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By TEH SHI NING
PATIENTS visiting Wood-lands Polyclinic with runnynoses and sore
throatscould find themselves ush-ered into a Health & Well-ness
Kiosk (Hawk) beforethey enter the doctorsroom.
There, they are invitedto key in responses to basichealth
questions on theirmedical history and clinicalsymptoms related to
upperrespiratory tract infections,and take their weight
andtemperature.
All this information isthen sent electronically tothe
polyclinics medicalrecords system and logged even before the
doctorhas met the patient.
By providing a meansfor patients to conductpre-screening
independent-ly, these kiosks aim to bet-ter utilise the
polyclinicslimited clinical resourcesand expedite the registra-tion
process, reducing pa-tient waiting time.
Doctors can also nowspend more quality timewith patients during
con-
sultsforthe assessment, di-agnosis and treatment ad-vice to
them, says the Na-tional Healthcare GroupPolyclinics (NHGP),
whichoperatesa totalof ninepoly-clinics including Wood-lands
Polyclinic.
With an estimate d 20percentof Singaporespop-ulation affected by
the flueach year, polyclinics,where healthcare servicesare
subsidised, are oftencrowded with flu patients.
A cons erva tiv e doc-tor-to-patientratio forinflu-enza at the
polyclinics is1:50, says A*Star (Agencyfor Science, Technologyand
Research), which initi-ated the Hawks projectalong with CIMIT
(Centrefor Integration of Medicineand Technology,
BostonMassachusetts).
The project is fully fund-ed by A*Star as one of itsA*Star-CIMIT
commerciali-sation projects.
NHGP provided specifi-cations on what patientswould need to help
createthe kiosk, while IHiS (Inte-grated Health
InformationSystems), which architectsand manages the integrat-ed IT
systems across Singa-pores public healthcaresector, linked the
kioskwith the electronic medicalrecords system.
The pilot run of Hawks,
launched at WoodlandsPolyclinicin April,is stillbe-ing
evaluated.
But this could not havehappened if NHGP had notcompletedits
switchto elec-tronic medical records. Pi-loted in May 2009, the
newE-notes module for elec-tronic record taking wasrolled out
across all NHGPclinics by January 2010.
Going paperless was noeasy feat for a family ofnine polyclinics,
but doingso was far more than an at-tempt to keep up with
thetimes.
Better, safer care for pa-tients was the ultimate aim,which
electronic clinicaldocumentation has helpedto achieve, says Lew
Yii
Jen, NHGP senior director,clinical services.
Previously, paper medi-cal records for each patientwere filed in
folders andstored away in a medicalrecords office in each
poly-clinic.
But the time taken to re-trieve and deliver casenotes to the
doctors oftenled to consultation delays.
On occasion, patientscase notes were misplaced.On top of that,
laboratoryand X-ray reports were notalways in the case folderand
the medication list foreach patient was at timesnot updated.
It was resource inten-sive and time-consumingforstaff tomanage
these pa-
per records, says Dr Lew.NHGP set up a digital docu-ment system
in November2008 to convert all old,handwritten records
intoelectronic format this wascompleted in February2011.
The time, manpowerand even space savingsb r o ug ht a b o u t b
y t heswitch to electronic medi-
cal records have not beentrivial.
IHiS, which was also be-hind the implementation ofthe electronic
medicalrecords (EMR) systemacross all public hospitals,national
specialty centresand polyclinics, says theEMR has raised
healthcarestaff productivity as well asimproved patientcarequali-ty
and safety significantly.
Dr Lew estimates thatthe introduction of theE-Notes system has
savedeach NHGP patient about35 minutes of waiting time.
An d th e qu al it y ofrecords has also improvedas the
electronic formscome with structured tem-plates and eliminate
errorsdue to bad handwriting.
Patient laboratory test
results and X-rays onceready, are input into theEMR system, so
doctorsand healthcarestaff can ac-cess them quickly.
Doctorsinputtheirprescriptions in-to the system and pharma-cists
can read them online.The pharmacists no longerhave to spend time
deci-phering doctors handwrit-ing, and can review more
medication orders for morepatients. Thishas alsoelim-inated the
risk of potentialmedication errors from de-ciphering doctors
unclearhandwriting, says IHiS.
Staff who previouslyhad to manage these fold-ers of medical
records havealso been retrained to as-sistdoctorsand othermem-bers
of the healthcareteam, againresultingin bet-ter patient care, says
DrLew.
Not only has the systemfreed up manpower, it hasfreed up
polyclinic space,too.
The NHGP polyclinicshave been able to convertmore than 50 per
cent ofwhat was previously stor-age space for case notes in-to new
consultation rooms.
NHGP stresses that the
impetus for productivityand efficiency for health-care providers
is the needto deliver ever-better careto patients.
In NHGP, our goal is toprovide quality care, de-fined by
providing accessi-ble, safe, patient-centredandappropriatecare
toourpatients, says Alice Tang,NHGP deputy director, Op-erations
Lean Office.
In seeking ways to con-tinuallycut waste frompro-cesses and
improve pro-
cesses, the groups goal isto bring more value to pa-tients. Its
productivity pushthus extends beyond tech-
nologyto whatNHGPrefersto as Team-Based Care,Ms Tang says.
T hi s k e y a p p ro a c hadoptedby the group toim-prove
healthcare outcomesand productivity has meantmoving away from a
Doc-tor-only model to engagethe expertise of the entirehealthcare
team includingnurses and allied healthprofessionals, to care
foreach patient in a coordinat-ed manner.
Buteven there,technolo-gy helps. The E-Notes sys-
tem includes a module thatsupports communicationand
collaboration betweenmembers of each health-care team too.
GRAPPLING with therising demand forhealthcare
services,ChangiGeneral Hos-pital (CGH) hasbeenintroducing
newtechnology as wellas redesigning job
scopes, infrastructure and work pro-cesses to improve healthcare
deliveryfor both patients and staff.
The healthcare sectoris facingsig-nificant challenges as the
populationgrows and ages and as chronic condi-tions become more
prevalent, givenchanginglifestyles. With families nowsmaller in
size as well, it may proveharderto care
forelderlyfamilymem-bers.
The 800-bed CGH offers a range ofmedical services, such as
cardiology,endocrinology, orthopaedic surgeryand sports medicine.
It employs
about 4,000 people, of which 70 percent are doctors, nurses and
al-lied-healthprofessionals.It sees near-ly 40,000 inpatient
admissions,368,000 patients at its specialist clin-ic and 160,000
patients in the A&Eannually. Over 80 per cent of
CGHsadmissionscomes viaits A&Edepart-ment.
Optimising resourcesWhile we will be expanding capacityand staff
strength to meet this in-creaseddemand, doingthisalonewillnot be
sustainable. We need to opti-mise the way healthcare resourcessuch
as infrastructure and workforceare used. At CGH our aim is to
deliverbetter outcomes instead of just out-putssuchas numberof
patientstreat-ed and thus better value for our pa-tients, says Lee
Chien Earn, chief ex-ecutive of CGH.
This may mean not treating thepatient in the hospital but
keepingpeople healthier longer and enablingthe patient to be cared
for in the com-
munity. This may result in fewer pa-tients coming to the
hospital and weseethis asa goodoutcomeas itreduc-es healthcare
costs, making healthcare affordable for Singaporeans, headds.
The hospital also supports theHealthcare Tripartite
Workgroup,whichis trying topush upthe salariesof healthcare support
workers, suchas healthcare assistants and patientservice
associates, who currentlyearn $1,700 and under.
CGH is progressively raising theirbase salaries by 10 to 20 per
centfrom 2012 till end-2014. This is justi-fied by redesigning job
scope, train-ingstaffto enhancetheir skills aswell
as boostingproductivitythrough tech-nology and devices.
Among the productivity driving
measures implemented at CGH is anelectronic system called Closed
LoopMedication Management to helpfacili-tate the dispensing of
medicine,where the medication prescribed bydoctors can be reviewed
by pharma-cists and served by nurses all via theelectronic
platform, cutting down onadditionalstepsandreducingthelike-lihood
of errors.
According to the hospital, errorsin the dispensing of medication
havecome down by at least 30 per cent,while freeing up more time
for staff toattend to patients.
Other initiatives include theHealth Management Unit (HMU),
which aims to help patients managetheir chronic diseases after
they havebeen discharged as the HMU nurses
ring patients regularly to educatethem and follow up on areas of
caresuch as medication.
An IT programme called the pa-tient relationship management
(PRM)programme helps these telecarenurses pull up information on
the pa-tients medical condition, treatments,tests and clinic
visits.
This enables the patient to makefewer A&E visits and avoid
hospitaladmissions, which means cost-sav-ings for both the patient
and hospital.
In addition, theprogrammeallowsCGH to redesign job scope for
oldernurses, who may not want to contin-ue with clinical nursing as
they age,since it can be tiring.
As such, older nurses can be de-ployed to this department as
telecar-ers, bringing their years of experi-
ence to the job.According to CGH, its HMU teamof 13 nurses can
monitor some 2,600patients. Half of the nurses at HMUare above the
age of 50.
RedesignAside from this, CGH has also rede-signed the layout and
work flow of itsOrthopaedicClinicwiththe helpof
de-signconsultancycompanyIDEO toim-prove the experience for its
patients,tapping the Healthcare Quality Im-provement and Innovation
Fund todo so. The project took into accountfeedback from patients
by conductinginterviews with them, while also inte-grating best
practices from other in-dustries.
The so-called backbone design ofthe clinic where the core work
areafordoctors and nursesis in the centre
of the clinic and aligned with pa-tients rooms helps to boost
produc-tivity.
It has enabled the same numberofnursesto servea largerpoolof
doc-torsand patients by improving visibili-ty and concentrating the
resourcescentrally. The design also allowedqueues to be cleared
faster as visibili-ty of the flow can be seen at the back-bone of
the clinic, says Dr Lee.
Besides driving productivity, thehospitalhas alsolookedat
softerini-tiatives to cater to patients needs sothat their
experience at CGH is morecomfortable.
For example, patients in the criti-
cal care unit may have trouble com-municating, forcing them to
mouthandgesticulate theirrequests orscrib-ble them down on pieces
of paper. Inaddition to taking up time, this could
be exhausting for the patients.To overcome this, CGH has
come
upwith a programmeloadedonto theiPad that helps improve
communica-tion for mechanically ventilated pa-tients in the ICU,
enabling them to ex-press how they are feeling to caregiv-ers with
greater ease.
Centre for InnovationAnother recent addition to the hospi-tal
includes the Centrefor Innovation,which was launched by the
EasternHealth Alliance (EH Alliance). Thefounding members of the EH
Allianceinclude CGH, St Andrews Communi-ty Hospital, SingHealth
Polyclinicsand The Salvation Army PeacehavenNursing Home.
The centre aims to instil a cultureof innovation, acting as a
platformwhere the alliance and its partnerscan come up with
solutions to tackleproblemsand improvehealthcare de-livery.
At the same time, Dr Lee says thehospital needed to ensure that
safetyand efficiency were not compromisedwhen new measures are
implement-ed.
Improving productivity often re-quires changes in mindset and
careparadigm.We alsoneedto balancein-novation with safety. For
example,we could train staff to take on newroles but there must be
proper safe-guards to ensure competency, hepoints out.
Automation alone will not im-prove productivity. We need to
firstimprove our processes, including re-designing it if necessary,
before auto-mating the process. Otherwise wemay end up automating
and perpetu-ating or worseamplifying anineffi-cient process, he
says.
Polyclinics
coordinatedsystem ofpatient care
Changi General Hospital introduces new technology, redesigns job
scopes and work processes, reports NISHA RAMCHANDANI
Fast and accurate: Polyclinic doctors now key in notesfrom each
consultation into the E-notes system (screenon the right), which is
automatically linked to a
patients medical record. This prevents errors, speedsup records
retrieval and cuts patients waiting time.
NHGP makes use oftechnology andthe expertise ofthe
entirehealthcare team
Telecarers: CGHs Health Management Unit aims to help patients
manage their chronic diseases after they have been discharged as
the HMU nursesring patients regularly to educate them and follow up
on areas of care such as medication.
This series is a collaborationbetween The Business Times and
the National Productivity &Continuing Education Council
In seeking ways to continuallycut waste from processes
andimprove processes, the groups
goal is to bring more value topatients. Its productivity
pushthus extends beyondtechnology to what NHGPrefers to as
Team-Based Care.
The Centre for
Innovation aims to instil
a culture of innovation,
acting as a platform
where t he alliance and
its partners can come up
with solutions to tackle
problems and improve
healthcare delivery.
HEALTH CARE
Delivering better quality
Clinic DIY: By allowing patients to conductpre-screening
independently, the Health and WellnessKiosks (Hawks) at Woodlands
Polyclinic aim to betterutilitise limited clinical resources and
reduce patients
waiting time.
The Business Times, Tuesday, December 11, 2012 PRODUCTIVITY
MATTERS 11
