In response to the convergence of three major developments, namely genomics, artificial intelligence (AI) and the focus on preventive care, the Ministry of Health (MOH) is seizing the opportunity to transform healthcare through technology. This will be done by: i) applying AI in health institutions; ii) developing predictive preventive care: and iii) building up the IT infrastructure systems to enable these capabilities.
2. MOH has partnered with the Health Promotion Board (HPB), Synapxe, the public healthcare clusters (National Healthcare Group, National University Health System, and SingHealth), and national clinical translational programmes, to leverage cutting-edge technology while maintaining public trust in and security of Singapore's healthcare system.
Applying AI in Health Institutions
3. AI can help healthcare providers improve patient outcomes and deliver healthcare more efficiently. MOH is injecting about $200 million over five years into the MOH Health Innovation Fund, to support ground-up development and test-bedding of innovations in our public healthcare institutions, including innovations in AI.
4. To make a strong impact with technology, MOH will identify proven and impactful use cases for AI and make a centralised push to scale them up into system-wide, national projects. We will start with Generative AI (Gen AI) for routine documentation, and AI for imaging.
Generative AI for routine documentation
5. MOH plans to scale the use of Gen AI tools to automate repetitive and time-consuming tasks, such as documentation and summarisation of medical records. We will roll out automated record updating throughout our public healthcare system before the end of 2025, so that healthcare professionals can spend more time caring for patients, and be less occupied with routine tasks.
Imaging AI
6. MOH plans to scale AI for imaging across the healthcare system to improve the quality of care by enabling earlier detection and follow-up on clinically significant signs.
7. Together with HPB and the healthcare clusters, we will study how AI can make the workflow for reading breast cancer screening images more efficient and improve turnaround time for patients to receive their screening results. If proven effective, we will progressively adopt it for use in our national subsidised screening programme from end-2025, with the proper workflows and care pathways in place.
8. To accelerate the deployment of imaging AI across various applications, we have established AimSG, a single platform through which public hospitals can access imaging AI models from different vendors. AimSG can also support continuous monitoring of AI models to ensure model accuracy and patient safety.
Developing Predictive Preventive Care
9. MOH is also developing predictive preventive care, starting with a national programme for Familial Hypercholesterolemia (FH). FH is a genetic condition that affects the body's ability to process cholesterol, increasing the risk of heart disease by 20-fold and leading to premature heart attacks. This hereditary condition can be effectively managed through early detection and intervention.
10. Building on the success of a Clinical Implementation Pilot conducted by public healthcare institutions and Precision Health Research, Singapore (PRECISE), MOH will launch a national FH genetic testing programme by mid-2025.
11. Under this programme, Healthier SG General Practitioner clinics and polyclinics will identify patients with abnormally high cholesterol levels and refer them for FH genetic testing at a newly set-up Genomic Assessment Centre. If an individual tests positive for FH, their immediate family members will be encouraged to undergo the same genetic test as well. Both the patient and his immediate family members undergoing FH genetic testing will enjoy means-tested subsidises of up to 70% under the Specialist Outpatient Clinic subsidy framework. The remaining co-payment can be further reduced using MediSave, under the MediSave500/700 scheme.
12. Patients diagnosed with FH will receive support from their Healthier SG clinics to adopt healthier lifestyles and start appropriate, subsidised cholesterol-lowering therapies. This proactive approach aims to significantly reduce the risk of premature heart disease and avoid future cardiovascular complications.
13. If the FH programme is successful, we will work on other major severe diseases, such as breast and colon cancers, diabetes, kidney failure, stroke and heart attacks. They will require sophisticated and multi-variate AI models to be trained.
Safeguarding Risks
14. As we embrace the potential of precision medicine and genetic technologies, MOH is taking proactive steps to mitigate potential risks, including discriminatory practices and escalating healthcare costs. We worked with the Life Insurance Association to put in place a Moratorium on Genetic Testing and Insurance since October 2021, to disallow the use of genetic test results for insurance underwriting.
15. MOH is working on new legislation to govern the use of genetic and genomic data. This aims to address potential undesirable outcomes, such as the discriminatory use of genetic information in insurance and employment sectors. We will conduct broad consultations and aim to submit the Bill to Parliament in one to two years.
16. MOH has implemented several key initiatives to enhance data security and privacy. Healthcare data is stored on dedicated clouds managed by GovTech and Synapxe, where we have full control of the data. Additionally, our office devices are not fully connected to the Internet. Healthcare staff access only whitelisted internet sites via virtual browsers on office devices with limited connectivity.
17. To safeguard data privacy, MOH has developed TRUST (Trusted Research and Real-World Data Utilisation and Sharing Tech), a national secure platform where datasets can be shared for research purposes. TRUST removes patient identities from datasets according to government anonymisation standards. Researchers are not allowed to download any data, and upon completion of analysis, the data is deleted.
Building Up IT Infrastructure
18. To support new AI capabilities and transform healthcare delivery, MOH will significantly enhance our IT infrastructure while prioritising data security and privacy. This includes consolidating EMR systems across public healthcare institutions, which will increase data accessibility and quality throughout a patient's journey, informing better clinical decisions across institutions.
19. MOH has established HEALIX (Health Empowerment through Advanced Learning and Intelligent eXchange), a cloud-based data infrastructure developed in collaboration with Synapxe. HEALIX enables secure sharing of up-to-date, consistent, and anonymised clinical, socio-economic, lifestyle, and genomic data across healthcare clusters. This platform serves as the AI technology factory for the healthcare system, allowing clusters to create, train, and deploy AI/Machine Learning models for hospital operations and clinical decision-making.
20. Looking ahead, MOH will review and enhance national governance on AI use in healthcare to enable the development and deployment of more AI solutions while ensuring safe and secure care delivery to patients.
21. By leveraging advanced technologies while maintaining a strong focus on ethics, data security, and equitable access, we can transform healthcare, improving care for individuals as well as the overall health and well-being of the nation.