in 2015 healthcare

8/12/2019 In 2015 Healthcare

1/44

Singapore: An Intelligent Nation, a Global City,powered by Infocomm

IMAGINE YOUR WORLD

INTEGRATING HEALTHCARE,EMPOWERING PATIENTSReport by the iN2015 Healthcareand Biomedical SciencesSub-Committee


2/44

Notice: This document is protected by copyright, trademark and other forms of proprietary rights. Save as permitted by law, no part ofthis document may be reproduced, distributed or adapted without the express permission of IDA.

This document is provided AS IS without any express or implied warranty of any kind. Whilst IDA has made every reasonable effortto ensure that the information contained herein are obtained from reliable sources and that any opinion and/or conclusions drawntherefrom are made in good faith. To the extent not prohibited by law, IDA, its employees, agents and/or assigns shall not be responsibleor liable for reliance by any person on the information, opinion and/or conclusion contained herein. IDA, its employees, agents, and/orassigns shall not be liable for any direct, indirect, incidental or consequential losses arising out of the use of this document.


3/44


4/44

iN2015 Healthcare and Biomedical Sciences Report

2


5/44

3

Professor Tan Chorh Chuan

ChairmaniN2015 Healthcare and Biomedical Sciences Sub-Committee

PrefaceInfocomm technology is opening up new possibilitiesfor the healthcare sector, a sector that is heavilyreliant on data. The potential is wide-ranging,encompassing how patients can be more effectivelycared for; the way patients, doctors and other caregivers communicate; monitoring systems that givepeople greater ability to manage their own health;and intelligent applications that assist doctors inmaking better medical decisions, and researchersto speed up new discoveries.

At the same time, socio-demographic trends,

changing disease patterns, the explosion inbiomedical knowledge and rapid advances inmedical technology provide a strong impetusfor changes in the healthcare system. Manyof these will benet from the innovative use ofinfocomm technologies.

However, the healthcare sector is a multifacetedand complex one. Although infocomm is a keyenabler, it requires strong support for change andleadership from key stakeholders in the healthcaresector to transform healthcare delivery. It also

requires concurrent changes in policies, legislations,business models and work processes.

While this report focuses mainly on healthcare,it also considers two major interfaces of biomedicalsciences with healthcare namely how infocommcould facilitate the application of new scienticdiscoveries to clinical medicine; and how healthcaredata could support Singapores biomedical scienceresearch thrust.

The report also took into consideration major learningpoints from infocomms strategic role in creatingvalue within other business ecosystems, such as theNational Library Board, nance and hospitality sectors(refer to Annex A for details). Key lessons drawnfrom such transformational efforts are:

A national infrastructure, with data standards,will be necessary to facilitate seamlessinformation exchange among differentmembers of the healthcare network.

Patients can be better empowered to managetheir own health if they have access to theirpersonal health record and other relevanthealth information.

Healthcare providers can help improveconvenience for patients through betterand more interactive information services.

We hope that the iN2015 Healthcare andBiomedical Sciences report will provide insightsinto how infocomm can support transformation

of the healthcare sector and serve as the basisfor continued discussions on national efforts totransform the sector.


6/44


4

iN2015 Healthcare and Biomedical

Sciences Sub-CommitteeName Designation

Professor Tan Chorh Chuan Provost and Deputy President(Chairman) Professor of Medicine National University of Singapore

Mr Abel Ang Head Medical Technology Biomedical Sciences Group Economic Development Board

(until May 2006)

Associate Professor Head & Senior ConsultantChristopher Cheng Department of Urology

Singapore General Hospital

Dr Jean-Paul Deslypere Director Clinical Trials & Epidemiology Research Unit (until January 2006)

Mr Fong Choon Khin Group Chief Technology Ofcer Singapore Health Services Pte Ltd

Associate Professor Acting Executive DirectorLam Kong Peng Biomedical Research Council

Agency for Science, Technology & Research

Mr Liak Teng Lit Chairman Jurong HealthConnect Management Committee Chief Executive Ofcer

Alexandra Hospital

Ms Lim Bee Kwan Director Healthcare & Social Cluster Infocomm Development Authority of Singapore

Dr Lim Juay Yong Deputy DirectorGrants Assessment

Biomedical Research CouncilAgency for Science, Technology & Research

Professor K C Lun Past President International Medical Informatics Association Professor School of Biomedical Sciences Nanyang Technological University

Dr Prem Kumar Nair General Manager Corporate Services Rafes Medical Group

Associate Professor Benjamin Ong Chairman Medical Board National University Hospital


7/44

5

The iN2015 Healthcare and Biomedical Sciences Sub-Committee would like to thank Dr James E. Tcheng,Duke University Medical Center, for his invaluable comments and providing an independent review ofthe report.

Name Designation

Professor K Satkunanantham Director of Medical Services Ministry of Health

Mr Linus Tham Chief Information Ofcer National Healthcare Group

Dr Kenneth Thean General Manager Parkway Group Healthcare Pte Ltd

Mr Tong Ming Shen Director Infocomm Division Ministry of Health

Advisors

Name Designation

Ms Yong Ying-I Permanent Secretary Ministry of Health

Mr Goh Aik Guan Deputy Secretary Ministry of Health


8/44


6

Executive SummaryKey Drivers and Implications

Based on a review of our current healthcare systemand the major trends in demographics, diseaseburden and medicine, the following will be keydrivers of change in our healthcare sector:

Ageing population and the increased burdenof chronic conditions such as diabetes,hypertension, high cholesterol levels and stroke.

Rising public expectations of healthcare services.

The current fragmented and relativelyuncoordinated healthcare services.

Very rapid advances in infocomm,medical science and technologies andbiomedical research.

As a result of these drivers, the Sub-Committeeforesees a number of likely shifts and changesto our healthcare system, as follows:

Shift in focus of the healthcare system fromtreatment of advanced-stage diseases toprevention, health promotion and wellness care.

Shift from provider-centric, fragmented caredelivery to a more integrated and patient-centredsystem of delivery.

Shift towards more consistent widespreadapplication of evidence-based medicine.

Greater role of members of the public inmanaging their own health.

Greater facilitation of data ows betweenhealthcare sector and biomedical sciencesresearch sector, to facilitate research that will

improve clinical care and outcomes.

iN2015 Goal for Healthcare and Biomedical Sciences

Our infocomm goal for the Healthcare and Biomedical Sciences sectors is:

To accelerate sectoral transformation through an infocomm-enabledpersonalised healthcare delivery system to achieve high qualityclinical care, service excellence, cost-effectiveness and strongclinical research.


9/44

7

Strong Clinical and HealthServices Research

More effective and efcient linkages betweenbiomedical and healthcare sectors will facilitatethe translation of new biomedical discoveries into

novel healthcare applications and treatments.

In addition to the above outcomes for the healthcaresector, the transformation of the sector will alsogenerate economic spin-offs for the infocomm,healthcare and biomedical sciences sectors.

iN2015 Strategies and Programmes

To realise the iN2015 goal, the following strategiesare recommended:

Enable integrated healthcare services.

- Health Information Exchange: e-Enableseamless and secured information exchangein the healthcare value chain.

- Integrated Healthcare Continuum: e-Enableprocesses and linkages across the healthcarevalue chain.

Enable integration between healthcare andadvances in biomedical sciences.

- Translating Biomedical Research to HealthcareDelivery: Integrate clinical and biomedicalresearch data and make it readily accessible,within a framework that protects patientcondentiality, to the clinical and biomedicalsciences research community.

This goal will help achieve the following outcomesby 2015:

Well-integrated Quality Healthcare Integrated and coordinated care will be enabled

by a common information network andappropriate data standards. This will also allowmore patients to be treated at the mostappropriate point of care. For some patients,where it is cost-effective to do so, remotemonitoring can also be used to monitor oradminister care while they are at home.

Cost-effective Healthcare Services In future, healthcare providers will be assisted

by clinical decision support systems to providea more consistent and evidence-based levelof care. Such systems can help reduce duplicatetests and medical errors and, in the future,facilitate the delivery of personalised medicinebased on analyses of specic genetic factorswhich inuence susceptibility to, and progressionof, disease and response to potential treatments.The adoption of infocomm to enable outsourcingof certain clinical services, e.g. teleradiology, canalso help to reduce costs while increasing quality.

Greater Ability of Public to Managetheir Health

In future, home infocomm systems will allow individuals to easily access authoritative and

relevant health information. Each person willhave an electronic personal health recordwhich captures and stores a pre-dened setof his essential longitudinal health data. Thehome infocomm system will be able to sendappropriate medical alerts to the individual basedon information from these records e.g. whento go for recommended regular health screeningtests. Interactions with healthcare providers suchas the making and changing of appointments canalso be made more convenient.


10/44


8

Relevant health-related information can bepushed to and pulled from the home by membersof the public, to support health promotionand wellness.

Clinical databases that strongly support medicalresearch. Linkages between clinical and researchdatabases that facilitate medical research whileprotecting patient condentiality.

Critical Challenges

Given the scale and complexity of makingtransformative changes in the healthcare sector, thereis a spectrum of critical challenges to be addressed.This would include infrastructure development,putting in place the necessary regulatory framework,nding the appropriate funding models, ensuringsufcient infocomm manpower and achieving buy-inby the medical/healthcare community and public.

These are by no means trivial challenges. But theyare not insurmountable, provided there is leadershipfrom relevant government agencies and healthcareproviders to transform the vision into reality.

Corresponding to each of the strategiesrecommended above, the following are keyinfocomm deliverables:

One electronic medical record for every patient

A pre-dened set of relevant medical data whichis accessible to healthcare providers in the publichealthcare system and in much of the privatesector. This will facilitate the integration of carefor individual patients.

One electronic personal health record A pre- dened set of data which each person will have

access to. It could include key vaccination andscreening data and key diagnoses.

Clinical decision support systems Systems that draw information from the electronic medical

records and provide assistance, alerts and agswhich support healthcare workers to practiceevidence-based care delivery and which helpreduce medical errors.

Home monitoring systems To monitor selectedpatients suffering from major chronic diseasessuch as diabetes, hypertension, high cholesteroland stroke, where it is cost-effective to do so.


11/44

9

CHAPTER 1

HEALTHCARE SCENARIOIN 2015


12/44


10

By 2015, many medical services now possible only in hospitals could be available close to your home, atclinics, other healthcare centres or a nearby central point in the community. In fact, you may not need toeven leave home for a number of them.

For instance, instead of going to the hospital for screening tests for certain diseases, you can carry out such

tests at home using simple diagnostic kits and equipment. The results of the tests will be captured andcombined with your health and medical history in your electronic personal health record. Such testing mayeventually be extended to the assessment of your genetic susceptibilities to selected diseases and allow thetailoring of appropriate healthcare treatments.

Infocomm systems with intuitive interfaces, willallow you to conveniently access relevant healthcareinformation and interact with your healthcareproviders. Amongst other things, it can:

Remind you to carry out recommended screeningtests at appropriate intervals.

Inform your family physician about thetest results.

Provide you with health information relevant toyour test results and medical history.

Help you locate an appropriate specialist if youneed one.

Explain the drugs and treatments that youare receiving.

Advise you of potential adverse drug interactionsbased on the medications you are taking or havebeen prescribed.

For major chronic diseases such as diabetes,hypertension, high cholesterol and stroke, selectedpatients could be monitored at home throughintelligent sensory networks and a system of smart,embedded nano-sensors. This will help to capturereal time data on the patients key clinical parameters

and automatically trigger alerts when a reading fallsout of a preset range. If necessary, patients caninteract with their doctors between clinic visits viathis home infocomm system.

A common information infrastructure will be availablefor the healthcare sector, allowing doctors to shareand access medical information on a patient evenif they have been captured at home or in differenthealthcare institutions. These systems will enablea seamless ow of information, so that data travelsrather than patients.

Intelligent clinical decision support systems will helpphysicians analyse the patients data and presentrelevant decision-making information as well as therecommended care paths. Point-of-care devicesthat will carry out analyses for genetic and/orbiomarker proles will facilitate diagnosis, risk-stratication of patients and assist in tailoring oftreatments for a selected number of diseases basedon pharmacogenetic data.

Infocomm will also alter acute and emergency care.Rapid diagnosis systems coupled with telemetrymay make it possible for essential emergencytreatment of a number of acute diseases such asheart attacks to be initiated at home by paramedicalor ambulance staff, before the patient is brought toa healthcare facility.

For the treatment of acute diseases, infocomm willprovide decision support systems that would improvethe quality and consistency of care, and reducemedical errors. It would allow for more effectivepost-acute treatment follow-up of patients.

Telemedicine will enable patients to seek andhave access to specialised medical care in differentcountries. There is also likely to be substantialoutsourcing of services to overseas providers,e.g. in teleradiology.

Finally, for infectious disease outbreaks, infocommwill greatly facilitate information collation, storage,analysis and dissemination for more effective andefcient control measures.


13/44

11

CHAPTER 2

KEY DRIVERS ANDIMPLICATIONS


14/44


12

1 Singapore Department of Statistics2 Ministry of Health Budget Speech (Part 3) The Elderly Chronic Sick, Dr. Balaji Sadasivan, Senior Minister of State for Information, Communication

and the Arts and Health, March 20063 Health Manpower & Expenditure, Ministry of Health, April 2006. An earlier study study by the `National University of Singapore projected that

Singapores healthcare costs will hit seven per cent of the countrys Gross Domestic Product (GDP) by 2030.

There are four developments that will have a profound impact on Singapores healthcare sector. They are:

Singapores Rapidly Greying Population

Singapores population is ageing rapidly withthe number of senior citizens forming 8.4 percent of our population 1 in 2005. 85 per centof this group will have one or more chronicdiseases that will require life-long treatment 2.With an ageing population comes:

An increased prevalence of chronic, non-communicable diseases such as diabetes,

hypertension, high cholesterol and stroke. Thereis also an increase in the number of patients withchronic degenerative disorders such as dementiaand arthritis.

A growing need for step-down, nursing and homecare. This will put a signicant nancial burdenon both the patients family and society.

A higher national healthcare bill.

In 2003, Singapore spent 3.8 per cent of its GDP,or S$6.3 billion, on healthcare 3.

The bill is expected to rise because the elderly willrequire more medical care. New treatments will

also become available. These treatments arelikely to cost more, and more patients wouldexpect to receive the latest therapeutic drugs.


15/44

13

Higher Demands for Relevant and AccurateHealth Information

Today, the public and patients are alreadyoverwhelmed with large amounts of information

about health, wellness and diseases. Informationoverload will be a growing challenge particularlywhere there is divergent or even wrong or misleadinghealth information being provided by differentsources. In addition, much of the informationgenerally available is not readily tailored to theindividuals specic set of interests, conditionsor medical problems.

To facilitate and encourage the public to moreproactively manage their health, it is important toprovide each individual with easy access to his/hermedical history and other relevant health informationwhich can be tailored to specic needs. There isalso a need to provide authoritative and trustedhealth and medical information, e.g. on new drugsand alternative medicine, to provide the necessarybalance to the broad range of information sources.

More Fragmented Healthcare

Rapid advances in medical knowledge andtechnologies have resulted in greater specialisationof healthcare professionals. Patients with chronicdiseases typically suffer from multiple medicalconditions and have to consult several doctors fromdifferent disciplines. They will also be prescribedseveral medications to deal with all these conditions.

The problem is that there are currently few or no linksamong doctors from different specialties. Neither isthere a central database with all the patients medicalrecords. So, often, no one doctor has a properoverview of a patients health.

This greatly increases the potential for poly-pharmacyand adverse drug interactions. To improve thesituation, healthcare services need to become muchmore patient- and disease-centric.

Another layer of complexity may be introduced bythe fact that large numbers of patients could optto have different parts of their care carried out indifferent countries, e.g. they could have diagnosticor screening tests done in one country, havesurgery in another and follow-up treatment in a

third. Integration of relevant clinical information andcoordination of care for such patients will become agreater challenge.

Advances in Medical Technologyand Infocomm

Advances in medical technology and biomedicalknowledge hold the promise for more personalised

treatments based on a persons medical conditionsand genetic prole.

Similarly, advances in infocomm can enable newhealthcare delivery models.

For instance, home diagnostics and remotemonitoring applications can make it safe and feasiblefor many patients with chronic illness and/or physicaldisabilities, to be cared for at home. Many patientsand their families are likely to prefer this and it wouldalso ease the pressure on nursing homes and step-down care facilities.

The tremendous speed of advances in medicalscience and practice make it increasinglychallenging for doctors and healthcare professionalsto keep abreast of the latest developments. Moreintelligent clinical decision support systems will alsobe developed that will help doctors make betterdecisions by incorporating rapidly growing medicalknowledge. Smart computer algorithms working ontop of electronic medical records and prescriptionscan ag up potential adverse drug interactions andreduce medical errors.


16/44


14

Public Health and Policy Implications

In view of these developments, it is likely thatseveral changes will occur in the healthcare system.They are:

Greater Responsibility by the Individual toProactively Manage his Health

Many of the major chronic medical conditionsare largely preventable. To achieve this, however,the individual will have to play his part by takingthe proper diet, exercising, managing his weight,having appropriate vaccinations and monitoringhis health regularly.

To help encourage him to do so, he should have easy access to his personal health records

and other relevant health information. Such aninformation system can even alert the individualto the need for timely interventions based on hishealth screening results and medical history.

Shift from Treatment of Diseases toPrevention, Health Promotion andWellness Care

More emphasis will have to be placed onpreventive care and health promotion.

Health screening can be made more affordableand accessible to the public. Its results can bemade more useful by having appropriate follow-up raised through a properly developed healthinformation system.

There is also a need to provide authoritativeand relevant health and medical informationto the individual, for instance, on new drugsand alternative therapies.

For patients with chronic non-communicablediseases, infocomm can be used to support awell-coordinated process of care which includesbetter long-term monitoring of test results andscreenings and timely follow-up action. Thiswill help prevent the development of seriouscomplications which require complex medicalinterventions and hospital admissions. Someof these patients could also be monitored fromhome using remote monitoring technologies.

Shift from Provider-centric, FragmentedCare Delivery to a More Integrated andPatient-centred System of DeliveryThe healthcare system is likely to evolve intoa more patient- and disease-centric healthcaredelivery model where services are coordinatedaround the patients specic needs and problems,particularly if these are multiple and complex.For patients requiring the care of multiplespecialists and healthcare teams, infocomm,by integrating different sources of patientsinformation across the healthcare system, canprovide doctors with a complete overview ofpatients medical information, reducing the needfor duplicate tests and the risks of medical errorsand unintended adverse drug interactions. It canalso enable the doctors to manage their patientsat the right level of care delivery (right-siting).Within hospitals, infocomm systems can playa central role in supporting and facilitatingimproved processes that can reduce waitingtimes and improve clinical outcomes andpatient satisfaction.

Stronger Shift towards Widespread use ofEvidence-based Medicine

At present, there are signicant variations amongdoctors in care delivery for the same diseaseand in the management of patients, particularlythose with long-term medical conditions.Infocomm systems will be critical to supportthe consistent delivery of evidence-based medicalcare for each patient on a long-term basis,through the following functions:

- Collate, integrate and display relevant medicaldata and laboratory results for each patient.

- Deliver relevant point-of-care medical practicedata to doctors, e.g. accepted clinicalguidelines, drug dosages, drug interactions,alerts, etc.

- Facilitate the monitoring of clinical outcomesand audit treatment effectiveness to continuallyimprove care delivery.


17/44

15

Advances in biomedical sciences have raisedthe prospect of personalised medicine in whichtreatments are made more effective based onthe patients health and genetic proles. Themost critical step however, is the robust clinical

validation of the utility of putative biomarkers ofdisease, prognosis and response to treatment.To achieve this, a tighter integration betweenhealthcare and biomedical research is necessaryin the following manner:

- Greater access to healthcare clinical data forbiomedical research purposes.

- Facilitating the translation of biomedical research ndings into effective healthcare

applications and treatment protocols.

However, it is critical that issues relating tocondentiality and privacy of patients dataare appropriately addressed and adequatesafeguards put in place.

The use of infocomm for these purposes willhelp to reduce costly medical errors. In theUnited Kingdom, a National Audit Ofce surveyof patient safety incidents found that there werearound 980,000 reported incidents and near

misses in 2004-5 4. These errors can be largelyreduced by providing clinicians with accessto timely and accurate information andcomplementing their decision-making processwith clinical decision support systems.

Furthermore, turning to such support systemswill become vital as medical knowledgeexpands dramatically.

Greater Integration of Information betweenHealthcare and Biomedical Sciences

Spectacular advances in research technologieshave led to rapid growth of medical knowledge.A major challenge however, is to gain a clearerunderstanding of how these may be relatedto human health and disease, either directly orthrough complex interactions with environmentalfactors. In turn, this could lead to fundamentalinsights into the genesis and developmentof diseases, the identication of newdiagnostic or prognostic markers, and newtreatment approaches.

To achieve this, we need better ways to discoverpatterns and connections between humanhealth and disease and changes to specicgenes, molecules or processes, and theirpossible interactions with environmental factors.In this regard, repeated observations of largepopulations of patients or individuals can providecritical clues and hypotheses. Infocomm inthe form of bioinformatics can help clinicians andresearchers carry out these tasks more quicklyand effectively.

To this end, extensive, linked and accuratecomputerised records provide a valuableresource for high quality clinical researchthrough a variety of ways. It allows researchersto look for patterns, form hypotheses, andidentify potential study participants. It enablesmore comprehensive and efcient surveillancefor adverse side effects of new drugs,therapies. It also facilitates health servicesand outcomes research.

4 A Safer Place for Patients: Learning to Improve Patient Safety, National Audit Ofce (UK), November 2005


18/44


16

CHAPTER 3

iN2015 GOAL FORHEALTHCARE AND

BIOMEDICAL SCIENCE


19/44

17

Taking into consideration the above drivers and their implications, our infocomm goal for the Healthcare andBiomedical Sciences sectors is:

To accelerate sectoral transformation through an infocomm-enabled personalised healthcare delivery system to achievehigh quality clinical care, service excellence, cost-effectivenessand strong clinical research.

Integrated Healthcare

Continuum

Translating BiomedicalResearch into HealthcareDelivery

PharmaceuticalCompanies

Research Institutes/ Clinical Trials

Hospitals

Laboratories

Nursing

Homes Clinics

Databanks

Insurance

PatientFolder

H e a l t h I n f o r ma tio n E x c h a n

g e


20/44


18

This goal will help achieve the following outcomes by2015 (refer to Annex B for details):

Well-integrated Quality Healthcare Infocomm systems that allow access to, and

sharing of, patients clinical and treatmentdata will enable different healthcare providersto work together in an integrated andcoordinated manner.

With access to patients complete medicalrecords, doctors can better judge the mostappropriate point of care to treat the patients.This will help patients save costs in the long run.

For a selected group of chronic diseases, remotemonitoring services would be available. Patientscan continue to receive the necessary medicalsupervision from home while saving unnecessaryhospital bills.

Cost-effective Healthcare Services Clinical decision support systems that provide

point-of-care clinical practice information canassist doctors and healthcare workers withclinical decision-making. Through thesesystems, hospitals and clinics will be able toprovide consistent and evidence-based care.This will help to reduce prescription and medicalerrors and improve clinical outcomes.

Greater Ability of Public to Managetheir Health

This will be made possible through simple home infocomm systems that will proactively facilitate

health promotion activities and wellness. Thesesystems will allow individuals to search andaccess healthcare information from healthcareproviders portals and make a signicantproportion of interactions with providers morepatient-centric and convenient.

All individuals will have a personal electronichealth record which will capture and store a pre-dened set of common longitudinal medical datafor each person. This would be made accessibleto all healthcare providers treating the individual.

These health records will also be integrated withthe home infocomm systems, thus allowing thesystems to alert the individual when there is aneed for appropriate medical interventions.

Strong Clinical and HealthServices Research

A conducive regulatory framework shouldbe established to govern the collection andsharing of health data. This would facilitateboth biomedical and health services research,while protecting patients condentiality.

Infocomm linkages between biomedical andhealthcare databases can then facilitate researchand conversion of new biomedical discoveriesinto more effective treatments. Pharmaceuticalcompanies can also leverage on these databasesto develop more effective drugs.

In addition to the above outcomes for the healthcaresector, the transformation of the sector will also havethe following economic spin-off benets:

Strengthen Healthcare Infocomm Sector- Accelerate development of exportable

healthcare infocomm solutions.

- Establish Singapore as a thought leaderin healthcare infocomm to provide a spring-

board for companies to venture overseas.

Strengthen Singapore as a Medical Hub - Attract more foreign patients to Singapore

through improved healthcare services enabledby infocomm and better information onproviders, expertise and key clinical outcomes.

- Anchor foreign patients through tele-medicinewhile they are outside of Singapore.

Strengthen Singapore as a BiomedicalSciences Hub- Position Singapore as an attractive location

to conduct biomedical sciences research through linking biomedical sciences and

healthcare infocomm infrastructure.


21/44


22/44


20

This thrust aims to facilitate the integration of care across different segments of the healthcare value chain fromhealth promotion, disease prevention to primary, secondary and step-down care.

As indicated by the Ministers speech above, Singapores long-term direction is to develop integratedhealthcare services for major chronic diseases such as diabetes, hypertension, high cholesterol and stroke.This will be achieved through building effective linkages between different parts of the healthcare value chain.

Infocomm would be used to link up all public hospitals, major community hospitals, all polyclinics, key step-down care facilities and family physicians.

Health Information Exchange e-Enable Seamless and Secured Information Exchange in the Healthcare Value ChainSince April 2004, the Ministry of Health has implemented an Electronic Medical Records Exchange (EMRX)which has facilitated information sharing among the public hospitals. The Sub-Committee recommendsthat a Health Information Exchange could be built on the EMRX to extend information sharing to allhealthcare providers.

Goal To accelerate sectoral transformation through an infocomm-enabled personalisedhealthcare delivery system to achieve high quality clinical care, service excellence,cost-effectiveness and strong clinical research

Outcomes Well-integratedquality healthcare

Cost-effectivehealthcare services

Greater ability ofpublic to managetheir health

Strong clinical andhealth servicesresearch

StrategicThrusts

Enable integrated healthcare services Enable integration between healthcareand advances in biomedical sciences

Strategies Health InformationExchange e-Enableseamless and securedinformation exchange inthe healthcare value chain

Integrated HealthcareContinuum e-Enableprocesses and linkagesacross the healthcarevalue chain

Translating BiomedicalResearch to HealthcareDelivery Integrateclinical and biomedicalresearch data

The goal and its corresponding set of objectives can be realised through the following two strategic thrusts(refer to Annex C for proposed project timeline):

Strategic Thrust 1:

Enable Integrated Healthcare Services

In his 2006 budget speech, Minister for Health, Mr Khaw Boon Wan, highlighted Singapores newconcepts in managing chronic diseases family physicians as the primary care provider, oneSingaporean, one Family Physician, right-siting of care, effective partnership between GPs and specialists,opportunistic health screening, co-operation and compliance by patients. He shared that these conceptscan be successfully implemented because Singapore is small, compact and better organised, butstressed the need to tear down barriers between public and private, GPs and specialists, hospitals andstep-down care homes, and leverage on technology.


23/44

21

With medical records stored across distributed systems, a Master Index in the Health Information Exchangewill be necessary to locate relevant data, retrieve them securely and present these to healthcare providers.A personal health record system can also be built within the Exchange based on a dened set of healthinformation. In addition, the Exchange can centrally host patients critical medical information such as medicalalerts and allergies.

Initiatives proposed under the Health Information Exchange include:

Develop Standards and Enable Inter-operabilityTo enable inter-operability, the rst step would be to put in place the necessary standards and mechanismsfor exchange of information.

A Health Information Exchange will need to be established to enable and secure ow of informationthroughout the healthcare ecosystem.

Besides acting as the conduit for information ow, the Exchange will need to have a Master Indexthat will locate information from different data sources and present relevant information to doctors.

Inter-operability standards are required to support a fully functional Exchange. The minimal data set forhealthcare records would be dened as part of the Exchange. An evolutionary approach can be adopted,and automatic translations at the Exchange can bridge the gap, whilst the standards are being adoptedin infocomm systems.

The Exchange will also contain the Health Data Dictionary, which maintains the data standards andseamlessly updates new codes into infocomm systems.

In addition, as part of the drive to be a global medical hub and strategic leader in healthcare, Singaporeshould actively participate and shape the development of international healthcare standards.

Roll Out Personal Health RecordsTo develop a personal health record for each individual, the minimum data set for the personal healthrecord, security framework and business models will have to be dened. This record must be accessibleby each individual. Information in the personal health records could include the following:

Medical alerts Allergies Immunisation records

Disease histories (for important diseases) Medication (for a dened period)

Establish the Necessary Medico-legal FrameworkConcurrent to dening inter-operability standards, policies are needed to address medico-legal issueswhich currently impede the sharing of medical information and use of genetic information. These wouldinclude data privacy, protection and condentiality.

Hospital discharge summaries(for a dened period)

Results of health screening (for a dened period) Status of Medisave claims

Key laboratory results


24/44


22

Integrated Healthcare Continuum e-Enable Processes and Linkages across Healthcare Value ChainTo facilitate the transformation of care processes across the healthcare value chain, it is critical to haveinfocomm systems that link up the respective entities within the healthcare value chain into an integratedecosystem. For example, to enable family physicians to be primary coordinators of care within the healthcare

ecosystem for major chronic diseases by 2015, infocomm links between them and the rest of the healthcaresystem would be critical.

Initiatives under the Integrated Healthcare Continuum include:

Enable Right-siting of Care and Chronic Disease ManagementDevelop infocomm linkages that facilitate different players in the healthcare value chain hospitals,community hospitals, family physicians, step-down care providers and patients to work together in anintegrated and coordinated manner to provide holistic care and manage chronic diseases. This will be anecessary to enable delivery of healthcare services at the most appropriate level, for example, primarycare for simple conditions rather than tertiary hospital care.

Increase Infocomm Adoption by Family Physicians, Step-down Care InstitutionsIn order for family physicians and step-down care institutions to actively participate in the care of patientswithin the healthcare ecosystem, active measures would be necessary to encourage a much higher levelof infocomm adoption in these facilities. In addition, processes should be streamlined to enable seamlesspatient referral and handing over between hospitals and these facilities.

Empower the Public to Manage their HealthBuilding on the personal health record system, applications can be built to push out relevant healthinformation so that individuals can better manage their health.

Remote home monitoring, sensory and tele-consulting systems can be developed to empower the public

to manage their health outside of hospitals and other healthcare institutions.

Patients with chronic, non-communicable diseases will be able to manage and monitor themselves largelyat home, assisted by appropriate infocomm and monitoring technologies linked remotely to a healthcareprovider and family members.

Enable Patient-centric Healthcare ServicesDevelop infocomm systems that enable information about patients to be available at all points ofcare. Healthcare professionals will then be able to deliver care based on patients specic needsand requirements.

Integrating these patient information systems with clinical decision support systems will facilitate

consistent delivery of evidence-based care and monitoring of key clinical and service outcomes.

Linkages to insurance and nance sectors can be established to enable straight-through processingof claims and payment.

Patients experience of healthcare delivery both in terms of convenience to the patient and satisfactionof his personal needs and preferences will also be enhanced.


25/44

23

The spectacular advances in basic medical sciences hold out the promise for fundamental improvements in the

diagnosis, treatment and monitoring of patients. To help realise this potential, however, it is critical to greatlystrengthen the links between clinical medicine and biomedical research.

Translating Biomedical Research to Healthcare Delivery Integrate Clinical with Biomedical Research DataThe second thrust aims to facilitate the translation of new discoveries in biomedical research into clinicalapplications and conversely, to enable clinical data to support and drive biomedical research.

An important factor towards achieving this is the ow of health and clinical information between the healthcareand biomedical sciences research sectors.

Two initiatives are proposed under this thrust:

Strategic Thrust 2:

Enable Integration between Healthcare and Advances in Biomedical Sciences

Develop Excellent Clinical DatabasesExcellent clinical databases and Disease Registries can be developed to serve as a major resource forclinical, biomedical and health services research. They should be made accessible to researchers anddoctors with proper systems to safeguard individuals condentiality and privacy.

Establish Intelligent Systems to Analyse Healthcare and Genetic DataIntelligent systems can be built to mine and analyse the databases and Disease Registries mentionedabove. These applications would help to accelerate clinical and biomedical research. They would alsogreatly facilitate the regular conduct of data analyses for the purposes of clinical care quality audit andmonitoring of outcomes. This would in turn facilitate the translation of biomedical discoveries into new

medical treatments.


26/44


24

Based on the above strategic thrusts, the following table depicts a recommended schedule of key milestones.

3 Years 5 Years 10 Years

Patients Patients have access to

their own basic personal health information(allergy, HIDS,immunisation,prescription record)

Reduction induplicate tests

More convenient interaction with healthcare providers

Healthcare providers in

the public sector andsome private providers have access to data on

patients medicalcondition even if theyhave not managed thepatient previously

Patients are providedwith comprehensiveinformation andtreatment advicetailored to their medicalconditions and needs

Patients and the publiccan navigate thehealthcare system moreefciently and effectively

Some patients withspecic medical conditionscan be monitoredoutside the hospital

Citizens can access

their basic longitudinal personal healthrecords online

Citizens have readyaccess to sufcientinformation to allowthem to self-managetheir health and wellness

Public/PrivateHospitals/Institutions

Healthcare providerssee relevant medicalrecords at all pointsof care within the public

healthcare system, andfor some functionalities(e.g. test result viewing)across both public andsome private institutions

Lower number ofmedical errors

Lower healthcare costby reducing duplicatetests and prescriptions

Infocomm systemsdesigned to facilitate

nation-wide responsesto emergencies

Hospitals pilot treatmentsthat combine genotypicand phenotypic data

Healthcare providers seerelevant medical recordsat all points of care withinthe public and private

institutions for relevantfunctionalities (e.g.test result viewing,prescription data) totreat patients holistically

Healthcare providerscan provide a consistentand evidence-basedlevel of treatment aidedby care path and decisionsupport systems

Better managementof selected patientsub-groups throughremote monitoring

Research databanksand systems aresufciently well-developedto support high volumeof quality research andhealthcare delivery

Tele-medicine systemsto extend healthcareservices to foreignpatients for pre-consultationand follow-up

All healthcare providersare infocomm-enabledto facilitate coordinatedand integrated care at

most appropriate levelof care in healthcarevalue chain

Healthcare providersand biomedicalresearchers canleverage on clinical andresearch databanks todo research whichimproves healthcaredelivery and outcomes

Singapore hospitalsrecognised as a worldleader in use ofinfocomm inclinical practice


27/44

25

3 Years 5 Years 10 Years

Polyclinics Healthcare providers

see relevant medicalrecords at all pointsof care within the publichealthcare system, andfor some functionalities(e.g. test result viewing)across both public andsome private institutions

Infocomm systemsdesigned to facilitatenation-wide responsesto emergencies

Healthcare providers

see relevant medicalrecords at all points ofcare within the publicand private institutionsfor relevant functionalities(e.g. test result viewing,prescription data) totreat patients holistically

Healthcare providerscan provide a consistentand evidence-basedlevel of treatment aidedby care path and decision

support systems Better management

of selected patientsub-groups throughremote monitoring

Timely and systematicfollow-up on healthscreening for citizens

All healthcare providers

are infocomm-enabledto facilitate coordinatedand integrated care atmost appropriate levelof care in healthcarevalue chain

GPs/SmallPrivatePractices/

Step-downCare

GPs are aware of the progress of patients

referred to publichospitals for specialist

treatment Hassle-free handing

over of patients forfollow-up aftertreatment in hospitals

GPs are infocomm- enabled to facilitate

referral of patientsappropriately back

to GPs/step-down carefacilities for follow-upcare after hospitalisation

Healthcare providerssee relevant medicalrecords at all pointsof care within thepublic and privateinstitutions for relevantfunctionalities (e.g. resultviewing, prescriptiondata) to treat patientsholistically

Timely and systematicfollow-up on healthscreening datafor citizens

All healthcare providersare infocomm-enabledto facilitate provisionof coordinated and

integrated care at mostappropriate point ofcare in healthcarevalue chain

Majority of GPs useinfocomm systemseffectively in thecare of patients


28/44


26

CHAPTER 5

CRITICAL CHALLENGE


29/44

27

Given the scale and complexity of making transformative changes in the healthcare sector, there is a spectrumof critical challenges. Taking into consideration the current state of infocomm adoption in the sector (refer toAnnex D for more details), these challenges include:

Developing sector-wide information infrastructure

to facilitate seamless exchange of medicalinformation for healthcare delivery and toenhance collaboration between the healthcareand biomedical sciences sectors.

Establishing minimum healthcare data standardsto ensure inter-operability and facilitate research.

Establishing a conducive regulatory frameworkto govern the exchange of medical information.This framework will have to address physicianliability and medico-legal issues, e.g. whenclinicians prescribe treatment throughinfocomm applications without physicallyseeing the patient.

Finding appropriate funding models throughwhich the government, private sector and thepublic can jointly develop and sustain thenational healthcare infocomm infrastructure.

Appropriate funding models are critical since amajor challenge of developing this infrastructureis that a few entities, e.g. public hospitals, arelikely to have to bear the bulk of the costs eventhough the benets will accrue to many.

One possibility is that the linkages to facilitatedata ow between the healthcare sector andthe biomedical sciences research sector, couldbe largely developed and supported usingresearch funds.

For the public healthcare system, it may be

possible to make a case for the governmentto provide a signicant part of the fundingrequirement, as there could be overall costsavings from reduced medical errors andunnecessary duplicate tests. These errors canbe largely reduced by providing clinicians withaccess to timely and accurate information andcomplementing their decision-making processwith clinical decision support systems.

Extension of inter-operable infocomm systemsand data exchange into the private healthcaresector will be more challenging. One optionthat might be considered is to require privatepractitioners, who are given governmentsubvention for treating certain types ofpatients, to establish the means in their clinic toparticipate in data exchange and for the doctorsto enter selected data on their patients into thenational system.

Ensuring sufcient availability of procienthealthcare infocomm manpower.

As healthcare processes are very complex,re-engineering these processes will requireinfocomm professionals with deep healthcaredomain knowledge. Such infocomm manpoweris currently lacking in Singapore. This hindersthe development of products and services for thehealthcare sector as well as the generation of newintellectual property for the infocomm companies.


30/44


28

Achieving buy-in and leadership by doctors andhealthcare providers for process changes.

Improving the quality and consistency ofhealthcare services will require healthcare

providers to re-engineer many of their careprocesses and to work more closely togetheras teams. The buy-in and active leadershipof physicians will be critical, to overcomeestablished healthcare/medical practices andresistance to change. A process of engagingand securing the support and buy-in of doctors,health professionals and medical students will benecessary. Part of this may require pilot projectsto demonstrate the benets of process changes.Appropriate incentives and policies will also beneeded to facilitate change management.

Improving public willingness to adopt infocommfor accessing healthcare services.

The proposed goal and strategies will require ahigher level of infocomm adoption for infocomm-

enabled healthcare services. Success of theprogrammes will therefore hinge on the level ofpublic infocomm acceptance and savviness. We willtherefore have to improve the publics awareness ofand prociency with new healthcare services andapplications. At the same time, particular emphasismust be placed on making infocomm interfacesas simple and intuitive as possible. Realistically,however, the process will take a long time as asignicant proportion of the population is not adeptin and probably uncomfortable with using infocomm.However, generational change will help address this,as the proportion of younger members of familyunits, to whom infocomm is a way of life, grows.


31/44

29

CHAPTER 6

CONCLUSION


32/44


30

This report outlines a bold, yet realistic, goal in which healthcare delivery models, enabled by infocommapplications, are transformed from what they are today.

The strategies proposed have outlined what needs to be done from the infocomm perspective. Althoughimportant, they play only an enabling role and cannot be meaningfully implemented in the absence of support

for change and leadership from the relevant government agencies and healthcare providers.

Transforming the healthcare sector will not only help address todays challenges, it will further provide richdevelopmental opportunities for healthcare infocomm companies, drive excellence in healthcare services anddistinguish Singapore as a medical and biomedical sciences hub.

It is therefore our sincere wish that key stakeholders in the healthcare and biomedical sciences sectors willnd this report useful as a starting point and, together with the infocomm industry, make the proposed goala reality.


33/44

31

Infocomm often plays a strategic role in creating value within business ecosystems. Hence, lessons can be gleaned from otherindustries that have used infocomm to transform service delivery. In the paragraphs below, we highlight how infocomm had beenapplied in transforming the national library system 5, enabling co-opetition in the payments industry, realising a customer-centricbanking model and attaining customer satisfaction in the hospitality sector 6.

Annex A: Relevant Perspectives

from other Industries

National Library Board (NLB) Paradigm shifts. In the early 1990s, technological advances

in infocomm were transforming the ways people obtainedinformation and knowledge. Under such a context, theNLB had to fundamentally change the role of library in

society and the way it delivered its services. It subsequentlyunderwent a paradigm shift from being a custodian of booksto being a service-oriented information provider.

Transforming customer experiences. A majorimplication of this paradigm shift was to transformcustomer experiences by signicantly reducing hassles(e.g. waiting times) and providing easier access toinformation. To speed up the time-to-shelf and time

to-checkout of books, an RFID-based Electronic LibraryManagement System was implemented to accelerateupdating of loan records. Self-service was also madepossible by consolidating multiple disparate informationsystems into one single system through which informationabout books, loan accounts, etc. was made accessible to

users over a variety of channels including borrower enquiryterminals and websites (nlb.gov.sg).

Implications for healthcare. Relevant medical informationcan be provided through information portals to allowpatients to proactively manage their health. Patientexperiences can be improved (e.g. reducing waiting timesand hassles) through re-engineering of work processes withthe aid of infocomm. Disparate medical databases can beintegrated for complete overview of patient medical history.This will further enable the practice of patient-centred care.

VISA Enabling co-opetition in the payments industry.

VISA is an instructive example of how technology-enabledcollaboration among competitors, coupled with appropriategoverning policies, led to increased businesses for all.

Before the formation of VISA, card holders could only usetheir cards at merchants acquired by their issuing banks.Merchants therefore had to incur unnecessary costsmaintaining different systems with multiple acquiring banks.Similarly, consumers required multiple cards with differentissuing banks in order to use credit with a large networkof businesses.

VISA was subsequently formed to facilitate the exchangeof card holder information between the issuing andacquiring banks. Supporting this exchange were commonsupercomputing infrastructure and high-speed switchingnetworks. Most customer and transaction-relatedinformation however continued to reside with the issuingand acquiring banks respectively. With this exchange,

the network of merchants available to card holders andvice-versa expanded signicantly without much need forincreased capital investment. This augmented networksubsequently attracted more businesses from merchantsand consumers for the banks.

Implications for healthcare. A common infrastructure,with data standards, exchange protocols/applications andfederated databases, can be built to enable the exchangeof patient information. Patients should own their medicalrecords and hold the key to open access to healthcareproviders (e.g. patient health card).

5 Transforming Singapores Public Libraries, Roger Hallowell, Carin-Isabel Knoop, Neo Boon Siong, 20016 Business Transformation Through IT: Case Studies, Frost & Sullivan, September 2005


34/44


32

Citibank Customer centricity. In a mature market like the nancial

services industry, differentiating through personalisedservices is key to retaining customers. Citibank implementsthis paradigm by utilising all data points it knows of acustomer to develop an individual prole for each one ofthem. This allows Citibank to push out customised servicesand products. At the same time, ofcers at all touchpoints (branch, online portal, telephone and ATM) with itscustomers have the same complete overview to providea consistent level of service. The latest information isalso uploaded into its databases and customers proleupdated accordingly.

Implications for healthcare. A common data

infrastructure can be developed to provide a completeoverview of patients medical history at all points of carein the healthcare value chain.

Wynn Resorts Ensuring customer satisfaction and loyalty. Due to a

large number of hotels, casinos, resorts and premiumrestaurants in Las Vegas, it became increasingly hard fornew entrants to make a mark, and hence, to earn revenue.In order to cater to a customers needs effectively, each hotelstaff needs to collect data about his/her behaviour and, atthe same time, provide relevant information to them inreturn. The two-way information exchange results inensuring customer satisfaction and loyalty.

Wynn implemented a seamless network where customersand the hotel staff can share information. The exchangewould help enhance the visitors experience and allowthe hotel service staff to provide customised services such

as a dynamic push capability that enables the hotel todisplay information, such as guest services, room occupancystatus and event information, right on the guest roomphones on its in-built browser. The phones are highlyinteractive devices wherein at the push of a button adirectory of phone numbers and services in the hotel can beobtained. Other information such as the opening hours of acertain restaurant or a shopping mall can also be displayed.

Implications for healthcare. Healthcare providers cansimilarly improve their level of service through interactiveinformation services with their patients, both within andbeyond the hospital environment. This will also providehealth education as well as reduce patients uncertaintyof the treatment process.


35/44

33

Well-integrated Quality Healthcare Infocomm systems that allow access to, and sharing of,

patients clinical and treatment data that would help drivethe integration and coordination of healthcare services.

- Coordination among different providers. The clinicsand hospital teams would work together in an integratedand coordinated manner, with an infocomm-enabledprocess of care and point-of-care clinical practiceinformation that ensures consistent delivery of evidence-

based care and which optimises overall patient outcomes.The aim would be for patients to be managed at the rightlevel of provider (e.g. primary care rather than tertiaryhospitals). For example, some of the more complexfollow-up patients could be managed by their regular

health provider and relevant step-down care facilities,with the appropriate support from the specialist.

For major chronic diseases such as diabetes, hypertension,high cholesterol and stroke, enhanced monitoring andmanagement could be carried out using the homeinfocomm system.

- Remote monitoring for key diseases. For a smallnumber of selected key diseases, e.g. chronic diseases,the home infocomm system would be augmented withappropriate remote monitoring technologies to allowpatients to be monitored at home (e.g. difcult-to-controldiabetes; INR for patients on anticoagulation; white cellcounts for patients on chemotherapy; telemetry for

cardiac diseases) with the results forwarded electronicallyto the patients primary care provider and the patientspersonal medical data e-docket. The system couldprovide various alerts to warn the patient and hiscaregiver to take specic actions or contact his healthcareprovider, e.g. when blood sugars are too high/low, if INRsare too high, if blood pressure is too high/low.

Annex B: iN2015 OutcomesCost-effective Healthcare Services Clinical support infocomm systems in hospitals and clinics

that provide point-of-care clinical practice informationand assist doctors and healthcare workers with clinicaldecision-making.

- Enhancing clinical decision-making. To help ensureconsistent evidence-based medicine practice, eachhospital and clinic will have a clinical decision supportsystem that assists with clinical decision-making basedon the common health data set of each patient,supplemented by additional relevant information enteredby the provider. In the future, this may include anumber of gene-based susceptibility or pharmacogenetictest data.

- Improving patient monitoring. The system agsreminders to the care provider on the standard testsnecessary for proper monitoring of patients, e.g. timingof regular tests to screen for complications in diabetics,liver function tests.

- Improving clinical outcomes. The system alsocaptures key monitoring data, e.g. serial HbA1c resultsfor diabetics, serial alpha fetoprotein results for patientswith chronic liver disease, etc. These data would be veryvaluable for clinical quality assurance.

- Reducing prescription and other medical errors. The electronic prescription system will ag up potential

drug interactions for drugs ordered by individualphysicians. The prescription system could also be linkedto the drugs li sted in the patients personal medicale-docket and potential adverse interactions with thesewould also be agged up. Ideally, there would also bea linkage to the infocomm system at the di spensing site(s)so as to reduce the risk of inadvertent drug interactionsthrough prescriptions being made by different groups ofcare providers. Simpler means of avoiding unnecessarypolypharmacy and unintended drug combinations maybecome available if RFID or equivalent technologies allowtagging of individual packs of medications. For somecategories of patients and drugs the medications couldbe dispensed in neighbourhood kiosks.


36/44


34

Greater Ability of Public to Manage their Health Simple infocomm systems in households that would

proactively facilitate health promotion activities andwellness, and make a signicant proportion ofinteractions with healthcare providers more patient-centricand convenient.

- The home infocomm system could be based on anycombination of infocomm technologies, e.g. Internet, TVor mobile.

- Enabling proactive self-management of health. The home infocomm system pushes out and is easilysearchable for authoritative, timely and relevant healthinformation. The system must be simple and intuitiveto use, interactive, allows monitoring of health progressand is capable of tailoring information to the individualsneeds for a number of selected medical conditions.

- Enabling effective health screening. The sameinfocomm system provides timely reminders about and

facilitates cost-effective screening which can be carriedout in the home but with the result read remotely andan electronic record created for the person in his/herPersonal Medical e-Docket, and pushes the informationout to the regular health provider. Potential examples:

> Faecal occult blood screening done at home butresult read remotely.

> Blood sugar/cholesterol done on home-kits but withthe results ported electronically to the Personal Medicale-Docket and the providers records.

> Capsule endoscopy carried out at home with thereadout sent remotely to a diagnostic site for analysis.

- Enhancing patient convenience. This system shouldalso allow easy navigation of the healthcare system sothat individuals can nd the appropriate provider (publicor private), register, make and change appointmentswith them through it. After medical consultation andtreatment, the patient should be able to order rells for

a prescribed range of drugs through his home infocommsystem. Simple advice about the drugs and othertreatments prescribed could be addressed through thesystem, which can also monitor and raise alerts aboutpotential drug-drug interactions.

A dened common longitudinal medical data set is capturedand accessible to any health provider treating the individual.

- Common medical data set. A common health dataset with standardised denitions should be capturedfor each individual. The data set could include drugallergies, vaccination history, record of a standard set ofscreening tests, presence of a dened set of commonmedical conditions (e.g. diabetes, hypertension, highcholesterol and stroke), short summaries ofhospitalisations, drug history.

- Accessibility of common data set. The common healthdata set for the individual should be readily accessible,with proper safeguards, to any health provider, public orprivate, who might look after the individual. A smallersubset of these data could be made available to eachindividual through his/her personal medical data e-docket.

Strong Clinical and Health Services Research A conducive regulatory framework.

- Facilitates sharing of information. This regulatoryframework should facilitate the collection and sharingof health data for healthcare and research purposes

while safeguarding privacy and condentiality. It shouldbe a robust but not restrictive data and human tissueregulatory framework.

Infocomm links that facilitate the ow of relevant informationbetween clinical databases and research databases, underconditions that protect patients condentiality.

- Linking healthcare and biomedical databases. Links between clinical databases, disease registriesand research databases will help maximise the valueof the clinical databases to carry out research and tofacilitate the translation of new scientic discoveriesinto useful clinical applications. Conversely, these willalso allow clinical data and materials to inform, support

and drive basic biomedical research and to focus it onissues of greatest relevance to healthcare.

- Improving treatment outcomes. Infocomm that canintegrate the clinical information for specic patientsand their family history, and stratify them into acceptedrisk prole and treatment groups. These can besupplemented by genetic and/or biomarker prolesthat can further improve stratication and choice oftherapies. In addition, with genetic knowledge ofdiseases and the persons genetic makeup as well ashis medical history, we may be able to predict oranticipate the type of illnesses a person might besusceptible to and hence administer preventive treatment.Besides better treatment outcomes and drug efcacies,infocomm systems can analyse different care paths toidentify the most effective treatment protocol.

- Enabling more effective and efcient drugdevelopment. Pharmaceutical companies can alsoleverage on the partnership to generate new drugcompounds and develop drugs that are targeted andindividualised for the Asian population. In addition,Singapore could leverage on the opportunity to helpdrug companies reduce their drug development cost.A major portion of these costs are incurred in the formof large-scale clinical trials. The presence of well-denedpopulations and sub-populations of patients with differentdisease susceptibilities and medical conditions wouldbe very useful for researchers and drug companies incarrying out clinical studies in more cost-efcient ways.


37/44


38/44


36

People Prole of population. Our population currently stands

at 4.3 million, with about 3.6 million Singapore residents.The percentage of Singapore residents aged 65 yearsand above is projected to rise rapidly from 8.4 per centof the population in 2005. Average life expectancy ofSingaporeans has also steadily increased and is now at79.7 years. In tandem with increasing afuence, there isa high prevalence of chronic, non-communicable diseasessuch as diabetes, hypertension, high cholesterol and stroke.

Healthcare Services Structure of healthcare system. Healthcare services are

provided by different types of providers throughout theentire healthcare value chain from primary care to tertiarycare through to step-down care.

- Primary care. Primary care includes primary medicaltreatment, preventive healthcare and health education.These services are provided through a network of 17government-subsidised outpatient polyclinics and 1,955private General Practitioners (GPs). The former caters toabout 20 per cent of general primary care needs while theGPs provide the remaining 80 per cent.

- Tertiary and acute care. These services are provided

by a network of 13 public and 16 private hospitals.The public hospitals are structured into two hospitalgroups SingHealth Group and National HealthcareGroup that operate as not-for-prot private companies.Each of these clusters consists of both general hospitalsthat provide multi-disciplinary healthcare services andspecialised hospitals in various disciplines, e.g. obstetricsand gynaecology and ophthalmology. Private healthcareis provided by two main providers Rafes MedicalGroup and Parkway Group Healthcare with similarspecialist disciplines and comparable facilities to thepublic clusters.

- Step-down care. Intermediate and long-term healthcareservices for the elderly are mostly run by voluntary

welfare organisations (VWOs). Government nancialassistance is provided to some of these VWOs. Thereare six acute hospitals providing geriatric services, fourcommunity hospitals, ve chronic sick hospitals, 56nursing homes (including private homes), 33 dayrehabilitation and dementia day centres, 10 VWO homemedical providers and 17 VWO home nursing providersserving the healthcare needs of the elderly in Singapore.

Biomedical Sciences Research Sector Biomedical sciences research ecosystem. Singapores

public sector biomedical research and developmentactivities are championed by the Biomedical ResearchCouncil, a unit under the Agency for Science, Technologyand Research (A*STAR). Currently, there are ve researchinstitutes in the biomedical sciences area, namely theInstitute of Molecular and Cell Biology, Institute ofBioengineering and Nanotechnology, Genome Instituteof Singapore, Bioprocessing Technology Institute andBioinformatics Institute. A major focus of the researchcommunity is how to better make use of clinical databasesto advance biomedical sciences research and how totranslate their discoveries into more effective healthcareapplications and treatments for patients.

Current Status of Infocomm Functionalities in theHealthcare Sector While infocomm holds great promise for transforming

the healthcare sector, it is generally acknowledged thatthe sector has historically lagged behind other sectors inthe adoption of infocomm for its key processes. Hence,a substantial amount of catching up will be necessarybefore some of the more novel potential applications canbe widely explored.

In devising a plan to realise the infocomm vision for thesector, it would be necessary to take into account thecurrent status of implementation and to set realistic goals,targets and timelines.

Adapting the approach used by Kaushal et al 7 the Sub- Committee made rough, non-quantitative estimates of the

status of a range of infocomm functionalities among existinghealthcare providers in Singapore. Refer to the followingtable for a summary of the results.

Annex D: Overview of Healthcare

and Biomedical Sciences Sectors

7 The functional gaps of health information technologies required for a national health information network: exploring policy solutions, Kaushal R, BatesDW, Poon EG, Jha AK, Blumenthal D, Health Aff., 2005


39/44

37

Current State of Infocomm Adoption in Healthcare Sector

Publichospitals/Institutions

Privatehospitals

Privatespecialistclinics

Polyclinics GPs Step-downcare

Result viewing 3 2 2, P 3 2, P 2, PCoreEMR

Inpatient 2, P 0 0 - 0 0-1

Ambulatory 2, P 0 0-1 2, P 0-1 -

Longitudinal EHR 3, P 0 0 3, P 0 0

Electronicprescribing

2, P 0 0-1 3 0-1 1, P

Computerisedphysicianorder entry

1, P 0 0-1 1, P 0-1 0

Patientcommunication

1, P 1 0-1 1, P 0-1 0

Patientsappointments,transactions

1 0-1 0 0 0 0

Claims 4 4 0 0 0 4

0: Not available1: Available within the hospital, or within the polyclinic or within the step-down care facility only2: Available within the public health cluster only3. Available across clusters in the public health system4: Available across public and private systemP: Available for some but not all itemsF: Available for all appropriate itemsResults viewing: Electronic viewing of test results, e.g. laboratory tests, radiology (text or lm), pathology resultsCore EMR: A standardised, well-dened core set of patient medical records for sharing by infocomm

Longitudinal EHR: Computerised systems that maintain relevant longitudinal health records including vaccination history, selectedscreening test resultsCPOE: An application that allows all medical orders to be entered electronicallyPatient comms: Secure email or messaging systems that allow private communications between patients and their

healthcare providersClaims: Electronic claims submissions between provider and third party payors including Ministry of Health

Note: This is a non-quantitative estimate by the Healthcare and Biomedical Sciences Sub-Committee.


40/44


38

Annex E: iN2015 Healthcare and

Biomedical Sciences FocusGroup MembersName Designation

Mr Dennis Ang Keng Leong Deputy DirectorProjectsSchool of Information TechnologyNanyang Polytechnic

Dr Christopher Chia Chief Executive OfcerMedia Development Authority

Mr Lin Cheng Ton Principal & Chief Executive OfcerNanyang Polytechnic

Dr Gunaretnam Rajagopal Deputy Executive DirectorBioinformatics InstituteAgency for Science, Technology & Research

Dr Patrick Tan Principal InvestigatorNational Cancer Centre Singapore

Mr Teo Chin Seng Chief Information OfcerSingapore Technologies Engineering

Dr Jason Yap DirectorHealthcare Services DivisionSingapore Tourism Board


41/44

39

Annex F: IDA Secretariat for

Healthcare and BiomedicalSciences Sub-CommitteeName Designation

Mr Arthur Lee Assistant DirectorHealthcare & Social ClusterInfocomm Development Authority of Singapore

Mr Lee Hoo Wah Senior ManagerHealthcare & Social ClusterInfocomm Development Authority of Singapore

Mr Teo Yi-Wei Associate ConsultantiN2015 SecretariatInfocomm Development Authority of Singapore


42/44


40

Annex G: GlossaryTerm Denition

Acute care Medical care generally given in a hospital set ting for more ser ious condi tions that often ariseover a short time frame and are usually of periodic or t emporary nature.

Anticoagulation Treatment that thins blood in order to make a patients blood less likely to clot.

Bioinformatics The science of managing and analysing data using advanced computational techniques asapplied to biological research.

Chronic disease A long-term disease that is non-infectious. This kind of diseases often has many causes.Examples include high blood pressure, diabetes and heart disease.

INR Internationalised Normalised Ratio. A test that reects how readily blood clots.

Medico-legal Pertaining to legal aspects of medical practices.

Pathology The scientic study of the nature of disease and its causes, processes, development,and consequences.

Point of care Location at which a pat ient is treated, e.g. the patients bedside. Also used to mean thepart of healthcare value chain where the patient receives care, e.g. acute care hospitals, GPclinics, nursing homes.

Poly-pharmacy The concurrent administrat ion of multiple drugs result ing in excessive medication and higherrisk of unintended interactions and side effects.

Primary care The type of holistic, basic healthcare that would be delivered by a family physician.

Prognostic markers Biological parameters (e.g. specic proteins or genes) that are used to indicate susceptibility,presence and stages of progress of diseases.

Step-down care An intermediate stage of care between hospital and home-based care. It is providedby community-based institutions like nursing homes, rehabilitation centres andcommunity hospitals.

Tele-consulting Medical consultat ion that is carried out using telecommunications rather than in person.

Telemetry Transmission of data collected remotely to a central location over communications links,e.g. satellite.

Teleradiology Electronic transmission of radiological images, e.g. X-rays, CTs and MRIs to a remote locationfor interpretation and/or consultation.


43/44

41

Infocomm Development Authority of SingaporeIDA is committed to growing Singapore into a dynamic global Infocomm hub. IDA uses an integrated approach to developinginfo-communications in Singapore. This involves nurturing a competitive telecoms market as well as a conducive businessenvironment with programmes and schemes for both local and international companies.For more information, visit www.ida.gov.sg

Singapore Computer Society SCS, established since 1967, is the premier professional body for IT practitioners and IT users in Singapore. With a membership ofover 22,000, it is an invaluable network for its members. SCS administers various certication programmes that help individuals gainprofessional recognition for career development.For more information, please visit their website at www.scs.org.sg

Singapore infocomm Technology FederationSiTF is Singapores national infocomm industry association. It brings together 500 corporate members from MNCs and localcompanies, who collectively account for over 80% of the industry revenue. The SiTF assists its members in business development,market intelligence, overseas trade missions, networking and alliances.For more information, please visit their website www.sitf.org.sg


44/44


Published by:

Supported by:

in 2015 healthcare

Documents