real time research in a singapore public primary care institution
TRANSCRIPT
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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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
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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