Singapore Healthcare Delivery and its Roadmap to Digital Health Mr Lim Hock Chye FinnBIZ Consultancy Date 23.09.16
Objective Digital Hospitals is a Team Finland growth program directed by Finpro. It serves Finnish companies working with technologies that improve the quality of care including efficiency, precision, reliability and safety not only in the hospital environment but also at home. Like Finland, Singapore also faces the challenges of an aging population and increasing costs of healthcare. It has undertaken many initiatives to tackle these challenges taking advantage of technology. This study is to analyse the current state of the art technologies adopted in Singapore and seek new business opportunities for Finnish companies in this sector. The assignment study is executed in close collaboration with the Embassy of Finland under the Team Finland spirit. 2
Contents Aging Population in Singapore Healthcare Systems Healthcare Financing Challenges in Healthcare Delivery Transforming Healthcare Delivery Through IT Technology Role of Digital Health Latest IT Systems at Public Healthcare Institutions Healthcare Masterplan 2020 Potential opportunities for Finnish solutions. 3
Aging Population In Singapore Singapore s population will age rapidly over the next 30 years. By 2030, 19% of its population will be aged 65 and above. There are currently about 6.3 citizens in the working-ages of 20 to 64 years, for each citizen aged 65 and above. By 2030, there will only be 2.1 working-age citizens for each citizen aged 65 and above. 4
Issues in Aging Population in Singapore. The ageing population is posing new challenges to Singapore's healthcare system. An increase in age-related degenerative disorders due to increased longevity would make it difficult for the family to care for their elderly in their own homes. Consequently, nursing homes may become increasingly relevant for families to cope with the burden of caring for a frail and dependent elderly. The elderly of the future will be better educated, more independent and a significant number will never have married. Most elderly persons are healthy and independent. Hence healthcare services will mostly cater to the senior citizens. Depression in the elderly is a major public health issue. The government s emphasis will be on health promotion and disease prevention. Many terminally ill elders prefer to die in their place of choice the home. While this will reduce acute care hospitalization, there will be end-of-life programs for the frail elderly. Most elderly adults care needs are complex and programs must be in place to improve coordination and continuity of care and reduce re-hospitalization and visits to emergency departments. Therefore, home visits for 1 to 2 months after discharge including coordination with other service providers (e.g. nursing homes etc) must be implemented. 5
Healthcare Systems Singapore healthcare system comprises of both the public and private healthcare. Healthcare Services are provided by both the government and the private sector. Currently, the public sector provides 80% of hospital care and 20% primary care. Public health services are subsidized through general taxation. Conversely, the private sector provides 20% of hospital care and 80% of primary care. Primary Healthcare Services In Singapore, primary health care is provided through an island network of outpatient polyclinics and private medical practitioner's clinics. There are 18 polyclinics and about 1,500 private medical clinics providing primary healthcare services. Hospital Services Singapore has 8 public hospitals comprising 6 general hospitals, a women's and children's hospital, and a psychiatry hospital. General hospitals provide multi-disciplinary inpatient and specialist outpatient services, and 24-hour emergency departments. Six national specialty centres provide cancer, cardiac, eye, skin, neuroscience and dental care. In the private sector, there are 10 private hospitals. 12/09/2016 6
Healthcare Financing Singapore offers universal healthcare coverage to its citizens, with a financing system based on the twin philosophies of individual responsibility and affordable healthcare for all. Through a mixed financing system, use of market-based mechanisms to promote competition and transparency and the adoption of technology to improve the delivery of healthcare services, It has been able to provide good healthcare outcomes for its people. Medisave is a national medical savings scheme which helps individuals put aside part of their income into their Medisave Accounts to meet their future personal or immediate family's hospitalization, day surgery and certain outpatient expenses MediShield Life is a basic health insurance plan, administered by the Central Provident Fund (CPF) Board, which helps to pay for large hospital bills and selected costly outpatient treatments, such as dialysis and chemotherapy for cancer Medifund is an endowment fund set up by the Government to help needy Singaporeans. 7
Changes in Healthcare Delivery Currently national healthcare expenditure is about 4% of Singapore s GDP, which is low among developed countries. However, this is expected to grow with an ageing population. With more elderly requiring care for longer periods, pressure on its hospital resources will increase as the population continues to age. In addition, more and more people are succumbing to chronic diseases, practising sedentary lifestyles that promote unhealthy habits and obesity. Therefore, innovative technology holds the key to safer, more efficient care; providing new forms of access to knowledge and with process automation, it will increase accuracy and timely intervention for the patients. The Ministry is also re-organising its healthcare system into Regional Health Systems (RHS). Each RHS will comprise an acute general hospital working closely with community hospitals, nursing homes, home care and day rehab providers, as well as polyclinics and private General Practitioners (GPs) within the geographical region. The aim is to provide seamless, hassle-free and holistic care. 8
Changes in Healthcare Delivery - Hospitals & Polyclinics Singapore will also build 4 more public hospitals by 2030 to cater for its aging population. The Ng Teng Fong General Hospital in Jurong was recently opened in Oct 2015 with 500 beds. Another 200 beds will be available in its community hospital section. The hospital is near Jurong East MRT and Jurong East Bus Interchange. Jurong Community Hospital and Yishun Community Hospital was opened in 2015 2018- The Sengkang General and Sengkang Community hospitals will be ready.- Located at the junction of Sengkang East Road and Sengkang East Way, the hospital complex sits on 6.9ha of land near public housing and will be linked to the Cheng Lim LRT station.- It will comprise a 1,000-bed general hospital and a 400-bed community hospital. They include 200 swing beds which could be used by either hospital. 2020- The Outram Community Hospital will be ready. 2020-2030- Four new general hospitals will be built. The Woodlands General Hospital is one of them. There will be up to 1,800 beds in a general hospital, community hospital and nursing home due to open in phases from 2022. The locations of the other three have not been identified. 9
Changes in Healthcare Delivery - Nursing Homes The government is increasing its capacity to meet the rising demand for senior care services. It will develop 10 new nursing homes by 2016 and another 9 more by 2020. These facilities will be developed through a Build-Own-Lease model whereby the Singapore government will build and own the nursing homes but will hold an open tender to select an operator to provide quality and affordable care. Some nursing homes provide a range of services to meet the needs of the residents. The services include medical care, nursing care, physiotherapy, dietary services and dental care. 10
Changes in Healthcare Delivery - Polyclinics Polyclinics in Singapore provide primary healthcare services including a range of services for the management of acute and chronic medical conditions, health education, childhood immunisation, vaccinations, X-ray and laboratory services to minor surgical procedures. Currently, there are 18 polyclinics and up to 12 more will be built by 2030. 11
Transforming Healthcare Delivery Through IT Technology Integrated Health Information Systems (IHiS) (incorporated in 2008) is a wholly-owned subsidiary of MOH Holdings (under the Ministry of Health) to manage and integrated systems and IT expertise across Singapore s public healthcare sector. This is to achieve greater synergies, consolidating public healthcare-it, demand for hardware and software and share innovative solutions across clusters. It is at the forefront of innovation, driving new standards in quality care. It focuses and synergises the IT resources of Singapore's six Regional Health Systems (RHS) to transform healthcare delivery across the country, for improved patient outcomes and cost-effective care. 12
Transforming Healthcare Delivery Through IT Technology Fragmentation of IT systems across healthcare institutions creates a number of issues that affect integration complexity, manpower sustainability, cost effectiveness and market viability. To manage this, IhiS established a clinical IT architecture policy for public healthcare institutions National Health IT Masterplan - IT Architecture 13
Role of Digital Health Singapore Healthcare 2020 Masterplan was launched in 2012. This strategy incorporates digital health tools that can help Singapore care for more residents who have gained universal coverage from expanded insurance plans, including seniors over 65 years old that will make up 20% of its population by 2030. Health IT projects in Singapore are being aligned to allow seamless sharing of digital information, easy access to providers, and greater self-management of chronic diseases at home and in the community. EHR/EMR Digitizing health records is a top priority. The National Electronic Health Record (NEHR) program is a linchpin for Singapore s Healthcare IT Master Plan. Launched in 2011, the NEHR system stores a unified medical record for every patient within and is used in more than 280 institutions by over 14,000 physicians. A high number of hospitals in Singapore have achieved HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) Stage 6 certification. Cloud Computing Institutions implementing integration programs incur significant costs in running their own health IT systems. To lower costs, Singapore s entire healthcare information exchange system is moving to the cloud. The health cloud, or hcloud, will reportedly cost $50 million over the next ten years around half of the total spending incurred by Singapore s facilities for these operations today. The plan is to store healthcare information from different hospitals in the private cloud, which will have enough capacity to host additional applications in the future. 14
Role of Digital Health Telehealth and Telemedicine. Singaporeans are living longer but the elderly tend to live independently from younger family members. To bring health services closer to them, the government is committing to telehealth and telemedicine programs to help seniors manage chronic conditions beyond the acute setting. Present services include: Telerehabilitation for stroke patients performing rehab at home Tele-ophthalmology for patients in polyclinics receiving a virtual eye exam by hospital ophthalmologists The telehealth programs can cut down unnecessary visits, offer convenience and savings to patients, and free up valuable hospital resources. mhealth Apps. Seniors are also using mhealth apps to maintain their well-being. In 2012, telecommunications carrier Singtel launched Project Silverline to give old iphones loaded with health and wellness apps to seniors. In the same year, Japan s NTT DoCoMo partnered with Omron Healthcare to design apps for residents that can track sleeping patterns, general health assessment and emergency services. Homegrown companies are active in offering mhealth solutions as well. An example is Borderless Healthcare Group (BHG), which delivers three Android and iphone apps, Smart Ageing, Heartsmart and Health Abacus via its Borderless Clinic mobile engine app. The apps allow live chat sessions when patients can ask their doctors questions about their conditions, medications and lab results. 15
Role of Digital Health Framework for Healthcare Clusters Integrated IT EMR Strategic Plans Target: EMR - hospitals Script-less, film-less, chart-less, paperless Advanced Clinical Decision Support Healthcare Analytics Intra-Cluster Integrated workflow One Electronic Medical Records system (EMR) Cross-Cluster One National Electronic Health Record (NE HR) Electronic Medical Records for details (EMRX) RH Regional Hospital CH Community Hospitals NH Nursing Homes GP General Practitioners 16
Latest IT Systems at Public Healthcare Institutions Singapore s public healthcare institutions are highly integrated. The following are some of the latest systems developed and implemented by IHiS at the public healthcare institutions. They are categorized as : Hospital Clinical Systems Hospital Ancillary Systems Patient Systems Healthcare Analytics Community Care Systems Some of the systems developed and implemented are presented in the Examples appendix. 17
Healthcare Masterplan 2020 The Ministry of Health launched Healthcare Masterplan 2020 in 2012 with the mission to make quality healthcare more accessible and affordable for all citizens in the future. Singapore s healthcare demands have been rising steadily over the years, driven by a rapidly aging population and an increasing number of people with chronic diseases. The Masterplan is to enhance the accessibility, affordability, and quality of healthcare to better meet the needs of Singaporeans. This is because: - The life expectancy of Singaporeans has gone up. - Premature mortality rate, such as among Singaporeans aged 35 to 64 suffering from heart disease, has fallen. - More elderly requiring care for longer periods, pressure on its hospital resources will increase as the population continues to age. - New models of care need to be developed as it cannot continue building hospitals. - Effective chronic disease management and sustainable intermediate and long-term care and support frameworks are needed. 18
Healthcare Masterplan 2020 Expansion of Services and building new facilities to make it easier for Singaporeans to seek healthcare 19
Healthcare Masterplan 2020 Healthcare Masterplan 2020 will be delivered through 7 IT Transformation Programmes. 1. Population Profiling Population Profiling programme involves analysing population data for proactive and effective health services, right-siting of care and care plan development. This will support targeted disease prevention, chronic disease management, stratified medicine and healthcare financing. Behavioural analytics will be used to increase effectiveness of intervention programmes. 2. Population Enablement Enablement Population Enablement programme will help individuals manage their and their dependents health at home, and healthcare finances by increasing their healthcare literacy and self-guided health services. There will be multi-channel collaboration among care providers and the population to develop healthcare literacy and self-guided services. 3. Prevention & Continuity of Care Prevention and Continuity of Care programme places individuals at the centre of healthcare to promote proactive, personalised healthcare. It will focus on early disease detection and intervention, and helping chronic disease patients delay disease progression. Continuity of Care involves care providers from different care settings working as one team, with electronic patient information and holistic views of patients, to deliver coordinated, quality care across the care continuum. 20
Healthcare Masterplan 2020 4. Provider Care & Operations Excellence Provider Care & Operations Excellence programme seeks to improve healthcare institutions clinical care and operational efficiency using robust common IT support services. This involves leveraging mature technology innovations and streamlining processes to improve quality, cost effectiveness, efficiency. 5. Healthcare Financial Excellence Healthcare Financial Excellence programme will enable financial transparency and agility, and views of resource utilisation and requirements across the national health system. This will support healthcare resource allocation and policy planning. 6. Policy & Public Health Workbench Policy & Public Health Workbench programme will help health administrators monitor public health with a complete view of the health system performance. This will enable them to draw up effective policies through simulation and assessment of differing policy levers. 7. IT Foundation & Resiliency IT Foundation & Resiliency programme will establish a scalable and resilient IT foundation to support healthcare operations and developmental needs. 21
Potential Opportunities for Finnish Solutions Integrated Health Information Systems (IHiS) handles all procurements for the Ministry of Health and companies are welcomed to submit proposals to transform Singapore s public healthcare by submitting their proposals at the following address: Integrated Health Information Systems Pte Ltd 6 Serangoon North Avenue 5 #01-01/02 Singapore 554910 Areas of interest to IHiS are Population Health, Hospital care, Home care, Robotics, VR and IOT. The following are some of the current call for proposals: National Harmonised Integrated Pharmacy Solution (N-HIPS) - To propose a solution to meet the future needs of pharmacies across all public and potentially private healthcare institutions in Singapore. The objective is to enable a new level of patient safety and efficiency in the area of medication management through 22
Potential Opportuities for Finnish Solutions making medication information available across clusters with consistent medication terminologies and harmonization of pharmacy operations to enable best practices. It shall provide the next generation pharmacy solutions that have the capabilities to meet the future needs of pharmacies across all public and potentially private healthcare nstitutions. Outpatient Pharmacy Automation System For Changi General Hospital Privilege ID Management This Call for Proposal is to propose new solutions to help IhiS in meeting compliance regulations and to prevent internal data breaches through the use of previliged accounts. e Performance Management System This Call for Proposal is to implement a Performance Management System to automate and steamline the current Performance Appraisal processes. 23
Contact Details Mr Lim Hock Chye FinnBIZ Consultancy 1 North Bridge Road 12-01 High Street Center Singapore 179094 Tel: +65 63364502 Fax: +65 63366534 Email: Hock.chye@finnbiz.com.sg Interview data & connection to IHiS: Mr Noah Tay, Senior Manager 24