Mr Linus Tham, Chief Information Officer of Singapore’s National Healthcare Group (NHG) shares with iN.SG on the dynamics that are driving and pushing the adoption of information technology (IT) in healthcare and the challenges that healthcare industry face when it comes to IT innovation.
About the National Healthcare Group:
The NHG provides comprehensive primary to tertiary public healthcare services in Singapore. The group operates hospitals such as Alexandra Hospital, Tan Tock Seng Hospital, National University Hospital, Institute of Mental Health/Woodbridge Hospital, National Skin Centre, The Cancer Institute, The Eye Institute, The Heart Institute, 9 polyclinics throughout the island, and six business divisions that provides pharmacy, diagnostics and other related medical services. Incorporated in March 2000, NHG has over 11,000 employees and more than SGD$1 billion in revenue (US$610 million).
Q: What do you think are the key factors involved in the development & delivery of information technology in healthcare today?
Linus:
It is a well-recognised fact that despite generating and consuming so much information, and the level of technological development in the various medical equipment such as Röntgen rays (X-rays), Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and laboratories, healthcare lags far behind other industries in exploiting IT.
Provision of care by doctors and nurses has not changed much over the last century. In addition, healthcare is a risky business. There is recognition of this risk, and the recognition that through exploiting IT, it is possible to significantly reduce errors, and improve care to our patients. There are also ways where the exploitation of IT allows us to reduce costs, or do more with the same costs. This recognition, especially by board-level and senior management, provides the top-level executive support to invest in IT. At the same time, our care providers are all IT literate - they make use of computers while they are in school and in their daily lives. They are therefore more conversant with IT, and receptive to IT use in the healthcare system. Some even expect it.
Q: Would you be able to share more on the successful examples of NHG's IT implementation programme for clinicians?
Linus:
Our first 'shining' example is the roll-out of our home-grown Computerised Patient Support System (CPSS) - which originated in National University Hospital (NUH) under the leadership and guidance of the hospital’s Chairman of Medical Board, Associate Professor Benjamin Ong, to the rest of the cluster.
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Mr Linus Tham CIO, National Healthcare Group shared that Singapore is fortunate to have a pool of extremely dedicated, forward looking and committed clinician
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This system, with various enhancements, has allowed our two largest institutions – NUH and Tan Tock Seng Hospital (TTSH) - and our nine polyclinics to convert to full electronic prescription in record time; something that takes even some Western countries several years to do, we have done in one year. The system now makes prescribing in the outpatient setting safer - as we can check for allergies and some drug to drug interactions.
The roll-out of the Cluster Patient Record Sharing (CPRS), and subsequently linking it to the Electronic Medical Record Exchange (EMRX), is another successful example. The transformation of the emergency department process - where triage staff now look up information about the patient en-route in the ambulance to the hospital - and having more information to treat the patient with, helps to save precious minutes for the doctors in caring for the patient.
Our electronic verification of laboratory and, recently, pathology tests has also enhanced patient safety. Our doctors in NUH and polyclinics, and soon TTSH, will be alerted when there are abnormal results, so that they can take action faster. Missed results will eventually permanently be a thing of the past.
Q: Has this programme greatly increase efficiency and cost-effectiveness? For example in reducing patients' waiting times, improve bedside care, reduce doctors' workload etc?
Linus:
While there are some 'improvements' on doctors’ efficiency through the system - for example being able to click 'repeat' for drugs for a follow-on visit rather than having to write out all the drugs in a new prescription - the implementation of clinical applications really focuses on improving the safety and quality of care to our patients.
However, we have pursued efficiency gains in other areas such as teleradiology where we now achieve faster and cheaper X-ray reports for our polyclinic patients. Patients can receive X-ray reports on the same day, saving them one extra visit to the polyclinic. Our laboratory automation systems have also dramatically trimmed turnaround time for laboratory results.
Q: Are clinicians receptive to these IT programmes?
Linus:
Most certainly yes. We are very fortunate to have a large pool of extremely dedicated, forward looking and committed clinicians who work tirelessly - often late into the evenings, with the IT team to deliver the programmes. These clinician leaders also help us with change management for the entire group of clinicians.
Q: Can you share what are some of the challenges that healthcare industry face when it comes to IT innovation?
Linus:
For Singapore, our small market poses a problem. Well-established names and products in other countries often find it hard to justify setting up shop on our shores unless they have it in their plans to use Singapore as a springboard into the region. This limits our access to new technologies. Our small market also provides less opportunity for local companies to develop new innovations. Thus we need to find new models of collaboration in order to develop new solutions.
Our heavy workload is a double-edge sword. It forces us to innovate though it also makes it difficult for clinicians to find time and bandwidth to work with IT to innovate. The ability to 'try out' new things is limited by the workload as any pilot trials which invariably slow down the process would not be well-received by our patients. Thankfully, we have many clinicians who continue to persevere.
Q: What do you hope to see in the area of developing medical informatics professionals given the relatively new area for Singapore's healthcare sector?
Linus:
I hope to see more training courses for them. There could also be more done in the area of industry partnership to develop capability and intellectual property in Singapore – for example, where local company partners with a hospital or an entire cluster - or a large MNC doing the same. Such development will create a vibrant market and the demand for professionals.
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