LET`S C.H.A.T. (Conversation on Health And Technology)

LET’S C.H.A.T. (Conversation on Health And Technology)
With a packed-room of over 300 attendees from the Healthcare family, the “Let’s Chat”
session in the National Health IT Summit 2015 offered a rare opportunity for the
audience to listen first-hand, to views on Health and IT from a distinguished panel. The
panelists in the “Let’s CHAT” segment were hosted by Mr Bruce Liang, CIO of MOH/H,
and comprised PS Mrs Tan Ching Yee, 2PS MG (NS) Ng Chee Khern and DMS Associate
Prof Benjamin Ong.
A total of over 40 responses were garnered from the floor during the session, via
“PigeonHole”, a real-time interactive Q&A platform tool that enabled the audience to
post their burning questions . Here are the responses from the panel for the questions
that were addressed that day:
Why can't we have one EMR for all public hospitals?
 DMS opined that while one EMR would be desirable from a population/patient
perspective, there are legacy issues that would take time to resolve. Moving forward,
we should strive to reduce the complexity in the system and seek to achieve having
one medical record per patient – one that ought to be available through the patient’s
life, everywhere he goes and be protected such that it is accessed only for the right
reasons.
 PS emphasised that Singapore healthcare was already “One” in several aspects – i.e.
we have one Minister, and we have one main funding source. PS opined that the
boundaries between what was “one” and “multiple” has not been defined clearly
enough and we were, perhaps, not drawing the “one” far enough to give our patients
a seamless experience; variations at high cost should not be tolerated if such
variations did not have strategic value for the individual institutions.
Why do we keep pouring money into NEHR when very few people are using it?
 PS emphasized that the investment was necessary for us from a patient-centricity
LET’S C.H.A.T. (Conversation on Health And Technology)
perspective: if we had not started putting records together in the public sector and
then extending them to primary care and ILTC sectors, we will never achieve a
patient-centric view. The investment was also accompanied by endeavours to build
very deep and pervasive use cases based on feedback gathered from stakeholders.
What do you foresee as the top 3 challenges of the Singapore healthcare system?
 PS opined that the Ministry’s short term challenge was capacity. Current capacities
were planned in the absence of full knowledge of what Singapore would be facing
today. The building of more hospitals was one of the many ways to tackle this
challenge. The longer term challenge for the system would be sustainability and that
would involve moving upstream, pushing the frontiers to engender progressive
changes that will allow citizens to remain healthy for a longer period of time as they
lived longer. To deal with that challenge, the Ministry and its partners have invested
in huge conversations and campaigns around ageing productively, lifelong
employability etc, as well as enabling infrastructure in the community to make it
easier for citizens to stay active. From a supply perspective, the models of care will
also need to transform, while the healthcare workforce would also have to start
acquiring skills to be ready for the future.
Due to time constraints, the panel was not able to address the other highly-voted
questions. Here are the responses developed by the MOHH IT team:
It is very hard for IT to drive business hence it is hard to align and consolidate. As IT
enables the business, shouldn't we be looking at consolidating the businesses first?
It is true that it could be easier to align IT if business is consolidated. In the absence of line
of sight to businesses consolidation, should we and can we wait to deal with the issues of IT
fragmentation until businesses are consolidated (if ever?) IT fragmentation impacts patient
care and cost of care. We need to address it now.
In my hospital, clinicians are complaining all these IT changes are frustrating to
learn. Patient say doctors look at screen, not at the patients.
There is clear evidence that IT introduction into clinical practice, in clinics, wards and
various care settings show benefits in many areas, some of which include enhanced patient
safety, better clinical care decision making and also enhanced clinician to patient
relationship and patient satisfaction. However, it is also true, that contrary evidence exist to
show that if IT implementations are not done well and correctly, undesirable side effects
may surface. Transiting from a manual and paper way of clinical practice to that of eenablement requires careful and purposeful rationalization of existing culture, processes
and practices that will be required in the “new” work environment. This forms part of the
clinical change management process that is needed to ensure that the principles of good
patient care and relationship continue to remain strong. Invariably there will be changes in
current practices and methods along the adoption journey. In our public healthcare
LET’S C.H.A.T. (Conversation on Health And Technology)
institutions, CMIOs (Chief Medical Informatics Officers) usually lead these changes to use
IT and informatics in the best way possible within your environment. Work with them to
ensure that the best can be achieved both for the patients and for you as the provider.
More healthcare projects is concentrated on institution basis, when can we start
collaborating and consolidate data and normalize it to be used within Singapore
health industry?
(A similar question) How to solve the problem of sharing data across MOH, MOHH
and clusters? Everyone is requesting for data but how to ensure their willingness to
share data as well.
There is an ongoing RFP for Health Data Grid (HDG) to pilot real time linkage and sharing
of data from different PHI repositories for analytics. Moving forward, there are plans to
achieve HITCAP requirements through a common national analytics platform which will
leverage on HDG. Through this platform, parties across PHIs can collaborate to use data to
address population needs.
On resolving the issue of data sharing across MOH/H and the clusters, HDG will address
PDPA where data pertaining to patients which may scatter across PHIs will be linked and
presented in anonymised manner for analysis. The possibility of a common governance
structure is being evaluated as part of HITCAP to manage data requests centrally so as to
expedite the approval process.
How do we reach lower income families/patients who can't afford IT? Just a thought.
I'm social worker. Many poor famiies don't have smartphones.
In the context of patient engagement, the use of the smartphone is not the only way to
engage patient.
In many social support settings, case managers leverage basic telephony to interact with
patient and their care-givers, remind them via phone call to take their medication or go for
appointment. They also leverage community support structure like home visits to provide
coaching and guidance to patient and caregiver. It is important to provide the case
manager and the community support team with relevant data to contextualise and
personalise their support to the patient’s condition.
How do the ABCs apply to ILTCs? Especially 'sustain'.
ABCS stands for Anticipate, Build, Consolidate and Sustain and together make up the
Health IT Strategy. Here’s what they each mean:
Anticipate. We are anticipating the future needs of ILTC by leveraging demographics and
clinical data to match future demands and supply. As the sector consolidates and providers
starting to offer multi-services, there is a need to find a common IT solution that can scale
LET’S C.H.A.T. (Conversation on Health And Technology)
to that need.
Build. We are building more CH and NH to fulfil current and future needs. We are enabling
all the NH with IT system to provide them with basic management capabilities, claims
administration, clinical documentation and referral management. All CH will be integrated
to their RHS partner by FY15 to provide seamless flow of patients between RH and CH.
Consolidate. We are consolidating the needs of the sector like case management, referral
to ILTC and advance care planning to identify common capabilities. We have recently rolled
out a common Case management system to support case manager handling frequent
admitters and transition care to the community.
Sustain. We are aware of the cost concerns in the ILTC sector and have sized up IT solution
based on affordability. We have empowered AIC as the project management office to ensure
that the IT solution are fit for purpose and engaging the ILTC provider to rollout the IT
solution to them.
New IT capabilities inevitably need more investment and related increasing OPEX,
and our institutions are concerned about the rising IT costs. How do we balance and
manage this?
Over the last 5 years, there is a push in the Public Service to ‘Do More With Less’. That ethos
is applicable to our healthcare sector too.
Without a doubt, IT spending needs to increase as IT becomes an integral part of business
planning and operations. What makes a lean and mean ecosystem is how we can stretch
every dollar and invest in new capability with minimal resources. One way, which the PPSC
is trying to encourage over the past 2 years, is aggregation of common needs across the
sector, and invest in shared solutions that not only meet these needs, but in the process
level up every clusters’ capabilities. Many good examples have been pursued such as: OneBill-One-Queue System, Common case management system, etc.
IHiS, MOHH and our IT teams in MOH, HPB and HAS will continue to support our
respective business divisions in seeking the most cost-effective means to render IT
capabilities that are of good quality and affordable.
Why are the duplicate resources between MOHH and IHIS?
Are we moving towards a single cluster model?
There is no duplication of resources in terms of IT resource allocation to work. IHiS and
MOHH resources carry out different parts of many related work, but each party with
focused attention to support their respective business user groups and fulfilled their
respective charters.
Over the last 2 years, IT resources from both organisations have worked as one virtual
LET’S C.H.A.T. (Conversation on Health And Technology)
team in many occasions, bringing the best business insights and technology capabilities
and experience to deliver good results within a shorter turnaround time. The HITMAP
initiative is one, the National Pharmacy Landscape Study and associated projects is
another. There are many more examples. Overtime, the organization structure for IT
resources may evolve, but the key is how the groups of our IT resources can work
collaboratively to achieve common goals. It is therefore not an issue of duplicate resources,
but one of how to optimize our available resources to fulfill our national healthcare
priorities, so that IT investments can be optimized, IT services rendered in a cost-effective
and sustainable way, yet ensuring reliable and high quality of service is continually
rendered to our business and public users.