Speech by A/Prof Benjamin Ong, Director of Medical Services, Ministry of Health, at the Opening Ceremony of the Healthcare Information Management Systems Society (HIMSS) Singapore eHealth Innovations Summit, 7 October 2016

Distinguished speakers and guests, 

Ladies and gentlemen,

Good morning.

Introduction

1.            It gives me great pleasure to join you this morning to open the inaugural HIMSS Singapore eHealth Innovations Summit 2016.

2.            Healthcare systems around the world are not only facing challenges but increasingly using technology to try and address them. In Singapore, these challenges include an ageing population, manpower shortages, and the rising impact of chronic diseases. These changes make the acute hospital based approach to disease intervention much less effective. In Singapore as elsewhere, we aim to balance quality and accessibility with sustainability in our HealthCare goals for 2020 and beyond. All these require us to be much more innovative and productive in providing good care for an increasing number of patients while learning to rely on less manpower.

3.            One advantage we have in Singapore is that we have an increasingly digitally savvy and enabled population. In addition, a larger percentage of patients and caregivers have the desire to and are taking greater ownership in their own and their loved ones’ health and disease management. This enables us to increasingly leverage technology to deliver Smart Health, so that care can be more personalised, integrated, proactive, and empowering.

Recent Developments in Healthcare Technology in Singapore

4.            Allow me to share on the healthcare technology landscape in Singapore as a whole, and our journey. We have been developing national platforms such as our National Electronic Health Record (NEHR) system, which now facilitates flow of patient health information and allows us to meaningfully develop integrated personalised care for our citizens. Such patient information is accessible beyond hospitals to care professionals in community settings to enable better coordinated continuity of care and holistic management of patients regardless where such care is sought.

5.            We also aim to leverage Telehealth as a workforce multiplier. Beyond connecting care professionals to patients in the community, remotely collecting and analysing clinical data to track progress, pre-emptive interventions guided by analytics can reduce institutionalisation of the patient, while enabling a healthcare professional to manage larger numbers of patients in a risk stratified manner substituting actual visits. Tele-rehabilitation systems supplement traditional post-acute care community-based rehabilitation, and can overcome the inconvenience of travel, by using video conferencing for one-to-one or multiparty remote consultation. This helps address the significant drop-outs from post discharge rehabilitation that will impact mobility.

6.            We are now increasingly using digital channels to engage, empower and partner our population to take greater ownership of their health and wellness. HealthHub is one key application which aims to be a one-stop digital healthcare companion for every citizen. It allows citizens to increasingly access their health records key content. Apart from viewing one's screening, appointments and laboratory test results, users are enabled to view their children’s school health and immunisation records.

7.            With access to huge amounts of data, we will see an increasing application of Analytics. We see this being important at multiple points, from Population Health to customised prevention or intervention, from assisting and guiding care decisions to optimising care coordination. We are working on developing national predictive models that can identify patients who are at risk of having unplanned admissions in the future. This will support patients to transit safely from hospital to home and stay well in the community for as long as possible, especially for those patients with complex care needs. In the future, we will look to incorporate biological, psychological and social data which would equip us with Genomic, Clinical and Social Behavioural analytics capabilities.

The Importance of Healthcare Innovations in Improving Patient Care

8.            While IT innovation potentially facilitates better care outcomes, the roles of healthcare professionals remain indispensable in bringing about the needed process and mind-set changes. To maximise the impact of innovation, we need to first realise the need to change and re-skill to wisely apply technologies while making the necessary and disruptive changes to our workflow. Let me illustrate this with a few examples.

9.            Take the case of medication safety. We know that medication errors are a significant cause of avoidable harm and that this occurs throughout the healthcare system. Minimising medication errors in the total medication use process is therefore of strategic importance in improving patient safety. In New Zealand, the Waitemata District Health Board (DHB) discovered that approximately 25% of Adverse Drug Events (ADE) were due to preventable medication errors. These adverse drug events occurred in 29 out of every 100 of their hospitals’ admissions. In response, the DHB piloted an innovative MedChart electronic prescribing system to prevent errors and create a closed loop medication system. This resulted in the elimination of transcription error and the 100% legibility of prescriptions.

10.           Imaging is costly, and the tests are more often than not over-ordered. To find cost-effective solutions, we need to think how technology can support the processes and also curb over-ordering of wasteful or duplicative and expensive tests. In radiology, the concept of enterprise imaging is heralding a paradigm shift to this new world: Picture Archiving and Communication System (PACS), deep learning and vendor neutral archiving are improving diagnostics and saving lives. Samsung Medical Center in Korea utilizes a diagnostic imaging solution that applied deep learning technology to ultrasound imaging for the first time in breast lesion analysis, leading to a reduction in unnecessary biopsies¹. Most Korean hospitals with more than 500 beds have a film-less radiology department. Out of the 100 – 500 bed capacity privately-owned hospitals, more than 50% have adopted PACS. In Singapore, the Integrated Health Information Systems and Changi General Hospital recently implemented an intelligent automated work distribution system within the Radiology Information System (RIS) of the radiology department. This has resulted in man-hour savings of over 1,600 hours a year and big improvements in reporting turnaround time.

Health IT Needs to Demonstrate Benefits: Productivity and Sustainability

11.           There is a need for health IT to demonstrate its benefits in productivity and sustainability in meaningful ways. Project OneCare by Ng Teng Fong General Hospital is an example of how IT can potentially play such a role to enhance patient care and productivity of our healthcare professionals. In this project, the hospital wanted to achieve a 4-less Environment – Chartless, Scriptless, Filmless and Paperless. Through their vendor neutral Medical Devices Middleware integration solution, electronic measurements of vital signs across some 1,000 medical devices are automatically captured in the system. This saves the nursing team an average of more than 3,000 hours per month, allowing them to spend more time on direct patient care instead of manually charting vital signs. I would like to congratulate Ng Teng Fong General Hospital for achieving the HIMSS EMRAM Stage 7. Their achievement is the first in Singapore, ASEAN and Australasia. Congratulations.

12.           In another example from our regional neighbours, Paknampo Hospital, Thailand’s first HIMSS EMRAM Stage 6 hospital, improved care delivery processes with HIS integration with traceable health records to ensure continuity and quality of care. Their transformation has resulted in improved patient satisfaction from 75% in 2011 to just under 90% in 2016 and greater completeness of health records from 75% (2011) to 95% (2016) across their hospitals.

Importance of Healthcare Professionals amidst Rapid Healthcare Technology Advancements

13.           In the era of rapid healthcare technological advances, the need has become more important that we ensure sustainable delivery of patient-centred healthcare. One core competency healthcare professionals need to possess is the ability to leverage technology and system workflow optimisation to function effectively. Healthcare professionals need to acquire skills to harness the masses of data and information being generated to be more predictive, precise and productive. Further skills will be required in horizon scanning and integrating new technologies to enhance health and the delivery of care.

14.           While technology holds much promise, the emotional needs of patients and their families will continue to require compassionate healthcare professionals who can communicate sensitively and establish rapport with them as part of delivering effective, personalised care.

Looking Towards the Future

15.           Looking ahead, Asia Pacific’s healthcare sector will continue to take big strides into the digital age, aimed at helping us reduce errors, increase precision and improve outcomes through novel approaches to treatment and intervention. I hope that you will receive invaluable insights from this Summit and I will leave you with a quote from Leonardo da Vinci, “Knowing is not enough, we must apply. Being willing is not enough, we must do.”

16.           I wish you a fruitful conference, and, for our foreign delegates, I hope you have an enjoyable stay here in Singapore. Thank you.