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MOH Holdings has embarked on its journey to build a National EHR system. What can others learn from Singapore’s experience?
To improve healthcare quality for all residents, increase patient safety, lower healthcare costs and develop more effective health policies, Singapore’s Ministry of Health (MOH) created the National Electronic Health Record (NEHR) vision—“One Singaporean, One Health Record”—which enables patient health records to be shared across the nation’s healthcare ecosystem. In 2009, MOH Holdings (MOHH), the holding company of the nation’s public health assets, initiated the project to develop the NEHR system.
As other countries continue to grapple with the issue of how to implement a nationwide EHR, MOHH has embarked on its journey to build its NEHR system to provide a common access point for medical information for its population of 5.1 million. Additonally, the healthcare ecosystem in Singapore has more than 36,000 healthcare providers across the public and private sectors. Private practitioners provide 80 percent of the primary healthcare services, and the government polyclinics provide the balance. The ratio changes for more costly hospital care, with the government providing 80 percent through eight public hospitals.
MOHH initially engaged Accenture to develop an architecture blueprint for the NEHR system which detailed the business, information, application and technology architectures. In 2011, Accenture and MOHH began deploying the NEHR to provide clinicians with a summary care record for each patient including problem lists, medications, discharge and event summaries.
MOHH has identified some useful lessons in its ongoing journey to improve quality of care and health outcomes while optimizing efficiency and cost.
The first phase of the NEHR system went live in April 2011 and included putting in place the entire technical solution, all physical system components, and data centre equipment in fully tested and approved state. This was followed by the synchronization and integration of the NEHR system with existing legacy systems. The long term goal of the NEHR is to allow primary-, acute- and community-care clinicians access to shared clinical data that help to enhance medical treatment and improve safety and in the future help analyze health trends and better manage disease.
More specifically, the initial release offers the following capabilities:
NEHR Architecture: Starting with the End in Mind
Working with Accenture, Singapore’s MOHH invested in the development of a goal-state architecture—which serves as the blueprint for achieving short-term and long-term goals. At a high level, the blueprint includes four core elements:
In its ongoing journey to improve quality of care and health outcomes while optimizing efficiency and cost, Singapore’s MOHH has identified some useful lessons:
1. Make the complex simple. The solution blueprint for Singapore’s NEHR includes a framework for sophisticated business logic, analytics, decision support and other services. This framework will let MOHH incorporate new capabilities in the future. For the initial phase, however, Singapore focused on “Continuity of Care.” The requirements for achieving this initial vision: a rich, view-only system with clinical events, investigation reports, radiology reports, alerts and allergies, immunization records, medications and a host of supporting documents.
With this approach, MOHH was able to successfully address three key challenges:
2. Value the importance of governance. In a perfect world, all data sources would provide uniform and quality data. Of course, the real world is far more complicated. With that in mind, it was important to focus on understanding up front what was available and work within those confines to aggregate data without losing meaning.
The work in Singapore also underscored the importance of governance in bringing together organizations and systems. Three types of governance were put in place:
3. Address operational needs with intense discipline. From the beginning, MOHH and the project team took a disciplined approach to security operations, technical operations and service management. In addition, operational areas specific to an EHR were defined. These included:
May 4, 2012
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