Technology that enables better, safer healthcare

INNOVATIVE technology solutions that are deployed in hospitals and health institutions are playing a critical role in helping doctors, nurses and other practitioners give better care to patients across Singapore’s healthcare landscape.

The public health structure essentially comprises the National Healthcare Group and the SingHealth Group. Together, they operate seven public hospitals – the Singapore General Hospital, National University Hospital, Changi General Hospital, Tan Tock Seng Hospital, Alexandra Hospital, KK Women's & Children's Hospital and the Institute of Mental Health.

There are well over 6,700 doctors, 1,200 dentists and 20,100 nurses, supporting the country’s healthcare delivery system.

As IT director Ho Khai Leng of the National Healthcare Group points out, technology has been well-established in much of the core capability that any major healthcare organisation requires. Looking ahead, the next step is to organise an overall IT framework and structure, he says, during a presentation on Oct 17 for ICT vendors.

Grand vision

In his wide-ranging presentation, Mr Ho lists out future and immediate requirements where technology is indeed the enabler to realise the ultimate goal of a comprehensive, effective national healthcare delivery for all citizens both in and out of hospitals and clinics.

This grand vision comes under the Healthcare Call-for-Collaboration (CFC) project that is intended to bring healthcare providers and the infocomm technology companies together to develop and pilot innovative solutions and products. The project is the brainchild of the Ministry of Health, the Infocomm Development Authority of Singapore and the Enterprise Challenge under the Prime Minister's Office.

Such a framework, says Mr Ho, would include creating a central clinical depository and master database, for instance. It would also include dashboard capability serving the care providers as well as patients and their family members. “An intelligent dashboard by the bed would give real-time information on the patient,” he says.

However, he points out that capturing data in the healthcare context is not straightforward. “How do you capture X-ray images so that you can share them across the hospitals?” Mr Ho asks.

Mental wellbeing for all

His second priority is in mental health, basically in using technology, such as the Worldwide Web, to facilitate the promotion of mental wellbeing among the general public, and the delivery of mental health services within the institution or in the community.

Promoting mental wellbeing is new in Singapore. Mr Ho suggests using games to educate the public, and having online assessment tools that any ordinary citizen can use.

Chronic disease management

Singaporeans are living longer but they are also sick for more years, according to a Ministry of Health study. An average woman can expect to live to nearly 82 years and the man to 78 years, but both men and women will spend eight years in poor health!

The culprits for this depressing state are heart disease and stroke, cancer, diabetes and mental illness.

Hence, we can expect more people suffering from chronic illness, as the population ages. Thankfully, technology can play various specific functions in managing patients suffering chronic disease. Mr Ho gives three IT-based solutions: (a) an infrared ray detection system to alert nurses when a weak patient attempts to get out of bed; (b) a mobile arrhythmia detection system using the cell phone to detect abnormal heartbeats when the patient is outside the hospital, and (c) a radio-frequency identification system or RFID to double-check the counting of sponges in the operating theatre after surgery.

RFID, of course, is being widely used among retailers in checking and recording inventory. With a bit of creative thinking, it can be used in keeping track of the many bits and pieces of instruments and accessories that are required during surgery, and to ensure that nothing ends up inside the patient’s body!

Again, using the Web, Mr Ho envisages a patient’s safety site where doctors and nurses can help manage chronic patients remotely. “You can use the site to do video-conferencing with patients at home, making sure they do their treatment procedure correctly, such as insulin injection, using an inhaler or changing their wound dressing.”

Tech-savvy patients

The rise of tech-savvy and health-wise patients by year 2020 is another important consideration for healthcare providers and their technology vendors, says assistant IT director Alvin Ong of the SingHealth Group. Speaking on the same CFC theme, Mr Ong points out that patients would want evidence-based management of illnesses, personalised therapies and having their lifelong medical history accessible to them via an Internet-based Personal Health folder. This kind of healthcare goes beyond the confines of a hospital, he says.

For hospitals and healthcare groups to transform themselves into digital health services providers, they would require hospital enterprise applications, research and education and innovative solutions, Mr Ong explains. Innovations include telemedicine, the so-called digital wards and digital clinics.

Taking into account the tech-savvy patient, Changi Hospital, for instance, is having a self-service patient kiosk and KK Hospital is installing the intelligent patient room.

The CFC project is part of the “Intelligent Nation 2015” (or iN2015 in short), a blueprint to realise the vision of an intelligent nation, a global city underlined by an IT network, says IDA deputy director Low Aik Lim. He says IDA will provide funding to help local IT vendors lower the cost of their products and applications, for example, to the network of private GP clinics spread across the island.

In summing up, IDA director for healthcare and social cluster, Mrs Lim Bee Kwan, says the CFC project will cast a wide net, covering three areas: the delivery of safer care, enhancement of the quality of care (e.g. helping doctors in decision-making), and in greater efficiency in operating healthcare enterprises.

“We’re looking for pilot solutions that are original, comprehensive, and have the potential to be rolled out on a larger scale,” she adds.

Better decision-making for doctors

PATIENTS will be provided with the quality of care according to the best medical science available today (such as the availability of timely information to support decision-making).

This is the promise and vision of the Call-For-Collaboration Healthcare Project for 2007.

One key benefit when the CFC project is realised is better decision-making. For example, visibility of patients’ medical history allows the principal physician to manage and coordinate the overall care of patients with chronic diseases who may require treatment from different specialists across the healthcare system.

Since the previous Healthcare CFC issued by IDA in September 2005, 12 innovative projects were supported and a majority of pilot projects are moving to the next phase. Some of the 2005 innovations are:

• A project by the National Skin Centre to allow doctors to describe patients' conditions diagrammatically with precise location of the clinical findings in electronic form. All annotated charts are integrated with the centre's Electronic Medical Record systems and retrievable during consultations. The project has led to better patient care because doctors can now record more accurate information to chart progress of skin disorders.
• Singapore General Hospital’s integrated wireless monitoring system that automatically captures a wide range of patients' vital signs, namely blood pressure, pulse rate, electrocardiogram, oxygen saturation, respiration rate and temperature in its Digital Ward.
• GinX or Geriartric In-Patient Nursing Record for Efficient Ward Management and Nursing Information Exchange at Ang Mo Kio Thye Hua Kwan Hospital. The aim is to eradicate patient’s medication errors. During patient’s first admission, the doctor creates an electronic inpatient medical record (eIMR). The eIMR enables the doctor to record his diagnosis, the medication, drug allergies, alerts and other information pertinent to a patient. During administration of drugs, this information is accessed wirelessly from the server and processed on a PDA with barcode and RFID capabilities. The Electronic Inpatient Medical Record can be shared within the hospital and also nationwide.

• Changi General Hospital’s Inpatient Vital Signs Monitoring System (VSM) at its Cardiac Ward. The aim is to record and monitor the vital signs of patients in the cardiac ward, using Bluetooth-enabled vital sign sensors and the hospital’s Wi-Fi network. The solution enables doctors to monitor the patient anywhere in the hospital. Currently most of the solutions available use proprietary body sensors; VSM on the other hand is based on an open platform, which enables the hospital to connect to variety of sensors from different manufacturers.

  At a networking session on Oct 29 2007, more than 30 technology providers – both large multinationals such as Oracle, SAP and even SingTel, and small, niche players – present their products and prospective solutions.

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