IT is helping patients get better faster. Singapore will soon get a centralised system of patients’ medical records which doctors islandwide can access to give speedier treatment. TAN CHONG YAW reports
IN TEN years’ time, when you visit a doctor in a public hospital, his computer screen will list the health problems that you might face in the future – like heart disease or cancer – based on your genetic make-up.
Based on your age and family history, medical tests that you need to go through, say, a colonoscopy, will also be flagged to him.
The good doctor will have in his electronic records your complete medical history, which is also kept by your neighbourhood doctor or the polyclinic specialist whom you see.
Working with a wide view of a patient’s condition and his medical history is part of the thrust towards preventive health care. Five years from now, genomic data captured by the public hospitals will also be added, said Dr Chong Yoke Sin, chief executive officer of Integrated Health Information System (IHIS).
The IHIS pools the IT resources of the various public health-care groups including Singapore Health Services (SingHealth) and National Healthcare Group (NHG) which together support seven hospitals and 18 polyclinics.
The foundation of this preventive move will be the National Electronic Health Record (EHR), which aims to have health-care records shared by all public hospitals and polyclinics, private clinics and community hospitals.
MOH Holdings, a holding company of Singapore’s health-care assets, issued a call which closed on Monday for vendors to send in their track records to pre-qualify them for a tender to be called later.
Singapore is now “between stages four and five” of EHR implementation, said Yoke Sin, whose company IHIS is part of MOH Holdings. This is based on an eight-stage scale, which starts at zero, for the extent that IT is used in health care at any hospital in the world.
The scale is devised by HIMSS Analytics – a Chicago-based non-profit organisation that analyses health-care trends – to track the progress of hospitals towards creating a paperless patient record system. (See other story.)
When the genetic make-up of patients start to be captured and incorporated in the EHR in five years’ time, patients can benefit better with more accurate diagnoses and medication.
Yoke Sin said: “Key to this is the sharing of medical records with doctors, who will be able to access the information. The patient will benefit from faster and more accurate diagnosis and treatment.”
Technology has been a part of Singapore’s public health-care system, with X-rays being largely digitised, and is now the backbone of a series of IT-based services from pinpointing a patient’s location to the remote monitoring of his vital signs.
Yoke Sin cited this scenario: Say, an unconscious diabetic man is admitted to the emergency ward of a public hospital.
Once he has been identified, doctors can view all his medical records on an A4-sized wireless computer. Armed with the knowledge of his pre-existing medical conditions and drug allergies, doctors can proceed to treat him immediately.
There is no need to duplicate tests. Also, when medication is ordered, the system will check and prompt the doctor if it is not suitable for the diabetic patient.
Ready for roll-out
The first phase of the National EHR is targeted for December next year.
By then, general practitioner clinics and community hospitals will have access to “summaries of patients’ medications, test results, disease history, allergies and episodes at the hospitals”, said Yoke Sin.
Two more groups need to be linked to complete the chain of information flow. At the front-end are private doctors who provide 80 per cent of the primary or basic health care.
At the other end are the community hospitals, such as St Luke’s Hospital and Ang Mo Kio-Thye Hua Kwan Community Hospital, which provide intermediate and long-term care.
By the end of next year, a patient can go to a public or private health institution confident that his medical records will be available to the doctors treating him.
Also, with medical records available in digital form, research can take a quantum leap.
Together with data on age, sex and race, aspects like the function of drugs against DNA profiles can be studied.
Where e-medical records are concerned, Singapore would be considered on par with the Massachusetts General Hospital and Mayo Clinic, said Yoke Sin.
“Our medical records and claims – like those for Medisave – are very well integrated,” she said.
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Cool health-care tools
THESE professional devices have been on trial in the three hospitals in the SingHealth cluster, namely the Singapore General Hospital, Changi General Hospital and KK Women’s and Children’s Hospital.
SingHealth did not commit to dates for complete roll-outs.
The Electronic Dental Records system was fully implemented at Alexandra Hospital in 2007.
Bedside Mobile Workstation
A wireless notebook mounted on a height-adjustable trolley, the Bedside Mobile Workstation (BMW) was unveiled in December last year and is connected to a label printer to print adhesive labels to immediately tag patient specimens like blood samples. It is an upgrade of an earlier model called Computer on Wheels introduced in 2004, which was then not height-adjustable.
Paper files and charts including X-ray images have been replaced by digital files and are easily accessible on the BMW, which can be wheeled to a patient’s bedside.
Doctors update records on-the-fly and place orders for medication and tests directly from the BMW. No more worries about lost prescription orders or illegible handwriting.
Vega system
Even the monitoring of vital signs like temperature, blood pressure and pulse rate has been replaced by technology.
Three sensors in the system measure different vital signs: an arm cuff reads blood pressure, a fingertip sensor checks blood oxygen levels and a small coin-like sensor attached to the abdomen measures body temperature. The readings are transmitted wirelessly to a central server in the hospital.
Patients no longer need to be roused from sleep for these measurements. Human error like recording wrong temperatures is also a thing of the past.
Palm-sized Wi-Fi tags worn by patients and hospital staff can be used to track their movements and who they have been in contact with – crucial information especially during an infectious disease outbreak like Sars (Severe Acute Respiratory Syndrome).
The Vega system was first introduced three years ago.
Mobile Electronic X-Ray Computing
This cabinet-on-wheels has a PC inside and three or four LCD monitors mounted on top, depending on the model. The LCD panels can display medical records or digital X-ray images pulled wirelessly from the patient’s medical records in the hospital computer system.
The MERC acts as a visual aid for doctors to explain proposed therapies and options to a patient and his family members.
Patient Bedside Terminal
Patients can make a video call to a nurse immediately via the Patient Bedside Terminal (PBT) instead of waiting for her to come to him.
This is a touchscreen panel which is also used by hospital staff to check patient records. Patients can also use the PBT to watch TV and surf the Internet.
The PBT was introduced two years ago in the orthopaedic surgery ward at the Singapore General Hospital.
DentalNotes
Dental patients at Alexandra Hospital have been benefiting from faster service since their records were digitised two years ago. Instead of juggling handwritten notes on dental charts and separate X-ray and photo records, the dentist can access all the documents from his workstation while consulting.
Called the Electronic Dental Record, it was developed from scratch by a local IT company together with the hospital’s dentists. It is now also used at Tan Tock Seng Hospital and nine polyclinics of the National Healthcare Group.
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Consult the Internet
FROM health-care tips to checking out queues at polyclinics, the Internet offers many one-click conveniences.
Counting calories
If you are clueless about how many calories your body needs, check out the Calorie Calculator in the Health Promotion Board’s website at www.hpb.gov.sg. Personal details such as your weight, sex, age, the type of work you do and whether you exercise are needed. The system then calculates the calories you need to maintain your weight.
SingHealth Polyclinic queues
Before you go to any SingHealth polyclinic, hit the Internet. Webcams mounted at these clinics will show you the number of patients in the queue waiting to see the doctor or to collect medicine at the pharmacy.
Introduced over a year ago, the webcam images are refreshed every five minutes.
Go to he.ecitizen.gov.sg/hecorp/qwatch.aspx to find out which are the busiest polyclinics.
The typical waiting times for registration and consultation at each polyclinic for each month can be found at he.ecitizen.gov.sg/hecorp/pphealthcare.aspx?id=644.
Virtual neonatal ICU visit
Families who worry about how their newborn are doing in the neonatal intensive care unit (ICU) can watch their baby via the Internet or 3G mobile phone. Video images are captured by individual webcams mounted above each baby’s cot. This service allows the baby to be viewed at any time without disturbing him. It is a free service at the neonatal wards at the Singapore General Hospital. All you need is a PC or a 3G cellphone and an Internet link.
Mothers who are recovering at home and family members who are overseas can use this service to join in the vigil.
