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Challenges in Implementing EMR: The Singapore Story

This PPT explains about how Singapore is using IT in healthcare, Integrated Health Information Systems, Singapore's Shifting Demographics and 2020 Master Plan. For more information visit: http://www.transformhealth-it.org/<br>

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Challenges in Implementing EMR: The Singapore Story

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  1. Challenges in Implementing EMRThe Singapore Story Dr. Chong Yoke Sin CEO, IHiS

  2. aboutSingapore and IHiS About Singapore

  3. ~ 5.4million people on 707.1sq km (6,489/km2) Ethnically diverse: Chinese: 75% Malays: 14% Indians: 9% Others: 2% 40,000+healthcare providers 11,230 hospital beds ~450,000 hospital admissions Public sector out-patient visits Specialist Outpatient Clinics ~3.6m A&E ~800k Polyclinics ~4m Singapore is a small vibrant country

  4. Integrated Health Information Systems IHiSis a healthcare-IT leader, transforming patient care throu​gh excellence in technology. ​Our healthcare-IT professionals architect and manage the highly integrated systems across Singapore’s Regional Health Systems, public hospitals, national specialty centres and polyclinics.​ IHIS played a key role in 7 out of 8 Singapore hospitals and 1 Primary Care facilities becoming among the first public institutions in the Asia Pacific region to achieve HIMSS EMRAM Stage 6, an international benchmark for advanced technology used in patient care. IHIS works with the healthcare institutions to drive innovation so as to achieve new standards in quality care.

  5. A humble beginning … A humble beginning …

  6. Evolution of Singapore Healthcare IT Patient Master Index Electronic Medical Record Smart Healthcare Health Informatics eHealth EMR

  7. The driving force behind the change …

  8. Singapore’s shifting Demographics as Singaporeans are living longer • Our total fertility remains low and our life span is increasing • Population as a whole will “age” faster in the next one to two decades. • A higher proportion of Singaporeans who are 65 year old or above • By 2030, one in five of us, will be 65 years and older • Fewer Working-Age Adults to Each Citizen Aged 65 and above

  9. Healthcare 2020 Master Plan ?

  10. Our Strategies …

  11. Overview of Public Healthcare IT • Hospitals • Information sensing • Paperless • Clinical & Business integration • Advanced Clinical Decision support NEHR GP CH • Intra-Cluster • Integrated Workflow • One EMR • One Patient Relationship Management PRM RH • Cross-Cluster • One EHR • EMR for Details EMR EMR Exchanges of Images, Records EMRX

  12. Take a System-Wide View to Solutions Create an Eco-System & Culture for Solution Re-use Comply with Solution Governance: Solutions Review Board (SRB), Process and Program Steering Committee (PPSC) Enterprise ArchitectureGuidance Towards Solution Harmonisation Better Quality, More Resiliency, Fewer Interfaces Shorter time to Deployment Lower Development & Maintenance Cost 12

  13. Strategy to achieve Non-Disruptive IT shared Services Architect the Roadmap • Federated Enterprise Architecture • PHI Operating Model Integrate the Systems • Interface through QDX • Standardize • Integrate and Optimize Patient Centric Records • EMRs/NEHR/Clinical systems / Master patient index • Patient Relationship Management • Connect with AIC, NH, CHs, GPs, etc

  14. Back to BasicsData Standard and Right Channel Common Data Standardized • ICD 10 AM • SNOMED CT • LOINC Integrate Analytics across Continuum • Structured notes • Clinical analytics Intervene at the RightChannels • Clinical decision support (EMRs, NEHR) • Tele-health

  15. Our EMR Journey … About IHiS EMR

  16. Our EMR Journey … The ABC of Cluster’s EMR digital journey 2015 2011 • Advance Clinical Analytics • Proactive and Predictive Alerts • Tele-Health, Self-Monitoring & Home Care • Mobile Health – Healthcare Social Media • Analytics for population care • EMRAM Stage 6/7 ? 2010 2006 • Clinical & Nurse Documentation • Knowledge-Based Medication Management • CLMM Implementation • CPOE/CCOE Implementation • eLab & eRad interface to EMR 2005 2001 • A common EMR platform & EMRX • Results Reporting and Discharge Summary • Perioperative & ED Notes • Cluster eRx, Film-less 10/17/2015 ©2011 Healthcare Information and Management Systems Society 16

  17. Our EMR Journey … • Cluster EMR Roadmap • Application Landscape • EMR Building Blocks • Implementation Strategies • EMR Capabilities Highlights: • CLMM • CPOE • Clinical Document • Coding Standardization • Statistics • Benefits • Challenges & Lessons Learnt

  18. The EMR Architecture

  19. Patient Safety, Our First Priority Closed Loop Medication Management (CLMM)

  20. WHYClosed Loop Medication Management • Value to Patients • Improve patient safety through reducing medication errors • Value to Hospitals / Staff • Remove waste, improve system efficiency • Technology Innovation • 1st in Asia with a complete end-to-end closed-loop solution • Scalability • Implemented in KKH, NUH and TTSH • Average Unit Dose Serving / year • KKH - 3.9m of unit dose drugs for 65,000 patients • NUH - 5.5m of unit dose drugs for 92,000 patients • TTSH - 6.6m of unit dose drugs for 110,000 patients

  21. WHATare the CLMM components • Electronic Prescription System • Patient’s medication prescriptions • Clinical Decision Support System (CDSS) • Enterprise wide Business Intelligence to support clinical care • Packaging Robot • Unit dose Packaging • Nursing Administration System • Bar-code technology to serve drugs correctly

  22. HOWthe CLMM works

  23. CLMM ensure 5 RIGHTS Right patient Right drug Right dose Right route Right time • Enhanced Medication Safety Process • Improve patient safety • Efficiency of ward processes • Reduce turn around time for medication stock • On-time, on-demand serving (urgent medication order) • No more faxing of prescription • Improve the billing process • Billing is done upon medication administration

  24. Lessons Learnt • Robot technology for filling medication according to orders from EMR system eliminate human errors and enhanced patient safety. • The 2D barcode is capable of storing more information and also ensure higher degree of accuracy compared to one dimensional bar code. • If the unit dose packaged medication is not consumed or when the doctor change the patient’s medication, it can be returned to pharmacy for the next patient. • For the medications bundled with a ring, it helps to speed up the cart-fill and enable the pharmacy staff to spend more time for other clinical activities. • The robot is capable of packing mini-bottle medicine but not big bottles. • Labeling medications with 2D barcode enables clinicians to scan and verify medication administration at the point of care, helping to ensure the ‘5 rights’ of medication administration. • Filling the robot for unit dose packing has to be observed very closely for patient safety

  25. Better Communication, Quality Reporting, More Effective Patient Care Clinical Documentation & Standard

  26. EMR Clinical Documentation Implémentation Stratégies • Organization Support • Effective systems to support accurate and concise documentation of practice in medical records • Appropriate policies and procedures in relation to effective documentation systems, practices and management of patient health information • The provision of adequate time allocation to document appropriately and review previous documentation as part of patient care • Leadership • Involve clinical staff in decision making in relation to selecting, implementing and evaluating documentation systems • Implementing quality improvement processes related to effective documentation • Promote documentation as an integral and core part of practice and professional responsibility • Resources • Access to an appropriate physical environment that supports and increases efficiency and confidentiality of documentation • Reliable, accessible and appropriately maintained equipment

  27. EMR Clinical Documentation Implémentation Stratégies • Engage all clinical chiefs and administrators • on the new clinical documentation • Conduct roadshow for all doctors to create • awareness • Set up ‘sandbox’ with feedback system for • clinicians to trial the new clinical documentation • Implement clinical documentation in outpatient • settings first as it is less complex than the • inpatient settings • Implement clinical documentation with a group of related stakeholders • Deploy additional IT support staff on site during the rollout

  28. Benefit of Clinical Documentation • Appropriate documentation promotes • A high standard of clinical care • Improved communication and dissemination of information between • and across service providers • An accurate account of treatment, intervention and care planning • Improved goal setting and evaluation • of care outcomes • Improved early detection of problems • and changes in health status • Evidence of patient care

  29. Challenges in Clinical Documentation Clinicians’ Adoption - Integrated with consultation workflow - Balance between Structured and Free Text - Minimal clicks/ data entry - Auto-retrieved Allergy, Health Issues, Lab / Rad Results and Medication - Incorporate CPOE into document - Incorporate CDSS into document - Short and concise printout - Reduce duplicate entry

  30. Challenges in Clinical Documentation Standardisationand Governance • Same Coding standards for Clinical Decision Support and Analytics • Same Data items for same observations in all documentation to facilitate future analytics • e.g. Smoking History, Pain score etc • Same look & feel across institutions for ease of use, particularly for junior doctors rotating from institution to institution

  31. Lessons Learnt • Improve Clinician Engagement • EMR becomes a common platform for information sharing and real-time reporting, resulting in greater communication and partnership among different clinical teams and improved patient outcomes. • Accountability • Demonstrates the clinician’s accountability and records their professional practice. • Communication • The basis for communication between health professionals about the (a) Care provided, (b) treatment, (c) Care plan, (d) outcome • Quality • Should be clear, concise, correct, contemporaneous, complete, collaborate, patient-focused • Confidentiality • Must maintain confidentiality

  32. Data Standardization • Adopt SNOMED-CT for Problem List and Diagnosis • Problem List and Diagnosis can be set as ‘General’, ‘Chart’ and • ‘Visit’. • SNOMED-CT coded Problem List and Diagnosis facilitates Decision Support. • SNOMED-CT coded Problem List and Diagnosis assist in Analytics

  33. Governance Process • Involve clinicians from all institutions for requirement study so that clinical notes for same specialty are standardised across institutions • Change Control Committee (CCC) comprising of IT representatives from different clinical document teams to review data items for new clinical document • Core Clinical Design Team (CCDT) comprising of clinicians, nurses and IT to review the new clinical document

  34. Dr Chong Yoke Sin chong.yoke.sin@ihis.com.sg

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