HEALTHCARE Empowering patients and transforming care delivery
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HEALTHCARE Faced with challenges such as an overburdened healthcare system, a rapidly-aging population and rising healthcare costs, the focus of healthcare is now on keeping people healthy and managing their chronic conditions within the community, while improving the quality and efficiency of health services delivered by care providers to their patients. NCS’ vision is to enable this transformation by using ICT to deliver smart healthcare.
Enabling Early Detection, Empowering Patient In line with this, one of our key strategies is to use technology to enable early detection of diseases, enhance patient engagement and empower them to take care of their own health. For example, the Enhanced Integrated Screening System helps a government health agency monitor the health of the population and facilitate programmes for disease prevention, while Personal Health Management solutions provide patients with access to contextualised health information and empower them to self-manage their health as well as to connect with their clinicians.
Technology is also being used to improve medication management and raise the bar in patient safety. The Electronic Inpatient Medication Record System developed by NCS for National University Hospital, Tan Tock Seng Hospital and Institute of Mental Health is a key component of the Closed Loop Medication Management System in these hospitals for the achievement of the 4 “rights” desired in Medication Administration at the hospital wards, i.e. Right Medication, Right Dose, Right Patient, Right Serving Time. We have also developed an ePrescription system to provide clinicians and nurses with a unified and simplified way of ordering medication, and an Outpatient Pharmacy Automated System which integrates robotics and multi-disciplinary technologies into the medication workflow.
Improving Healthcare Operations
Delivering Insights
Another area of focus is the use of technology to improve healthcare operations. For example, we delivered an Outpatient Administrative System that enables the SingHealth group to synergise outpatient operations across all its healthcare institutions. We also implemented a 1 Queue 1 Bill system at National Heart Centre Singapore and other healthcare institutions to help cut down on queues and simplify the payment process.
We are leveraging analytics to empower healthcare organisations in unlocking invaluable insights from the massive data in their systems.
To ensure that healthcare remains affordable to all citizens, we implemented and linked up various healthcare finance systems to provide easy access to information and facilitate policy planning. In forensics management, a system called FIONA helps streamline and automate administrative processes and workflows associated with forensic medical services.
DRIVING CARE EXCELLENCE We work with healthcare providers to develop integrated solutions for delivering better quality of care. 201
For example, the National Dental Centre’s Electronic Dental Record System provides a unified view of a patient’s medical record, enabling better diagnosis and treatment, while at Khoo Teck Puat Hospital, the Computerised Integrated View of the Customer delivers a “360-degree view” of each patient for a more personalised healthcare experience.
To support decision-making on healthcare-related policies, we worked with the Ministry of Health to build a Data Hub that unifies healthcarerelated information from different sources and transforms it into useful and meaningful analysis and reports. This has enabled MOH to draw deeper insights into patient healthcare needs and system relationships in Singapore’s healthcare. For hospitals, we implemented enterprise business intelligence systems integrating finance, business workload and clinical information for reporting and analysis. Through these and many other IT initiatives, NCS aims to make a significant contribution in improving the quality of care and making healthcare services more accessible and affordable to all Singaporeans.
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A holistic view of healthcare To provide a holistic perspective of Singapore’s healthcare system and enable more proactive decision-making on healthcare policies, NCS worked with the Ministry of Health (MOH) to build a Data Hub that unifies healthcare-related information from a wide range of sources and transforms it into useful and meaningful analysis and reports. For example, in recent years, growing demand for healthcare services has resulted in a strain on public healthcare resources with longer wait time at Accident and Emergency (A&E) departments and high bed occupancy rates at hospitals. To better manage the situation on the ground, MOH needed greater visibility and more timely insights into key healthcare workloads and resource utilisation at the national level. With the Data Hub, these requirements were met by extracting the relevant information and building interactive dashboards and reports for peace-time planning and crisis management. Intelligent building blocks in the Data Hub enable MOH officers to create ad-hoc queries using an interactive drag-and-drop interface, allowing for faster analysis and decision-making. This has also led to significant productivity gains and cost savings, eliminating the need for manual data consolidation and allowing reports to be generated without the need for programming expertise.
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Improving the quality of care with Electronic Medical Records A patient-centric Electronic Medical Record (EMR) brings together fragmented patient information from multiple sources for doctors and medical practitioners to support patient care including diagnosis and treatment.  An example is the Electronic Dental Record (EDR) system which NCS developed for the National Dental Centre of Singapore (NDCS), enabling it to digitise dental records and unify patient history, X-rays, laboratory test results, and drug allergy alerts into a single digital workspace. NDCS is part of the SingHealth public healthcare cluster network and is the main referral centre for patients needing specialist oral healthcare in Singapore. It sees over 150,000 patients a year. The centre’s EDR system is the first enterprise-class solution in Singapore to seamlessly integrate all major aspects of patient management in a large-scale dental institution with multiple specialties. It caters to all record-keeping needs in the dentistry specialist environment, allowing clinicians to electronically chart all general and specialty dental records and document their diagnoses, findings and treatments. Patient records can be accessed electronically, saving time in retrieving paper records and delivering them to the dentist. The system also interfaces with the larger SingHealth EMR system and enables critical medical information such as the patient’s medical history, lab test results and drug allergy alerts to be shared with the dentists to improve the quality of care.
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Cutting queues at the National Heart Centre From four different queue numbers and three separate payments to 1 Queue 1 Bill (1Q1B) – this was one of the major steps taken towards more patient-centric care delivery at the new National Heart Centre which was opened in 2013. The National Heart Centre Singapore is a 185-bed national and regional referral centre for cardiovascular diseases. It provides comprehensive preventive, diagnostic, therapeutic and rehabilitative cardiac services for heart patients. Each year, the Centre handles over 100,000 outpatient consultations in addition to interventional and surgical procedures and inpatient admissions. A typical outpatient visit includes seeing the cardiologist, taking a blood test and a cardiac diagnostic test, and collecting medication. With the previous standalone queue and payment systems, patients had to obtain separate queue numbers and pay separately whenever they visited the clinic and ancillary service areas. With the new system, patients only have to register once at the clinic upon their arrival. The system allows the same queue number to be transferred to the various service locations. This saves them time in queuing and re-queuing. There is also a single point of payment which combines the fees for clinic consultation, cardiac investigations and medication for the day into a single bill. The successful implementation of 1Q1B at the National Heart Centre has led to its adoption by other healthcare institutions. For example, the system has also been implemented in some departments at the Singapore General Hospital and at the new Integrated Building in Simei which is jointly managed by Changi General Hospital and St Andrew’s Community Hospital to provide geriatric, psychology and rehabilitation services.
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16 healthcare institutions, one seamless experience – this was one of the key improvements in patient service made possible by the Outpatient Administration System (OAS) deployed across the SingHealth cluster.
Facilitating patient administration across the care continuum
OAS is developed to standardise, synergise and facilitate seamless patient information flow and outpatient operations across the SingHealth institutions with a view to provide more patient-centric services and to improve operational efficiency. The system supports daily patient management at all SingHealth outpatient clinics and interfaces with ancillary systems such as the Electronic Medical Records (EMR) and financial systems. Patients benefit from functions such as e-registration, cross-institutional appointment scheduling and e-payment, while the cluster as a whole has better visibility into each patient’s healthcare need through a Cluster Patient Master Index (CPMI) which integrates all records of a patient into a single view for efficient management and patient follow-up. Replacing disparate outpatient systems that were previously in use, OAS is the first secure enterprise-class system to integrate and standardise the outpatient system architecture and platform across all the SingHealth institutions. It is also the first cluster system to integrate the nine polyclinics’ systems into one to facilitate patient administration across the continuum of care, from specialist care in hospitals to primary care. The implementation of OAS allows the institutions to adopt a common standardised platform for information capture and exchange for outpatient. This paves the way for improved data analysis and ensures greater accuracy and transparency across all the SingHealth institutions. At the same time, user-configuration capabilities ensure that the system is flexible enough to support institution-specific requirements or modules.
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Three zeros for the outpatient pharmacy Three zeros is not a bad outcome for Tan Tock Seng Hospital (TTSH) - not when it translates into “zero needless wait” for greater efficiency, “zero needless re-work” for greater productivity, and “zero preventable errors” for greater patient safety. The hospital is targeting to achieve this with its Outpatient Pharmacy Automated System (OPAS) which integrates automated dispensing machines and scanning devices into the medication workflow to manage tasks such as the picking, packing, labelling, assembling, verifying and dispensing of medication. Unique to the TTSH system is the use of the robotic armatures which are traditionally deployed in car manufacturing industries. Prescription orders which are verified and confirmed will trigger the armatures and automated dispensing machines to pick and pack the medication, which then travels on the conveyor system to the counter where it will be ready for collection the moment the patient reaches the pharmacy. With the system automating 80 per cent of the medication dispensing workflow, “zero needless wait” is becoming a reality for the majority of patients. The pharmacy is also able to redeploy staff to more high value tasks such as verifying the medication and addressing patients’ concerns on the spot, reducing rework rates. At the same time, the use of highly-accurate picking and packing technologies, the incorporation of RFID for tracking purposes and the deployment of pharmacy staff at the beginning and the end of the process helps reduce preventable errors. OPAS is integrated with iPharm, a patient-centric pharmacy system which provides pharmacists with core prescription processing capabilities. iPharm enables medical practitioners to have quick and easy access to comprehensive and accurate drug databases as well as patients’ medication records and medication histories to ensure that accurate prescriptions are given.
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Closing the loop in medication administration Delivering the right medication, in the right dose, to the right patient, at the right time – these are the essential 4 “rights� (4Rs) in administering medication. And NCS has been working with hospitals in Singapore to achieve this through a Closed Loop Medication Management System (CLMMS) which incorporates the Electronic Inpatient Medication Record System (eIMR) developed by NCS. CLMMS is a revolutionary process that leverages automation and intelligent systems to improve the entire medication administration process from the way doctors prescribe medication to how each dose of medicine is consumed by patients. This enables hospitals to significantly improve patient safety and the efficiency of healthcare staff even as patient volumes grow. eIMR is a key component of CLMMS, enabling doctors to order medication electronically and pharmacists to review the prescriptions and provide interventions, if required, before the medication is served by nurses to patients in the wards. We have also built interfaces between eIMR and the automated dispensing machines and hand-held scanning devices in the hospital to enable a closed-loop approach to ordering, dispensing and administering medication in the course of patient care. Implemented across National University Hospital, Tan Tock Seng Hospital and Institute of Mental Health, the system helps enhance patient safety through the 4Rs. It enables early detection of risky medication regimes which could cause overdosing, allergic reactions in patient or result in cross-drug interactions, and allows for timely intervention by pharmacists to prevent medication errors.
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FIONA achieves a breakthrough in forensics operations Tracking bodies is a grim undertaking, but it is something that FIONA has been able to carry out efficiently while achieving a paperless breakthrough in forensics operations. FIONA or Forensic Integrated Operations Network Applications is an IT initiative by the Health Sciences Authority (HSA) to streamline the administrative processes and workflow associated with forensic medical services. HSA’s goal was to reduce the manpower required for data entry, improve data flow within the Forensic Medicine Division and better coordinate with external agencies such as the police for case registration. It was also looking for a way to improve the tracking and management of bodies and related document flows. To address these requirements, NCS integrated a suite of technologies to create a wireless, paperless environment for the Forensic Medicine Division. An Integrated Track and Trace framework was implemented using RFID technology to track the movement of bodies and specimens. Clinical mobile notebooks were also introduced for body charting and note-taking in the autopsy suite while the pathologist was performing the autopsy. This allows the data to be synchronised with HSA’s servers, removing the need for manual data entry. Documents such as post-mortem reports can also be generated directly through FIONA. FIONA proved to be a breakthrough for HSA. The adoption of RFID technology greatly increased efficiency in the management of body parts within the forensic setting. The cost and effort associated with manual data entry was significantly reduced with the use of technologies for data capture and updates. Furthermore, with more streamlined workflows, inter-agency interaction such as the exchange of data between the police and HSA can now take place electronically, allowing cases to be processed much more rapidly.
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Presenting each patient’s story in seconds “The hospital knows me”. This is the message that Khoo Teck Puat Hospital is sending with the help of CIVOC (Computerised Integrated View of the Customer), a system that integrates data from various operational and clinical systems to present a “360-degree view” of each patient within seconds. With each patient’s story accessible on a single dashboard, the aim is to create a hassle-free, personalised experience across all stages of patient engagement. Before each visit, the hospital is able to recognise the patient’s needs and advise him accordingly. During the visit, the hospital recognises the patient and understands his medical and personal needs, without him having to repeat his story. This translates into a hassle-free patient flow with minimal wait time. Post-visit, the hospital keeps in touch with the patient for follow-ups and also to provide appropriate updates and suggested services based on the patients’ needs. CIVOC provides the foundation for effective population health management. It interfaces with various operational and clinical systems such that patient records are aggregated to form a patient-centric repository. With this, patients can be profiled using analytics. The hospital can then determine the needs for different patient groups and tailor specific services for each of them. For example, an outreach home visit programme could be developed for elderly patients recuperating at home. Data from such a programme could be fed back to the patient repository and further analysed for insights that will enable the hospital to address patient needs better.
Taking a more proactive approach to health management Early detection of diseases can help prevent severe and expensive complications down the road. Under the Health Promotion Board’s nationwide population-based screening programme, Singaporeans and permanent residents aged 40 years and above are encouraged to go for regular screening for conditions such as diabetes, high blood pressure, high blood cholesterol, and colorectal cancer. Women are also encouraged to go for cervical cancer and breast cancer screening. The programme enables early detection of the various conditions through holistic and evidence-based screening. Supporting these efforts is the Enhanced Integrated Screening System, a centralised repository which compiles the screening results of the eligible population so that health officials can reach out to those who have not yet been screened. The consolidated screening results also provide a framework for the government to develop better and more relevant disease prevention programmes which are then delivered to the community for more proactive management of population health.
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Hassle-free medication ordering With a user-centric design and the use of predefined templates to simplify complex medication ordering, the National Healthcare Group’s ePrescription system has helped contribute to the advancement of the quality of care across the cluster.
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Designed, built and delivered by NCS, the system provides clinicians and nurses with a unified and simplified way of ordering medication. It enhances patient safety by delivering a consolidated view of the patient’s past medication across all institutions and providing medicationrelated decision support, including integration to drug databases and other cluster-wide clinical systems for drug-to-drug interaction, adverse drug reaction and drug allergy checks. Productivity enhancement features include the predefined order templates and smart filtering of drug names and auto-complete features based on recommended dosage and frequency, which facilitate medication order entry and save time.
BRINGING TOGETHER HEALTHCARE FINANCE SYSTEMS FOR EFFECTIVE POLICY-MAKING Singapore’s Ministry of Health (MOH) is constantly striving to provide the public with access to good and affordable healthcare through effective policies and healthcare finance schemes. In line with this objective, NCS worked with MOH to develop a suite of IT applications which supports the various financing programmes designed to make healthcare affordable. For example, the MediClaims links hospitals and clinics with government agencies and private insurers in Singapore for the processing of claims under the Medisave and Medishield schemes. Data captured by the healthcare finance systems for subvention, claims and various health assistance schemes is fed into MOH’s Data Hub for analysis. The insights that are generated provide policy makers and stakeholders with a better understanding of medical bill sizes and other finance indicators across the Singapore healthcare landscape. This in turn supports better policy decisions to ensure the affordability of healthcare.
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Empowering patients to take personal responsibility for health One of the key thrusts of Singapore’s healthcare strategy is to promote personal responsibility for managing one’s own health. To empower patients to do this, the Personal Health Management (PHM) system provides them with access to timely, actionable information on their personal health through an online portal or on their mobile devices. At the heart of the PHM is the patient’s personal health record. Based on this data, the system is able to provide educational information contextualised to the patient’s demographic profile and medical conditions as well as information on the management of chronic diseases such as diabetes, hypertension and lipid disorders. In addition, it enables patients to track their physical activities and nutrition for disease prevention and wellness promotion. The PHM also allows healthcare provider to maintain regular contact with the patient after the latter is discharged, to help him manage his own health at home. It enables the care provider to develop care plans for the patient, and actively monitor his condition, treatment adherence and progress, and schedule follow-up appointments where necessary. Going forward, technologies such as tele-health and tele-consultation will be incorporated into the PHM to automate the monitoring of vital signs and also enhance communications between patient and care provider through video conferencing.
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