8
A PUBLICATION OF THE SINGHEALTH ACADEMIC HEALTHCARE CLUSTER R ecent strides made in pharmacy management have significantly contributed to improving quality of care. From inpatient medication to outpatient prescriptions, SingHealth patients can now reap the rewards of new highly automated drug dispensing processes in the form of shorter wait times and minimised error. These initiatives are part of a larger strategic plan to use automation and information technology to improve patient safety. SGH and KKH have now advanced to paperless IT prescription systems under the Closed Loop Medication Management (CLMM) initiative. Clinicians are able to order medication online, aided by IT decision support tools that ensure correct doses and prevent drug interactions and allergies. Pharmacists no longer need to decipher handwriting, further enhancing safety. Closing the loop in SGH is its new radio frequency identification (RFID) drug delivery system which automates the laborious outpatient dispensing process. This was dependent on pharmacy technicians who had to manually locate, pack and sort the appropriate medication for dispensing to patients. On a regular day, the outpatient pharmacy at SGH can receive some 1,200 prescriptions. During peak hours with higher patient volume, human error causing the wrong medicine or dosage to be dispensed can disrupt the daily process. In its drive towards reduced error and process automation, SGH pharmacy management made the bold decision to create a proprietary drug dispensing system entirely from scratch. Taking four years from conceptualisation to delivery, they are the first in the world to use such innovative technology in healthcare, with potential to be replicated worldwide. Lim Mun Moon, Deputy Director, Pharmacy, SGH said, “This system is the first of its kind and not an off-the-shelf procurement. Being created from the ground up meant we had full control over the system so it integrates into our particular workflow. It transformed the way we work with end- to-end automation. The results have been greatly satisfying.” The homegrown initiative was developed in collaboration with Innotech Resources, PSB Technologies, EurekaPlus and Integrated Health Information Systems (IHiS) with partial funding by the Ministry of Health and enterprise development agency, SPRING Singapore. Mun Moon shared, “Our industry partners possessed the technological expertise while we offered domain knowledge to specify standards for safety and time criticality. Together, we have created a safe, efficient and innovative solution that reduces human error. “With an automated process, we now have a smooth flowing production line that is more efficient, productive and near perfect with medication errors reduced to almost zero.” With the system, the overall patient experience has improved - average processing time for prescriptions has been nearly halved from 15 minutes to seven minutes. THE VOICE OF ACADEMIC MEDICINE MEDICINE TOMORROW’S ISSUE 4, NOVEMBER 2013 A new age in pharmacy management Automated drug dispensing systems in SGH and KKH redefine standards in medication safety and efficiency MICA (P) 143/07/2013 I n the multidisciplinary healthcare hub that is SGH Campus, it is not uncommon for a patient to visit more than one department to treat their condition. This is especially true for transplant patients, who often need to see different healthcare professionals at different times and places within the campus for chronic treatment. Professor Tan Ser Kiat, Emeritus Consultant at SGH, conceptualised the idea of a patient- centred transplant centre during his tenure as SingHealth Group CEO. Dr Terence Kee now leads the SGH Transplant Centre as its Director. The centre puts various healthcare professionals involved in transplant under one roof to minimise movement and waiting times for their patients. Apart from the integrated work processes, the centre will also have dedicated resources to provide transplant care rather than compete with existing equipment within the campus. Dr Kee said, “We focus on lean work processes and bringing out the best patient journey possible. We have an innovative single queue number and bill system that allowed for real time management and monitoring of the patient journey. “We make sure that our doctors know which clinic slots are overbooked, giving patients the flexibility to choose their appointment times. Pharmacist and pharmacy technician support also brings safer and more seamless collection of medication.” The centre’s design and concept was guided by the end users from the beginning. To create a truly patient-centred experience, Dr Kee and team took advice from a multidisciplinary team of administrators, clinicians, nurses, coordinators and allied health professionals. The ideas from that team were further supplemented by staff and patient feedback on their current working and clinical experience, which then helped to improve and shape working processes and infrastructure. Dr Kee explained, “In reality, it all translates to free-flowing multidisciplinary care without bottlenecks. This reduces waiting time – the most important concern expressed by patients. “I believe the centre has brought in many innovations, and will be the standard in defining patient-centred care in SingHealth.” The SGH Transplant Centre has been operational since 13 September and was officially opened on 7 November. Completing the picture will be the transplant-specific training programme and service culture training given to the staff at the centre. Patient- centred transplant care at SGH With an automated process, we now have a smooth flowing production line that is more efficient, productive and near perfect with medication errors reduced to almost zero. – Lim Mun Moon Continued on page 2

Tomorrows Medicine November 2013

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Page 1: Tomorrows Medicine November 2013

A publicAtion of the SingheAlth AcAdemic heAlthcAre cluSter

Recent strides made in pharmacy management have significantly contributed to improving quality of

care. From inpatient medication to outpatient prescriptions, SingHealth patients can now reap the rewards of new highly automated drug dispensing processes in the form of shorter wait times and minimised error.

These initiatives are part of a larger strategic plan to use automation and information technology to improve patient safety.

SGH and KKH have now advanced to paperless IT prescription systems under the Closed Loop Medication Management (CLMM) initiative. Clinicians are able to order medication online, aided by IT decision support tools that ensure correct doses and prevent drug interactions and allergies. Pharmacists no longer need to decipher handwriting, further enhancing safety.

Closing the loop in SGH is its new radio frequency identification (RFID) drug delivery system which automates the laborious outpatient dispensing process. This was

dependent on pharmacy technicians who had to manually locate, pack and sort the appropriate medication for dispensing to patients.

On a regular day, the outpatient pharmacy at SGH can receive some 1,200 prescriptions. During peak hours with higher patient volume, human error causing the wrong medicine or dosage to be dispensed can disrupt the daily process.

In its drive towards reduced error and process automation, SGH pharmacy management made the bold decision to create a proprietary drug dispensing system entirely from scratch.

Taking four years from conceptualisation to delivery, they are the first in the world to use such innovative technology in healthcare, with potential to be replicated worldwide.

Lim Mun Moon, Deputy Director, Pharmacy, SGH said, “This system is the first of its kind and not an off-the-shelf procurement. Being

created from the ground up meant we had full control over the system so it integrates into our particular workflow.

It transformed the way we work with end-to-end automation. The results have been greatly satisfying.”

The homegrown initiative was developed in collaboration with Innotech Resources, PSB Technologies, EurekaPlus and Integrated Health Information Systems (IHiS) with partial funding by the Ministry of Health and enterprise development agency, SPRING Singapore.

Mun Moon shared, “Our industry partners possessed the technological expertise while we offered domain knowledge to specify standards for safety and time criticality. Together, we have created a safe, efficient and innovative solution that reduces human error.

“With an automated process, we now have a smooth flowing production line that is more efficient, productive and near perfect with medication errors reduced to almost zero.”

With the system, the overall patient experience has improved - average processing time for prescriptions has been nearly halved from 15 minutes to seven minutes.

the voice of AcAdemic medicine

medicinetomorrow’S

iSSue 4, november 2013

A new age in pharmacy managementAutomated drug dispensing systems in SGH and KKH redefine standards in medication safety and efficiency

MICA (P) 143/07/2013

In the multidisciplinary healthcare hub that is SGH Campus, it is not uncommon for a patient to visit more than one

department to treat their condition. This is especially true for transplant patients, who often need to see different healthcare professionals at different times and places within the campus for chronic treatment.

Professor Tan Ser Kiat, Emeritus Consultant at SGH, conceptualised the idea of a patient-centred transplant centre during his tenure as SingHealth Group CEO. Dr Terence Kee now leads the SGH Transplant Centre as its Director. The centre puts various healthcare professionals involved in transplant under one roof to minimise movement and waiting times for their patients.

Apart from the integrated work processes, the centre will also have dedicated resources to provide transplant care rather than compete with existing equipment within the campus.

Dr Kee said, “We focus on lean work processes and bringing out the best patient journey possible. We have an innovative single queue number and bill system that allowed for real time management and monitoring of the patient journey.

“We make sure that our doctors know which clinic slots are overbooked, giving patients the flexibility to choose their appointment times. Pharmacist and pharmacy technician support also brings safer and more seamless collection of medication.”

The centre’s design and concept was guided by the end users from the beginning. To create a truly patient-centred experience, Dr Kee and team took advice from a multidisciplinary team of administrators, clinicians, nurses, coordinators and allied health professionals.

The ideas from that team were further supplemented by staff and patient feedback on their current working and clinical experience, which then helped to improve and shape working processes and infrastructure.

Dr Kee explained, “In reality, it all translates to free-flowing multidisciplinary care without bottlenecks. This reduces waiting time – the most important concern expressed by patients.

“I believe the centre has brought in many innovations, and will be the standard in defining patient-centred care in SingHealth.”

The SGH Transplant Centre has been operational since 13 September and was officially opened on 7 November. Completing the picture will be the transplant-specific training programme and service culture training given to the staff at the centre.

Patient-centred transplant care at SGH

With an automated process, we now have a smooth flowing production line that is more efficient, productive and near perfect with medication errors reduced to almost zero.

– Lim Mun Moon

Continued on page 2

Page 2: Tomorrows Medicine November 2013

Pharmacy technicians who used to do packing and sorting can now be deployed to other areas to further improve service levels at the Outpatient Pharmacy. The role of the pharmacist is now also more defined with greater focus on clinical skills, such as reviewing and approving prescriptions.

Since its implementation, the system has received strong interest from other hospitals both locally and abroad. The positive results have been further studied and presented by research pharmacists at the Asian Congress of Clinical Pharmacists and other similar international conferences.

At KKH, the CLMM is completed with an automated drug dispensing system for inpatients, pioneered in 2010. The Inpatient Pharmacy Automatic System (IPAS) is a centralised robotic medication management system that picks, packs and dispenses inpatient drugs by unit dose, leveraging system integration, robotics and barcode scanning capability technology.

IPAS has achieved remarkable results, improving medication safety by 63 per cent. In addition, the hospital implemented the first 24-hour real-time pharmacist verification of medication orders, reducing drug verification

turnaround time from 51 minutes to just seven minutes. This reduced stock variance to 2.2 per cent in 2011 versus 22 per cent in 2009, accounting for at least $40,000 cost savings annually.

Irene Quay, Chief Pharmacist, KKH, said “The outcomes have demonstrated improvement in medication safety as well

What distinguishes a superstar National Collegiate Athletic Association basketball team from

one that is merely very good? What do stellar English football teams do differently from their peers?

The answer may lie not in what they do differently but in who leads them. It turns out that the best performing teams are frequently managed or coached by former brilliant players.

These observations have led to the belief that expert domain knowledge is correlated with organisational performance. Organisations should therefore look towards “expert leaders” for leadership.

Amanda Goodall has extrapolated these findings to the healthcare setting. Goodall studied the performance of thousands of US healthcare institutions and hospitals and discovered that hospitals positioned higher in the US News and World’s Report’s Best Hospitals ranking are led disproportionately by physicians.

While this study does not establish that physicians make more effective leaders when compared to professional managers, it is consistent with findings in other high-skill settings such as professional sports. Therefore, it does raise the association between physician leadership and hospital performance.

Hospital Leadership and Management have however often been viewed as the “dark side” by physicians trained to provide

professional excellence for their individual patients. The traditional skills of physicians have focused physicians on management of an individual patient, scientific training, autonomy, working as an individual and optimisation of a single outcome.

In contrast, leadership and management focus on the organisation, systems training, standards, teamwork and the big picture view. Contrary to popular belief, these skill sets are complementary and not mutually exclusive.

In the light of the compelling evidence, it is perhaps timely that physicians should consider taking up the mantle of leadership. In the words of Mahatma Gandhi, we must be the change we wish to see in the world.

EdItoRS-In-CHIEfTan-Huang Shuo MeiAudrey Lau

EdItoRSJennifer WeeKenice TayArthur WongStephanie Jade

JoInt EdItoRIAl tEAmGoh Sai Luan (SGH)Ichha Oberoi (KKH)Edwin Yong (NCCS)Lio May Fern (NDCS)Jessica Koh (NHCS)Christina Valerie Wee (NNI)Dr Thiyagarajan Jayabaskar (SNEC)Eric Lim Wei (SHP)Wee Lai Ming (Duke-NUS)

dESIGnRedstone Communications

CoPyWRItInGHedgehog Communications

tomoRRoW’S mEdICInE - ISSUE 4, NovEmbEr 2013PAGE 2

Tomorrow’s medicine welcomes comments from our readers.

Write to us at [email protected]

visit Tomorrow’s medicine onlinewww.tomorrowsmed.com

A new age in pharmacy managementContinued from front page

NovEmbEr 2013

All rights reserved. Reproduction in whole or part is prohibited without the written permission of SingHealth and the publisher. The views and opinions expressed or implied in the publication are those of the authors or contributors and do not necessarily reflect those of SingHealth and the publisher. Whilst due care has been exercised, both SingHealth and the publisher do not accept responsibility for errors in advertisements or articles, unsolicited manuscripts, photographers or illustrations. Tomorrow’s Medicine reserves the right to edit all materials submitted for publication. While contributors will be given the opportunity to comment on articles for factual accuracy, this policy is about ensuring a consistent and clear writing style throughout.

Tomorrow’s medicine is a monthly publication on Academic medicine news

Join our social network today!www.facebook.com/singhealth

members of the SingHealth Academic Healthcare Cluster

Singapore General Hospital (SGH)KK Women’s and Children’s Hospital (KKH)

National Cancer Centre Singapore (NCCS)National Dental Centre Singapore (NDCS)National Heart Centre Singapore (NHCS)

National Neuroscience Institute (NNI)Singapore National Eye Centre (SNEC)

SingHealth Polyclinics (SHP)bright vision Hospital (bvH)

Sengkang Health (SKH)

Partner in Academic medicineDuke-NUS Graduate medical School Singapore

(Duke-NUS)

EdItoRS’ notE

The article “Home for transplant on SGH Campus”, published in the last issue stated

that the gift by Lee Foundation helped establish “the SingHealth Transplant

Centre.” This should be rightly reflected as “the SGH Transplant Centre.”

A pharmacy technician preparing a cytotoxic drug in an isolator at KKH’s new oncology Pharmacy, while another pharmacy technician removes a finished drug from the ‘Out’ hatch

IPAS has achieved remarkable results,improving medication safety by 63 per cent.

The case for physician leadership by Associate Professor ng Wai HoeAcademic Deputy Chair, Neuroscience Academic Clinical ProgramDeputy Director, National Neuroscience InstituteHead, Neurosurgery, National Neuroscience Institute

Organisations should therefore look towards “expert leaders” for leadership.

References

‘Why Do Leaders Matter? A Study of Expert Knowledge in a Superstar Setting’, with Lawrence M. Kahn and Andrew J. Oswald, Journal of Economic Behavior & Organization, July 2009, 77 (2011) 265–284.

‘Physician-leaders and hospital performance: Is there an association?’ (Social Science & Medicine 73 (4): 535-539 August 2011)

This article is brought to you in partnership with SingHealth Leadership and Organisational Development

Page 3: Tomorrows Medicine November 2013

When you interview medical students for admission, is there a set of criteria that you’re looking for?

Besides the usual metrics, Grade Point Average and Medical College Admission Test, we look for other elements that suggest interest and success. Intelligence has to be a given, but there is the very important question: Why do they want to do Medicine and are they passionate about it? The other metric is the indication that they will work very hard to get what they want.

From next year in the US, the Medical College Admission Test will be changed to include behavioural knowledge. The authorities are beginning to realise that a lot of what physicians do as practitioners is learning to listen and communicate effectively. If they find it hard to communicate effectively, it’s going to be difficult.

How do we persuade clinician practitioners to become clinician scientists?

It is not possible or preferable to have a scenario where everyone wants to become clinical research scientists. No country can afford to sustain them. What we want is for every practising physician to be able to innovate in his or her area of practice. Our goal is to have physicians who keep asking the two questions: “Why?” and “Can we do it better?”

Do you think Duke-NUS can engage in positive interactions and forge synergistic relationships with Yong Loo Lin School of Medicine (YLLSoM) and Lee Kong Chian School of Medicine (LKCMedicine)?

LKCMedicine is essentially going with our model of teaching. They are using a model similar to our Team-Based Learning

approach and they have hired one of our people. We are willing to work with them as we move forward in trying to train the next generation to think. Education should not be thought of as another competitive arena.

Our collaboration with YLLSoM is probably closer to percolation rather than extensive direct engagement, but I think what their students are experiencing at SingHealth is similar to what we have built for Duke-NUS students.

Do you think management and leadership skills are an important part of the syllabus for medical students?

Everybody needs to know how to work in a team and how to lead. Often, doctors’ roles in a team are to provide critical leadership, and that is what we have been trying to do from day one with Team-Based Learning for our students. In fact, all our students partake in leadership training during their orientation. We are trying to incorporate more of it in the wards.

You recently wrote in an article in Today newspaper that having a clear set of goals is crucial to the education journey. How do you ensure that your students fulfil these goals?

The students have explicit goals that are increasingly differentiated as they progress. We teach them that having clear goals helps chart their path.

the MRCP PACES examinations, a clinical exam for trainee doctors to enter higher specialist training, have

traditionally been a stressful experience for Residents, with the passing rate hovering at just above 60 per cent.

This trend made a miraculous turnaround a few months ago, with the passing rate surging to above 80 per cent. So what caused the 180-degree change?

Without hesitation, residents credit CADENCE – a peer-support teaching initiative by Dr Mark Cheah, Resident, Internal Medicine (IM) Program and Dr Jonathan Yap, Senior Resident, Cardiology Senior Residency Program.

Based on the concept of paying it forward, Residents who have just passed the MRCP

examinations take on the role of Resident mentors and guide a group of Residents about to take the examinations, once a week over a three-month period.

Residents such as Dr Tanujaa d/o Rajasekaran, who recently passed her examinations, lauded the initiative, “The fact that someone has been so dedicated in coaching me and following through in preparing for the examinations has only made it natural that I should do the same for my peers.”

So far, more than 80 Residents have benefitted from CADENCE. In addition, the initiative has helped foster strong bonds and camaraderie within the IM community. The sharing culture within IM is not new. In fact, it was mentors such as Dr Phua Ghee Chee, IM Program Director Designate, whose

dedication to teaching inspiredDr Mark Cheah to start CADENCE.

“If Dr Phua, despite his busyness, can offer dedicated time to teach us in small groups, what excuses do we have not to do the same?” Dr Cheah explained.

Dr Phua is, in turn, extremely proud of the generous spirit demonstrated by his Residents. “Their energy and enthusiasm in running Resident-led peer support initiatives such as CADENCE, inspires us to work harder to provide them with the best learning experience.”

Dr Cheah and Dr Yap have been conferred the SingHealth ‘Outstanding Young Educator Award’ this year, for their ground-breaking initiative.

PAGE 3tomoRRoW’S mEdICInE - ISSUE 4, NovEmbEr 2013

nurturing the next generation of doctorsProfessor ranga Krishnan, Dean, Duke-NUS Graduate medical School, shares his thoughts on medical education in Singapore

CAdEnCE: music to the earsresident peer teaching initiative bears results

Extracted from an interview by Dr Toh Han Chong, Head of NCSS Medical Oncology and Editor of SMA News (a publication of the Singapore Medical Association), published in SMA News August 2013

See how CLMM in SGH and KKH work on page 4

Our goal is to have physicians who keep asking the two questions: “Why?” and “Can we do it better?

as operational safety. The monitoring will continue, along with newer process improvement projects to further improve the results.”

KKH’s CLMM is the result of collaboration between its pharmacy, Division of Nursing, Medical Informatics and IHiS.

Another feather in the cap for pharmacy management is KKH’s new state-of-the-art Oncology Pharmacy. The pharmacy comes with a negative pressure cleanroom, complete with isolators for drug preparation, alarms for spills and systems for purging dangerous vapours. Clearly segregated zones further reduce the risk of contamination and infection, and staff have quick access to dedicated decontamination facilities.

Ng Cheng Li, Principal Pharmacist, Oncology Pharmacy, said, “The separation of production and administrative areas improves our drug preparation workflows.

“The new features allow our pharmacists and pharmacy technicians to perform their tasks efficiently and with a greater safety margin.”

The push for new heights in medication standards is clear evidence of the priority SingHealth places on patient safety.

Page 4: Tomorrows Medicine November 2013

PAGE 4 tomoRRoW’S mEdICInE - ISSUE 4, NovEmbEr 2013

treatment and management plans for epilepsy focus principally on the prevention of seizures. While 60 to 70

percent of children with epilepsy can have their seizures controlled with medication, the remaining may occasionally still have seizures.

When a child experiences an epileptic seizure, it is often a scary event for both the child and the caregiver. For children who have seizures occasionally or children newly diagnosed with epilepsy, caregivers can find it difficult to remember the correct care

procedures in times of emergency. This can compromise the safety of the child.

A collaborative team from KKH’s Neurology Service, Division of Nursing and Pharmacy

Department has introduced an Epilepsy Action Plan to help parents and caregivers manage their child’s seizures. Colour-coded for easy reference, the illustrated guide shows the appropriate first aid for seizures of varying levels of severity.

Dorothy Lee is a senior pharmacist at KKH who worked closely with Neurology Resource Nurse Clinician Martha Kao and the neurology team on the plan’s initiation and development. She said, “Parents are often overwhelmed with critical information on coping with epilepsy and first aid

management, and the child’s safety may be compromised if first aid medicine is not administered correctly in a timely manner.

This Epilepsy Action Plan acts as a “safety

net” that parents can fall back on after they leave the hospital.”

Before its roll out, the Epilepsy Action Plan was given to 35 caregivers of children with epilepsy or seizures to test its efficacy. On a verbal questionnaire, these caregivers demonstrated an improved knowledge of 12 per cent after receiving the plan.

Over the following months, newly diagnosed patients who received the plan did not make any calls to KKH on seizure first aid and management, nor attended the hospital for seizures that did not need immediate medical intervention. In comparison, queries related to seizure first aid and management constituted 14 percent of all enquiries from

caregivers who did not receive the plan and 28.6 per cent of them sought treatment at the hospital.

The plan was also well-received by healthcare providers. Of 36 doctors, nurses and pharmacists surveyed, all agreed that the plan was an efficient way to maintain high standards in counselling and education on seizure-related first aid to caregivers.

Neurology Resource Nurse Clinician Martha Kao has given several educational talks to teachers and caregivers at schools and childcare centres. She shared, “Since its implementation, the plan has empowered many patients’ families, caregivers and school teachers to provide appropriate

Seizing the day for epilepsy managementKKH’s epilepsy action plan gives essential first aid knowledge to caregivers

This Epilepsy Action Plan acts as a “safety net” that parents can fall back on after they leave the hospital.

– Dorothy Lee

Patient presents prescription at the outpatient registration counter

Packed medication are put in the RFID-

tagged basket, back onto the conveyor belt

A pharmacist reviews the prescription and puts it in

an RFID-tagged basket, which goes onto a conveyor belt

Medications are automatically assembled and channelled to the dispensing counter based on sequence

A pharmacist verifies the packed medication and dispenses it to the patient

RfId technology and automated system at SGH

outpatient pharmacy

What is RFID?

Radio frequency identification (RFID) is a wireless way to transmit data to identify and track individual objects. Some common usages include contactless cards and library borrowing systems.

Medications belonging

to the same patient are

detected

Page 5: Tomorrows Medicine November 2013

Traffic lights for epilepsy care

The Epilepsy Action Plan is systematically designed to allow caregivers easy access to picture guides for the appropriate positioning of the child and medication administration, using traffic light colour codes according to severity.

Each plan is personalised with the type, dosage and frequency of medication for short and prolonged seizures.

PAGE 5tomoRRoW’S mEdICInE - ISSUE 4, NovEmbEr 2013

Staff of SingHealth institutions seek to put patients at the heart of all they do, and the role of the newly formed

OST is to work with them to further improve processes across institutions.

In some cases, this entails working with stakeholders to review current processes and systems, and redesigning them to be more patient-centric, value-driven, and sustainable. The objectives are better outcomes for patients, delivery of care at the appropriate setting, smoother processes and a more positive patient experience.

One of the projects that OST is working on, in close partnership with the medical social workers (MSWs) and Group Allied Health, is to align the assessment for Medifund across the different SingHealth institutions, starting with the SGH Campus.

Often, needy patients have to undergo multiple assessments when applying for assistance at different institutions. This will soon change as patients will need to undergo only one assessment that is valid for six months across the SGH Campus. Staff also benefit as MSWs will spend less time assessing repeat cases, and more time on new assistance cases.

Good progress has already been made on this, as they now have a shared Financial Assistance Memo that allows a single Medifund assessment. This is just the first step as it covers only the straightforward, fully-assisted cases.

The taskforce is working towards sharing the assessment for all Medifund cases (including non-straightforward cases, inpatient cases and non-standard drugs). This means that needy patients need not apply multiple times for financial assistance from institutions within SGH Campus.

Associate Professor Celia Tan, Group Director of Allied Health, SingHealth and co-chair of the One MediFund Assessment taskforce, said, “This is an important initiative which will allow MSWs across SingHealth to work together to improve patient service. The OST team has brought a fresh dimension to the team discussions with their systems

and strategic framework of problem solving. Despite the very busy and tight schedules of the MSW leaders, Group Allied Health and OST, it was amazing that much was achieved in a short period.

“This was because everyone was working synergistically with wonderful leadership and teamwork displayed by all.” The co-leads of the workgroup are Ms Esther Lim and Ms Genevieve Wong, Head MSWs of SGH and NHCS respectively.

Other OST projects in partnership with internal stakeholders across the various SingHealth institutions includes improving the appointment booking process across SingHealth institutions with the various Operations teams, and reducing waiting times for lab services at polyclinics with SGH Pathology and SHP.

The focus on such projects will have significant impact on patient service and transcend institutional boundaries. OST will take up selected projects in single institutions, if these can be scalable cluster-wide, have learning extendable to other institutions, or if there is leadership consensus for OST’s involvement.

taking steps in our patients’ shoesThe Office for Service Transformation (OST) will partner SingHealth Institutions to improve patient experience

and holistic care to children with seizures. It has also helped to dispel caregivers’ misconceptions about epilepsy and its management.”

Dorothy further shared, “We are very encouraged by how the plan has not only empowered caregivers in the administration of first aid medicine, but also impacted schools and the community, whose support is critical in ensuring safety for the affected child.”

Green for short or no seizures

Yellow for seizures lasting more than five minutes, or a cluster of seizures (three or more seizures

within an hour)

Red for life-threatening seizures requiring immediate medical

attention and intervention

Closed loop medication

management system at KKH

Pharmacist’s validation of medication order

Bedside verification and medication administration

Patients will need to undergo only one assessment that is valid for six months across the SGH Campus.

Packed medication are put in the RFID-

tagged basket, back onto the conveyor belt

A machine (top left) automatically picks and packs the medications based on

information carried by the RFID tags. If manual packing is required, a pharmacy

technician scans the barcode on the prescription label and LED lights flash to indicate the drug’s location (bottom left)

Automatic packing process

RFID readers along the conveyor belt

track the medication’s

position and processing

stage in real time

robotic system packs medication according to

unit dose

Patient medication with barcoded label is

delivered

Inpatient electronic prescription order

Page 6: Tomorrows Medicine November 2013

ndCS ramps up on research

PAGE 6 tomoRRoW’S mEdICInE - ISSUE 4, NovEmbEr 2013

nDCS is not a new player in the research scene. The dental centre has been cultivating investigative

projects for the past two decades, and with strategic research initiatives in hand, NDCS aims to garner more regional and international recognition.

Dr Goh Bee Tin, Head of Clinical Research at NDCS, envisions the centre being more

competitive in obtaining research grants and ultimately drawing like-minded talents to choose NDCS as their training destination.

Her vision is followed through with the key appointments of two research consultants - Professor Teoh Swee Hin, Head of Division of Bioengineering at Nanyang Technological University, and Professor Niklaus P Lang, Professor Emeritus at University of Bern, Switzerland.

Dr Goh said, “They are here to advise on research studies, identify flaws early and ensure credible methodologies.”

By nurturing and inspiring a pool of clinician researchers, the centre hopes to first increase the number of significant research papers published in top journals and from there, lead the way to new discoveries that improve patients’ lives.

Prof Lang arrives with some 520 publications to his name amassed over a period of 40 years. The firmly established researcher has a history with the institution that dates

back 15 years. Beyond his specialty in periodontology and implant dentistry, Prof Lang has gathered enough experience to advise and guide extensively across the different specialities.

Since his appointment, Prof Lang has helped NDCS roll out the Residents Research Incubators Programme, a three-year programme designed to guide masters students on their research theses.

Prof Lang’s influence also extends beyond the incubator programme, with results promising to improve patient care.

In a recently concluded study under Prof Lang’s mentorship, Dr Tan Wah Ching, consultant at NDCS’ Department of Restorative Dentistry, revealed that the antibiotics used to prevent infection in single implant surgeries on otherwise healthy patients should be avoided as the risk outweighs the benefit. His discovery not only saves cost, but also reduces unnecessary risks for the patient.

Dr Ken Tan, a senior consultant in the same department has published 15 systematic reviews also under Prof Lang’s mentorship, some of which are now taught to residents.

And Prof Lang is not looking to stop at just these two.

Noting that NDCS has strong infrastructure support in place, efficient review processes and now a strategic commitment made to research, Prof Lang is confident that there is a high potential to put the centre on the research map.

He is also passionate about improving research outcomes and believes that research has the potential to make a tremendous impact on policy making.

He said, “Research must make sense to the community. If research does not percolate down to the right level – to the patients – it means nothing.”

Strategic developments at NDCS guide and inspire a research culture

Research must make sense to the community. If research does not percolate down to the right level – to the patients – it means nothing.

– Prof Niklaus P Lang

Between the SERI and Duke-NUS, a significant quantum of project data flows through the research

administration offices each day. Responsible for tracking entire research project lifecycles, the respective teams faced growing challenges supporting the highly active and vibrant research work churned out each day.

With an eye on future needs, SERI and Duke-NUS each sought to independently develop a research database management system that could ease the manual data crunch as well as increase the productivity and efficiency of research administrators.

However, recognising that a collaboration could result in a more robust system, the two institutes worked together on one geared towards cluster-wide implementation. The combined research database management system is slated for completion in early 2014.

Lydia Tan, Director, Sponsored Research, Duke-NUS said, “Duke-NUS’s focus on basic science research modules is an ideal fit with SERI’s clinical modules. Together, the new chimera system leverages both our strengths to serve a greater, cluster-wide purpose.”

Sharmila Kannan, Director, Administration, Research Affairs & Support Services at SERI shared, “Our partnership truly epitomises cluster values of innovation and collaboration. SERI and Duke-NUS have come together to innovate, automate and commercialise a licensable system that will benefit the entire SingHealth-Duke-NUS research ecosystem.”

The new robust system allows detailed data capture of all key parameters in a research project such as grants, clinical

trials, researcher CVs, research agreements, approvals and accreditation. For example, research administrators can easily identify co-researchers with common research interests to embark on projects together, and retrieve their CVs if necessary.

The highly flexible system also allows administrators to generate customised reports for funders and senior management for strategic planning and receive alerts on flagged items such as low recruitment numbers or contract expiry dates.

Lydia shared that the combined user-friendly system has potential to transcend the cluster and be utilised by all and any research administration offices including within hospitals, tertiary healthcare centres and also academic and research institutes, with early interest already being received.

“With diverse functional modules and levels of access rights, certain data modules could be further extended to principal investigators and researchers to self-monitor and extract data for their own grant progress reports or applications,” she said.

Sharmila added, “As one of the pioneer research institutes, SERI has a treasure trove of research data encompassing 1,069 studies from as early as 1997. Rather than compete, we chose to collaborate with each other. As a result, we have created a superior and far more valuable research database management system that can benefit the entire cluster and beyond.”

Combined forces for research administrationSingapore Eye research Institute (SErI) and Duke-NUS collaborate to launch and commercialise cluster-wide research database management system

dr Goh Bee tin and Prof niklaus P lang

Research administrators can easily identify co-researchers with common research interests to embark on projects together, and retrieve their CVs if necessary.

Top row from left to right:Jillesica lee, Zhou ting, Sangeetha nagarajan, teh Hoe leng, Karen Haybottom row from left to right:Chung Wing yi, lydia tan, Sharmila Kannan, lim lee yan

Page 7: Tomorrows Medicine November 2013

High Speed Lab Automation System• Specimen Transportation Conveyor (4 lanes, RFID-enabled)• Archival Stockyard (2 units of 5,400 tubes each)• Decapper and Aliquoter

STAT and Routine Tests• More than 1.4 million specimens• More than 9 million tests• Round-the-clock operations• Services for clinics, hospital and labs across Singapore

Analysers• Chemistry Analyser

> Designated for STAT tests (up to 1,200 tests/hour)• Chemistry Analyser

> 2 units for STAT and Routine tests (up to 4,000 tests/hour each)

• Immuno-assay Analyser> 2 units (up to 4,000 tests/hour each)

three years ago, SingHealth Polyclinics rolled out its TeleCare service (TLC) – a chronic care management service

that delivers follow-up care via telephone calls by dedicated nurses. Extending the provision of care beyond the clinic, the service aims to continue care delivery in between doctor visits.

1,800 patients have enroled in TLC – Well Controlled programme since its launch, while more than 600 have enrolled in the TLC – Insulin Initiation programme.

TeleCare nurses have also succeeded in assisting patients to adjust their insulin doses remotely based on their home sugar monitoring under the TLC – Insulin Titration programme which started in February 2013. To date, more than 40 patients with diabetes have participated, with 85 per cent showing a marked improvement in their condition.

The service has improved patient satisfaction since its implementation. Not only has TeleCare reduced the need for frequent trips to the clinics and waiting times, patients exercise self-management on their own terms and gain greater independence over their condition.

Professor Andrew Farmer from the Department of Primary Health Care Sciences, University of Oxford, is a visiting expert

under the Health Manpower Development Plan scheme. He has been passionately involved in bettering the delivery of care through technology in the UK. He shared on what more can be done at SingHealth, and the medical community in general, in this blossoming area of healthcare.

He said, “There are exciting developments in the area of telemedicine and a rising demand for these new forms of healthcare. We are collaborating with patients, doctors and engineers to develop systems that are easily usable by patients and can fit into the clinician’s way of working. “We aim to make care easier and more convenient for the patient. Doctors can receive real-time updates from patients remotely and while on the go. Basic care can be immediately dispensed over the phone. All these will transform care the way we know it.”

Data will also be an important outcome of telemedicine, with considerable impact. Prof Farmer highlighted, “With telemedicine, we have a huge opportunity to collect large amounts of reliable, real-time patient data. This intelligence can then be used for research; to create better outcomes and enhance healthcare management.

“It is clear that in the future, there will be a variety of ways that people can interact with the healthcare system and benefit from its extensiveness. It is about ensuring that healthcare is tailored and focused on the needs of the individual.”

PAGE 7tomoRRoW’S mEdICInE - ISSUE 4, NovEmbEr 2013

Sharing the psychology of giving

Philanthropy plays a big part in advancing initiatives in research, care and education. The SingHealth

Institutional Development Council (IDC) was set up in July last year to further this objective of Academic Medicine.

IDC comprises development officers from the different institutions in SingHealth and Duke-NUS. They work together to promote collaborative major gifts fundraising, share information and best practices in healthcare philanthropy, and coordinate approaches by different institutions towards potential major donors.

On 18 September, IDC held its inaugural retreat at Academia. Three invited fundraising

veterans shared their insights on the pursuit of philanthropic gifts. One of them recounted his unique experience of being both an active donor and an effective volunteer fundraiser. He also shared his view on the psyche of giving and dished out practical tips on how to map and achieve fundraising goals.

Participants learnt strategies on pursuing annual giving as a foundation of fundraising efforts, the art of establishing goals and attributes for success in fundraising efforts as well as touchpoint management for donors. These dialogues serve as resources for the IDC members to develop fundraising strategies and initiatives in their own institutions and ACPs.

SingHealth development offices coordinate fundraising efforts

Smart care with telemedicinevisiting expert Professor Andrew Farmer discusses what more can be done to personalise healthcare through telemedicine

the SGH Department of Pathology’s new home at Academia consolidates its nine laboratory services at close proximity to SGH and Duke-NUS, allowing for implementation of lean workflows, automation technologies and digital pathology.

The Clinical Biochemistry Laboratory on level 8 integrates state-of-the-art automated analytical processes with cutting-edge technology to offer a large repertoire of tests that complements the wide spectrum of services in SGH.

The lab is the largest in Singapore, handling 1.35 million specimens and performing 8.8 million tests in 2012.

SGH Pathology: Clinical Biochemistry LaboratoryAcAdemiAAT

It is about ensuring that healthcare is tailored and focused on the needs of the individual.

– Prof Andrew Farmer

Page 8: Tomorrows Medicine November 2013

tinkering away in the labs of Academia is the Surgery ACP’s Device Development Office (DDO). The

department finds and creates strategies to move solutions through regulatory and reimbursement processes to actualise medical devices that have a direct impact on patient care.

One such device is the Mona Lisa that was developed in collaboration with engineers from Nanyang Technological University. Mona

Lisa is a robot that can help doctors detect prostrate cancer more accurately and safely.

Following such success, the work of the DDO is now in the process of being translated cluster-wide as the Medical Technology Office (MTO), which aims to replicate similar discoveries on a broader

scale. The DDO was conceived by Professor London Ooi, Chairman of the Surgery ACP, and is now led by Dr Henry Ho, Consultant, Department of Urology, SGH. For Dr Ho, the DDO realises SingHealth’s Academic Medicine vision through a different way from the traditional publications and poster presentations.

He said, “The DDO is a pathway from academic discovery to commercial phenomenon. We create a runway for ideas to flow through, transform and become medical devices directly beneficial to patients.

“What we do is match-make clinical ideas to their industry partners to turn clinical ideas into reality for patient benefit.”

With discoveries in basic science generally taking longer to materialise, the DDO focuses on inventions that can be applied to the patient in a shorter span of five to ten years.

Dr Lim Chee Tiong, Head of Academic Affairs at the Surgery ACP, added, “Basic research is extremely important for new discovery and advancement of knowledge and technology.

“But within a hospital setting, there will be more focus on translational research. Device development falls in this line, especially with the emphasis on medtech nationally.”

Dr Ho shares the need for a creative academic environment where ideas can be nurtured, “Out of ten or 20 ideas, only one is ready to go to market. But it is not a sure-kill exercise. Within the campus, there must be a vibrant academic ecosystem where all sorts of ideas can thrive.”

The ‘Tinker Studio’ started by Surgery ACP at Academia works towards creating such vibrancy.

In this open, interactive space, clinician scientists, surgeons and engineers can talk and experiment with prototypes and tools. Acting like a garage and meeting space, it infuses the factors of fun and relaxation important to creativity.

Looking towards the future of medtech, Dr Ho remarked, “SingHealth is gearing up to become a powerhouse of medical technology. The current wave of bioengineering students is going to come to us in three to five years, hungry to drive projects. We need to invest in their talent and the infrastructure to welcome them.”

tomoRRoW’S mEdICInE - ISSUE 4, NovEmbEr 2013PAGE 8

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medical technology for improved patient careSurgery ACP’s Device Development Office brings innovative solutions to the bedside

The DDO is a pathway from academic discovery to commercial phenomenon.

– Dr Henry Ho

dr Henry Ho (second from left), dr lim Chee tiong (third from right) and the Device Development Office

Grant Closing Date Grant Amount

National Medical Research Council (NMRC) Nov 2013 Grant Call

1. Singapore Translational Research (STaR) Investigator Award

2 December 2013, 5pm

Grant support of up to $5 million for 5 yrs + PI’s salary support of up to $600,000 per yr + Start-up fund of $500,000

2. Clinician Scientist Award (CSA)

i) Investigator (INV) category: PI’s salary support + Grant support of up to $675,000 for 3 yrsii) Senior Investigator (SI) category: PI’s salary support + Grant support of up to $1.75 million for 5 yrs

3. Transition Award (TA) PI’s salary support + Grant support of up to $375,000 for 3 yrs

4. Clinician Scientist Individual Research Grant (CS-IRG) Up to $1.5 million for 3 yrs

5. CS-IRG New Investigator Grant (CS-IRG-NIG) Up to $200,000 for 2 yrs

6. Cooperative Basic Research Grant (CBRG) Up to $1.5 million for 3 yrs

7. CBRG New Investigator Grant (CBRG-NIG) Up to $200,000 for 2 yrs

8. Health Services Research New Investigator Grant (HSR-NIG) Up to $100,000 for 2 yrs

9. Communicable Diseases - Public Health Research Grant (CD-PHRG)

2 January 2014, 5pm Up to $1 million for 3 yrs

10. Ministry of Health Industry Alignment Fund (IAF) Category 2

29 January 2014, 5pm Up to $3 million for 3 yrs

Singapore Sports Science & Technology Research Grant Call

15 November 2013, 5pm

Up to $50,000 for ≤ 1 yrUp to $100,000 for ≤ 2yrsUp to $200,000 for ≤ 3 yrsUp to $400,000 for ≤ 4 yrs

Singapore Heart Foundation (SHF) Research Grant Call 6 December 2013

< S$60,000 for 1 selected research project for up to 2 yrs

< S$80,000 for 3 selected research projects for up to 2 yrs

SIgN-NTU Immunology PhD Program

1. Singapore International Graduate Award (SINGA) 13 December

2013$2,000 to 2,500 per month for 4 yrs

2. A*STAR Graduate Scholarship (AGS) $3,300 per month for 4 yrs

Research Grants For more information on funding sources and support for research in SingHealth, visit http://research.singhealth.com.sg or email [email protected]

AM•EI EventsFor details and registration, contact the Academic Medicine Education Institute (AM•EI) at [email protected]

AM•EI EDUCATION GRAND ROUND 14 Nov, 5.30pm-6.30pm: Knowledge Structures: What they are and how can they be used in Medical education?

FACULTY DEVELOPMENT WORKSHOPS7 Jan, 1.00pm-5.00pm: Creating a positive learning experience21 Jan, 1.00pm-4.00pm: Why keep your plans a secret? Designing effective objectives and their links to quality multiple choice questions5 Nov, 1.00pm-4.00pm: Making learning sessions engaging – the role of facilitation in group teaching environments

AmRI EventsFor details and registration, contact the Academic Medicine Research Institute (AMRI) at [email protected]

13 Nov, 9.00am-6.00pm:Linear & logistic regression in SPSS software