Health IT in SingaporeDr Sarah MuttittCIO, MOH Holdings Pte Ltd7th Feb 2012
Getting ready for the “Silver Tsunami”Pressures on Singapore healthcare system set to increaseBy 2030 • 1 in 5 Singaporeans will be over 65By 2050 • Singapore will be among the world’s demographically oldest countries with median age of 54 “A Different Pattern of Healthcare” • Integrated healthcare delivery system • Appropriate care from the right site • Better allocation of resources • More cost-effective treatment and care in the healthcare continuum
New Directions We need to do more than building more acute hospitals. Khoo Teck Puat Hospital Jurong General Hospital (2014) 550-bedded regional hospital 700-bedded regional hospital• Community hospitals, nursing homes, primary care• Train and/or recruit healthcare providers (and IT professionals!)• Support informal and community based care givers• Address incentives, disincentives• New responsibilities, accountabilities
Vision of Future Healthcare Landscape- enabled by the Regional Health Systems (RHS) Community Hospital Polyclinic/ Family Nursing Medicine Homes Clinic Home Screening & Palliative Prevention Care Family Physician Rehab supported by Centres CHCs Restructured Hospital Medical CentresOrganisation of the RHS, where Home is the central location for care, withprimary care delivering person-centric care integrated with the rest of the care spectrum for both physical and mental healthcare.
Supporting the Care Continuum Strengthened Primary Care providers to Strengthening ILTC sectors to support support better chronic care management , increasingly aging population in the community disease prevention and wellness and at homes• Encourage greater participation of GPs into chronic • Encourage greater care efficiency of community providers by care management by equipping them with tools and equipping them with tools and facilitating data linkages facilitating data linkages • Enhance community capacity to support increasing aging• Enhance ‘sensory’ networks in primary care from population through care coordination between providers and peace-time monitoring and emergency activations care givers ILTC IT Strategy Community Hospital Polyclinic/ Family Nursing Medicine Homes Clinic Screening & Home Palliative Prevention Care Family Physician Rehab supported by Centres CHCs Restructured Hospital Medical Centres Primary Care IT Strategy NATIONAL ELECTRONIC HEALTH RECORD
eHealth Systems in Singapore National EMR Exchange Hospital based Immunisation (EMRX) EMR & CPOE RegistryMultiple EMR SystemsMultiple Lab & Radiology Systems Critical Medical 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 (over 400 out of more than 2,000 have a CMS) EMR Community Hospitals and other ILTC providers
Top 3 Priorities for Health IT• Priority 1: Establish a Health Information Exchange to facilitate care integration across the different segments in a trusted and standardised manner.• Priority 2: Create an Integrated Healthcare Continuum where care providers are e-enabled and linked; to participate in the integration of care across the healthcare value chain.• Priority 3: Enhance Manpower Capability to support the infocomm- enabled model of integrated healthcare services.Other Priorities / ObjectivesAs an key enabler to support MOH’s vision and Singapore’s growth as a Medical hub.
National Electronic Health Record(NEHR)Vision of“One Singaporean, One Health 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.
EMR vs EHREMR EHRSpecific to a facility Specific to an individual(institution, private office)• Equivalent of its paper • Captures a key subset of health predecessor information from multiple• Includes everything recorded point-of-service systems by the organization about a • Available electronically to given patient authorized healthcare providers• Has “depth” but lacks “breadth” anytime, anywhere • Designed to facilitate the sharing of data across the continuum of care, across healthcare delivery organizations and across geographies
What Our Clinicians Want Consolidated view of patient’s current medications Ability to share critical Consolidated view of patient information patient’s current across all providers problems involved In patient’s clinical care journey What Our Patient information accessible at the point Longitudinal summary health care profiles Clinicians of care – to support clinical decision Want making
Interoperability - Enterprise ArchitecturePragmatic approach adopted to deliver an Enterprise Architecture that is Implementable Fit-for-purpose i.e. delivering value for clinicians in the near term Future-Proofed to support longer term vision for healthcare, analytics and research
Interoperability - National Data Standards Clinically-DrivenEstablishing a suite of Standards that are: Easy to Use Internationally Recognised to ensure clinical data included in the EHR can be: Shared and exchanged safely and reliably Relied on for the monitoring and care of patients Global Standards Engagements Used meaningfully for secondary purposes • HL7 (Health Level Seven) • IHTSDO (International Health including the production of clinical knowledge Terminology Standards Development Organization) Standards also provide a platform for long • ISO TC215 on Health Informatics term semantic interoperability and research informatics
Change Management “It simply doesn’t make sense that patients in the 21st century are still filling out forms with pens on papers that have to be stored away somewhere.” US President Barack Obama Need to manage change as large majority of American Medical Association clinicians learnt their professions in the absence Annual Conference, 15 June 2009 of automation, and continue to practice without it Concerns Programmes & Initiatives Privacy of patient information Privacy and Security Framework Impact on efficiency of work Process redesign & workflow integration Cost of automation Subsidies and incentives Quality of available solutions Common functional requirements definition How to make transition from Peer network & transition support services paper-based to e-documentation
The Journey towards One Health Record Formation of the Creation of the Award of contract Implementation of2008 2009 2010 2011 National Health goal state for NEHR solution the production Informatics architecture for an system Build and Strategy electronic health Development over Integration with the Formation of the record solution 10 months legacy systems clinical advisory Beginning of providing Collaborative focus demographic and groups and Vendor Selection group discussions clinical data to the taskforces on NEHR design NEHR with key clinicians Beginning of and industry deployment to thought leaders Singapore public healthcare Award of contract for the delivery of a primary care solution to integrate with the NEHR
NEHR Phase 1Who will have access by 2012 2 x Nursing 6 x Community Hosp Home/Hospice AIC 18 x Polyclinics 8 x Restructured Hosp 6 x Specialist Centres 50 x GP Clinics SAF
NEHR – Towards A Fully Integrated Care Record:Providers are “on the same page” Community Acute Hospital Hospital Community Hospital Common System (CHCS) Demographics Events History Nursing Home IT Enablement Discharge NEHR Medication Nursing Program (NHELP) Summary History Home Emergency Department Laboratory Tests Radiology Tests Clinic EMR & Operations (CLEO) Pharmacist General Practitioner
The Next Wave: Transforming HealthcareThrough Innovative Use of Technology Reaching and touching the patient via Multi-access Channel, Multi-modal Means Web, Mobile Phone National Call Centre •Triaging Personal Health •Case management for CDM Management •Healthcare services (e.g. PCPS) •Self management •Patient empowerment, education/literacy •Shared repository of patient- entered data •Web and mobile applications for CDM, wellness •Open platform Telehealth •Remote monitoring and consult (telehealth) •Telemedicine : provider to provider, mobility, specialist care delivery (e.g. Teleoptometry) •Call for collaboration Devices and Network
The Promise of HITBetter 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-helpBetter 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