources Content from HPB Online (e.g. articles, RSS feeds, podcasts) Search function Health expenditures Interface with CPF for Medisave / Medishield / Eldershield information Health insurance & coverage Phase 1 Other Portal Features

Appointment Booking

Interface with clusters’ appointment systems

Calendar of events

Interface with clusters’ events calendar & eventshub.sg

Health education resources

Content from HPB Online (e.g. articles, RSS feeds, podcasts)

Search function

Health expenditures

Interface with CPF for Medisave / Medishield / Eldershield information

Health insurance & coverage

Outreach Strategy Beyond Phase 3, the NHP shall be operated via a Public Private Partnership (PPP) model Year Phases Cumulative Number of Users Outreach For Recruitment Of Users 2009 1 10,000 Polyclinic and government specialist clinics patients 2010 2 50,000 Civil service workplace 2011 3a 100,000 Private clinics and hospitals patients Selected private workplaces 2012 3b 200,000 More workplaces Insurance policyholders

Beyond Phase 3, the NHP shall be operated via a Public Private Partnership (PPP) model

NHP Project - Beyond Phase 1

Additional Functionalities / Features: Evaluation of Phase 1 PHR Integration with GPs’ Clinical Management Systems (CMS) Health management tools Mental Wellness BHIP Clinician Access to PHR Private GPs Interfaces National Immunisation Registry (NIR) Student Health Assessment Programme (SHAPE) Integrated Dental Electronic Assessment for Students (IDEAS) Phase 2 - 2009 to 2010

Additional Functionalities / Features:

Evaluation of Phase 1

PHR

Integration with GPs’ Clinical Management Systems (CMS)

Health management tools

Mental Wellness BHIP

Clinician Access to PHR

Private GPs

Interfaces

National Immunisation Registry (NIR)

Student Health Assessment Programme (SHAPE)

Integrated Dental Electronic Assessment for Students (IDEAS)

Additional Functionalities / Features: Evaluation of Phase 2 PHR Full integration with EHR Health management tools Other BHIPs (e.g. Nutrition BHIP) Clinician Access to PHR Private hospitals Community hospitals & nursing homes Phase 3 - 2010 to 2012

Additional Functionalities / Features:

Evaluation of Phase 2

PHR

Full integration with EHR

Health management tools

Other BHIPs (e.g. Nutrition BHIP)

Clinician Access to PHR

Private hospitals

Community hospitals & nursing homes

Additional Functionalities / Features: Additional languages Remote monitoring devices Extend mobile / non-web access Social networking tools In the Pipeline

Additional Functionalities / Features:

Additional languages

Remote monitoring devices

Extend mobile / non-web access

Social networking tools

Standardization of data entry, sharing, and interoperability No common national standard across all healthcare providers currently MOH holdings (MOHH) has been set up to co-ordinate efforts Legal & ethical concerns - data privacy & security Policy on EHR data yet to be determined Managing users’ expectation Concerns about healthcare providers’ responsibility and legal liability Engaging relevant stakeholders Co-ordination of stakeholders’ involvement; garnering their full support Minimising disruption to existing systems & workflows Increasing user adoption Marketing the NHP to the different target audiences Incentivising participation, while maintaining sustainability Critical Success Factors

Standardization of data entry, sharing, and interoperability

No common national standard across all healthcare providers currently

MOH holdings (MOHH) has been set up to co-ordinate efforts

Legal & ethical concerns - data privacy & security

Policy on EHR data yet to be determined

Managing users’ expectation

Concerns about healthcare providers’ responsibility and legal liability

Engaging relevant stakeholders

Co-ordination of stakeholders’ involvement; garnering their full support

Minimising disruption to existing systems & workflows

Increasing user adoption

Marketing the NHP to the different target audiences

Incentivising participation, while maintaining sustainability

Thank you [email_address]