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Using IT to Support Quality and Affordable Healthcare


The thrust of the National Computer Board's efforts in the healthcare sector is to put in place an infrastructure to support the use of IT in medicine and provide a life-long medical record for each Singaporean. This is aimed at ...

The thrust of the National Computer Board's efforts in the healthcare sector is to put in place an infrastructure to support the use of IT in medicine and provide a life-long medical record for each Singaporean. This is aimed at improving the quality of healthcare as well as keeping healthcare costs affordable. In the past year, the NCB has been working with healthcare institutions and government agencies to realise this goal.

Life-long Medical Record

The NCB has been promoting the concept of a longitudinal medical record (LMR) system to the healthcare community in Singapore. Patients visit several medical practitioners in their lifetime. Hence, their medical records tend to be fragmented and exist in numerous locations. There is an increasing need to aggregate key medical data into a longitudinal, or life-long, medical record that can be made available to the healthcare provider where and when it is needed. This will provide continuity in care, resulting in better healthcare delivered. Costs can also be contained in the long run as there will be fewer duplicate medical tests and medical resources can be optimised.

Electronic Medical Record Systems

As a first step to realising a life-long medical record system for Singapore, the NCB is facilitating the implementation of electronic medical record (EMR) systems within local healthcare institutions. With electronic medical records, patients' medical information can be retrieved concurrently and shared across different departments easily. EMR initiatives have been started at the Singapore General Hospital (SGH) and Tan Tock Seng Hospital (TTSH). EMR implementation in SGH is expected in the third quarter of 1997. TTSH has already piloted EMR in its Eye Clinic and is looking at expanding EMR implementation to its other outpatient settings. With EMR, voluminous paper-based records, repeat medical tests and procedures, and unavailable medical records will be a thing of the past.

A&E Clinical Support System

To provide more efficient health services within healthcare institutions, the NCB is also working with SGH, TTSH and Knowledge Engineering Pte Ltd to develop a clinical support system for the hospitals' Accident & Emergency Departments (A&E). Work on the system will begin this month and implementation is expected in mid-1998. The system will support the entire process of the A&E encounter - from patient registration, triage, and consultation with the doctor, to the booking of follow-up appointment, payment for consultation and collection of medication. For the patients, the system will mean faster turnaround in the A&E as a 30% improvement in patient throughput is expected. The average waiting time for medical reports will be reduced to one week compared to the current two to four weeks. For the staff in the A&E department, the system will allow them to monitor the movement of patients, receive test results from the hospital's laboratories on their desktops, and to have concurrent access to medical records.

Teleradiology Pilot

The NCB and SGH are co-funding a teleradiology pilot to determine the clinical acceptability and cost effectiveness of remote diagnosis, reporting and consultation of medical images such as X-rays, computed-tomography scans (CT-scan) and magnetic resonance imaging (MRI).

The proposed teleradiology system will enable a patient to have his X-rays taken at the polyclinic or community hospital and then transmitted to a remote reading centre situated at the Singapore General Hospital for analysis. It will support expert consultations between radiographers and specialists in the event of complex cases.

Development of the teleradiology system has started. Links will be established between the Department of Diagnostic Radiology of the SGH, Geylang Polyclinic and Ang Mo Kio Community Hospital by the end of this year. These links will support primary diagnosis and expert opinions of X-ray images for an estimated 55 patient examinations per day when it is fully operational by the end of 1997. This represents 30% to 50% of patient examinations handled at the two sites. A link will also be set up between the A&E Department of SGH with a specialist at home to pilot after office hour specialist care. Transmission of computed-tomography scans and magnetic resonance images will be explored in the second phase, scheduled to begin in July 1997.

Central Appointment and Referrals System (CARES)

The NCB is also looking into piloting a Central Appointment and Referrals System to streamline and automate the workflow and exchange of information between primary care practitioners with specialist centres and hospitals.

For a start, CARES will allow GP clinics and polyclinics to electronically search an online directory of specialists, submit referrals and book outpatient appointments with participating hospitals and specialist centres. Hospitals and specialist centres can send discharge information back to the primary care practitioners using CARES. The system will lay the foundation for an infrastructure that links the primary and tertiary care providers to support the implementation of shared care programmes in Singapore.

The National University Hospital (NUH) and Kandang Kerbau Hospital (KKH) will be the first to pilot CARES in the fourth quarter of 1997. Requirements study will begin in December 1996. The IT industry will be invited to collaborate with the NCB and the participating hospitals in May 1997.