Dr Sarah Muttitt's (CIO of MOH Holdings) presentation slides during the Healthcare IT SIG launch

1. Health IT in Singapore
Dr Sarah Muttitt
CIO, MOH Holdings Pte Ltd
7th Feb 2012

2. Getting ready for the “Silver Tsunami”
Pressures on Singapore healthcare system set to increase
By 2030 • 1 in 5 Singaporeans will be over 65
By 2050 • Singapore will be among the world’s demographically oldest
countries with median age of 54
“A Different Pattern of Healthcare”
• Integrated healthcare delivery system
• Appropriate care from the right site
• Better allocation of resources
• More cost-effective treatment and care in
the healthcare continuum

3. New Directions
We need to do more
than building more
acute hospitals.
Khoo Teck Puat Hospital Jurong General Hospital (2014)
550-bedded regional hospital 700-bedded regional hospital
• Community hospitals, nursing homes, primary care
• Train and/or recruit healthcare providers (and IT
professionals!)
• Support informal and community based care givers
• Address incentives, disincentives
• New responsibilities, accountabilities

4. Vision of Future Healthcare Landscape
- enabled by the Regional Health Systems (RHS)
Community
Hospital
Polyclinic/
Family Nursing
Medicine Homes
Clinic Home
Screening & Palliative
Prevention Care
Family
Physician Rehab
supported by Centres
CHCs
Restructured
Hospital
Medical
Centres
Organisation of the RHS, where Home is the central location for care, with
primary care delivering person-centric care integrated with the rest of the
care spectrum for both physical and mental healthcare.

5. Healthcare Landscape of the Future

6. Supporting the Care Continuum
Strengthened Primary Care providers to Strengthening ILTC sectors to support
support better chronic care management , increasingly aging population in the community
disease prevention and wellness and at homes
• Encourage greater participation of GPs into chronic • Encourage greater care efficiency of community providers by
care management by equipping them with tools and equipping them with tools and facilitating data linkages
facilitating data linkages • Enhance community capacity to support increasing aging
• Enhance ‘sensory’ networks in primary care from population through care coordination between providers and
peace-time monitoring and emergency activations care givers
ILTC IT Strategy
Community
Hospital
Polyclinic/
Family Nursing
Medicine Homes
Clinic
Screening & Home
Palliative
Prevention Care
Family
Physician Rehab
supported by Centres
CHCs
Restructured
Hospital
Medical
Centres
Primary Care IT Strategy
NATIONAL ELECTRONIC HEALTH RECORD

7. eHealth Systems in Singapore
National
EMR Exchange Hospital based
Immunisation
(EMRX) EMR & CPOE
Registry
Multiple EMR Systems
Multiple Lab & Radiology Systems
Critical Medical
Public healthcare clusters Information Store
(CMIS)
NHG and SingHealth hospitals,
polyclinics and specialist clinics
Ministry of Defence (MINDEF)
EMRX Extension
to Community
GP Clinic
Hospitals
Management
Systems
Minimal EMR Systems
Community
Hospital based Private GPs (over 400 out of more than 2,000 have a CMS)
EMR
Community Hospitals and other ILTC providers

8. Top 3 Priorities for Health IT
• Priority 1: Establish a Health Information Exchange to facilitate care
integration across the different segments in a trusted and standardised
manner.
• Priority 2: Create an Integrated Healthcare Continuum where care
providers are e-enabled and linked; to participate in the integration of
care across the healthcare value chain.
• Priority 3: Enhance Manpower Capability to support the infocomm-
enabled model of integrated healthcare services.
Other Priorities / Objectives
As an key enabler to support MOH’s vision and Singapore’s growth as a
Medical hub.

9. National Electronic Health Record
(NEHR)
Vision of
“One Singaporean, One Health Record”
The EHR is an integrated healthcare record centered
on each person. It extracts and consolidates in one
record, all clinically relevant information from their
encounters across the healthcare system throughout
his/her life
Secure “real-time” access to patients’ EHR
by authorised clinicians and healthcare providers:
>enable greater coordination and informed decision-
making,
>resulting in more accurate diagnosis, better treatment
and patient-centric integrated care.

10. EMR vs EHR
EMR EHR
Specific to a facility Specific to an individual
(institution, private office)
• Equivalent of its paper • Captures a key subset of health
predecessor information from multiple
• Includes everything recorded point-of-service systems
by the organization about a • Available electronically to
given patient authorized healthcare providers
• Has “depth” but lacks “breadth” anytime, anywhere
• Designed to facilitate the sharing
of data across the continuum of
care, across healthcare delivery
organizations and across
geographies

11. What Our Clinicians Want
Consolidated view of
patient’s current
medications
Ability to share critical
Consolidated view of patient information
patient’s current across all providers
problems involved In patient’s
clinical care journey
What Our Patient information
accessible at the point
Longitudinal summary
health care profiles Clinicians of care – to support
clinical decision
Want making

12. Interoperability - Enterprise Architecture
Pragmatic approach adopted to deliver an Enterprise Architecture that is
Implementable
Fit-for-purpose i.e. delivering
value for clinicians in the near term
Future-Proofed to support longer
term vision for healthcare, analytics
and research

13. Interoperability - National Data Standards
Clinically-Driven
Establishing a suite of Standards that are: Easy to Use
Internationally Recognised
to ensure clinical data included in the EHR can be:
Shared and exchanged safely and reliably
Relied on for the monitoring and care of patients
Global Standards Engagements
Used meaningfully for secondary purposes
• HL7 (Health Level Seven)
• IHTSDO (International Health
including the production of clinical knowledge
Terminology Standards Development
Organization)
Standards also provide a platform for long
• ISO TC215 on Health Informatics term semantic interoperability and research
informatics

14. Change Management
“It simply doesn’t make sense that patients in the 21st
century are still filling out forms with pens on papers that
have to be stored away somewhere.”
US President Barack Obama
Need to manage change as large majority of
American Medical Association
clinicians learnt their professions in the absence Annual Conference, 15 June 2009
of automation, and continue to practice without it
Concerns Programmes & Initiatives
Privacy of patient information Privacy and Security Framework
Impact on efficiency of work Process redesign & workflow integration
Cost of automation Subsidies and incentives
Quality of available solutions Common functional requirements definition
How to make transition from
Peer network & transition support services
paper-based to e-documentation

15. The Journey towards One Health Record
Formation of the Creation of the Award of contract Implementation of
2008
2009
2010
2011
National Health goal state for NEHR solution the production
Informatics architecture for an system
Build and
Strategy electronic health Development over Integration with the
Formation of the record solution 10 months legacy systems
clinical advisory Beginning of providing
Collaborative focus demographic and
groups and Vendor Selection group discussions clinical data to the
taskforces on NEHR design NEHR
with key clinicians Beginning of
and industry deployment to
thought leaders Singapore public
healthcare
Award of contract
for the delivery of a
primary care
solution to integrate
with the NEHR

16. NEHR Phase 1
Who will have access by 2012
2 x Nursing
6 x Community Hosp
Home/Hospice
AIC
18 x Polyclinics
8 x Restructured Hosp
6 x Specialist Centres
50 x GP Clinics
SAF

17. NEHR – Towards A Fully Integrated Care Record:
Providers are “on the same page”
Community
Acute Hospital
Hospital
Community
Hospital Common
System (CHCS)
Demographics Events History
Nursing
Home IT
Enablement
Discharge
NEHR Medication Nursing
Program
(NHELP)
Summary History Home
Emergency
Department
Laboratory Tests Radiology Tests
Clinic EMR &
Operations
(CLEO)
Pharmacist General
Practitioner

18. The Next Wave: Transforming Healthcare
Through Innovative Use of Technology
Reaching and touching the patient via
Multi-access Channel, Multi-modal Means
Web, Mobile Phone
National Call Centre
•Triaging
Personal Health •Case management for CDM
Management •Healthcare services (e.g. PCPS)
•Self management
•Patient empowerment,
education/literacy
•Shared repository of patient-
entered data
•Web and mobile applications
for CDM, wellness
•Open platform
Telehealth
•Remote monitoring and consult (telehealth)
•Telemedicine : provider to provider, mobility, specialist
care delivery (e.g. Teleoptometry)
•Call for collaboration
Devices and Network

19. The Promise of HIT
Better Clinical Care and Streamlined Workflows
Patient information at the point of care
Supports clinical decision making and workflows
Enables providers involved in patient care journey to work as a team
Seamless transition of patient into different care settings
Better management of chronic illnesses
Enables greater patient participation and supports self-help
Better Practices and Greater Patient Safety
Shared patient’s clinical records
Enforces better prescribing practices with peer reviews
Reduces human errors related to handwritten records
Takes the guesswork out from the lack of past records
Prevents duplicate and unnecessary tests; and adverse drug events

20. Thank You
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