To realise Singapore’s nationwide healthcare transformation strategy, Healthier SG, the Ministry of Health (MOH) has announced its intention to reorganise care delivery by enabling data-sharing and building up preventive and community-based care. But healthcare organisations have historically operated in siloed systems, making it difficult for them to move from reactionary to preventive and primary care.

Hospitals are the least conducive environments to deliver care, said Asst Prof Eric Wong, Group Chief Data and Strategy Officer at Singapore’s National Healthcare Group. There thus arises a pressing need to move to community-based care. This requires a whole-of-sector paradigm shift, and now – in preparation for Singapore’s “ageing tsunami” – is the best time to consider one, Wong said.

At GovInsider’s recent event, Connectivity at the core of healthcare transformation, healthcare leaders from Singapore’s key healthcare clusters shared the ingredients for the seamless and secure integration of healthcare in order to deliver better overall patient and population health outcomes for the nation.

Health data backbone

The Healthier SG strategy can be summarised into “three P’s”, said Dr Cheong Wei Yang, Deputy Secretary of Technology at the MOH Headquarters, during his keynote address. These are preventive health, population health, and precision health.

All of this collectively requires what Cheong referred to as a “health data backbone” – an ecosystem of data that needs to flow seamlessly to support in-depth health studies.

Preventive health is the shift to primary care, targeting the onset of diseases within the community before they even have a chance to escalate. This can be done by monitoring people’s digital biomarkers through wearable technology, and behaviourally nudging those at risk to make better lifestyle choices.

Population health studies allow governments to have a clearer picture of how citizens react to various health interventions and policies across generations, to better tailor these interventions and policies. These could be increasing adult vaccinations, or providing more birth control options to reduce the rates of unwanted pregnancies, for example.

In Singapore, precision health entails an increased focus on Asian-centric genetic studies. “Many therapeutics are actually left on the shelf because they don’t perform so well in Western populations, but they might actually have value in Asian populations if we stratify our population studies properly,” said Cheong. The Singapore Integrative Omics Study, for example, is a research project that aims to provide valuable baseline data differentiating the three key ethnicities in Singapore (Chinese, Malay, and Indian) based on clinical, lifestyle, and dietary variations. Epigenetics, the study of the impact of the environment on population health, will also be a priority, he added.

In light of the ageing tsunami, Cheong also highlighted that a larger proportion of older people will not adapt well to digital devices. Therefore, there needs to be an abundance of “community touchpoints” in order to reach out to these people near their own residencies, before they find their way into hospitals.

“The health data backbone requires all of us who are collecting such data to treat it with utmost confidentiality, and assure everyone that this data will be collected primarily for the purpose of each individual’s own health improvement,” said Cheong.

Putting care in the hands of patients and other caregivers

Singapore’s healthcare transformation efforts will not only require a data ecosystem, but also an ecosystem of caregivers and self-helping citizens.

A big part of moving into community-based care is getting people to take ownership of their own health, instead of leaving it in the hands of healthcare workers by default, said Mr Keith Sng, Director, Principal Engineer, Future Primary Care at the MOH office for Healthcare Transformation (MOHT).

“People can simply do this by measuring their own blood pressure and submitting the readings to their clinics via telehealth apps, for example. If these readings are well-controlled, that actually frees up capacity for healthcare providers. And from the patient’s perspective, they are now more aware of their own health,” Sng said.

This approach of funnelling patients who are most at-risk in the community using self-service data will also drive down healthcare costs. “Screening, for example, is a great way to identify early onset diseases, but we can’t screen everyone or it will cost too much – so we use data to find out who to screen in order for us to deliver healthcare effectively,” said Cheong.

Community touchpoints will be crucial in getting the public to start taking charge of their own health. The National University Health System’s (NUHS) Regional Health System Office (RHSO) is seeking to reorganise and unify community care, said Dr Ling Zheng Jye, Head of Insight & System at NUHS’ Regional Health System Office.

The RHS targets those who have simple chronic conditions, such as high cholesterol and high blood pressure, and prevents them from progressing to more serious conditions like liver, kidney, or heart failure. It will set up community health posts, and work alongside senior activity centres and active ageing centres to reach elderly populations that are often associated with such conditions.

“Because they are already involved with their social care partners, the relationship they can build with their healthcare professionals can be much warmer and less intimidating. As they open up, the nurse or counsellor can even go deeper into some lifestyle details that they otherwise might not share with a general practitioner (GP) at a clinic,” said Ling.

“We will also activate the ‘younger old’ (those in their 50s) to become advisors to the ‘older old’, so that in that process, they become self-helpers themselves when they grow older,” said Cheong.

“While a large part of our jobs right now is to develop this backbone for Singapore, the reality is that once these tools are built, we can share them with developing countries who often lack these very same infrastructures to reach out to their rural communities,” he added.

A duty to share

While oversharing data can harm patients by putting them more at risk of data breaches, the reverse is true as well, stresses Dr Mark Davies, Chief Medical Officer for IBM Europe, Middle East, and Asia. “When people are harmed, it’s usually because decisions are made without a full view of their patients – not having access to complete and accurate data as well,” he said.

Those who collect and possess data thus have a duty to share it with allied healthcare professionals. “The question now is how do we achieve a balance between use and confidentiality,” added Davies.

In line with this, Cheong said that a key responsibility communicated to GPs, as part of the shift to decentralised care, is that they must report the right sets of patient data back to the central healthcare data system.

The global experience is that most people are happy to share their data, but there will be some who are not. This can derail the sharing experience, and we need to cater to the minority as well, said Davies.

As opposed to adopting an all-or-nothing approach, healthcare leaders can share less sensitive data such as height, weight, or blood pressure openly, said Sng. More personal data such as family history or socioeconomic status can be anonymised so that they can still contribute to population health research.

MOH recently launched a data exchange platform, MOH TRUST, to call for healthcare professionals, institutions, and even private healthcare providers to contribute their data for research. “While we will not be able to share the raw data with companies, users can actually run queries and insights using analytical tools on our platform to gain insights,” said Cheong.