Technology has the cure

09 Jul 2007, Today

Question

Name of the Person: Chia Eu Foong

Alexandra Hospital's procedure complements medical records exchange

Despite e-medical record exchange, hospitals appear not to be sharing vital info

Monday July 2, 2007

I refer to the report, "Getting the pills right — safer and cheaper" (June 28), which reported that Alexandra Hospital has adopted a medical reconciliation method from the United States that enables doctors and hospitals to compare the complete list of patients' current and past home medications issued.

I am perplexed to hear that at this point in time, with our current technological advances, doctors are still requesting patients to bring all of their medications to hospital for the purpose of verification and updating the national electronic medical record system.

This contrast is even greater given the fact that, should Alexandra Hospital not have adopted this system, patients would have to be interviewed on their medical history upon admission.

Furthermore, it was reported that other healthcare institutions only started to adopt the system after Alexandra Hospital initiated this pilot project. This suggests weaknesses inherent in our present system.

Currently, there is an electronic medical record exchange, which allows all public hospitals and polyclinics here to share patient records online.

While Alexandra Hospital may not be in the loop of this information-sharing, it is sad to see that hospitals and healthcare institutions are not releasing and sharing information among themselves — information which may be vital for the patients. As the Today report stated, such information helps patients save on medication costs and reduces complications in the course of examination.

While family members coming forward to declare all medications would be a positive move, complications can arise if patients who are aged or disabled and homeless without family support, cannot communicate properly. Vital information could be lost along the way, with more time and effort incurred for verification of past medical histories and records. This inevitably pushes the burden back onto the doctors and health institutions concerned.

The Ministry of Health should step in and ensure that all healthcare institutions have access to the patients' database built on a national level, leaving no doctor and hospital out of the loop.

Where assessment of patients is concerned, doctors should rely on this database as the primary source of information, complementing with the physical declaration of past medications. This certainly reduces the man-hours required for verification of medicines, duplication of medicines issued and tests conducted, and increases the safety level where drug allergies are involved.

At the end of the day, the overall operating costs for the institutions are lowered, with patients benefiting hugely from this simplified system too.

Reply

Reply from MOH 

In “Technology has the cure” (TDY Voices, 2 July), Mr Chia Eu Foong wondered why the need for  Alexandra Hospital to have a medical reconciliation programme for its patients when  there is already an Electronic Medical Records Exchange (EMRX) in the public hospitals.

All public hospitals, including Alexandra Hospital, are on the EMRX system and they all have access to patients’ information.  The EMRX allows for the cross-cluster exchange of patient data such as inpatient discharge summaries, laboratory and radiology reports, x-ray images, drug allergies and medical alerts. Immunisation and school health records of children are also available to the hospitals.

The initiative by Alexandra Hospital on medication reconciliation complements the EMRX by updating all medicine that its patients are taking at the time of admission. The medication reconciliation initiative captures all medications obtained from the patients' General Practitioners or private specialists, over-the-counter medicine, herbal or Traditional Chinese Medicine, which may interact with their prescribed medicine. This is useful for patients on multiple medicines which may interact with their prescribed medicine; or those seeing many different doctors for their chronic conditions. This in turn translates into safe and appropriate administration of medication and cost-savings as there is less duplicate medication for the patient.

The Ministry shares Mr Chia's vision.  Our next major steps are to set national data and IT standards, and to put in place the legislative framework for data protection. These will provide the foundation on which we will build a national electronic health records database containing critical health records of every Singaporean. The goal will be to have all healthcare institutions, both in the public and private sector, linked to this national database, accessing and providing real-time clinical information of the patients they are treating.