Exclusive Interview: Chief Executive, Mount Elizabeth Orchard Hospital, Singapore

By Nurfilzah Rohaidi

Dr Noel Yeo shares how the hospital is cutting man hours and using AI for bill estimates.

Mount Elizabeth Orchard Hospital is a private multi-specialty 345-bed hospital in downtown Singapore. Hospital Insider speaks to Chief Executive Dr Noel Yeo on how the hospital is harnessing AI, improving the patient-doctor relationship, and building empathy in staff.

How are you using automation in your hospital to become more efficient?

Healthcare is primarily a service sector. Many things right now still can't be automated. You still can't automate nursing, you still can't automate the human touch. A lot of our innovations focus primarily on taking away things like data collection and analysis to make it easier for our staff.

A major pain point for patients is when we do not get the bill estimate right. Bill estimation is a global problem. This is difficult to do because there are so many variants in a patient's condition. Even at the time of admission, the condition can change, and you must also factor in the types of medication used, surgery and drugs needed. It is almost impossible to calculate this manually.

So what we did is that we collaborated with a company called UCare.AI. We are the first hospital group in Singapore to use an artificial intelligence system, which was rolled out last November, to create personalised and more accurate hospital bill estimates. They vary from the actual bill by 18 percent on average, which is an improvement of 60 percent over the current bill estimation system.

It uses machine learning, so we feed it data from EMRs and our billing system. For example, we can predict for a particular patient of a certain demographic - you can go down to the race, age, nationality, gender and then maybe certain medical conditions and to the diagnosis and procedure. Once you key in all these factors, the machine will generate an estimate using past data.

The more data you give to the machine, the smarter it becomes, and the better in terms of prediction. As the machine self-learns, it becomes more accurate. Maybe one day, just by looking at the face of a patient, or height or the weight, the algorithm can predict their bill size.

Another recent example is when patients order meals. We created an electronic meal ordering system. Before the system was implemented, staff used pen and paper to fill out meal chits, which are given to a porter, who would bring it down to the kitchen where it’s fulfilled, and finally distributed.

The problem was that you needed people to manually send forms down to the kitchen, so there's time wasted. Second, you need to look through and verify the food orders against the meal chits - it is critical that orders are accurate. And when you have so many steps, you make mistakes.

Now we have iPads in the wards, very much like what you see at Sushi Tei. You can see the menu. Patients just click on their orders and send them straight down to the kitchen. And then we have the diet aids and dietitians that will screen through and verify the orders.

This cut away so much man hours, improving productivity by 16 percent and slashing food wastage by 4,500kg.

One trend in healthcare is improving patient experience. How are you using technology here?

What we have in the pipeline is a patient-doctor app, which will launch on 1 April. We see it serving both patients and doctors. What we want to create is a very convenient environment for our patients and our doctors to work in, and we believe this will then improve healthcare.

For the patient, it can display lab or scan results directly on their phone. There is also the ability to make appointment bookings. It can also be a source of health information for our patients. They will be able to access healthcare articles written by doctors. We have thousands of articles in the bank, but we load it on our website; it would be even better if we have an app that helps to connect and distribute these articles to the patient.

For the doctors, they can view patients’ lab results and medical records. They are able to locate their patient if they are admitted, for example. Other things may also be a notification reminder when an appointment has been made. What’s more, usually doctors require the hospital to collect bills on their behalf. They will be able to view the outstanding balance that patients have yet to pay.

We were not satisfied with what we found when we went out to look for third party app builders, so this app was built in-house to suit our specific needs. I think eventually, it might become more than that - maybe we might have teleconferencing or telemedicine capabilities through this app.

A big concern of hospitals today is skills transformation. How do you improve skills and capabilities of your staff?

Occasionally we do leadership swaps to broaden exposure and bring in new dimensions. Last year, our Director of Nursing went over the Gleneagles Hospital, and vice versa.

One decision I made with the nursing director from Gleneagles is that we decided to restrict any of our Heads of Department in this hospital from holding internal meetings from 8am to 12 noon. We wanted them to be on the ground or shop floor in the mornings from Monday to Friday. They must be in the wards to meet the doctors, meet the relatives, or to see the patients themselves.

That is how we create the clinical leadership on the ground as a first step. It is something that is perhaps the most impactful and engaging for our patients and doctors.

The second step is, how do we also improve cultural understanding? Up to 35 percent of our patients are from around the region such as Indonesia or Vietnam, and when you have a patient where we don't understand their culture well enough, it becomes difficult for us to serve them.

So we started to have cultural workshops. We get tutors who are translators by profession, but they are natives of these countries to come in and conduct classes. They also teach us simple language. I learned how to speak some Bahasa Indonesia as a result of attending the workshop.

Last but not least - we focus on empathic skills, something that medical school has never taught me and nursing school never taught the nurses. We wanted our staff to learn what empathy is, but we were not well-equipped to do that.
[blockquote]These are very specific modules that help our staff to prepare themselves for handling difficult conversations.[/blockquote] We collaborated with a local executive training institute that offers courses in counselling. We sent our nurses for selected modules that focus on empathy, communication, bereavement, mediation, and complaint management. These are very specific modules that help our staff to prepare themselves for handling difficult conversations.

We send mostly nurses for now, it takes time to do that. I guess over time, as we start to send more and more, we will be able to upskill. Everyone will be able to raise their level of competency in terms of communication.

Images from Dr Noel Yeo & Mount Elizabeth Orchard Hospital Facebook Page