Speech by Mr Gan Kim Yong, Minister for Health, at National Health IT Summit, at Singapore Expo Convention & Exhibition Centre, 17 July 2018

Distinguished guests

Ladies and gentlemen,

Good morning to all of you.

1.             I am very delighted to be here this morning at the National Health IT Summit 2018, the tenth edition of the event.

2.             Globally, there has been a tremendous rise in research and development, as well as innovative application and adaptation of technology in the healthcare sector. Some are making current healthcare models better and more efficient. Others have the potential to revolutionise how we receive care services or nudges to live more healthily. Examples include telemedicine, artificial intelligence and machine learning, robotics, big data analytics, augmented or virtual reality, chatbots, digital services and more.

3.             Here in Singapore, we have been making progress too in embracing technology in healthcare. The majority of our public hospitals and specialty centres have achieved the Health Information Management Systems Society’s (HIMSS) Electronic Medical Record Adoption Model (EMRAM) Stage 6 or 7, the highest two stages of the international benchmark that measures the level of digitalisation for better patient care.

4.             We are also leveraging technology in new ways beyond traditional delivery models. Take for example, Health Promotion Board’s (HPB) National Steps ChallengeTM, which will be receiving an award today. Through deploying smartphone apps and step-trackers, harnessing data and delivering behavioural nudges, HPB successfully encouraged many Singaporeans to walk more and adopt healthier habits. In the current third season, the National Steps ChallengeTM has attracted over 670,000 participants, almost double that of the last season. 9 in 10 participants continue to clock nearly 9,000 steps daily even after the past season ends. By the way, I notice that our event today is only on level two – so I strongly encourage you to take the steps instead of the lift or escalator, as I did so today. But of course, not just today, but I hope you will do so every day.

Scope to Do More; Ways to Do Better

5.             The technology promises for healthcare are exciting. But we must remember not to adopt technology just for the sake of doing it. It must always be for the purpose of helping our citizens achieve better health outcomes. We must also be mindful to use technology in ways that make good use of system resources and patient dollars. The Steps Challenge example I cited shows that innovative adoption of technology does not always have to be state of the art or most costly.

6.             Today, allow me to share a few thoughts on how and where we can do better in making more effective and impactful use of technology. First, we must Move Faster. Second, Transform The Core. Third, Collaborate andScale Wider.

Move Faster

7.             First, move faster. Today, the technology development and adoption cycle in healthcare, here and also elsewhere, tends to be rather long. Part of this is understandable. What we do is complex, and we should rightfully be concerned about possible risk to patient safety. However, we sometimes adopt too much of a “kiasu” mentality and over-specify or over-customise our IT solutions at the onset. Those of us who have been in the system long enough would know how difficult it can be to get everyone to agree completely on the design!     

8.             With technology advancing so rapidly and demands in healthcare on the uptrend, we need to move faster. Here, we can take a leaf from other industries where the concept of developing Minimum Viable Products(MVP) via agile development is becoming more common. This approach focuses on first developing a minimum set of features that are valuable. The MVP is then launched to test the feasibility of the innovation before refining, adding features and optimising the solution to make it more relevant to its users. Over-specifying and customising a product at the onset is the best way to kill the project. This iterative MVP approach enables earlier adoption of innovative products and services, while optimising the use of resources.

9.             HealthHub is one example where we adopted this approach.  While we have a longer-term goal of making it a one-stop portal and mobile app for citizens to access health-related content, programmes and services, we launched the first phase of HealthHub in 2015 focusing only on a few key features. We are iterating the product on an ongoing basis, giving citizens earlier access to the digital service, while obtaining feedback and suggestions from users to refine the product before expanding on the suite of functionalities. The caregivers module, for example, was one feature that was added after feedback from caregivers. Today, HealthHub has many more features added to it since its launch. This includes appointment management for all polyclinics and selected hospital specialist outpatient clinics, a diabetes risk assessment tool, medication refill request, action plans to improve health and many more. We will continue to progressively add more useful features for our citizens down the road, including a refresh of the user interface for a more targeted experience.

10.          I have tasked IHiS to encourage and make greater use of the MVP. IHiS will be setting up what they can call “fast prototyping squads” to work with some of you to deploy this approach in upcoming projects. Coupled with adopting and adapting solutions that are already available in the market rather than reinventing the wheel, I hope that we can shorten our technology development and adoption cycle.

11.          Sometimes, moving faster on a new innovation requires us to put a project in a “Sandbox” where the risks are appropriately managed rather than subject it to the mainstream rules and processes that do not quite fit. Earlier this year, MOH launched the Licensing, Experimentation and Adaptation Programme (LEAP) to provide regulatory sandboxes to enable new and innovative models and services to be developed and refined in a safe and controlled environment. Such a framework allows providers to transit more seamlessly into the eventual regulatory framework and meet patient safety and welfare requirements. Telemedicine is the first service to come under LEAP and we hope to look for other areas where we can deploy a sandbox approach.

Transform the Core

12.          Second, transform the core. The motto of the Singapore digital government blueprint released last month is “Digital to the Core”. For maximum impact, technology should not be applied just at the surface or on improving the existing. While digitisation and automation of existing processes bring benefits, true transformation and quantum leaps can only happen when we go deeper to redesign processes and reinvent delivery models and concepts, with technology as an enabler.

13.          The Singapore Integrated Diabetic Retinopathy Programme (SiDRP) is a good example. Many of you would know that diabetes can lead to vision complications, and in severe cases, even blindness. For this reason, our polyclinics offer retinal screening for diabetics.  Grading of the retina images captured used to be conducted by doctors in each of our polyclinics after consultation hours. With limited time and large patient volumes, the turnaround time was between 2 to 4 weeks. Through a collaboration between National Healthcare Group Eye Institute, the Singapore Eye Research Institute, IHiS, and our polyclinics, the entire process was re-engineered. Retina images captured in our polyclinics are now transmitted to two centralised centres, where trained graders would assess the images using advanced analysis tools, with greater consistency in grading. The results can now be received within a day, enabling earlier diagnoses and interventions, and more timely care for patients.

14.          But we are not stopping here. We will soon deploy machine learning and grading to complement human graders in screening the images for diabetes-related complications. We believe this can greatly improve accuracy and reduce error rates, address issues of manpower constraints and deliver better outcomes.

15.          We need to do more of these. Digitalise and apply technology to re-engineer business processes, re-architect our solutions and reinvent our services. In other words, we need to transform the core.

Collaborate and Scale Wider

16.          Third, collaborate and scale.  We need to collaborate more widely to solve difficult common problems. In some of these collaborations, we can involve private sector players. We ought to think how we can apply technology and innovate at the systems level, beyond individual institutions.

17.          Robotics is one area where we are beginning to do this. We will be developing a Robotics Middleware Framework (RMF) for Healthcare. The vendor-neutral RMF will redefine the standards for interoperability of robots in healthcare, reduce the complexities for integration and accelerate the adoption and co-ordination of robotics innovations, sensors and Internet of Things (IoT) devices. By enabling different technology systems within and outside of healthcare to ‘talk’ and work with each other, it creates more opportunities for innovation, cross-sector collaborations, and the deployment of IoT to bring care closer to our citizens, and at scale. The initiative is a 3-year multi-party R&D effort led by the Centre for Healthcare Assistive and Robotics Technology (CHART) and IHiS, involving government and industry partners.

18.          In March this year, we launched the inaugural National HealthTech Challenge, which brought together professionals from healthcare institutions, research institutes, universities and polytechnics, start-up and technology companies to identify common problems and co-create solutions that can scale. I understand that 76 proposals have been submitted, including five from Finland, Israel, and New Zealand. Participants were then matched into groups to develop innovative concepts. Today, we will be able to see displays of the top 20 shortlisted projects later, when we break for tea.

Conclusion

19.          Let me conclude. Ladies and gentlemen, this is an exciting time for innovative development and application of technology in healthcare.  We have already gotten started on this journey. If we Move Faster; if we Transform The Core; and if we Collaborate and Scale, we will be able to harness the benefits in more effective and impactful ways, and accelerate the transformation of our healthcare system for the benefit of our nation.

20.          On that note, I wish everyone a fruitful seminar. Thank you.