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

This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. 2M O H H o l d i n g s P t e L t d

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


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


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.


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)


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


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


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

“

”


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


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)

Innovation:Healthcare landscape of the future


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


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


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


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


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.


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)


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


Personal Health Record (PHR)


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


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


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

Health & Medicine

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