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08 Oct 2009
By Health Minister Khaw Boon Wan
First Paperless Polyclinic
1. We are quietly transforming our polyclinics; they are innovating to bring better care to our patients. This is a long journey. The end point is easy enough to define: better health for all. But there are many paths to this end point. We encourage experimentations as we cannot be sure which pathway is the best or the most effective. We ask our polyclinics to be bold, to pilot new ideas, learn from the experience and rapidly share best practices.
2. The polyclinic leadership in both clusters has not disappointed us. With their boards’ support, they have not been afraid to try out new ideas. For example, they were the first to implement tele-radiology in Singapore, sending X-rays to India for immediate reporting. Patients get the results almost immediately, saving them a follow-up clinic visit. Time and money are saved. A couple of polyclinics tried it out first, demonstrated real benefits to patients and the idea spread to other polyclinics and some hospitals. Everyone gained.
3. This morning’s event marks another milestone in this journey of innovation, towards better health for all. The redeveloped Bt Batok Polyclinic has become the first polyclinic to go paperless. It has converted all its paper medical records into Electronic Medical Records (EMR). All new medical records are now created digitally. The old Medical Records Office was closed, and the space freed up for patient care. In this polyclinic, there is no more problem with misplaced medical records or bad handwriting. This is a major achievement; it will make the care here safer and better.
4. I applaud NHG Polyclinic CEO Dr Jason Cheah and his team for this achievement. It has changed the way of delivery, enabling the doctors and nurses to gain instant access to patients’ medical history. What medical illness is the patient suffering from? Which medication is he on? Is his diabetes under control? Has he been immunised against seasonal flu? Is it time for him to undergo an endoscopy? What is his family history? What is his drug allergy? Access to this information allows the doctors to make timely decisions and interventions. It also reduces the likelihood of human error.
5. The Bt Batok Polyclinic has shown the way forward and the other polyclinics should follow suit. With closer integration of care, the EMR will allow patients to move between institutions seamlessly, beginnning with the residents living in Bt Batok.
Innovations Elsewhere
6. Elsewhere, our Polyclinics in both clusters have been taking steady steps to transforming primary health care delivery. Let me profile some specific areas.
7. First, our polyclinics have significantly complemented the doctors with nurses and allied health professionals, so that polyclinics are no longer a mere collection of doctors, but an integrated and comprehensive system of primary healthcare services. Physiotherapists and psychologists are now fully integrated into the NHG Polyclinics’ care processes. Nurses now play key roles as care managers in the management of patients with chronic diseases, in partnership with the doctors. For example, they teach the diabetics to monitor their blood sugar every day, so that they are reminded of the importance of their daily diets. The case managers are trained with appropriate skills to engage and motivate patients into taking responsibility for their own conditions. This often requires a significant change in their lifestyle.
8. Second, we have created a new career track for our nurses, in the form of the Advanced Practice Nurse, or APNs. These are specially trained nurses who have an expanded skill set and knowledge to complement the doctors in clinical areas. Locally, 3 batches of APNs have already graduated from NUS. They perform physical examinations, assess and monitor health changes and where necessary, order laboratory tests and suggest medication changes. Only if patients develop unexpected complications will the APNs need to refer them to the doctor. With this approach, clinical care at the polyclinics is now appropriately shared between the doctor and the APN. This allows the doctors to focus on patients with more complex problems. In NHG Polyclinics, there are 5 full-time APNs, with positions for many more. I would encourage our nurses to take on this challenging career.
9. Third, NHG Polyclinics are setting up disease specific clinics to enhance care for such patients. It now has “HDL-Clinics” to attend to patients whose Hypertension, Diabetes and hyper-Lipidemia (high cholesterol) conditions are not well controlled. This is the first time we have such clinics in a primary care setting in Singapore. At the “HDL-Clinics”, patients have several medical conditions and are taking a combination of drugs. The clinical pharmacists help to assess the drugs they are taking and adjust them or the dosages to achieve the best clinical outcome. This was first piloted here in Bt Batok Polyclinic, with good results. One in four of the patients achieve optimal diabetes control, within 6 months after consulting the Clinical Pharmacist.
10. Fourth, our polyclinics now run Family Physician (FP) Clinics regularly for those with chronic diseases, requiring long term care. FP Clinics charge a few dollars more for consultation, but the patients get to see the same doctor each time and by scheduled appointments. Care is provided through a structured care management plan, with sufficient time set aside for full consultation. With scheduled appointments, patients experience a shorter waiting time. FP Clinics are becoming popular with the chronically ill patients. In NHG Polyclinics, FP Clinics have 20,000 patients with chronic diseases on their regular register. We expect the number to grow rapidly.
Scope for More Innovations
11. While we have made significant progress in our polyclinics, more remains to be done. These include better integration of services between the hospitals, polyclinics and other community care providers. As chronic care require many healthcare professionals to work in teams, the sharing of medical records is critical. Technology has now enabled us to this, though rolling it out nation-wide will take a few more years. We will make it happen and bring real benefits to both the patients and the providers. This will transform the way we deliver care to patients, achieving better care coordination and disease management. It should translate into better health outcomes for our patients.
12. This will mean a lot of hard pioneering work for our healthcare teams. But it will also be a lot of fun, finding new solutions to old problems and making lives better for all. And this is precisely why we join this profession and remain in this sector all these years. All in all, it has been a meaningful journey of innovations, towards better health for all. Let’s rally more like-minded people to join us on this journey.
13. On this note, let me once again congratulate the NHGP and Bukit Batok team on the re-opening of the Polyclinic.