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To cater for the healthcare needs of a growing and ageing population, Singapore’s newest healthcare cluster was designed with IT at its core, a strategy which has seen the 700-bed Ng Teng Fong General Hospital (NTFGH) recognised for its high standards of data use.
“Our difference is the employment and deployment of technology,” said Lim Soo Tong, CIO at Integrated Health Information Systems (IHiS), which oversees the hospital and provides health services covering predominantly the western part of Singapore, with a population of almost one million.
“In public healthcare, we need to keep the cost of healthcare affordable and make sure that it is sustainable in terms of outcome, quality and affordability,” he added.
NTFGH reached the Healthcare Information and Management Systems Society (HIMSS) Electronic Medical Record Adoption Model (EMRAM) Stage 6 certification barely three months after it opened its doors in June 2015.
Moreover, there are plans to eventually go for the coveted HIMSS Stage 7 certification (where a hospital achieves all the steps necessary towards a paperless environment) supporting true sharing, information exchange and immediate delivery of patient data to improve process performance, quality of care and patient safety.
Both NTFGH and Jurong Community Hospital (JCH) come under JurongHealth, and the JurongHealth Regional Health System provides health services through the hospitals, medical centres and clinics, and also partners with other care facilities such as nursing homes, polyclinics and GPs.
“Singapore is a small country with a relatively big population. With 5.5 million people, the right approach to public healthcare is to segment the country into regions and have regional systems to look after the health of the population,” said Lim. “Our concern is to deliver quality care seamlessly and effectively, and that’s where technology comes in, to improve the hospital processes, productivity and efficiency.”
Fundamental to delivering affordable and effective care is the Project OneCARE at JurongHealth, where over 50 healthcare IT systems are integrated for an enhanced patient experience, improved patient safety and greater efficiency.
The implementation and integration of all these systems took four years and has enabled the hospitals to become fully digitised, delivering a near paperless, filmless, chartless, and scriptless environment.
Each patient has his or her health record in the Electronic Medical Record (EMR) system. The results of any test, scan or medical procedure are electronically updated to the EMR, while 140 integrated medical devices pass data directly to the EMR, with the hospitals using the Medical Devices Middleware Integration System to transmit the data. This helps to eliminate manual charting and reduce charting errors.
The flow of data extends to the hospital bed, where each one has a Patient Information Board that displays crucial data, updated in real-time for care givers to view at a glance. This includes important data such as allergies, as well as dietary and care requirements. This does away with the traditional approach of paper notes on a clipboard attached to each bed.
To combat the tedious manual searching for costly, mobile equipment or to locate a patient, the hospitals have implemented a Real Time Location Tracking System, enabling the tracking of patient and medical equipment and assets. This tracking system comprises Wi-Fi triangulation software, low-frequency exciters and some 6,000 active radio frequency identification (RFID) tags.
Another manpower-saving implementation is the Warehouse Management System that uses a two-bin shelving system with passive RFID technology. Stock at the wards is split into two bins. When stock in one bin is used up, the users will drop the designated RFID tag into the reader, automatically triggering a request for restock.
Other processes have also been automated, such as meal ordering and the inpatient pharmacy automation, where the medication is pre-packed and transferred to medical carts at the wards, where the right patient’s identification tag is scanned and confirmed, allowing the drawer with the medication to be opened.
The technology implementation was not without its challenges. A significant one was to implement and integrate all the 50 systems, in addition to having to train many new staff and also working in the new processes and procedures while the hospital buildings were being constructed.
“A greenfield site has its advantage, but it also means having to work in incomplete buildings, and having to put in all the necessary IT infrastructure, cables and servers, as well as run rehearsals, with hard hats on,” said Lim.
Continuum of care
Another aim of JurongHealth is to take healthcare beyond the walls of the hospitals, moving towards telehealth to remotely monitor and follow up with discharged patients who might still need follow-up care at home.
“Being a small country, the supply of hospital beds is finite,” said Lim. “The way to manage the bed crunch situation is not to increase the supply, but to reduce the demand for acute hospital beds.”
“We want to provide a continuum of care at the right site, whether at step-down care facilities such as community hospitals and nursing homes or at GP clinics and even at home,” added Lim.
Other innovations in the hospital include using business intelligence and data analytics to improve operational efficiency. A one-stop information dashboard has been built, providing a centralised overview of key activity indicators in the emergency medicine department, outpatient clinics, inpatient wards, operating theatre and ICU surgery areas.
The system also collects and analyses the daily, weekly and monthly statistics to support timely operational and management decision-making.
The next step is to collect data for clinical analytics that would greatly improve patients’ health outcomes.
JurongHealth already stands out for its radical use of technology. The automation and digitisation of its hospitals has resulted in a nearly paperless environment and a highly efficient hospital workforce. Ultimately, the goal is to provide affordable healthcare and better health outcomes for its patients.