As Singapore ages, how can public healthcare innovations be scaled for lasting impact?

Technology has emerged as a key enabler in Singapore’s strategy to manage rising healthcare demand amid population ageing.

The Ministry of Health (MOH) has said that it will drive technology adoption with a focus on impactful systemwide use-cases, while healthcare clusters are developing various tech solutions to optimise resources, boost preventive care and manage care needs for our ageing population.

Examples include an AI-powered brain care programme by the National University Health System to identify individuals at risk of mild cognitive impairment and encourage adoption of exercise and a healthy diet to address the risk of dementia.

Another example is SingHealth Polyclinics’ virtual reality tool to detect pre-dementia and Tan Tock Seng Hospital’s app-based support portal for caregivers.

The success of innovations hinges on their implementation. This is fundamentally dependent on how users interact with such technologies, interpret their results and harness their value.

While tech tools are abundant, their expected benefits only materialise with actual use. However, over 50 per cent of consumers may abandon health apps within the first 100 days, according to a 2024 review of published studies globally.

This reminds us that even the most promising digital enabler can fail if we neglect the larger web of interconnected human factors and systems surrounding the tech: the habits and preferences of older adults and their caregivers, the workflows of healthcare providers, the resources of care settings, and so on.

Hence, as we live longer lives, ensuring our digital enablers “age well” in our health systems matters as much as creating them.

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The implementation challenge in context

A major factor in implementing and scaling an innovation is its fit within real-world care settings, as each new tool adds a layer to existing clinical practices and routines.

The Geriatric Education and Research Institute (GERI) has been evaluating how interventions for healthy ageing can be implemented effectively and sustainably in our health systems.

For example, GERI worked with NHG Health and Tan Tock Seng Hospital to evaluate a predictive algorithm to identify patients with advanced dementia who are at risk of mortality for early referrals to supportive care.

We found that for sustainable implementation, the tool had to be well-integrated into the hospital’s existing clinical workflow, including its electronic medical records (EMR) system.

It should not require much effort from already-busy clinicians, who would prefer something simple, easy-to-use, and intuitive.

Elsewhere, another human-centric factor – staffing – proved critical in a study on the implementation of an AI-powered mortality risk prediction model in the United States.

The findings underscored the importance of pairing the artificial intelligence (AI) model with dedicated staff to orchestrate alerts and to ensure adequate palliative care staffing, so that clinicians could act on the predictions.

For tech solutions where older adults are the target users, their design and implementation require an understanding of age-specific factors, especially for person-facing components of the tool, and outcomes that are relevant to the older person need to be accounted for.

For example, in GERI’s study of a national community-based frailty programme, we found that it may be more difficult to implement interventions, such as physical exercise, which older adults felt needed more time and commitment than say, popping a pill.

Such perceptions could affect the implementation of tech-based interventions that require older adults’ commitment and sustained use, to gather meaningful health data or achieve lifestyle changes.

Five strategies to go from silver bullet to sustained impact

What can innovators and implementers do to build digital enablers that work well and age well in different settings?

1. Create evidence-informed and contexualised innovations. These tools should be developed based on what we know works, using internationally available evidence and, where possible, local data. Importantly, their content and implementation need to be culturally appropriate so they can work well in local settings and for local users.
    
2. Co-develop with stakeholders. From a human-oriented perspective, we need to understand how innovations can be embedded in daily routines, workflows, and interactions, such as the hospital EMR. To facilitate this, key stakeholders such as patients, caregivers, clinicians, and researchers need to work closely with the development team in the design phase. This helps to ensure that tools are tested, proven, and can serve target users well.
    
3. Harness multidisciplinary inputs for a holistic picture on older adults’ health needs. Working with the Ageing Research Institute for Society and Education at NTU, GERI found that applying a text-mining algorithm to patients’ EMR helped to improve prediction of hospital readmission risk for older adults. The algorithm produced better results when it included input from a more diverse group of stakeholders, such as patient notes from medical social workers and case managers, not just physicians, in the EMR.
    
4. Account for cost. As NHG Health’s Group Chief Executive, Professor Joe Sim, noted in a Straits Times interview, “having a good use case is not the same as having a good business case”. Professor Sim points to AI pilot programmes, where costs are usually absorbed by MOH during testing phases. But when it comes to system-wide scaling, tools that offer moderate benefits at disproportionately high costs may not make the cut. In this regard, health economic evaluation can yield useful insights for decision-making.
    
5. Leverage social networks and community partnerships. A digital intervention could be paired with programmes at Active Ageing Centres so that peers or ground staff can help older adults navigate the technology and nudge them towards continued use and adherence.

This is timely, as the number of older adults living alone in Singapore has more than doubled in the past decade, and the number of seniors requiring assistance with daily activities is also set to rise.

Against this backdrop, Singapore’s investments in AI and digital solutions must deliver sustainable impact for our healthcare system and older population.

By taking a systematic, evidence-driven and collaborative approach in developing and implementing these technologies, we avoid costly trial and error and build innovations that can be effectively scaled and well-integrated into public healthcare.

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Dr Tan Woan Shin is the Deputy Executive Director of the Geriatric Education and Research Institute (GERI), a national research institute under MOH. Dr Tan is also a Scientist and member of the Research Management Committee at GERI. She is an interdisciplinary researcher with a background in economics. An experienced leader of multidisciplinary research teams, she has collaborated with stakeholders across health services, charitable organisations and government agencies.