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Is Sustainability of Healthcare
Possible without eHealth?
The Singapore Experience
Dr Sarah Muttitt
Chief Information Officer
Information Systems Division
MOH Holdings, Singapore
eHealth Conference 2010
Barcelona, 16 March 2010
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Healthcare in Asia
Heterogeneous Region
Geography and population
Culture and education
Social economic development
and infrastructure
Common Themes
Economic objectives are top priorities
Significant healthcare provision
beyond the public sector
Aging population
From
http://en.wikipedia.org/wiki/File:Location_Asia.svg
Shared Concerns in a Diverse Region
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Asia is successful so far in keeping healthcare costs down
What are the incentives for investing in Health IT if costs are already low?
Reference:
Health Systems in East Asia: What Can Developing Countries Learn from Japan and the Asian Tigers?
World Bank Report 2005 by Adam Wagstaff
Successful cost containment
Share of GDP spend on Health
1998 2001
Japan 7.2 7.8
Taiwan 5.5 6.0
Hong Kong SAR 5.6 5.7
Korea 4.3 5.1
Singapore 4.2 3.9
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Reference: Population
Age Shifts .
Reshape Global
Economics and
Geopolitics. Adele
Hayutin, Ph.D. Director,
Global Aging Program,
Stanford Center on
Longevity, 2009
Rapidly ageing population
In 2030, 3 out of 5
oldest nations in the
world will be in Asia.
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Healthcare in Singapore
1/3 of JCI-accredited hospitals in Asia are in Singapore.
All 7 public hospitals and 2 national specialty centres in Singapore
are JCI-accredited.
Singapore’s healthcare system is ranked first in Asia and
sixth in the world by the World Health Organisation.
Singapore is ranked third in health infrastructure and 4th on
health problems not having an impact of on companies in the
World Competitiveness Yearbook 2007.
Land area: 700 sq km
Population: 4.6 million (3.6 million residents, I million foreign workers)
Healthcare expenditure: 4% GDP (S$2,134 per capita)
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Employer
benefits
Medi-
saveCash*
MediShield
& Elder-
shield
Medi
fund
Government
Subvention
National Healthcare Expenditure (NHE)
Individual Financing Government
Healthcare
Expenditure
KEY GOVERNANCE PRINCIPLES
Individual responsibility for health; patient co-payment to minimize moral
hazard and wastage
Government subsidies to keep basic healthcare affordable
Healthcare Financing in Singapore
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Primary Healthcare
Secondary andTertiary Care
Intermediate and Long Term Care
80% Public
7 Restructured Hospitals
6 Specialty Centers
20% Private
16 Hospitals
30% Private
70 % Voluntary Welfare
6 Community Hospitals
36 Care Homes, 8 Hospices
64 Nursing Homes
80% Private
> 2,000 GP clinics
20% Public
17 Polyclinics
Universal healthcare coverage for all Singaporeans
Philosophy
Building a healthy nation through preventive healthcare programmes
and promoting a healthy lifestyle
Good affordable basic healthcare is available to Singaporeans
through subsidised medical services in public hospitals and clinics
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Political VisionIntegrated Healthcare System
“ What does it mean when we say our population will be older? It means there
will be more demand on healthcare because older people are sick more often.
But this also means it is
a different pattern of healthcare
So we have to respond to this by putting in
more resources into our hospital system,
building new hospitals.
… get the whole system to be structured
properly so that it will be adapted to cater
o the ageing population. To structure
it properly means we need step-down care.”Picture taken from asiaone.com
And one key thing we must do with this step-down care is to link up our
acute hospitals […] with community hospitals, so that you can have the
best of both worlds.Prime Minister Lee Hsien Loong
National Day Rally 2009
“
”
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Integrated healthcare delivery system
Appropriate care from the right site
Better allocation of resources
More cost-effective treatment and
care in the healthcare continuum
“Fast medicine”
diagnosis and treatment of
patients with acute needs
Getting ready for the “silver tsunami”
Long Term Care
Primary Care
Acute & Tertiary Care
“Slow medicine”
physiotherapy, rehab and
care for chronic sick
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Strategic vision of patients moving seamlessly across the
healthcare system, receiving coordinated patient-centric care
at the most appropriate settings.
RH
CH
NHPolyclinics
FPsHome
Care
Rehab &
support
services
Screening &
PreventionPalliative
Care
RH
CH
NHPolyclinics
FPsHome
Care
Rehab &
support
services
Screening &
PreventionPalliative
Care
RH
CH
NHPolyclinics
FPsHome
Care
Rehab &
support
services
Screening &
PreventionPalliative
Care
RH
CH
NHPolyclinics
FPsHome
Care
Rehab &
support
services
Screening &
PreventionPalliative
Care
RH
CH
NHPolyclinics
FPsHome
Care
Rehab &
support
services
Screening &
PreventionPalliative
Care
RH
CH
NHPolyclinics
FPsHome
Care
Rehab &
support
services
Screening &
PreventionPalliative
Care
Enabled by the National
Electronic Health Record
(EHR)
Innovation:Healthcare landscape of the future
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Innovation:Chronic Disease Management Programme
Holistic approach
• Diabetes mellitus
• Hypertension
• Hyperlipidemia
• Stroke
• Asthma
• COPD
• Schizophrenia
• Major Depression
8 chronic diseases covered currently:
Patients work closely with their doctors in managing their chronic diseases
Started in 2006 in collaboration with GP clinics
Provides patients systematic, evidence-based chronic disease
management programme
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Better care and improved outcomes
Study of diabetic patients in 2nd year of CDMP
Patients received
increase of care
components
Significant
improvement in
diabetic, lipid
and blood
pressure control
Taken from published paper from Ministry Of Health, Singapore:
“Medisave for Chronic Disease Management Programme – The Second
Year” by Dr Lee Heow Yong, Ms Noureen Mervani & Dr Aley Moolayil
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Innovation:Integrated Health Screening Programme
Early detection of chronic diseases
Collaboration between Health Promotion Board and CDMP-certified clinics
Aimed at patients 40 and above
Subsidized rates for lower income group• BMI screening
• Diabetes mellitus
• Hypertension
• Hyperlipidemia
Females:
• Pap smear for cervical cancer
Mammogram recommended
for breast cancer
Nationwide Screening for
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Ageing population - By 2030, 1 in 5 Singaporeans over age
65 (three-fold increase)
Changing diseases – more chronic and emerging infectious
diseases
Increasing public expectations, perhaps excessively so
Rising prices of drugs and equipment
Yet, limited resources
Global shortage of healthcare professionals
Lack of facilities
Challenges for Singapore
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Vision of “One Patient, One Record”
Secure “real-time” access to patients’ EHR by authorised
clinicians and healthcare providers:
enable greater coordination and informed decision-making,
resulting in more accurate diagnosis, better treatment and
patient-centric integrated care.
The EHR is an integrated healthcare record centered on
each person. It extracts and consolidates in one record,
all clinically relevant information from their encounters
across the healthcare system throughout his/her life.
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NEHR builds on existing eHealth Systems
Multiple EMR Systems
Multiple Lab & Radiology Systems
2 public healthcare clusters
NHG and SingHealth hospitals,
polyclinics and specialist clinics
Ministry of Defence (MINDEF)
Hospital based
EMR & CPOE
EMRX Extension
to Community
Hospitals
Community
Hospital based
EMR
Minimal EMR Systems
Private GPs (approx 300 out of more than 2,000 have a CMS)
Community Hospitals
GP Clinic
Management
Systems
National
Immunisation
Registry
Critical Medical
Information Store
(CMIS)
EMR Exchange
(EMRX)
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Foundation for the Singapore eHealth Portal
A unified web portal for empowering
individuals and their care-givers
with health/medical information and
preventive/monitoring tools for
personalised health management
to achieve better health outcomes.
Personal Health Record (PHR)
Vision
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Personal Health Record (PHR)
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Roadmap to sync with National eHealth Record
Provide tailored
healthcare content
Interface with existing
health repositories
Incorporate mental
wellness and pregnancy
tracking modules
Alignment with
National EHR
Architectural review for
PHR integration
Personal Health Records
Health Risk Assessment
Behavioural Health
Intervention Programmes
Health Trackers & Tools
Self-entered Screening
Results, Allergies,
Appointments & Calendar
of Events
Alignment with NEHR
Facilitate individuals to
share PHR with their
clinicians
Incorporate new programmes
Foster family concept in
Active Health Management
Support interface with
remote-monitoring devices
Enable online communities
on healthcare topics
2009 2010 2011/12
Adapted and summarised from HPB presentation
on Singapore eHealth Portal
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The promise of Integrated eHealth
Shared patient’s clinical records
Enforces better prescribing practices with peer reviews
Reduces human errors related to handwritten records
Takes the guesswork out from the lack of past records
Prevents duplicate and unnecessary tests; and adverse drug events
Better Clinical Care and Streamlined Workflows
Better Practices and Greater Patient Safety
Patient information at the point of care
Supports clinical decision making and workflows
Enables providers involved in patient care journey to work as a team
Seamless transition of patient into different care settings
Better management of chronic illnesses
Enables greater patient participation and supports self-help
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Sustainable, High Quality Healthcare in Singapore
Political Vision
Bold Innovation
In structure, policy, services
Robust IT Infrastructure
providing info and decision support at the point of care
capturing info for CQI and system management
Empowered Population with Information and Choice
Key Factors
Thank YouMOH Holdings
www.mohh.com.sg