This PPT explains about how Singapore is using IT in healthcare, Integrated Health Information Systems, Singapore's Shifting Demographics and 2020 Master Plan. For more information visit: http://www.transformhealth-it.org/

1. 1
Challenges in Implementing EMR
The Singapore Story
Dr. Chong Yoke Sin
CEO, IHiS

2. About
Singapore
about Singapore
and IHiS

3. 3
 ~ 5.4 million people on 707.1 sq km (6,489/km2)
 Ethnically diverse:
 Chinese: 75%
 Malays: 14%
 Indians: 9%
 Others: 2%
 40,000+ healthcare providers
 11,230 hospital beds
 ~450,000 hospital admissions
 Public sector out-patient visits
 Specialist Outpatient Clinics ~3.6m
 A&E ~800k
 Polyclinics ~4m
Singapore is a small vibrant country

4. 4
IHiS is a healthcare-IT leader, transforming patient care through excellence in technology.
​Our healthcare-IT professionals architect and manage the highly integrated systems across
Singapore’s Regional Health Systems, public hospitals, national specialty centres and polyclinics.​
IHIS played a key role in 7 out of 8 Singapore hospitals and 1 Primary Care facilities becoming
among the first public institutions in the Asia Pacific region to achieve HIMSS EMRAM Stage 6,
an international benchmark for advanced technology used in patient care.
IHIS works with the healthcare institutions to drive innovation so as to achieve new standards in
quality care.
Integrated Health Information Systems

5. A humble beginning …
A humble beginning …

6. 6
Evolution of Singapore Healthcare IT
Stand Alone
Applications
Stand Alone
Applications
Hospital Information
System and
Cluster EMR
Population based,
Lifetime Health Record,
NEHR
Patient Portal,
Personalized Health
Record
Limited Functionality Extended Functionality Full Functionality Full Functionality,
Telehealth
Full Functionality,
Home Monitoring
No interoperability Limited Interoperability,
within the Health
Institution
More
Interoperability
Across Health Clusters
Full
Interoperability,
Nation-wide
Full
Interoperability,
Home and Community
Focus:
Financial, Inventory and
Patient master Index
Focus:
Administrative, ADT,
Scheduling, Lab, Rad
and Pharmacy
Focus:
Integration of
Administrative and
Clinical
Focus:
Advance Clinical &
decision Support and
Business Intelligence
Focus:
Personal Health &
Wellness, Population
Enablement and
Advance Analytics
Patient
Master
Index
Smart
Healthcare
Health
Informatics
Electronic
Medical
Record
EMR
eHealth

7. The driving force behind
the change …

8. 8
 Our total fertility remains low and our life span is increasing
 Population as a whole will “age” faster in the next one to two decades.
 A higher proportion of Singaporeans who are 65 year old or above
 By 2030, one in five of us, will be 65 years and older
 Fewer Working-Age Adults to Each Citizen Aged 65 and above
Singapore’s shifting Demographics as
Singaporeans are living longer

9. 9
?
Healthcare 2020 Master Plan

10. Our Strategies …

11. 11
Overview of Public Healthcare IT
Hospitals
Information sensing
Paperless
Clinical & Business
integration
Advanced Clinical
Decision support
RH
EMR EMR
NEHR
GP CH
EMRX
Exchanges of Images, Records
Intra-Cluster
Integrated Workflow
One EMR
One Patient
Relationship
Management PRM
Cross-Cluster
One EHR
EMR for Details

12. 12
Take a System-Wide
View to Solutions
Create an Eco-System
& Culture for Solution
Re-use
Comply with Solution
Governance: Solutions
Review Board (SRB),
Process and Program
Steering Committee
(PPSC)
Better Quality,
More
Resiliency,
Fewer
Interfaces
Shorter time to
Deployment
Lower
Development &
Maintenance
Cost
Enterprise Architecture
Guidance Towards Solution Harmonisation
12

13. 13
Strategy to achieve
Non-Disruptive IT shared Services
 Federated Enterprise
Architecture
 PHI Operating Model
EMRs/NEHR/Clinical systems /
Master patient index
Patient Relationship Management
Connect with AIC, NH, CHs, GPs, etc
 Interface through QDX
 Standardize
 Integrate and Optimize
Architect the
Roadmap
Integrate the
Systems
Patient
Centric
Records

14. 14
 ICD 10 AM
 SNOMED CT
 LOINC
 Structured notes
 Clinical analytics
 Clinical decision
support (EMRs,
NEHR)
 Tele-health
Integrate
Analytics across
Continuum
Intervene
at the Right
Channels
Back to Basics
Data Standard and Right Channel
Common
Data
Standardized

15. About IHiS
Our EMR Journey …

16. 16
10/29/2015 16©2011 Healthcare Information and Management Systems Society
?
Strategies 2001 2003 2005 2007 2009 2011 2013 2015
Achieving
High Quality
Integrated Care &
Advance Clinical
Analytics
Building
Clinical Capabilities,
Harvest Full
Potential & Benefits
of EMR
Consolidation
Core Systems,
Harmonize Clinical
Process & Workflow
2005
2001
2010
2006
2015
2011
 Advance Clinical Analytics
 Proactive and Predictive Alerts
 Tele-Health, Self-Monitoring & Home Care
 Mobile Health – Healthcare Social Media
 Analytics for population care
 EMRAM Stage 6/7
 A common EMR platform
& EMRX
 Results Reporting and
Discharge Summary
 Perioperative & ED Notes
 Cluster eRx, Film-less
 Clinical & Nurse Documentation
 Knowledge-Based Medication
Management
 CLMM Implementation
 CPOE/CCOE Implementation
 eLab & eRad interface to EMR
Cluster’s EMR
The ABC of
digital journey
Our EMR Journey …

17. 17
 Cluster EMR Roadmap
• Application Landscape
• EMR Building Blocks
 Implementation Strategies
 EMR Capabilities Highlights:
• CLMM
• CPOE
• Clinical Document
• Coding Standardization
• Statistics
 Benefits
 Challenges & Lessons Learnt
Our EMR Journey …

18. 18
The EMR Architecture

19. Patient Safety,
Our First Priority
Closed Loop Medication
Management (CLMM)

20. 20
 Value to Patients
• Improve patient safety through reducing
medication errors
 Value to Hospitals / Staff
• Remove waste, improve system efficiency
 Technology Innovation
• 1st in Asia with a complete end-to-end
closed-loop solution
 Scalability
• Implemented in KKH, NUH and TTSH
• Average Unit Dose Serving / year
 KKH - 3.9m of unit dose drugs for 65,000 patients
 NUH - 5.5m of unit dose drugs for 92,000 patients
 TTSH - 6.6m of unit dose drugs for 110,000 patients
WHY Closed Loop Medication Management

21. 21
WHAT are the CLMM components
Electronic Prescription System
• Patient’s medication prescriptions
Clinical Decision Support System (CDSS)
• Enterprise wide Business Intelligence
to support clinical care
Packaging Robot
• Unit dose Packaging
Nursing Administration System
• Bar-code technology to serve drugs
correctly

22. 22
HOW the CLMM works

23. 23
CLMM ensure 5 RIGHTS
Right patient
Right drug
Right dose
Right route
Right time
 Enhanced Medication Safety
Process
• Improve patient safety
 Efficiency of ward processes
• Reduce turn around time for
medication stock
• On-time, on-demand serving
(urgent medication order)
 No more faxing of prescription
• Improve the billing process
 Billing is done upon medication
administration

24. 24
Lessons Learnt
• Robot technology for filling medication according to orders from EMR system
eliminate human errors and enhanced patient safety.
• The 2D barcode is capable of storing more information and also ensure higher
degree of accuracy compared to one dimensional bar code.
• If the unit dose packaged medication is not consumed or when the doctor change
the patient’s medication, it can be returned to pharmacy for the next patient.
• For the medications bundled with a ring, it helps to speed up the cart-fill and enable
the pharmacy staff to spend more time for other clinical activities.
• The robot is capable of packing mini-bottle medicine but not big bottles.
• Labeling medications with 2D barcode enables clinicians to scan and verify
medication administration at the point of care, helping to ensure the ‘5 rights’ of
medication administration.
• Filling the robot for unit dose packing has to be observed very closely for patient
safety

25. Clinical Documentation
& Standard
Better Communication,
Quality Reporting,
More Effective Patient
Care

26. 26
 Organization Support
• Effective systems to support accurate and concise documentation of practice
in medical records
• Appropriate policies and procedures in relation to effective documentation
systems, practices and management of patient health information
• The provision of adequate time allocation to document appropriately and
review previous documentation as part of patient care
 Leadership
• Involve clinical staff in decision making in relation to selecting, implementing
and evaluating documentation systems
• Implementing quality improvement processes related to effective
documentation
• Promote documentation as an integral and core part of practice and
professional responsibility
 Resources
• Access to an appropriate physical environment that supports and increases
efficiency and confidentiality of documentation
• Reliable, accessible and appropriately maintained equipment
EMR
Clinical Documentation Implémentation Stratégies

27. 27
• Engage all clinical chiefs and administrators
on the new clinical documentation
• Conduct roadshow for all doctors to create
awareness
• Set up ‘sandbox’ with feedback system for
clinicians to trial the new clinical documentation
• Implement clinical documentation in outpatient
settings first as it is less complex than the
inpatient settings
• Implement clinical documentation with a group of related stakeholders
• Deploy additional IT support staff on site during the rollout
EMR
Clinical Documentation Implémentation Stratégies

28. 28
Benefit of Clinical Documentation
Appropriate documentation
promotes
 A high standard of clinical care
 Improved communication and
dissemination of information
between
and across service providers
 An accurate account of treatment,
intervention and care planning
 Improved goal setting and
evaluation
of care outcomes
 Improved early detection of
problems
and changes in health status
 Evidence of patient care

29. 29
Challenges in Clinical Documentation
Clinicians’ Adoption
- Integrated with consultation
workflow
- Balance between Structured and
Free Text
- Minimal clicks/ data entry
- Auto-retrieved Allergy, Health
Issues,
Lab / Rad Results and Medication
- Incorporate CPOE into document
- Incorporate CDSS into document
- Short and concise printout
- Reduce duplicate entry

30. 30
Standardisation and Governance
 Same Coding standards for Clinical
Decision Support and Analytics
 Same Data items for same observations
in all documentation to facilitate future
analytics
e.g. Smoking History, Pain score etc
 Same look & feel across institutions for
ease of use, particularly for junior
doctors rotating from institution to
institution
Challenges in Clinical Documentation

31. 31
 Improve Clinician Engagement
EMR becomes a common platform for information sharing and
real-time reporting, resulting in greater communication and
partnership among different clinical teams and improved
patient outcomes.
 Accountability
Demonstrates the clinician’s accountability and records their
professional practice.
 Communication
The basis for communication between health professionals
about the (a) Care provided, (b) treatment, (c) Care plan,
(d) outcome
 Quality
Should be clear, concise, correct, contemporaneous,
complete, collaborate, patient-focused
 Confidentiality
Must maintain confidentiality
Lessons Learnt

32. 32
Data Standardization
• Adopt SNOMED-CT for
Problem List and Diagnosis
• Problem List and Diagnosis can
be set as ‘General’, ‘Chart’ and
‘Visit’.
• SNOMED-CT coded Problem
List and Diagnosis facilitates
Decision Support.
• SNOMED-CT coded Problem
List and Diagnosis assist in
Analytics

33. 33
Governance Process
 Involve clinicians from all
institutions for requirement study
so that clinical notes for same
specialty are standardised across
institutions
 Change Control Committee (CCC)
comprising of IT representatives
from different clinical document
teams to review data items for
new clinical document
 Core Clinical Design Team (CCDT)
comprising of clinicians, nurses
and IT to review the new clinical
document

34. 34
Dr Chong Yoke Sin
chong.yoke.sin@ihis.com.sg