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Unleashing the Benefits of a National EHR Dr Sarah Muttitt Chief Information Officer Information Systems Division [email_address] Oct 16, 2008
Singapore: a small country….. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Achieving Positive Health Outcomes with Low Expenditure Affordable healthcare expenditure at about 3-4% of GDP (1% is government spending)  Top-ranked overall healthcare system by WHO (6 th  overall) -  World Health Report 2000   1 st  for infant mortality, 8 th  in life expectancy, 20 th  for health and primary education and 15 th  in terms of social parity in health care quality -  The  Global Competitiveness Report 2006-07  (by WEF)   3 rd  in health infrastructure; 4 th  in terms of impact of health problems (AIDS, drug, alc abuse etc) on companies -  The  World Competitiveness Yearbook 2007  (by IMD)   1/3 of JCI-accredited hospitals in Asia are from S’pore - All 7 public hospitals achieved JCI accreditation Clinical expertise recognized internationally with many “Firsts’  Attracted internationally known partners such as Johns Hopkins, St Jude Children’s Research Hospital, Duke University and JCI regional HQ
Individual Financing Government Healthcare Expenditure ,[object Object],[object Object],[object Object],Healthcare Financing in Singapore Employer benefits Medi- save Cash* MediShield & Elder- shield Medi fund Government Subvention National Healthcare Expenditure (NHE)
Singapore’s Healthcare Delivery Eco-system Primary Healthcare - 18 Polyclinics (22%) - Private GP Clinics (78%) Secondary & Tertiary Specialist Care -  7   Restructured Hospitals  & 6 specialty centers (80%)   - 16 Private Hospitals (20%) Public sector Private sector People sector Patients have freedom of choice to choose any providers of care  in various sectors Step-down & Long Term Care -  Voluntary welfare Organizations (70%) - Private Healthcare Organizations (30%)
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Healthcare Drivers
Healthcare Budget Continuing and Growing Government Investment in Healthcare More capacity Sustained excellence Better capabilities Increasing manpower New or expanded infrastructure Exploitation of IT Integration of Care Medical excellence and specialization Translational  and Clinical Research  Healthcare financing reforms New  governance structures
GPs as Long Term Patient Advocates Holistic Patient Centric Care Affordable Ageing-in-Place Active Health Management What a person needs at each stage Preventive Care Individual at home Primary Care Family Physicians Tertiary Care Hospitals Step-Down Care Nursing Homes Community Hospitals Healthcare System Optimization Integration of Care and Right-siting Hospice Community Care
Public Healthcare Sector MOH Holdings National Health Group SingHealth Group
Electronic Health Records  The International Scene   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Most industrialized countries have recognized the need to implement electronic health record solutions quickly to improve the quality and safety of patient care and system efficiency.
iN2015 Healthcare & Biomedical Sciences EMRX in Clusters GP Clinic Management Systems GP CDMP IT Capabilities EMRX extension to Community Hospitals These national initiatives have opened the clinical community to the potential clinical & operational benefits of HIE & greater coordination of Health IT at the national level.
EMRX - History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
EMRX - Today ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Where We Are Now Current Gaps Performance (Technical) ,[object Object],[object Object],Performance (Clinical) ,[object Object],Standards ,[object Object],Analytics ,[object Object],Reach ,[object Object],Privacy & Security ,[object Object]
Taking the Next Step (MSM April 2008) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Taking the Next Step – What’s the Big Deal? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Leadership & Governance Interoperability Change Management Accountability
[object Object],[object Object],MOHH Mission Centralise Treasury Corp Fin Advisory Compliance & Risk Mgt ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Legal Structuring Restructuring & Central Services Systems Coordination  Human Capital  Manpower Facilitation  & Recruitment Talent Development &  Management Leadership College Remuneration  & Benefits Branding & Marketing  Build Brandwidth International Media Outreach & Events Strategic Global Channel Financial & Corporate Governance
MOHH ISD Leadership & Governance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MOHH Master HIT Planning HIT master planning will support the national agenda for an Electronic Health Record by 2010 by facilitating strategic alignment at various Levels of the Healthcare System Organization Specific IT Capabilities Strategic Alignment National EHR & Related Integrative Projects
Clinical Leadership Clinical Quality & Informatics Partnership Co-chairs CIO MOHH Snr Dir Healthcare Performance Group MOH
Clinical Leadership Clinical Informatics Roadmap The Roadmap will articulate Clinical Focus Areas, Objectives …  and corresponding Health IT capabilities  (illustrative)  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],EHR & Extensions Continuity of Care ,[object Object],[object Object],[object Object],Medication Management ,[object Object],[object Object],Diagnostics ,[object Object],[object Object],Secondary Data Use ,[object Object],[object Object]
Interoperability Enterprise Architecture Clinical Informatics Privacy & Security National  Standards ,[object Object],[object Object],[object Object],Health Informatics Architecture
Illustrative Focus for EHR Illustrative Contribution of Acute Journey to EHR Outpatient Primary / Community Booking GP Referrals  Presentation  & Triage Care Delivery Testing Care Delivery Discharge  Co-ordination Transition Post Acute Care Testing Care Delivery Testing Arrival Emergency Inpatient Rehab. ,[object Object],[object Object],Primary / Community eReferral ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Interoperability Standards ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Change Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],“ The most remarkable feature about twenty-first century medicine is that we hold it together with nineteenth century paperwork.” US Secretary Tommy G. Thompson, Washington, D.C., May 6, 2004.
Accountability Develop the Business Case for HIT Investment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
EHR: Overall benefits and value Access ,[object Object],[object Object],[object Object],[object Object],Quality ,[object Object],[object Object],[object Object],[object Object],Productivity ,[object Object],[object Object],[object Object],[object Object],Capital cost: $10 billion – $12 billion Benefits:  $ 6 billion – $  7 billion in savings annually Source: Canada Health Infoway; Booz Allen Hamilton
Accountability Measure the Benefits  ,[object Object],Use Use Behavior/ Pattern Self Reported Use Intention to Use NET BENEFITS Quality ,[object Object],[object Object],effectiveness ,[object Object],Access ,[object Object],to access services ,[object Object],participation Productivity ,[object Object],[object Object],[object Object],[object Object],User Satisfaction Competency User Satisfaction Ease of Use Service  quality Responsiveness Information quality Content Availability System quality Functionality Performance Security
Timeline Overview Integration of Workstreams Identity Management EHR Business Case 2009-13 Block Budget for HIT GP IT Adoption Strategy Community Hospitals EMR National eHealth Portal Research Informatics Strategy National Drug Dictionary IT for new ‘hassle-free’ hospital Leverage national IT infrastructure & systems
ISD Timelines & Deliverables 3-year Projection FY08 Clinical & Business Strategy Information Architecture FY09 Funding Model  Data Stds Implementation FY10 National EHR Phase 1 Implementation Constitute advisory groups, taskforces Develop allocative funding projections for each functional area Longitudinal health record  with  summarized, aggregate data Articulate clinical priorities, informatics roadmap & enterprise architecture Monitor data standards implementations True semantic interoperability through standards based data model Develop core business, clinical-usage scenarios Develop business, clinical usage scenarios for emerging clinical services (e.g. AIC) Robust, extensible access controls & security framework Initiate harmonization activities for key data standards Centralized, scalable infrastructure Develop data privacy, security policies Dovetail with ongoing implementations Involve ongoing implementations in harmonization activities
The Promise of the EHR ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],A young boy waiting at  A&E, Tan Tock Seng Hospital
Thank You [email_address]
 

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Unleashing the Benefits of a National EHR

  • 1. Unleashing the Benefits of a National EHR Dr Sarah Muttitt Chief Information Officer Information Systems Division [email_address] Oct 16, 2008
  • 2.
  • 3. Achieving Positive Health Outcomes with Low Expenditure Affordable healthcare expenditure at about 3-4% of GDP (1% is government spending) Top-ranked overall healthcare system by WHO (6 th overall) - World Health Report 2000 1 st for infant mortality, 8 th in life expectancy, 20 th for health and primary education and 15 th in terms of social parity in health care quality - The Global Competitiveness Report 2006-07 (by WEF) 3 rd in health infrastructure; 4 th in terms of impact of health problems (AIDS, drug, alc abuse etc) on companies - The World Competitiveness Yearbook 2007 (by IMD) 1/3 of JCI-accredited hospitals in Asia are from S’pore - All 7 public hospitals achieved JCI accreditation Clinical expertise recognized internationally with many “Firsts’ Attracted internationally known partners such as Johns Hopkins, St Jude Children’s Research Hospital, Duke University and JCI regional HQ
  • 4.
  • 5. Singapore’s Healthcare Delivery Eco-system Primary Healthcare - 18 Polyclinics (22%) - Private GP Clinics (78%) Secondary & Tertiary Specialist Care - 7 Restructured Hospitals & 6 specialty centers (80%) - 16 Private Hospitals (20%) Public sector Private sector People sector Patients have freedom of choice to choose any providers of care in various sectors Step-down & Long Term Care - Voluntary welfare Organizations (70%) - Private Healthcare Organizations (30%)
  • 6.
  • 7. Healthcare Budget Continuing and Growing Government Investment in Healthcare More capacity Sustained excellence Better capabilities Increasing manpower New or expanded infrastructure Exploitation of IT Integration of Care Medical excellence and specialization Translational and Clinical Research Healthcare financing reforms New governance structures
  • 8. GPs as Long Term Patient Advocates Holistic Patient Centric Care Affordable Ageing-in-Place Active Health Management What a person needs at each stage Preventive Care Individual at home Primary Care Family Physicians Tertiary Care Hospitals Step-Down Care Nursing Homes Community Hospitals Healthcare System Optimization Integration of Care and Right-siting Hospice Community Care
  • 9. Public Healthcare Sector MOH Holdings National Health Group SingHealth Group
  • 10.
  • 11. iN2015 Healthcare & Biomedical Sciences EMRX in Clusters GP Clinic Management Systems GP CDMP IT Capabilities EMRX extension to Community Hospitals These national initiatives have opened the clinical community to the potential clinical & operational benefits of HIE & greater coordination of Health IT at the national level.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19. MOHH Master HIT Planning HIT master planning will support the national agenda for an Electronic Health Record by 2010 by facilitating strategic alignment at various Levels of the Healthcare System Organization Specific IT Capabilities Strategic Alignment National EHR & Related Integrative Projects
  • 20. Clinical Leadership Clinical Quality & Informatics Partnership Co-chairs CIO MOHH Snr Dir Healthcare Performance Group MOH
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29. Timeline Overview Integration of Workstreams Identity Management EHR Business Case 2009-13 Block Budget for HIT GP IT Adoption Strategy Community Hospitals EMR National eHealth Portal Research Informatics Strategy National Drug Dictionary IT for new ‘hassle-free’ hospital Leverage national IT infrastructure & systems
  • 30. ISD Timelines & Deliverables 3-year Projection FY08 Clinical & Business Strategy Information Architecture FY09 Funding Model Data Stds Implementation FY10 National EHR Phase 1 Implementation Constitute advisory groups, taskforces Develop allocative funding projections for each functional area Longitudinal health record with summarized, aggregate data Articulate clinical priorities, informatics roadmap & enterprise architecture Monitor data standards implementations True semantic interoperability through standards based data model Develop core business, clinical-usage scenarios Develop business, clinical usage scenarios for emerging clinical services (e.g. AIC) Robust, extensible access controls & security framework Initiate harmonization activities for key data standards Centralized, scalable infrastructure Develop data privacy, security policies Dovetail with ongoing implementations Involve ongoing implementations in harmonization activities
  • 31.
  • 33.