Planning the Development of the Singapore National Health Portal [4 Cr3 1330 Amin]


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Planning the Development of the Singapore National Health Portal [4 Cr3 1330 Amin]

  1. 1. Amin, H. et al.: Planning the Development of the Singapore National Health Portal <ul><li>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 </li></ul><ul><li>Do not miss the next Medicine 2.0 congress on 17/18th Sept 2009 ( ) </li></ul><ul><li>Order Audio Recordings (mp3) of Medicine 2.0’08 presentations at </li></ul>
  2. 2. 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
  3. 3. All About Singapore
  4. 4. <ul><li>An island city-state in Southeast Asia </li></ul><ul><li>>15,000 km from Toronto </li></ul><ul><li>Land area of 700 km 2 </li></ul>Geographic Location Maps courtesy of The World Factbook
  5. 5. The People of Singapore <ul><li>Vibrant global city; thriving centre of commerce </li></ul><ul><li>Multi-ethnic resident population of >3.6 million </li></ul><ul><ul><li>Chinese 76.8% </li></ul></ul><ul><ul><li>Malay 13.9% </li></ul></ul><ul><ul><li>Indian 7.9% </li></ul></ul><ul><ul><li>Others 1.4% </li></ul></ul><ul><li>Total population of <4.6 million </li></ul>Images courtesy of the Singapore Tourism Board
  6. 6. Things to do in Singapore Images courtesy of the Singapore Tourism Board
  7. 7. Singapore’s Healthcare System
  8. 8. <ul><li>Individual responsibility towards healthy living & medical expenses </li></ul><ul><li>Affordable basic healthcare </li></ul><ul><ul><li>Subsidised medical services at public hospitals and clinics </li></ul></ul><ul><li>Principle of “co-payment” </li></ul><ul><ul><li>Medisave </li></ul></ul><ul><ul><li>Medishield </li></ul></ul><ul><ul><li>Medifund </li></ul></ul><ul><ul><li>Eldershield </li></ul></ul><ul><li>S$ 7.6 billion or 3.8% of GDP on healthcare (2005) </li></ul>Singapore’s Health Philosophy
  9. 9. <ul><li>Medisave (1984) </li></ul><ul><ul><li>National medical savings scheme (6.5% - 9% of monthly salary) </li></ul></ul><ul><ul><li>Personal or immediate family's hospitalization, day surgery and certain outpatient expenses </li></ul></ul><ul><li>Medishield (1990) </li></ul><ul><ul><li>Low cost catastrophic illness insurance scheme </li></ul></ul><ul><ul><li>Operates on a co-payment and deductible system </li></ul></ul><ul><li>Medifund (1993) </li></ul><ul><ul><li>Endowment fund set to help needy Singaporeans </li></ul></ul><ul><li>Eldershield </li></ul><ul><ul><li>Affordable severe disability insurance scheme </li></ul></ul>Healthcare Finance Schemes
  10. 10. <ul><li>Primary care (outpatient) </li></ul><ul><ul><li>80% public – 18 polyclinics </li></ul></ul><ul><ul><li>20% private – Over 2,000 General Practitioners (GPs) </li></ul></ul><ul><li>Acute care (inpatient) </li></ul><ul><ul><li>20% public – 7 public hospitals, 9 specialty centres / institutes </li></ul></ul><ul><ul><li>80% private – 13 private hospitals </li></ul></ul><ul><li>2 public healthcare clusters </li></ul><ul><ul><li>National Healthcare Group (NHG) </li></ul></ul><ul><ul><ul><li>9 polyclinics, 4 hospitals, 4 specialty centres / institute </li></ul></ul></ul><ul><ul><li>Singapore Health Services (SingHealth) </li></ul></ul><ul><ul><ul><li>9 polyclinics, 3 hospitals, 5 specialty centres </li></ul></ul></ul>Public Versus Private Healthcare
  11. 11. Reasons for a National Health Portal
  12. 12. <ul><li>Health Promotion Board (HPB) </li></ul><ul><ul><li>Established on April 1, 2001 </li></ul></ul><ul><li>Vision </li></ul><ul><ul><li>A nation of healthy and fit Singaporeans </li></ul></ul><ul><li>Mission Statement </li></ul><ul><ul><li>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. </li></ul></ul>The Health Promotion Board
  13. 13. 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
  14. 14. The Chronic Disease Challenge
  15. 15. <ul><li>Promote the concept of Active (& Individualised) Health Management (AHM) </li></ul><ul><li>Empower Singaporeans to actively manage their own health </li></ul><ul><li>Provide relevant resources and tools to support AHM </li></ul>Active Health Management
  16. 16. <ul><li>Reduce medical costs </li></ul><ul><li>Change medical encounters from episodic to continuous </li></ul><ul><li>Enable prevention and early detection of illnesses </li></ul><ul><li>Enable provision of quality healthcare services based on individual needs and requirements </li></ul>Objectives of AHM
  17. 17. Exploiting IT, E nabling AHM
  18. 18. <ul><li>National Health Portal (NHP) </li></ul><ul><ul><li>Personal Health Record (PHR) </li></ul></ul><ul><ul><li>Health education resources </li></ul></ul><ul><ul><li>Personalised health management tools </li></ul></ul><ul><ul><ul><li>Health Risk Assessment (HRA) </li></ul></ul></ul><ul><ul><ul><li>Behavioural Health Intervention Programmes (BHIP) </li></ul></ul></ul><ul><ul><ul><li>Health Trackers </li></ul></ul></ul><ul><ul><li>Collaborative disease management between patient and care providers </li></ul></ul>Exploiting IT, E nabling AHM
  19. 19. The National Health Portal Project
  20. 20. <ul><li>The NHP Taskforce </li></ul><ul><ul><li>Drive development and implementation of NHP </li></ul></ul><ul><ul><li>Comprising of representatives from various stakeholders: </li></ul></ul><ul><ul><ul><li>HPB </li></ul></ul></ul><ul><ul><ul><li>Health Clusters (SingHealth, NHG) </li></ul></ul></ul><ul><ul><ul><li>Ministry of Health (MOH) </li></ul></ul></ul><ul><ul><ul><li>Healthcare professional organisations (e.g.. College of Family Physicians of Singapore) </li></ul></ul></ul><ul><ul><ul><li>Infocomm Development Authority (IDA) Healthcare Cluster </li></ul></ul></ul><ul><li>Feasibility study </li></ul><ul><ul><li>Global review of health portals </li></ul></ul><ul><ul><li>Dialogues / focus groups with stakeholder representatives </li></ul></ul>Conceptualising the NHP
  21. 21. <ul><li>“ 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.” </li></ul>The NHP Vision
  22. 22. NHP Project – Phase 1
  23. 23. 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
  24. 24. <ul><li>Functionalities / Features: </li></ul><ul><li>PHR </li></ul><ul><ul><li>Self-entered records; no integration with Electronic Health Records (EHR) </li></ul></ul><ul><ul><li>Lab results from Integrated Screening Programme (ISP) </li></ul></ul><ul><ul><li>Drug allergies from Critical Medical Information Store (CMIS) </li></ul></ul><ul><li>Health management tools </li></ul><ul><ul><li>HRA </li></ul></ul><ul><ul><li>Weight Management BHIP </li></ul></ul><ul><ul><li>Smoking Cessation BHIP </li></ul></ul><ul><ul><li>Diabetes Management BHIP </li></ul></ul><ul><ul><li>Health Trackers </li></ul></ul><ul><li>Clinician Access to PHR </li></ul><ul><ul><li>Public healthcare sector </li></ul></ul><ul><li>Interfaces </li></ul><ul><ul><li>Interface with clusters’ events calendar & </li></ul></ul><ul><ul><li>Interface with CPF for Medisave / Medishield / Eldershield information </li></ul></ul>Phase 1- 2008 to 2009
  25. 25. <ul><li>Conditions </li></ul><ul><li>Family history </li></ul><ul><li>Allergies </li></ul><ul><ul><li>Food </li></ul></ul><ul><ul><li>Environmental </li></ul></ul><ul><li>Drug (Critical Medical Information Store, CMIS) </li></ul><ul><li>Lab tests </li></ul><ul><ul><li>Results from Integrated Screening Programme (ISP) </li></ul></ul><ul><li>Contact information </li></ul><ul><li>Print PHR Summary </li></ul><ul><li>Print In Case of Emergency (ICE) Card </li></ul>Phase 1 PHR Features
  26. 26. <ul><li>Concept of tailoring </li></ul><ul><ul><li>More tailored, more engaging, more effective </li></ul></ul><ul><li>HRA </li></ul><ul><li>BHIPs </li></ul><ul><ul><li>Weight Management </li></ul></ul><ul><ul><li>Smoking Cessation </li></ul></ul><ul><ul><li>Diabetes Management </li></ul></ul><ul><li>Health Trackers </li></ul>Phase 1 Health Management Tools
  27. 27. Phase 1 Health Management Tools Low Tailored Story Tailoring Variable Used In This Case: + Gender
  28. 28. 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
  29. 29. <ul><li>Health Trackers </li></ul><ul><ul><li>Weight / BMI </li></ul></ul><ul><ul><li>Blood Pressure </li></ul></ul><ul><ul><li>Blood Sugar (fasting and non-fasting) </li></ul></ul><ul><ul><li>Smoking </li></ul></ul><ul><ul><li>Nutrition </li></ul></ul><ul><ul><li>Physical Activity </li></ul></ul><ul><ul><li>Hemoglobin A1c </li></ul></ul>Phase 1 Health Management Tools
  30. 30. <ul><li>Appointment Booking </li></ul><ul><ul><li>Interface with clusters’ appointment systems </li></ul></ul><ul><li>Calendar of events </li></ul><ul><ul><li>Interface with clusters’ events calendar & </li></ul></ul><ul><li>Health education resources </li></ul><ul><ul><li>Content from HPB Online (e.g. articles, RSS feeds, podcasts) </li></ul></ul><ul><ul><li>Search function </li></ul></ul><ul><li>Health expenditures </li></ul><ul><ul><li>Interface with CPF for Medisave / Medishield / Eldershield information </li></ul></ul><ul><li>Health insurance & coverage </li></ul>Phase 1 Other Portal Features
  31. 31. Outreach Strategy <ul><li>Beyond Phase 3, the NHP shall be operated via a Public Private Partnership (PPP) model </li></ul>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
  32. 32. NHP Project - Beyond Phase 1
  33. 33. <ul><li>Additional Functionalities / Features: </li></ul><ul><li>Evaluation of Phase 1 </li></ul><ul><li>PHR </li></ul><ul><ul><li>Integration with GPs’ Clinical Management Systems (CMS) </li></ul></ul><ul><li>Health management tools </li></ul><ul><ul><li>Mental Wellness BHIP </li></ul></ul><ul><li>Clinician Access to PHR </li></ul><ul><ul><li>Private GPs </li></ul></ul><ul><li>Interfaces </li></ul><ul><ul><li>National Immunisation Registry (NIR) </li></ul></ul><ul><ul><li>Student Health Assessment Programme (SHAPE) </li></ul></ul><ul><ul><li>Integrated Dental Electronic Assessment for Students (IDEAS) </li></ul></ul>Phase 2 - 2009 to 2010
  34. 34. <ul><li>Additional Functionalities / Features: </li></ul><ul><li>Evaluation of Phase 2 </li></ul><ul><li>PHR </li></ul><ul><ul><li>Full integration with EHR </li></ul></ul><ul><li>Health management tools </li></ul><ul><ul><li>Other BHIPs (e.g. Nutrition BHIP) </li></ul></ul><ul><li>Clinician Access to PHR </li></ul><ul><ul><li>Private hospitals </li></ul></ul><ul><ul><li>Community hospitals & nursing homes </li></ul></ul>Phase 3 - 2010 to 2012
  35. 35. <ul><li>Additional Functionalities / Features: </li></ul><ul><li>Additional languages </li></ul><ul><li>Remote monitoring devices </li></ul><ul><li>Extend mobile / non-web access </li></ul><ul><li>Social networking tools </li></ul>In the Pipeline
  36. 36. <ul><li>Standardization of data entry, sharing, and interoperability </li></ul><ul><ul><li>No common national standard across all healthcare providers currently </li></ul></ul><ul><ul><li>MOH holdings (MOHH) has been set up to co-ordinate efforts </li></ul></ul><ul><li>Legal & ethical concerns - data privacy & security </li></ul><ul><ul><li>Policy on EHR data yet to be determined </li></ul></ul><ul><ul><li>Managing users’ expectation </li></ul></ul><ul><ul><li>Concerns about healthcare providers’ responsibility and legal liability </li></ul></ul><ul><li>Engaging relevant stakeholders </li></ul><ul><ul><li>Co-ordination of stakeholders’ involvement; garnering their full support </li></ul></ul><ul><ul><li>Minimising disruption to existing systems & workflows </li></ul></ul><ul><li>Increasing user adoption </li></ul><ul><ul><li>Marketing the NHP to the different target audiences </li></ul></ul><ul><ul><li>Incentivising participation, while maintaining sustainability </li></ul></ul>Critical Success Factors
  37. 37. Thank you [email_address]