Second Ministry Of Health IT Seminar

18 Nov 2000

By Mr Lim Hng Kiang

Seminar Theme - INTERNET: Driving The Revolution of HealthcareDelivery

Mr Lim Yong Wah, Chairman SingHealth

Mr Michael Lim, Chairman NHG

Distinguished guests

Ladies and Gentlemen

Introduction

Let me first extend a very warm welcome to all our distinguishedoverseas guest speakers from Australia, US and Canada who will besharing with us their experience in the use of the Internet technologyto bring about more efficient delivery of health care services.

I am pleased to be here with you this morning for the 2nd MOH ITSeminar. The MOH IT Seminar series was initiated by MOH two years agoto provide a forum for our public healthcare institutions to reviewdevelopments in the use of IT in healthcare, and to share theirknowledge and experiences on how IT has been used to improve the careof their patients.

Challenges

The theme for this year's MOH IT Seminar is on the impact of theInternet on Healthcare. The Internet revolution has touched every facetof our lives and brought about major changes to the way business isdone and services are delivered. The healthcare sector is no exception.Through the Internet the public can have quick and easy access to ahuge database of information on health and disease conditions. As ourpopulation grow more IT-savvy, the well-informed and more educatedpatients will increasingly want to be involved in the decisions andmanagement of their health. In the past, doctors were practically theonly source of information for patients. Doctors had the complete trustof their patients because the patients did not know any better.Nowadays, patients are well read and well-informed through surfing thenet where they can get up-to-date health information from all over theworld. I am told some patients turned up at the clinic armed with astack of information and questions for the doctor.

There are two major consequences of this trend. The first is patientsare demanding to know more about their medical conditions. Being moreknowledgeable makes it possible for them to play a bigger role inmanaging their own health. This is a plus and we must, therefore, makesure that our system is able to tap this strength.

The second consequence is patients will no longer be satisfied withjust what is available based on the doctors recommendation. Patientswill get to know of successful treatment modalities and effectivemedicines available elsewhere very quickly. The sharing of knowledgethrough the Internet and telemedicine will also greatly enhance theprofessional knowledge of our doctors, nurses and other healthcareprofessionals. The result of this is greater pressure to bring inhigher end medical services and a faster rate of upgrading ofhealthcare standards compared to the past. While it is good andnecessary to maintain high healthcare standards, we must guard againsta rapid escalation of healthcare costs. We should, therefore, introducea new medical treatment only when it is proven to be medically sensibleand cost effective.

IT Initiatives in Our Public Healthcare Institutions

IT technology and applications in healthcare will raise publicexpectations and will lead to an escalation of healthcare costs if wedo not have a practical IT strategy. So far our approach has beentwo-fold. One, to keep abreast of developments, tracking where thetechnology is progressing but assessing the applicability in a hardheaded way. We should not be carried away by technological hype. But wewill continue to keep up with developments as long as they are provencost-effective.

Two, to make use of IT to improve our operations and care deliveryprocesses so as to achieve better service levels for our patients. Manyof these IT developments were in backroom operations and have hencebeen largely transparent to the patient. In the next few years, we willcontinue with this pragmatic approach but with greater emphasis onimproving patient care and outcome. IT will therefore impact patientsmore directly.

One of the objectives of forming the two clusters is to facilitateintegration of healthcare services at the various levels. The clustershave begun introducing measures to integrate primary healthcare at thepolyclinics and secondary care at the hospitals. In doing so, I have nodoubt that IT will have a major role to play. For example, NHG will beintegrating its registration systems such that its patients only needto register the first time that they are seen at an NHG institution andnot at subsequent visits to any other NHG institution. SingHealth hasalso started the link-up with the restructured polyclinics by extendingaccess of the Electronic Medical Records system, or EMR , in SGH todoctors and care-givers at the SingHealth polyclinics.. This willenable transfer and retrieval of key patient information, such aspatient's biodata, laboratory investigation results, hospital inpatientdischarge summaries and other relevant treatment procedures. Doctorsacross the different levels of care setting will now be able to shareexpertise and pool resources to manage patients, especially those withchronic disease conditions such as diabetes and high blood pressure.

The two clusters have put in place comprehensive IT strategies andplans to be implemented over the next few years. The focus will be onthe use of IT to further enhance the integration of care within eachinstitution, within each cluster and eventually across clusters andwhere practical, with the private sector. The clusters will firstdevelop the key systems within selected institutions. Thereafter, thesesystems will be replicated in the other institutions in each cluster.An example of a key building block in this effort is the development ofEMR to replace our system of filing records in bulky compactors andfiling cabinets. EMR will facilitate sharing of the information andquick reference by the doctors attending to patients. It will also openup the scope for some of the medical records to be shared with thepatients themselves.

I am pleased to note that SingHealth has already started using an EMRsystem in SGH. Similarly, the National Healthcare group has alsostarted using EMR systems in TTSH and NUH. The aim of the clusters isto implement the EMR in all institutions within each cluster within thenext three years.

SingHealth and NHG have initiated a study on a cross-clustere-procurement system for drugs (generics and proprietary), medical andsurgical supplies, as well as other supplies required in providing thevarious services to patients. A new Group Procurement Office has beenset up with effect from 1 Oct 2000 to manage the central procurementfunctions for both clusters while studying how best to put in place themost appropriate and cost-effective supply-chain management system,including e-procurement, to meet the needs of both clusters. This willenable standardisation of the procurement procedures, standardising ofdrugs formularies, and pooling of volume to obtain lower prices.

Personal Medical Dossier

A pertinent question to ask is how will the IT developments helppatients directly? As medical advances bring better healthcare servicesto patients, they also require doctors to specialise and sub-specialisein narrower and narrower fields. A patient with chronic diseaseconditions is likely to see more than one doctor over a period of time.Under such a scenario, it will be very useful for each doctor to haveready access to the patient's medical records. This will reduce theneed for repeat tests and procedures, thus moderating increases inhealthcare costs. The availability of comprehensive medical records inelectronic form will also make it easier to allow patients to haveaccess to selected information on their medical conditions. The patientcan then maintain his or her own health dossier. Before the EMR isavailable throughout all the institutions in both clusters, theMinistry is working with the clusters to consider the feasibility ofmaking the hospital in-patient discharge summary available in ahardcopy form to all patients. This document will summarise the salientmedical findings of the episode of care. Should there be a need toconsult another doctor, this summary would allow the new doctor tobetter understand the patient's medical history. We expect this to beimplemented by our public hospitals within the next 12 months.

A Health Information Portal

One of the key prongs of our approach to better health for Singaporeansis to emphasise health education and promotion. The Ministry hasalready announced the formation of the Health Promotion Board on 1April 2001 as the arm of the Ministry to develop and implement nationalhealth education and promotion programmes. The Board will be developinga Health Information Portal that will provide the public with reliableand authoritative information on health promotion and lifestyle-relateddiseases. In addition, it will also be linked to recommended sites thatprovide reliable information on disease treatment and prevention. TheHealth Information Portal will be launched in April 2001.

Role of Ministry of Health

Before the full potential of IT can be exploited in health careapplications, complex issues such as patient health data privacy andconfidentiality and other medical-legal concerns need to be addressed.The Ministry has formed a Medico-legal Workgroup to study and put inplace the legal, ethical and policy framework necessary to support theeffective and innovative use of IT in the healthcare sector.

The Ministry will also form a National Health Data Standards Committeeto formulate data standards, policies and guidelines to facilitate thesharing of electronic healthcare information at a national level. TheCommittee will oversee four Sub-Committees that will be responsible fordeveloping national standards for health data, data exchange format,and policies and regulations to address issues related toconfidentiality and control over information access, This will ensurethat patients' medical records are accurate, reliable, updatedregularly, and protected from unauthorised access. The National HealthData Standards Committee will make available the national standardsonce they are ready.

It is the intention of my Ministry to work closely with the twoclusters to ensure that, where practical and necessary, commonstandards will be set. This will give us the assurance of betterconnectivity of systems within and across clusters. Where appropriate,my Ministry will share our experience with the private sectorhealthcare providers.

CONCLUSION

In conclusion, I would like to thank all the organisers for the effortsthat they have put in for the 2^ndMOH IT Seminar. You have brought together a distinguished panel ofoverseas and local speakers and workshop leaders to stimulate ourthoughts on how IT can be usefully and appropriately applied in healthcare delivery to achieve a higher standard of healthcare.

I am also heartened to note the enthusiasm of the participants,illustrated by your presence here today, from the various institutionsof both clusters, the Ministry and MOH institutions. The showcase of ITprojects that individual institutions have put on exhibition will be anexcellent opportunity for you to share and learn from each other. I amconfident that you will be able to harness the potential of IT tomaintain a high standard of healthcare delivery in Singapore. I wishyou a fruitful Seminar and look forward to seeing more examples ofinnovative use of IT in your respective organisations.

It is my pleasure to declare the 2^ndMOH IT Seminar open.

Thank you.