Healthcare Systems Sustainability. Is sustainability of healthcare possible without eHealth?: The Singapore experience

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

Healthcare in Asia

Shared Concerns in a Diverse Region
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

MOH Holdings Pte Ltd
This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 2

Successful cost containment

 Asia is successful so far in keeping healthcare costs down

 What are the incentives for investing in Health IT if costs are already low?

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

Reference:
Health Systems in East Asia: What Can Developing Countries Learn from Japan and the Asian Tigers?
World Bank Report 2005 by Adam Wagstaff


Rapidly ageing population

In 2030, 3 out of 5
oldest nations in the
world will be in Asia.

Reference: Population
Age Shifts .
Reshape Global
Economics and
Geopolitics. Adele
Hayutin, Ph.D. Director,
Global Aging Program,
Stanford Center on
Longevity, 2009


Healthcare in Singapore

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)

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.


Healthcare Financing in Singapore

National Healthcare Expenditure (NHE)

MediShield
Employer Medi- & Elder- Medi Government
benefits save Cash* fund Subvention
shield

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


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

Secondary and
Tertiary Care
80% Private 30% Private
> 2,000 GP clinics 80% Public 70 % Voluntary Welfare
7 Restructured Hospitals 6 Community Hospitals
20% Public 6 Specialty Centers 36 Care Homes, 8 Hospices
17 Polyclinics 64 Nursing Homes
20% Private
16 Hospitals Intermediate and
Primary Healthcare
Long Term Care


Political Vision
Integrated 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


Getting ready for the “silver tsunami”

 Integrated healthcare delivery system “Slow medicine”

 Appropriate care from the right site physiotherapy, rehab and
care for chronic sick
 Better allocation of resources
 More cost-effective treatment and
care in the healthcare continuum Long Term
Care

Acute & Primary
Tertiary Care Care

“Fast medicine”
diagnosis and treatment of
patients with acute needs


Innovation:
Healthcare landscape of the future

Strategic vision of patients moving seamlessly across the
healthcare system, receiving coordinated patient-centric care
at the most appropriate settings.
Enabled by the National

CH
Electronic Health Record
NH
Screening &
Polyclinics

Palliative
(EHR)
Prevention RH Care
Home
FPs Care
Rehab &
support
services

CH CH CH
Polyclinics NH Polyclinics NH Polyclinics NH
Screening & Palliative Screening & Palliative
Prevention RH Care Prevention RH Care
Screening &
Prevention RH Palliative
Home Home Care
FPs Care
FPs Care Home
FPs Care
Rehab & Rehab &
support support Rehab &
services services support

CH CH services

Polyclinics NH
Polyclinics NH
Screening & Palliative
Screening &
Prevention RH Palliative Prevention RH Care
Care Home
Home FPs Care
FPs Care
Rehab &
Rehab & support
support services
services


Innovation:
Chronic Disease Management Programme

Holistic approach
 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

8 chronic diseases covered currently:
• Diabetes mellitus • Asthma
• Hypertension • COPD
• Hyperlipidemia • Schizophrenia
• Stroke • Major Depression


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 Taken from published paper from Ministry Of Health, Singapore:
“Medisave for Chronic Disease Management Programme – The Second
pressure control Year” by Dr Lee Heow Yong, Ms Noureen Mervani & Dr Aley Moolayil


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
Nationwide Screening for
Subsidized rates for lower income group
• BMI screening
• Diabetes mellitus
• Hypertension
• Hyperlipidemia

Females:
• Pap smear for cervical cancer
Mammogram recommended
for breast cancer


Challenges for Singapore
 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


Vision of “One Patient, One Record”

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.

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.


NEHR builds on existing eHealth Systems

National
EMR Exchange Hospital based
Immunisation
(EMRX) EMR & CPOE
Registry
Multiple EMR Systems
Multiple Lab & Radiology Systems
Critical Medical
 2 public healthcare clusters Information Store
(CMIS)
NHG and SingHealth hospitals,
polyclinics and specialist clinics
 Ministry of Defence (MINDEF)

EMRX Extension
to Community
GP Clinic
Hospitals
Management
Systems
Minimal EMR Systems
Community
Hospital based  Private GPs (approx 300 out of more than 2,000 have a CMS)
EMR
 Community Hospitals


Personal Health Record (PHR)

Foundation for the Singapore eHealth Portal

Vision

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)


Roadmap to sync with National eHealth Record

2009 2010 2011/12

 Personal Health Records  Provide tailored  Alignment with NEHR
healthcare content
 Health Risk Assessment  Facilitate individuals to
 Interface with existing share PHR with their
 Behavioural Health health repositories clinicians
Intervention Programmes
 Incorporate mental  Incorporate new programmes
 Health Trackers & Tools wellness and pregnancy
 Foster family concept in
 Self-entered Screening tracking modules
Active Health Management
Results, Allergies,  Alignment with
Appointments & Calendar  Support interface with
National EHR
of Events remote-monitoring devices
 Architectural review for
 Enable online communities
PHR integration
on healthcare topics
Adapted and summarised from HPB presentation
on Singapore eHealth Portal


The promise of Integrated eHealth

Better Clinical Care and Streamlined Workflows

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

Better Practices and Greater Patient Safety

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


Sustainable, High Quality Healthcare in Singapore

Key Factors
 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


Thank You
MOH Holdings
www.mohh.com.sg

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