real time research in a singapore public primary care institution

Real Time Research in a Singapore Public Primary Care Institution: Opportunities & Challenges

Dr Tan Ngiap Chuan Director, Department of Research,

SingHealth Polyclinics1

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Source of information: http://www.moh.gov.sg

ingaporeHealthcare System

S

Public Healthcare System in Singapore

Secondary/Tertiary Healthcare

People

Primary Healthcare

ContinuingHealthcare

WellnessCare

Secondary/ Tertiary Care

• 20% private • 80% SingHealth &

National Healthcare

Primary Care• 20% in Polyclinics(serve 45 to 60% of

patients with chronic diseases)

• 80% private GPs

Wellness Care• Mainly private sector• Some public sector

involvement e.g. Health Promotion Board

Continuing Care• 70% public sector• 30% private sector• include community

hospitals, nursing homes, hospices etc.

Singapore Regional Healthcare Systems

• Tan Tock Seng Hospital• Institute of Mental Health• National Skin Centre• NHG Polyclinics

• Singapore General Hospital• KK Women’s and Children Hospital• Sengkang General Hospital (opening in 2018)

• Singapore National Eye Centre• National Cancer Centre Singapore• National Heart Centre Singapore• National Dental Centre Singapore• National Neuroscience Institute• SingHealth Polyclinics• Bright Vision Hospital

• Khoo Teck Puat Hospital

• Alexandra Hospital• Jurong General

Hospital (opening in 2015)

• Changi General Hospital• SingHealth Polyclinics• St Andrew’s Community

Hospital• Peacehaven Nursing Home • National University Hospital

3 Hospitals

9 Polyclinics

5 Specialty Centres

Members of SingHealth

Polyclinic Locations

National Healthcare Group Polyclinics

SingHealth Polyclinics

SingHealth

Ang Mo Kio

Hougang

Yishun

Toa Payoh

Choa Chu Kang

Clementi

Woodlands

Jurong

Bukit Batok

National Healthcare

Group

Queenstown

Sengkang

Bukit Merah

J

Roles of SHP• Primary Healthcare Services • Emergency Preparedness• Sentinel Surveillance for Epidemics• Primary Healthcare Professional

Training• Signature Research Programmes

Patient Attendances: 2009 - 2013

Patient Attendances for Year 2013 : 1.72 million

2.9%

2.5%

2.5%

(in ‘0

00s)

1.6%

Patient Demographic 2013

Patient Demographic

2013

Hypertension 15.9%

Top 5 Conditions SeenPatient Health Conditions 2013

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Hyperlipidemia 15.8%2

Upper Respiratory Tract Infection 8.9%3

Diabetes Mellitus 8.0%4

Other Screening or Monitoring 6.7%5

A typical visit to the polyclinic

PAST• Walk-in for all services• Manual Processes • Paper-based• Segmented

Patient Experience - Seamless Flow

NOW!

System Re-design

Decision Support Self Management Support

Clinical information system

What is next initiative at the Health Monitoring Station?

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HMS CAT screenshotPPIS HMS screenshot

EHR systems in SHP

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Polyclinic Patient Information System (PPIS) Clinical records/parameters – diagnosis, BP, weight, height, BMI,

ACT scores, Immunisation records, decision support tools

Allscript (Electronic Health Record) Clinical documentation of consultation Laboratory results Radiological results Referral documentation

Outpatient Administration System (OAS) Attendances by disease codes Personal data, payment status & bills (treatment costs)

Integration of Databases in SHP

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Data Warehouse: Work in progress

Data access is restricted to approved SHP employees and governed by SingHealth RHS data management policy

Data access for research projects must be approved by SingHealth Centralised IRB

Data access for other research purposes in SHP is vetted by Director, Department of Research

National Electronic Health Records (NEHR)

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Extract selected data from databases of all public healthcare institutions in Singapore and small group of GPs

Aim to integrate personal health data into a single record

Access is strictly monitored due to local regulation under the Personal Data Protection Act (PDPA)

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Personal Health Management

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Personal Health Management

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Multiple Functionalities: One Stop Health Portal

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Health@SG: Accessibility & Diagnostics

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Other Databases for Research in SHP

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Special asthma care programme is established in 2004 under the Singapore National Asthma Programme (SNAP): providing additional subsidy to allow patients to access expensive inhaled medications for asthma treatment (such as controller-LABA combination drugs)The database allows longitudinal study of this cohort of patients: multiple sub-studies are in progress

Cohort of patients with chronic Hepatitis B infection: database set up in 2002-3 with limited grant from SingHealth Foundation:Opportunity to study the potential flare-up of the HBV infection amongst asthma patients receiving short oral steroid courses to curb asthma exacerbations

Other Databases for Research in SHP

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The SingCloud is a Singapore Cardiac Data Bank linking major public hospitals and polyclinicsopportunity to evaluate outcomes of cohort of patients such as those with cardiovascular (post-AMI and CCF) and concomitant respiratory diseases

Challenges

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Progress in integrating the various databases

Access issues: cross-institution Department staff capacity and

training to operationalise database research

Limited financial resources from institution

Extremely competitive national research grants (vs established clinician scientists from tertiary and academic institutions)

What is in the horizon?

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Staff training to use Data Warehouse at end Feb 2015 Streamline processes to facilitate data access and

screening selected subjects for research without infringement of PDPA

Configuration of data fields in IT system which facilitates data-mining

Establish and strengthen collaboration with local and foreign academic institutions to expand research capacity, such as exchange programme

Advisory comprising of domain experts to guide and support database research development in SHP

Thank you

This presentation contains information which is confidential and/or legally privileged. No part of this presentation may be disseminated, distributed, copied, reproduced or relied upon without the expressed authorisation of SingHealth.

It has been our pleasure to share with you!

Acknowledgement

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Prof David Price Thao Le, Alison, REG Mr Tikki Gee, MOHH Ms Michelle Pae, Dept of Quality Management, SHP Ms Low Ming Li, Corp Communication, SHP