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Healthcare Systems Sustainability. Is sustainability of healthcare possible without eHealth?: The Singapore experience

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Healthcare Systems Sustainability. Is sustainability of healthcare possible without eHealth?: The Singapore experience. Muttit S. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

Healthcare Systems Sustainability. Is sustainability of healthcare possible without eHealth?: The Singapore experience. Muttit S. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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  • 1. Is Sustainability of Healthcare Possible without eHealth? The Singapore Experience Dr Sarah Muttitt Chief Information Officer Information Systems Division MOH Holdings, Singapore eHealth Conference 2010 Barcelona, 16 March 2010
  • 2. Healthcare in Asia Shared Concerns in a Diverse Region Heterogeneous Region  Geography and population  Culture and education  Social economic development and infrastructure Common Themes  Economic objectives are top priorities  Significant healthcare provision beyond the public sector  Aging population From http://en.wikipedia.org/wiki/File:Location_Asia.svg MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 2
  • 3. Successful cost containment  Asia is successful so far in keeping healthcare costs down  What are the incentives for investing in Health IT if costs are already low? Share of GDP spend on Health 1998 2001 Japan 7.2 7.8 Taiwan 5.5 6.0 Hong Kong SAR 5.6 5.7 Korea 4.3 5.1 Singapore 4.2 3.9 Reference: Health Systems in East Asia: What Can Developing Countries Learn from Japan and the Asian Tigers? World Bank Report 2005 by Adam Wagstaff MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 3
  • 4. Rapidly ageing population In 2030, 3 out of 5 oldest nations in the world will be in Asia. Reference: Population Age Shifts . Reshape Global Economics and Geopolitics. Adele Hayutin, Ph.D. Director, Global Aging Program, Stanford Center on Longevity, 2009 MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 4
  • 5. Healthcare in Singapore Land area: 700 sq km Population: 4.6 million (3.6 million residents, I million foreign workers) Healthcare expenditure: 4% GDP (S$2,134 per capita) 1/3 of JCI-accredited hospitals in Asia are in Singapore. All 7 public hospitals and 2 national specialty centres in Singapore are JCI-accredited. Singapore’s healthcare system is ranked first in Asia and sixth in the world by the World Health Organisation. Singapore is ranked third in health infrastructure and 4th on health problems not having an impact of on companies in the World Competitiveness Yearbook 2007. MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 5
  • 6. Healthcare Financing in Singapore National Healthcare Expenditure (NHE) MediShield Employer Medi- & Elder- Medi Government benefits save Cash* fund Subvention shield Individual Financing Government Healthcare Expenditure KEY GOVERNANCE PRINCIPLES  Individual responsibility for health; patient co-payment to minimize moral hazard and wastage  Government subsidies to keep basic healthcare affordable MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 6
  • 7. Universal healthcare coverage for all Singaporeans Philosophy Building a healthy nation through preventive healthcare programmes and promoting a healthy lifestyle Good affordable basic healthcare is available to Singaporeans through subsidised medical services in public hospitals and clinics Secondary and Tertiary Care 80% Private 30% Private > 2,000 GP clinics 80% Public 70 % Voluntary Welfare 7 Restructured Hospitals 6 Community Hospitals 20% Public 6 Specialty Centers 36 Care Homes, 8 Hospices 17 Polyclinics 64 Nursing Homes 20% Private 16 Hospitals Intermediate and Primary Healthcare Long Term Care MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 7
  • 8. Political Vision Integrated Healthcare System “ What does it mean when we say our population will be older? It means there will be more demand on healthcare because older people are sick more often. But this also means it is a different pattern of healthcare So we have to respond to this by putting in more resources into our hospital system, building new hospitals. … get the whole system to be structured properly so that it will be adapted to cater o the ageing population. To structure it properly means we need step-down care.” Picture taken from asiaone.com “ And one key thing we must do with this step-down care is to link up our acute hospitals […] with community hospitals, so that you can have the best of both worlds. ” Prime Minister Lee Hsien Loong National Day Rally 2009 MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 8
  • 9. Getting ready for the “silver tsunami”  Integrated healthcare delivery system “Slow medicine”  Appropriate care from the right site physiotherapy, rehab and care for chronic sick  Better allocation of resources  More cost-effective treatment and care in the healthcare continuum Long Term Care Acute & Primary Tertiary Care Care “Fast medicine” diagnosis and treatment of patients with acute needs MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 9
  • 10. Innovation: Healthcare landscape of the future Strategic vision of patients moving seamlessly across the healthcare system, receiving coordinated patient-centric care at the most appropriate settings. Enabled by the National CH Electronic Health Record NH Screening & Polyclinics Palliative (EHR) Prevention RH Care Home FPs Care Rehab & support services CH CH CH Polyclinics NH Polyclinics NH Polyclinics NH Screening & Palliative Screening & Palliative Prevention RH Care Prevention RH Care Screening & Prevention RH Palliative Home Home Care FPs Care FPs Care Home FPs Care Rehab & Rehab & support support Rehab & services services support CH CH services Polyclinics NH Polyclinics NH Screening & Palliative Screening & Prevention RH Palliative Prevention RH Care Care Home Home FPs Care FPs Care Rehab & Rehab & support support services services MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 10
  • 11. Innovation: Chronic Disease Management Programme Holistic approach  Patients work closely with their doctors in managing their chronic diseases  Started in 2006 in collaboration with GP clinics  Provides patients systematic, evidence-based chronic disease management programme 8 chronic diseases covered currently: • Diabetes mellitus • Asthma • Hypertension • COPD • Hyperlipidemia • Schizophrenia • Stroke • Major Depression MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 11
  • 12. Better care and improved outcomes Study of diabetic patients in 2nd year of CDMP Patients received increase of care components Significant improvement in diabetic, lipid and blood Taken from published paper from Ministry Of Health, Singapore: “Medisave for Chronic Disease Management Programme – The Second pressure control Year” by Dr Lee Heow Yong, Ms Noureen Mervani & Dr Aley Moolayil MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 12
  • 13. Innovation: Integrated Health Screening Programme Early detection of chronic diseases Collaboration between Health Promotion Board and CDMP-certified clinics Aimed at patients 40 and above Nationwide Screening for Subsidized rates for lower income group • BMI screening • Diabetes mellitus • Hypertension • Hyperlipidemia Females: • Pap smear for cervical cancer Mammogram recommended for breast cancer MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 13
  • 14. Challenges for Singapore  Ageing population - By 2030, 1 in 5 Singaporeans over age 65 (three-fold increase)  Changing diseases – more chronic and emerging infectious diseases  Increasing public expectations, perhaps excessively so  Rising prices of drugs and equipment  Yet, limited resources  Global shortage of healthcare professionals  Lack of facilities MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 14
  • 15. Vision of “One Patient, One Record” The EHR is an integrated healthcare record centered on each person. It extracts and consolidates in one record, all clinically relevant information from their encounters across the healthcare system throughout his/her life. Secure “real-time” access to patients’ EHR by authorised clinicians and healthcare providers:  enable greater coordination and informed decision-making,  resulting in more accurate diagnosis, better treatment and patient-centric integrated care. MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 15
  • 16. NEHR builds on existing eHealth Systems National EMR Exchange Hospital based Immunisation (EMRX) EMR & CPOE Registry Multiple EMR Systems Multiple Lab & Radiology Systems Critical Medical  2 public healthcare clusters Information Store (CMIS) NHG and SingHealth hospitals, polyclinics and specialist clinics  Ministry of Defence (MINDEF) EMRX Extension to Community GP Clinic Hospitals Management Systems Minimal EMR Systems Community Hospital based  Private GPs (approx 300 out of more than 2,000 have a CMS) EMR  Community Hospitals MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 16
  • 17. Personal Health Record (PHR) Foundation for the Singapore eHealth Portal Vision A unified web portal for empowering individuals and their care-givers with health/medical information and preventive/monitoring tools for personalised health management to achieve better health outcomes. MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 17
  • 18. Personal Health Record (PHR) MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 18
  • 19. Roadmap to sync with National eHealth Record 2009 2010 2011/12  Personal Health Records  Provide tailored  Alignment with NEHR healthcare content  Health Risk Assessment  Facilitate individuals to  Interface with existing share PHR with their  Behavioural Health health repositories clinicians Intervention Programmes  Incorporate mental  Incorporate new programmes  Health Trackers & Tools wellness and pregnancy  Foster family concept in  Self-entered Screening tracking modules Active Health Management Results, Allergies,  Alignment with Appointments & Calendar  Support interface with National EHR of Events remote-monitoring devices  Architectural review for  Enable online communities PHR integration on healthcare topics Adapted and summarised from HPB presentation on Singapore eHealth Portal MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 19
  • 20. The promise of Integrated eHealth Better Clinical Care and Streamlined Workflows Patient information at the point of care  Supports clinical decision making and workflows  Enables providers involved in patient care journey to work as a team  Seamless transition of patient into different care settings  Better management of chronic illnesses  Enables greater patient participation and supports self-help Better Practices and Greater Patient Safety Shared patient’s clinical records  Enforces better prescribing practices with peer reviews  Reduces human errors related to handwritten records  Takes the guesswork out from the lack of past records  Prevents duplicate and unnecessary tests; and adverse drug events MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 20
  • 21. Sustainable, High Quality Healthcare in Singapore Key Factors  Political Vision  Bold Innovation  In structure, policy, services  Robust IT Infrastructure  providing info and decision support at the point of care  capturing info for CQI and system management  Empowered Population with Information and Choice MOH Holdings Pte Ltd This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 21
  • 22. Thank You MOH Holdings www.mohh.com.sg

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