Ausinnovate Dr Sarah Muttitt Ministry Of Health Holdings

24 May 2010

Developing a National Electronic

Health RecordDr. Sarah Muttitt, CIO

MOH Holdings, Singapore

Developing a National EHR

Dr. Sarah Muttitt, CIO, MOHH24 May 2010

By 2030

By 2050

Getting ready for the “silver tsunami”

Pressures on healthcare system set to increase

� 1 in 5 Singaporeans will be over 65

� Singapore will be among the world’s demographically

oldest countries with median age of 54

� Disease patterns will change

� Demand for healthcare and care

of chronic diseases will rise

� Healthcare costs will be bigger burden

on families supporting the elderly

M O H H o l d i n g s P t e L t d



Vision of an Integrated Healthcare System


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 to the ageing population. To structure it properly

means we need step-down care.

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.

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

Picture taken from asiaone.com

““

””-- Prime Minister Lee Hsien Loong

National Day Rally 2009



� 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

“Fast medicine”

diagnosis and treatment of

patients with acute needs

“A Different Pattern of Healthcare”

“Slow medicine”

physiotherapy, rehab and

care for chronic sick

“Slow medicine”

physiotherapy, rehab and

care for chronic sick




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 &


Care

RH

CH

NHPolyclinics

FPsHome

Care

Rehab &

support

services

Screening &


Care

RH

CH

NHPolyclinics

FPsHome

Care

Rehab &

support

services

Screening &


Care

RH

CH

NHPolyclinics

FPsHome

Care

Rehab &

support

services

Screening &


Care

RH

CH

NHPolyclinics

FPsHome

Care

Rehab &

support

services

Screening &


Care

Enabled by the National

Electronic Health Record

(EHR)

Healthcare landscape of the future




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 integrated patient-centric 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.




� Captures a key subset of health information from multiple point of service systems

� Available electronically to authorized healthcare providers anytime, anywhere

� Designed to facilitate the sharing of data across the continuum of care,

across healthcare delivery organizations and across geographies

The difference between EMR and EHR

EHRSpecific to an individual

� Equivalent of its paper predecessor

� Includes everything recorded by the organization about a given patient

� Has “depth” but lacks “breadth”

EMRSpecific to a facility (institution, private office)




What clinicians need to see on the EHR




Existing eHealth Systems in Singapore

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 Hospital based

EMR & CPOEEMR & CPOE

EMRX Extension EMRX Extension

to Community to Community

HospitalsHospitals

Community Community

Hospital based Hospital based

EMREMRMinimal EMR Systems

� Private GPs (approx 300 out of more than 2,000 have a CMS)

� Community Hospitals

Minimal EMR Systems

� Private GPs (approx 300 out of more than 2,000 have a CMS)

� Community Hospitals

GP Clinic GP Clinic

Management Management

SystemsSystems

National National

Immunisation Immunisation

RegistryRegistry

Critical Medical Critical Medical

Information Store Information Store

(CMIS)(CMIS)

EMR Exchange EMR Exchange

(EMRX)(EMRX)




Information Systems Division (ISD)

Provides leadership in setting strategic direction for Singapore’s national

health informatics strategy

Interoperability - Governance

HIT master planning supports the national agenda for an Electronic Health Record by 2011

by facilitating strategic alignment at various Levels of the Healthcare System

Organization Specific

IT Capabilities

Strategic

Alignment

National EHR &

Related Integrative

Projects

MOHH Master HIT Planning




Interoperability – Enterprise Architecture

Pragmatic approach adopted to deliver an Enterprise Architecture that is

� Implementable

� Fit-for-purpose i.e. delivering

value for clinicians in the near term

� Future-Proofed to support longer

term vision for healthcare, analytics

and research




Interoperability – Standards

to ensure clinical data included in the EHR can be:

� Shared and exchanged safely and reliably for the monitoring and care of patients

� Used meaningfully for secondary purposes including production of clinical knowledge

Global Standards Engagements

• HL7 (Health Level Seven)

• IHTSDO (International Health Terminology

Standards Development Organization)

• ISO TC215 on Health Informatics

• IHE (Integrating the Health Enterprise)

Establishing a suite of standards that are � Clinically-Driven

� Easy to Use

� Internationally Recognised




Exploiting Other WOG Initiatives

Next Generation Broadband“By 2010, 60 per cent of homes and offices can expect to have access to this new, ultra high-speed,

all-fibre network. The network coverage is expected to reach 95 per cent by 2012. In the near future,

there will be a wide range of services riding on Next Gen NBN, which will empower business users,

home users, schools and learning institutions.”

National Authentication Framework“NAF, a key programme under IDA’s iN2015 Masterplan aims to deploy a nationwide platform for

strong authentication services for end-users accessing key online services…….. key economic sectors

(e.g. financial, government and healthcare).

iSPRINT“Small and Medium Enterprises (SMEs) looking to accelerate the adoption and innovative use of

infocomm can now receive a wider scope of assistance under a new scheme called iSPRINT

(Increase SME Productivity with Infocomm Adoption and Transformation)”

eGOV Masterplan, SOEasy, GDCs, NICF, etc. etc……




10 Year Investment Strategy

� Identified the investment amount & costs of the EHR

� Determined financial and non-financial benefits

� Quantified the benefits of the investment

Evaluating the Benefits of EHR Investment




10 year investment strategy identified areas with the most positive gain

Quantifying potential benefits




Procurement Update

Proof of Concept completed

in October 2009In Progress

Completed

Next Steps

Shortlist Targeted

Implementation

Detailed

EHR Design

EHR

Implementation

General Use Cases

EHR Capabilities,

Prioritization

Pre Qualification

EHR Proof

of Concept

Closed Tender

ImplementationProcurement




NEHR Rollout Roadmap

� Iterative rollout with refinement and enhancement from each deployment cycle

� System will mature and evolve with shifts towards shared information and care

At least 50 Clinics Approx 500 GPs Approx 1500GPs

2 3/4 6+Community

Hospitals

Care Assessment ReferralsAIC

2+ Polyclinics

2+ Restructured HospitalsPublic Sector

MINDEFOthers

Extended to entire public sector with shorter iterations in between

View of data available in whole of Restructured Hospital systems

Clinical & Business

Intelligence

Extended Clinical

Toolset

Facilitation of Care

Coordination and Team

Based Care

Summary Care Records

and EHR Foundations

EHR Solution Design Phase 1 Phase 3 Phase 4Phase 2




The promise of the EHR

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 WorkflowsBetter Clinical Care and Streamlined Workflows

Better Practices and Greater Patient SafetyBetter 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


24 May 2010

Thank YouMOH Holdings

www.mohh.com.sg

Ausinnovate Dr Sarah Muttitt Ministry Of Health Holdings

Health & Medicine

healthcare providers

sarah muttitt

integrated healthcare

cio moh holdings

healthcare landscape

moh holdings pte ltddr

patients ehr

continuum of care