SingHealth is the eastern public healthcare cluster consisting of 3 hospitals; Singapore General Hospital, Changi General Hospital and KK Women’s & Children’s Hospital; 5 Specialty Centres; National Cancer Centre, National Dental Centre, National Heart Centre, National Neuroscience Institute and Singapore National Eye Centre as well as 9 polyclinics.  

The SingHealth Vision is -  “To be a renowned organisation at the leading edge of Medicine, providing quality healthcare to meet our nation's aspirations.” 

This paper aims to demonstrate how SingHealth has continually harnessed technology to transform the way clinical information is captured and accessed, improve staff productivity and operational efficiency as well as improving patient safety. 

Imagine a future where hospitals have no paper case-notes or files. Information on a patient’s medical condition is automatically captured via intelligent context-aware devices and sent directly to the central computer systems. Information such as X-Ray images, laboratory tests, medication history and drug allergies are also available at one’s fingertips on computers located by the patient’s bedside. This means less time is spent tracking and documenting patient information, and more time for doctors and nurses to provide better patient care.  

The Digital Hospital is SingHealth’s vision of a “paperless” and “technology-enabled” hospital incorporating cost-effective and innovative technologies and a healthcare facility, which deploys IT pervasively to dramatically improve the outcomes and processes of care.  SingHealth believes there are 3 main pillars towards building a Digital Hospital: 

A.                  Digital Ward

B.                  Digital Clinic

C.                  Telecare, Telemedicine and Homecare 

Healthcare is an information intensive sector. Services are delivered at various points of care across the healthcare ecosystem, from prevention to primary care in the clinics, acute care in the hospitals and finally homecare. 

The objective of the Digital Hospital is to leverage on leading edge technology to innovate, automate, improve, change and transform the way healthcare professionals capture and access clinical information. Through IT, SingHealth has piloted various IT innovations within the 3 pillars of our vision of a Digital Hospital: 

1.      Digital Ward Innovations

2.      Digital Clinic

3.      Telecare, Telemedicine and Homecare 

These will be further elaborated under the Technology Section in Part 2 of this paper. 

Previously, some of the problems encountered BEFORE the implementation of Digital Hospital were: 

a)      Too much time spent on tedious menial tasks

b)      No access to critical information at patients’ bedside

c)       Slow retrieval or loss of critical information

d)      Disruption to patients’ rest

e)      Illegible documentation by clinicians

f)        Slower response time to unexpected abnormal vital signs readings

g)      Human error

h)      Heavy usage of paper 

Through the use of innovative technologies, the expected outcomes include 

a)      Reduction in time spent on tedious menial tasks

b)      Ability to have access to critical information at the patients’ bedside

c)       Faster retrieval of critical information

d)      Less disruption to patients’ rest, overall improvement for inpatient stay experience

e)      Online documentation by clinicians

f)        Fast response time to unexpected abnormal vital signs readings and homebound patient emergencies

g)      Better reach and care for overseas and traveling patients

h)      Reduce Human error

i)        Reduce usage of paper

j)        Automate tracking of door access data, staff attendance and staff    immunization data. 

The innovations in our Digital Ward can be easily replicated in any healthcare organization as the equipment can easily be customized to their healthcare environment’s setting.

SingHealth’s EMR and IMS project can be customized to the healthcare organisation’s need like any other software programme. They would require the vendor to study the healthcare environment to determine the features required for the particular organisation’s need. However our Electronic EMR Exchange (EMRX) is a National and Government initiative, spearheaded by our Ministry of Health, Singapore. 

The Heart of our Telecare project system is an application that can be easily set up on commercially available hardware anywhere. Minimal training for clinicians and patients is required to use the system. Overseas and local patients link by telecommunication channels can easily use the system once they are registered and given the appropriate access. Patients can use various communication modes (Web, SMS, and in the future touch-tone phones) that is most familiar and convenient for them. Depending on the disease, each of the modules (vital signs monitoring, symptom questionnaire and secure messaging) can be configured as standalone or integrated.

IT is a key enabler to realize the goal of a Digital Hospital. The role of IT in this project is exemplified in various ways:

 1.      Enables National sharing of information

For patients seeking treatment between the 2 healthcare clusters in Singapore, namely SingHealth and National Healthcare Group clusters, the SingHealth Integrated EMR system has been enhanced to allow Inpatient Discharge Summary, Allergy and Medical Alerts information to be exchanged between both healthcare clusters. This sharing of information facilitates better clinical decision-making, leading to improved patient care, safety and management across clusters. This collaboration is led by the Ministry of Health Electronic Medical Records eXchange (EMRx) initiative, which went live on 1st April 2004. 

2.      Empowerment

IT empowers both clinicians and patients with the power of knowledge and information, anytime, anywhere.

 3.      Improves Patient Doctor Relationship and Care Provision

The innovations in Digital Ward and Digital Clinic enables clinicians to have a convenient and efficient means to access patients’ medical information thereby improving doctor to patient dialogue and care provision. 

Timely and reliable access to comprehensive, accurate and up-to-date clinical data are important factors in assisting clinicians make critical decisions to manage patient care and treatment.

 4.      Time, Cost Savings and Convenience

There are immense time-savings, which result from online access to complete information versus manual paper-based reports and time spent making phone calls to laboratory and radiology departments for information.

Nursing staff time to retrieve and collate clinical information for review by clinicians is reduced significantly. This means that time savings could then be channelled for better nursing care management. Moreover, with our Digital Ward innovations, there is a potential for manpower cost savings of $750,000 per ward. 

From the patient’s perspective, there is improved quality of care and enhanced patient safety with quick online access to more complete, better quality and up-to-date clinical information and system alerts for abnormal results, duplicate medication orders, and drug-to-allergy interactions. Furthermore, there is cost savings for the patients by as much as **S$100 per patient as repeated laboratory tests and radiology procedures can be avoided when a patient goes to another institution. Online information from this integrated application compares favourably with the longer turnaround time for information access of the previous paper-based EMR system.

**Assume a patient spends $100 on average for repeated laboratory tests.  

It is a step towards a “paperless and filmless” environment that aims to improve patient service level through operational efficiency.