Lessons From Singapore: A Study in Electronic Health Records

Transcription

1 Lessons From Singapore: A Study in Electronic Health Records Stephen Rainey ǀ NEHR Program Director ǀ MOH Holdings Martin Renwick ǀ NEHR Program Manager ǀ Accenture Thursday, February 23rd DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Disclosure Stephen Rainey, MOH Holding, NEHR Program Director Martin Renwick, Accenture, NEHR Program Manager Has no real or apparent conflicts of interest to report. 2

3 Speaker Introductions Stephen Rainey Program Director MOH Holdings Pte Ltd Program Director for the National Electronic Health Record for Singapore. Manages all delivery activity for MOHH Information Systems Division. 30+ years Project and Program Management experience, with 25 years in major systems integration, systems development, and business transformational change. Stephen s delivery experience stretches across multiple sectors, disciplines and government departments. Martin Renwick Senior Director Health & Public Services Accenture Ltd Specializes in large-scale program management for Accenture s government health clients - currently the Accenture Program Manager for the National Electronic Health Record in Singapore 26+ years of experience with large-scale IT delivery and implementation. Also worked with the US Department of Health and Human Services leading multiple Accenture projects for the Nationwide Health Information Network. 3

4 Learning Objectives Describe the challenges associated with the vision of a national, integrated Electronic Health Record. Explain how Singapore realized its NEHR vision. Discuss what the future holds for Singapore s healthcare industry. 4

5 MOH Holdings Pte Ltd Company overview MOH Holdings (MOHH), a wholly-owned subsidiary of Singapore s Ministry of Finance. Manages the public healthcare assets for the Ministry of Health. Addresses technology gaps in health system and carries out strategic initiatives. Business challenge Initiated a revolutionary project to develop a national electronic health record (NEHR) for Singapore s healthcare sector. The single, unified health record for each patient aims to give clinicians more timely and accurate health information, facilitate more effective diagnosis and treatment of diseases, promote good health and better manage illness. 5

6 Singapore Healthcare Landscape of the Future Strategic vision of patients moving seamlessly across the healthcare system, receiving coordinated patient-centric care at the most appropriate settings. Screening & Prevention Polyclinics FPs CH RH Rehab & support services Screening & Prevention NH Home Care Polyclinics FPs Screening & Prevention Palliative Care CH RH Rehab & support services Polyclinics FPs CH RH Rehab & support services Screening & Prevention NH Home Care NH Home Care Polyclinics FPs Palliative Care CH RH Rehab & support services Palliative Care Screening & Prevention NH Home Care Polyclinics FPs Palliative Care CH RH Rehab & support services Screening & Prevention NH Home Care Polyclinics FPs Palliative Care CH RH Rehab & support services Enabled by the National Electronic Health Record (NEHR) NH Home Care Palliative Care 6

7 Singapore Healthcare Landscape JURONG GENERAL HOSPITAL Legend Public Healthcare Providers Major Private Healthcare Providers New Healthcare Providers 7

8 Singapore Healthcare Landscape Acute care is provided by 8 public hospitals and ~10 private hospitals Public hospitals comprise 6 general hospitals, a women's and children's hospital and a psychiatry hospital 2 new public hospitals providing additional 1,000 beds will be operational over the next 4 years 6 national specialty centers for cancer, cardiac, eye, skin, neuroscience and dental care The primary care network consists of 18 outpatient polyclinics and 1,600 private medical practitioner's clinics Establishing family medical centers and community health centers Intermediate and Long Term Care is provided by residential and community which are mostly outside the public healthcare system though some facilities receive government subsidies. 8

9 Vision: One Citizen, One Health Record The NEHR will revolutionize the timely and accurate communication of clinical information, which will help promote a healthier population. No patient will have their clinical care compromised by lack of access to clinical information Vision of Patients Vision of Clinicians Vision of Health Administrators 9

10 NEHR Journey and Engagement Commencement of NEHR Project July 2010 Infrastructure and application build Sept to Dec 2010 Phase 1,Go Live 30 April 2011 Extend Capabilities July 2011 to Present July to Sept 2010 Functional and technical design Jan to April 2011 Testing April to July 2011 Historical Data Load 10

11 NEHR Solution Architecture The NEHR Architecture consists of: Access Channels that enable viewing of NEHR data in an appropriate format for patients, clinicians and researchers NEHR Services that provide the NEHR functions to clinicians and researchers Data Sources, including clinical and supporting systems, that provide the patient and clinical data thorough the NEHR EHR Information Exchange is a set of services that facilitates the sharing of information Technology infrastructure that provides the supporting platforms, integration, security, and operations capabilities 11

12 NEHR Release 1 Functionality EHR Summary Record Patient Demographics Medical Alerts Care Team Alerts/Allergies Allergy /ADR Immunisations Immunizations Advance Medical Directives (AMD) Diagnoses/Problems Medications Lab Rad Procedures Source System Doc Repositories Events view existing reports Discharge & Event Summaries Reports Emergency Department) Inpatient Community Hospital Laboratory Radiology Procedure 12

13 Singapore s healthcare data is held by a diverse range of healthcare organisations and clinical systems. Integration and Information Flow 13

14 Building a NEHR System Think big but start simple Governance for clinical, technical and information Address operational needs with intense discipline Disciplined approach to security operations, technical operations and service management 14

15 1. Make the complex simple Think big but start simple: 1. Data: Use what you have 2. User Interface: Engage with clinicians 3. Continued Momentum: Do not allow issues to become roadblocks Address operational needs with intense discipline 15

16 Data: Complexity of disparate data from multiple sources was overcome by the use of production data analysis and the decision to focus on raw data for the initial release. Discovery Data Profiling: Deep dive of production data from the source systems Profiling Outcomes Variations in Data: Structured versus non-structured Coding of data and coding standards Population of data Semantic Meaning of Data: Definition of basic concepts Mapping multiple approaches to common data model Actions Balance the theoretical vs. practical Request changes to extractions of data, without changing source data Avoid/minimize transform data at NEHR level 16

17 User Interface: Simple and more intuitive Early and often engagement of clinicians across care continuum Align features and functions to targeted Use Cases (continuity of care for initial release) Use screen mockups for visualization during Design Sessions Simple and intuitive user interface (read-only for initial release) 17

18 Continued Momentum: Integrate the discussion of functional, technical and operational issues and do not allow issues to become roadblocks Refusal to let issues become barriers Decision-making to allow project to move forward Integrate discussion of functional, technical and operational issues to shape the solution design decisions 18

19 2. Overestimate the importance of good governance Steering Committee Program Board Address operational needs with intense discipline Clinical Solution Usability, User Functionality and Clinical Risk Project Board Architecture, Se curity and Operations Technical Solution Information Governance Data Standards and Data Quality 19

20 3. Address operational needs with intense discipline NEHR operates at the enterprise level, which requires specific linkages: Data Management and Data Governance User and Service Management Address operational needs with intense discipline Security Governance and Procedures User Provisioning and Roles Change Coordination and Management Across Systems 20

21 Where are we are today? Operational with users across care continuum, including public sector acute, community sector, general practitioners and public agencies By end of June 2012, deployment to 12,000 users 1 year of historical data available and growing Full 24/7 operations, including help desk, hosting, infrastructure, network and application management Disaster recovery and business continuity Significant progress to realize vision for integrated healthcare 21

22 Where are we going next? More integrated Two-way sharing with more integration partners More information Increase scope of information available. NEHR as data owner Reconciled problems, medications, allergies and ADRs NEHR Portal Just another (important) integration partner Supporting services National services to enable cross system integration. 22

23 Questions 23

24 For more information, please contact: Office: (65) Mobile: (65) Website: Mail: 1 Maritime Square # HarbourFront Centre Singapore Stephen Rainey Program Director MOH Holdings Pte Ltd Mobile: (65) Martin.Renwick@Accenture.com Website: health Mail: 250 North Bridge Road #33-00 Raffles City Tower Singapore Martin Renwick Senior Director Health & Public Services Accenture Ltd 24