It’s two decades into the future. You arrive home from the hospital to a community nurse who has already received your latest treatment plan from your doctor. With a single tap on your phone, you see your past prescriptions and upcoming appointments. A chirpy mascot even pops up to encourage you to go for a short walk.
This could be the future of integrated healthcare, but we’re still some way from this. After all, “the biggest challenge in healthcare is that data resides at different settings,” says Tan Tock Seng Hospital’s Chief Operating Officer, Dr Jamie Mervyn Lim.
But some organisations have leapt ahead, connecting disparate data sources to bring patients seamless care. Six leading healthcare experts shared how Singapore is moving towards integrated health at GovInsider’s recent ‘Connecting the dots for integrated healthcare’ webinar.
Cl Asst Prof Luke Low, SingHealth’s Chief Medical Informatics Officer, is optimistic about the future of apps and wearables in daily health monitoring. Users could take pictures of their meal to calculate its nutritional value and their smart watch could analyse their activity levels.
Smart devices could also upload vital signs readings onto a central health database and prompt citizens to visit the doctor if their readings are higher than usual, Low shared.
SingHealth already uses apps to help reassure patients and caregivers during unplanned admissions, which can be distressing. “They often are at a loss as to what has happened, and how things will move from there,” he said.
The app serves as an additional channel for the healthcare team to update family members. They can access the patient’s disease severity, progression and estimated length of stay as soon as healthcare providers enter it in the national health records, Low explained.
Even for planned surgeries, patients can browse through general information before they see a doctor. “The doctor can devote more time to dive deeper into patient-specific questions instead of generic procedure information,” he said. Hospitals can also give more targeted financial counselling based on information submitted to the app.
All this needs integrated data – how can healthcare balance this with security? “I see the ideal state as each and every patient holding on to his or her digital health passport,” Low said. Patients would have full control over what data to share with doctors.
Bringing care into the community
Singapore is moving healthcare beyond the hospital and into homes. National Healthcare Group, one of the nation’s three public healthcare clusters, started offering remote psychology, dietetics and physiotherapy in the pandemic.
National Healthcare Group Polyclinics used analytics to identify patients who would be suitable for teleconsultations, shared Dr Simon Lee, its Chief Operating Officer & Chief Clinical Informatics Officer. It then taught them how to use Zoom.
It is already running an at-home blood pressure reading programme for hypertension patients. Patients use a bluetooth device to automatically upload weekly readings. The polyclinic will then give advice and design treatment plans based on these.
As patients transit from the hospital back home, the “greatest risk” is when there is poor handover between care providers, noted SingHealth’s Low. SingHealth shares data internally to ensure their doctors can access crucial clinical information across hospitals.
Central health data system
Singapore plans to improve its system for centralising health records. The current system consolidates data from various healthcare institutions and national registries.
This includes diagnoses, adverse drug reactions and test results, noted Dr Simon Lee, Chief Operating Officer and Chief Clinical Informatics Officer of National Healthcare Group Polyclinics. Healthcare workers get a detailed overview of each patient’s health status, even if they had previously sought treatment elsewhere.
The Next Generation Electronic Medical Record will go one step further. It contains a “much richer dataset,” said Dr Lee, and connects databases from two of Singapore’s three public healthcare clusters.
This will allow for better patient care, he added. Healthcare workers can avoid conducting repeat tests and access a patient’s most updated list of medications.
Data and AI for decision making
Data has been critical in Singapore’s pandemic response. Tan Tock Seng Hospital set up a command and control centre which gathers data from various places to coordinate the hospital’s response, shared Chief Operating Officer Dr Lim.
“That’s very pertinent during the Covid outbreak last year, where we needed to pool resources, especially in the Novena campus where we support the National Center for Infectious Diseases,” he explained.
SingHealth used patient load data to determine what kinds of new wards to open, Low noted. If the community hospitals received increasing referrals for patients with high fall risk or dementia, they could develop more targeted programmes.
AI also came in handy. IHiS developed a tool to assess pneumonia patients’ risk levels.
Hospitals may choose to admit fewer patients with mild pneumonia to make room for those with life-threatening conditions, Andy Ta, Director of Data Analytics & AI at IHiS, shared. This could help hospitals beyond the pandemic, he added.
Predictive analytics are useful on a global level as well. Software company BlueDot was able to accurately predict the top 20 cities outside of China that would be most affected by Covid-19, shared Dr Andrew Jones, Head of Clinical Innovation, AWS Worldwide Public Sector.
Its analytics tool combined information from public health authorities, social media feeds and non healthcare data such as airline flight paths.
Hospital visits can be stressful. Connected data, intuitive apps and at-home care can go a long way to make the experience just a bit easier for patients.