Update on the National Electronic Health Records System

03 Mar 2010

Question No:  302   

Question

Name of the Person: Dr Lam Pin Min

To ask the Minister for Health if he will provide an update on the National Electronic Health Records System, its implementation strategy and the cost implication for Singaporeans once it is implemented.

Reply

Reply From MOH

1. Although the question is on the National Electronic Health Record (NEHR) currently being implemented, I will briefly provide the backdrop to this development so that NEHR is seen in its proper context.

2. Information Technology (IT) is an important capability and a critical infrastructure in any modern healthcare sector.  In fact, the weaknesses observed in the healthcare sector in many countries can be better addressed through greater and skilful investment in IT by the sector.  In the current healthcare reforms debate in the US, for example, there are many calls for NEHR investments. 

3. Traditionally, healthcare has been a laggard in the use and exploitation of IT, as compared to other economic sectors, such as finance, manufacturing.  Singapore is no exception, though we probably fare better than many other countries as we have been investing in healthcare IT for years.  As a result, the use of IT is now quite pervasive and widespread in our healthcare institutions. Some institutions have become “paper-less”, like the National Skin Centre and the Bukit Batok Polyclinic.  Many hospitals have gone “film-less”, as diagnostic images are digitised.  Some hospitals have adopted pharmacy systems with electronic ordering.  SingHealth Cluster and NHG Cluster have each an integrated core of financial, administrative, health service management and electronic medical record (EMR) systems which have become an integral part of their hospital operations.  Dr Lam, who works in our hospital, will know that his clinical work, whether in the specialist outpatient clinic or in the ward, will be severely hampered, if the IT system breaks down.

4. The clusters had developed their EMRs independently.  This created a problem when a patient moved across the cluster.  As an interim solution, we implemented an Electronic Medical Records Exchange (EMRX) to allow secure cross-cluster exchange of patient information so that regardless of where the patient seeks treatment, key information could be pulled to enable safer decision making. Subsequently, we extended EMRX to some healthcare partners.  Today, the EMRX is a pivotal capability that allows easy movement of records across the public healthcare clusters, community hospitals and MINDEF, facilitating care delivery.

5. All these efforts have shown the early benefits in safety and convenience for our patients as information is much more easily accessed at various points of care.  However, the current EMRX has a major drawback:  it is essentially a document-level exchange, with no standardised or structured data.  While it has been useful, it limits further exploitation of the data.  Seamless sharing of data beyond documents is very difficult, if not impossible.  For example, diagnostic images, including X-rays, cannot be exchanged over the EMRX, because various institutions use different vendors and their current viewers use different versions of image protocols. Images from one institution are therefore not easily readable in another institution without degradation of quality and significant translation effort. 

6. The lack of structured data also means that anything beyond information exchange, such as making the system “smarter” to aid clinical decisions, research and disease surveillance is technically impossible.

7. Recent progress in IT and further standardisation of medical data internationally has enabled us now to move into the next step of IT exploitation.  In particular, as healthcare systems seek to integrate service delivery beyond acute hospitals to include the providers in the community in order to right-site services, raise the level of chronic disease management and empower patients to look after their health proactively, the need for a National Electronic Health Record system has been recognised here and in many developed countries.  This is a necessary step forward to create a health record that is truly personalised and available everywhere. 

8. Unlike some other countries, we are not starting from scratch.  We are building on the strong foundations of the past investments in healthcare IT that our public hospitals already have in place today.  The NEHR is not to replace EMRs.  Indeed, we will need to continue to invest in the EMRs at the clusters level to further exploit IT within the institutions.  The level of details required in a local EMR is much more than in a NEHR.  The NEHR will ride on the EMRs, drawing key information from the various EMRs in the public healthcare institutions, in order to construct a patient-centric view for both healthcare workers and patients to make better care decisions. Thus, the NEHR sets out the system-level architecture for how the different existing and new systems must fit together. To make this possible, we have to settle the standards for the data and establish the ways to properly exchange and synchronise information over a longitudinal basis.  Moreover, in order to support integration of care and chronic disease management, NEHR has to cover the entire healthcare ecosystem, and not just the public sector.

9. This is therefore a complex and difficult undertaking.  Full implementation will take many years.  We are proceeding in phases so that each subsequent phase will take into account the experience of the earlier phase and be able to exploit emerging technologies. We may not need to extend the NEHR to every healthcare provider. Each phase of new incremental investment will have to be justified on cost-benefit grounds.  We have a long term goal but we are not committing to the details of each subsequent phase.  Put it another way, we have set the direction that we are going, but we are not committing to the pace of reaching each subsequent milestone.  We will settle such details incrementally and progressively.  This is a prudent way going forward, as IT will continue to evolve.

10. For the current phase of implementation, we will be spending $176 million and by the time of project completion in April 2011, key medical information including patient demographics, allergies, clinical diagnoses, medication history, X-rays, laboratory investigations and discharge summaries will be fully exchangeable.  They will also be in a form which lends them for more thorough analysis.

11. A number of primary and step-down care providers, including GPs, polyclinics and a community hospital will also be linked up in this current phase.  This will enable us to better prepare for the subsequent extension of NEHR to all the other healthcare providers, if we so decide. 

12. My Ministry has committed attention to IT governance and management of the NEHR project. Overall, we are progressing well along this journey towards “one Singaporean, one health record”, which is essentially what the NEHR seeks to achieve.  This will allow Singaporeans to move seamlessly across the healthcare system to get the most appropriate care in the most appropriate setting as we work towards integrated healthcare in Singapore. In particular, it will be the platform which will make possible proper, right-sited chronic disease management to the benefit of patients. The NEHR would bring about cost savings for patients, from eliminating duplicate or unnecessary tests, as well as reducing medication errors and adverse drug events that could result in unnecessary healthcare expenses.