Speech by Mr Chee Hong Tat, Senior Minister of State, Ministry of Health, Opening Ceremony of Healthcare Information Management Systems Society (HIMSS) AsiaPac17 Conference, 12 September 2017

Distinguished speakers and guests,

Ladies and gentlemen,

Good morning.

Achieving Better Health Outcomes and Patient-centric Care with Team-based Care

1.            Before I begin, please allow me to pay tribute to the late Ms Carmen Mark and her parents. Carmen was from Penang, Malaysia and she was studying nursing at Nanyang Polytechnic in Singapore. She passed away suddenly in 2015 at the age of 18. Her parents fulfilled her wish to save lives by donating her organs to four patients. In today’s Straits Times, you can read a touching story of how Carmen’s life-saving gift, has helped Ms Serene Lee - a lady who received her heart. Serene will be making a trip to Penang to meet Carmen’s parents, who said that they wished to hear their daughter’s heartbeat.

2.            This is a part of what healthcare is about. It is not about technology. Technology is an enabler, a tool. Healthcare is about people. Healthcare is about keeping people healthy. It is about saving lives. Thank you Carmen, you have exemplified the nightingale spirit in helping others both in life and in death. Thank you Mr and Mrs Mark, and thank you to all organ donors and family members for your life-saving gift. Our organ donors, just as our healthcare workers, play a very critical part in our healthcare system saving lives. Using technology to improve lives is really why we are here today, what we want to focus on. To make lives better, save lives.

3.            So team-based care is one of such examples, and I am glad that the theme of this conference is “Unifying Patients and Providers” – bringing different stakeholders together through smart use and appropriate use of technology, to be able to deliver better care for our patients.

Why team-based care is needed

4.            In recent years, healthcare systems around the world have adopted team-based care, partly in response to ageing populations and changing healthcare needs.  Patients with co-morbidities are becoming more common. Treatment is no longer straightforward as health issues getting more complex.  Next, there are also many non-clinical factors, including lifestyle, social and environmental factors, that can impact one’s health. These developments require the involvement of professionals with different expertise to better support our patients. The third reason is the advancement of technology. Today, technology has enabled sharing of information across disciplines and care settings, and this has facilitated new models of team-based care.

Team-based care programmes in Singapore

5.            The team-based approach plays an important role in achieving the Ministry of Health’s (MOH) three shifts. The first shift is moving beyond Hospital to the Community, the second shift is beyond Healthcare to Health, and the third shift is beyond Quality to Value. We have implemented several programmes involving professionals from multiple disciplines to enhance the care of our patients, sometimes going beyond the boundaries of the hospital to reach out to patients through the community and in their homes. Such arrangements benefit both patients and healthcare workers. Patients can enjoy better health outcomes, enhanced experience with seamless care and lower healthcare costs.  The team is usually led by a single care specialist or nurse, who will help to coordinate the patient’s care with other healthcare professionals. Let me share some examples with you.  

6.            The “Hospital to Home” programme was rolled out in April this year. It leverages the expertise of a range of professionals to support post-discharge patients. Implemented in all six restructured hospitals, some 5,000 patients have benefited from the programme so far. One of the patients enrolled in the programme was Mdm Lee Kum Ying, who is in her 90s and she is a patient at Tan Tock Seng Hospital. Mdm Lee had a stroke and also suffers from mild Alzheimer’s disease. The hospital’s predictive model assessed that she has a high risk of hospital readmission.  To prevent that outcome from happening, Tan Tock Seng Hospital’s transitional care specialist led a team of healthcare professionals including occupational therapist, nurses, and doctors to develop a care plan for Mdm Lee.

7.            The transitional care specialist provided training to her caregivers to help them make the appropriate changes to her diet and lifestyle, as well as teach them the correct techniques to assist Mdm Lee in her daily living activities. An occupational therapist recommended home modifications to enhance safety, and taught her caregivers simple exercises to strengthen Mdm Lee’s body. Before she enrolled in the programme, Mdm Lee was admitted to hospital twice within three months.  I am glad to know that Mdm Lee is now doing well, and she has not been readmitted since she started on the programme.  

8.            Another programme that adopts the team-based approach is the setup of the Acute Medical Ward (AMW) at Singapore General Hospital (SGH). A study found that 45 per cent of their admissions were for infection-related conditions such as pneumonia and cellulitis. 76 per cent of these patients were hospitalised for 3 days or more. The team at SGH wanted to help the patients by stabilising their conditions and allowing them to be discharged within 72 hours. They embarked on a complete redesign of the workflow and processes to enable patients to receive more timely assessments across disciplines. Multi-disciplinary team rounds involving different professions were introduced.  After discharge, the patients were scheduled for outpatient review within a week to ensure that they remain stable after leaving the hospital. So it’s not just looking after them while they are in the hospital, but also looking after them post-discharge.

9.              Collectively, the collaborative efforts and team-based measures have helped to improve the way care was delivered. It also helped to empower nurses, pharmacists, therapists and medical social workers in their respective fields. More importantly, for patients, it reduced the average length of stay by 2.4 days, with the average patient bill decreasing by 20%.  Similar programmes have been rolled out at Khoo Teck Puat Hospital and National University Hospital, I hope the other hospitals will adopt the programme and come on board as soon as possible.  

Technologies that support team-based care

10.         A key enabler to support team-based care is our technology infrastructure. This is guided by our Health IT Masterplan and implemented by IHiS.

11.         One such tool is the Care and Case Management System (CCMS). It enables the flow of patient information beyond the public healthcare sector to the intermediate and long-term care providers and this enables better healthcare and social support for patients. After they leave the hospital, the information flow to the providers in the ILTC sector ensure that there is continued quality care for our patients.

12.         Another key system is our National Electronic Health Record (NEHR). The backbone of team-based care, NEHR is designed to achieve “One Patient, One Health Record”. When patients move from one healthcare institution to another, NEHR provides authorised healthcare professionals with access to a patient’s medical history, enabling them to make better informed clinical decisions for treatment. Apart from better patient safety, NEHR minimises duplicative tests and reduces time and cost for patients.

Conclusion

13.         As we move forward in our care transformation efforts and into more team-based care, our healthcare professionals may want to keep in mind the 3 ‘C’s:

·         The first C is Collaboration.  We need to embody a collaborative spirit in working together. This is what team-based care is all about. We bring professionals of different expertise and fields to pool together their resources to see how we can better design the flow, processes and care approach – putting patients at the center, at the heart, of what we do. Collaboration also means thinking beyond our own institution. Collaboration is not just collaborating with our colleagues or those in the same institutions, but also thinking about working with other professionals outside the institution, including non-healthcare expertise. They have expertise too that they can bring on board – design, technology, and engineering. This is what will help to deliver better care for our patients.

·         The second C is Connection.  We need our healthcare partners to connect with the national IT systems so that we can better serve patients when they move from one institution to another. I know that this is an area that is still work in progress. Within the public sector I think we can make more rapid progress, our challenge really is how we can link up with the private sector. What we want at the end of the day is to deliver better care for our patients, we want to deliver better care for our patients. IT is an enabler that provides the connection to link up information when the patients move from one institutions to another.

·         And the final C is Co-creation. As I mentioned earlier, through connection and collaboration, we open up opportunities for us to co-create innovative solutions that support team-based care for the benefit of patients. In this areas, we have to be bold, we must be willing to try new ideas, be willing to question some of our existing policies, systems, and processes. To see how we can make changes to work better for our patients. To make our healthcare system more efficient, more productive, to deliver high value care. That is really what we should work towards – through connection, collaboration, and to co-create innovative solutions. Technology is an important enabler, as it opens up new ideas, new possibilities and allow us to translate these new ideas into reality.

14.         Let me end by wishing everyone a fruitful and enriching time at the HIMSS AsiaPac 2017 conference. To our overseas guests, please enjoy your stay in Singapore.  Thank you.