SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH, AT THE INTEGRATED HEALTH INFORMATION SYSTEMS 15TH ANNIVERSARY AND LAUNCH OF NEW IDENTITY, 27 JULY 2023, 9:40AM AT SINGAPORE EXPO HALL 3

Mr Richard Lim, Chairman, IHiS

Ms Ngiam Siew Ying, CEO, IHiS

Partners, colleagues and friends

I am happy to join you today to celebrate IHiS’ 15^th Anniversary.

The Birth and Test of IHiS

2.             How did it come about? This requires some recounting at an occasion like this. 15 years ago, the Ministry of Health (MOH)  consolidated IT teams across our public healthcare system. The objectives were to improve system interoperability and integration, and derive scale and efficiencies in IT operations. Several hundred IT professionals were therefore posted to a single organisation to form IHiS.

3.             This marked a milestone in the healthcare landscape in Singapore. Since then, IHiS has grown into a 4,000 strong organisation today. Today, IHiS supports the operations of 46 public healthcare institutions, including acute hospitals, specialty centres and polyclinics, as well as some 1,400 partners in the community such as community hospitals, nursing homes and General Practitioners.

4.             The formation of IHiS brought about greater synergies and powered the digitalisation of our public healthcare system. By creating a professional ‘home’ called IHiS for our HealthTech talents, we can better coordinate planning and implement important projects at the national level. Very importantly, there is better career progression for our HealthTech talents.  We are also better able to deliver large scale, cross-institutional, national projects that can transform the way  healthcare is delivered.

5.             Our healthcare system, including IHiS, was severely tested because of the COVID-19 pandemic. We were fortunate that by then, IHiS had already built strong capabilities and had ready technological assets to support our COVID-19 response.

6.             For example, within eight days, IHiS leveraged its existing technology stack to set up the COVID-19 Test Repository. The Repository brought the swab results from 31 labs together to one central location at the national level. They call it the source of truth. This allowed us to quickly identify infection clusters and trigger contact tracing and quarantine operations to control and manage the spread of the virus. This bought us very precious time. 

7.             When the Delta wave came and spread, we had to augment our healthcare facilities, by setting up Community Care Facilities (CCFs) to look after patients who were clinically well but who had tested positive for COVID-19. CCFs had a challenge as manpower was limited. So IHiS converted existing systems, developed new ones and assembled them to empower individuals to monitor their own vital signs. That way, the manning of CCFs was as lean as possible. 

8.             When COVID-19 vaccines became available, there was a major challenge. We had to administer them safely and efficiently across multiple Vaccination Centres across the island. IHiS faced a massive task – to integrate various IT systems, such as the National Immunisation Registry, SafeEntry and TraceTogether, and systems used by the private healthcare operators at various vaccination sites.

9.             And IHiS delivered. We were able to set up over 200 sites, administering as many as 80,000 doses of vaccines a day. The capabilities, unity and sense of mission of the organisation shone through, at the height of a crisis. So well done and thank you to IHiS and to all of you.

Strategic Priorities

10.          Today, the critical importance of IT in healthcare is well-recognised. It supports a skilled healthcare workforce in delivering effective care; it makes efficient operations at a large scale possible; it connects healthcare providers and enables seamless and integrated care; it stores data and generates insights that can inform policy making and planning, and it empowers individuals to monitor and take charge of their own health.

11.          As Singapore becomes a super-aged society, our healthcare system needs to undergo a  major transformation. It is not just expanding, which may be the easier part, but reconfiguring it to focus on value-based care and at the same time shifting its gravity away from acute hospitals into the community, and to preventive care. Healthcare settings will no longer be clinics and hospitals, but it will be in communities and in homes. 

12.          It is well-recognised that major healthcare transformations are undergirded by a few key drivers, which is in international literature. First, an effective organisational structure, of which we have the three healthcare clusters, each with a good critical mass of residents of about 1.5 million residents each, to look after.  Second, the right funding system which incentivises desired behaviour, of which we have implemented a  capitation model from this financial year. Third, a strong mindset for preventive care and building of health and not just the curing of sickness, of which we have implemented Healthier SG.

13.          Fourth,  we need the right IT systems to integrate all healthcare providers. We were fortunate that we have had IHiS for the past 15 years. IHiS’ work will therefore remain central and fundamental to our healthcare transformation moving forward. It has its work cut out.

14.          Today, let me focus on five priorities of IHiS that will be of strategic importance to Singapore’s healthcare ecosystem.  They all have something in common, which is they help connect and integrate the entire healthcare ecosystem.

Connecting the Ecosystem

15.          First, we need a national repository for patients’ medical records. This was the vision of former Minister for Health Mr Khaw Boon Wan – One Patient Record. This is the core objective of the National Electronic Health Record (NEHR) system, which supports the vision of “One Patient, One Health Record”.

16.          With NEHR, there is now a central digital repository of all our patients’ summary health records. It removes the need for patients who have to see multiple doctors to bring physical files from one clinic to another. It solves the problem where a patient is admitted to hospital for an emergency and the doctor finds that he has no data on this patient. 

17.          With NEHR, clinically relevant information would be built up with each encounter the patient has across healthcare providers and institutions, in standard, easily accessible formats. Patients save time and money in avoiding duplicative tests. Clinical care will be improved. Today, NEHR is used by over 21,000 healthcare professionals and administrators every month.

18.          To ensure that residents could access their healthcare records conveniently, IHiS developed the HealthHub app. HealthHub is a personal window to NEHR, through which residents can securely access their own medical records, and more. Today, two in three Singapore residents are using HealthHub and about one million of us use it every month – from managing our medical appointments, viewing health records, to ordering medication.

19.          Alas recently, a friend told me she may have high cholesterol but could not remember the readings. I asked to see her blood test results on HealthHub. She logged in but there were no results. She then recalled she took the test in a private hospital.

20.          We still have some way to go to fully integrate patients’ data. This will be resolved when and if we enact the Health Information Act next year. Having this national digital repository of patients’ medical records will be a very powerful change.

21.          Second, a system for remote healthcare. What epitomises it would be telehealth.  As we place greater emphasis on primary care, this becomes an important capability and telehealth is a key enabler. It means you can deliver care without the patient being physically in front of the doctor.   

22.          The adoption of telehealth took off during the COVID-19 pandemic. Then, we began to really appreciate how useful telehealth was – patients could consult a doctor in their homes, especially those who were less mobile. It also helped ease the high patient load in our institutions. It was a necessity at that time but it was not a bad solution at all. This necessity borne out of a crisis promises to become a new norm.

23.          We are well placed to deliver telehealth, especially given how well Singapore has been wired up. Currently, almost all of our public healthcare institutions use telehealth across many clinical specialities. But there is potential for us to expand its usage. This means we will require more work on the supporting functions around telehealth.

24.          We will need to ensure that clinical standards are maintained, whether care is delivered face to face or via telehealth. We need to decide on and apply our policies on CHAS subsidies, MediSave, Pioneer and Merdeka Generation packages for telehealth. There needs to be a robust system of governance, regulation and enforcement in case there is any form of abuse because of telehealth. 

25.          And since patients are not physically present at the clinic to collect their medication, there needs to be a national medication fulfilment system to work hand in hand with telehealth. 

26.          IHiS is working with ALPS, our national healthcare supply chain agency, to develop the National Central Fill Pharmacy (NCFP). For institutions like polyclinics, the NCFP aims to centralise the fulfilment of medication offsite, before it is delivered to the patients.

27.          The National Harmonised Integrated Pharmacy System (NHIPS), is another major initiative by IHiS and our clusters. It aims to consolidate existing legacy systems into a single pharmacy system for harmonised medication dispensing, and will serve as a key enabler to the NCFP. NCFP will serve as a key enabler to telehealth. Telehealth is in turn a key enabler to ensure we can deliver care outside of clinics and hospitals.

28.          This will relieve the workload at the polyclinic pharmacies and allow healthcare workers to focus on caring for patients. Our pharmacies dispense over 60 million medication items annually. Our goal is to use technology to centralise the workflow to fulfil 50% of medication needs outside the hospitals, and automatically manage orders from multiple sources for delivery to households nationwide.

29.          Third, a national billing system. We are quite some way away but we have to start working on it. The current situation is that we have disparate billing systems across clusters, hospitals, public and private healthcare institutions. For the public sector at least, we should aim for a unified billing system.  

30.          There are many advantages to our patients, such as a more consistent patient experience and the way in which bills are presented to them, as well as greater transparency of costs and subsidies. There will be optimisation of tech resources when our IT teams do not have to maintain a fragmented landscape of so many legacy systems.

31.          For the healthcare providers, the strategic benefit for the public sector is that when there is a change to funding and financing policies, our unified systems will enable adjustments to be made quickly and efficiently. These include the level of subsidy and making sure the subsidy extends not just for clinics and hospitals in the public sector, but also out in the community with the partners we work with. It also includes the use of MediSave or MediShield Life when receiving care wherever one goes. This is a strategic capability.

32.          Fourth, undergirding all this is strong cyber and data security. As we harness the power of technology for healthcare, we must continue to be responsible for the security of our systems and data. IHiS, together with MOH, has established a multi-layered defence to protect our public healthcare systems and data assets, involving more than 200 cybersecurity initiatives covering technical measures and process improvements. We have seen a three-fold increase in cybersecurity measures and capabilities over the last five years.

33.          For IHiS, data and cyber security has very much become part of this DNA, Our security design considerations are very much part of any development process. We have to keep it up and make it better. However, this area is not static and threats are constantly heightening and evolving and we have to keep on running. We therefore have to constantly keep abreast of the latest developments, and never be complacent.

34.          Final priority is looking into the future. There are many possibilities, so make exploring these possibilities part of your priority. I believe healthcare is at the cusp of a technological revolution. For example, new diagnostic techniques, coupled with wearables, can usher in a new era of preventive and personal care. Another major area of future possibilities is in Generative AI.

35.          Much has been talked about Generative AI and how it would threaten life as it is or industries by getting rid or replacing much manpower. But it is perhaps fortunate that with healthcare being such a high touch sector and being so tightly regulated, I do not think Generative AI is likely to replace manpower in a big way. Neither will it cause a major upheaval in the sector because it is so tightly regulated. In healthcare, we may have the space and time to thoughtfully deploy Generative AI in a more deliberate and systemic way, to better care for our patients and improve overall productivity, effectiveness and competence of our healthcare workers.

36.          AI is already ubiquitous in healthcare. For example, pattern recognition technology is used in medical imaging to recognise tumours. Healthcare apps use AI to nudge us to adopt good life habits like eating and exercise. 

37.          With generative AI like ChatGPT, there will be more possibilities. Today, there are already applications where consultations between clinicians and patients can be recorded, transcribed, synthesised, edited and uploaded as electronic medical records. 

38.          At the output end, clinicians can easily generate condensed patient information and track the patient’s medication use, without having to plough through lengthy clinical notes. All these will greatly improve productivity and change the way clinicians work today, for the better. IHiS is hence working closely with industry partners to develop a Secure GPT for healthcare professionals. It is an exciting development.

Synapxe

39.          I have outlined five strategic priorities for IHiS.  But IHiS will no longer be called IHiS after today. Today, we are launching its new identity – a new logo and a new name, called Synapxe, with an ‘X’. 

40.          Synapses are the critical nodes for transmitting information between neurons throughout our body. Only then can a human’s consciousness, through his or her brain, direct the functioning of the rest of the body.

41.          Likewise, Synapxe, as a critical entity under MOH, will ensure that patient medical records, data, care and medication, and healthcare subsidies and assistance – just like neurons of a human body - can transmit and flow seamlessly throughout the healthcare ecosystem. 

42.          When that happens, the entire nervous and sensory system of Singapore healthcare will be activated, and operate as one. Care can be delivered in the community and at home. Residents, with the support of community and GPs, can care for their own health. Seniors can better age gracefully in communities. We can all practise preventive care effectively. Acute hospitals can continue to save lives and attend to complex cases in more effective ways. Healthcare workers will find that they have more tools to make their work better, and make them more effective. All this is possible and Synapxe is at the centre of developing those capabilities.

43.          I want to thank IHiS for 15 years of service to public healthcare and to Singapore. Congratulations and I look forward to your continued contributions as Synapxe! Thank you.