Mr Hal Wolf, President & CEO, Healthcare Information and Management Systems Society
Mr Benedict Tan, Organising Committee Chairman
Ladies and Gentlemen
1. I am happy to join you today at the Healthcare Information and Management Systems Society 21 APAC Conference.
Appreciation
2. Let me begin by acknowledging healthcare professionals all over the world for your indomitable spirit, and for working tirelessly throughout this pandemic, under such trying circumstances and severe stress. Many countries have gone through massive waves of infections and incurred many tragic deaths, with their hospitals coming under immense pressure and even overwhelmed.
3. In Singapore, we have averted that so far, because of our strict controls throughout the large parts of the past 20 months. With the great majority of our population now fully vaccinated, the disease is no longer life threatening for the vast majority of us, and we will have to start transiting to living with COVID-19 and restoring our normal lives.
4. Even then, in recent weeks, infection numbers have shot up, and unfortunately, so did patients who succumbed. To those who suffered the loss of a loved one, please accept our condolences. To the healthcare workers who hold the fort at the last line of defence in our clinics and hospitals, let’s give them whatever support we can.
5. At the Ministry of Health (MOH), we are mobilising more manpower resources, such as from PCR swab operations which we are doing less of. We have 1,600 trained volunteers who have stepped forward to help, and we have deployed them.
6. We have simplified healthcare protocols, so hopefully the days of healthcare workers being regularly quarantined due to exposure to infected persons are behind us. We are also roping in private sector hospitals to help share the load and the burden.
7. The path Singapore has chosen is unique in the world – we did not take a purist ‘zero COVID’ or ‘living with COVID’ approach. We adopted an eradication strategy when our population was vulnerable, mainly last year and earlier part of this year. After vaccines have given us a protective shield, we are opening up progressively, and avoiding a sudden lifting of all restrictions. Some may feel that this middle of the road approach is perhaps unclear, and may even appear to be a ‘flip-flop’. But it has helped us avert the massive deaths that many countries have suffered. It is the correct approach for Singapore, and day by day, we are moving closer to the light at the end of tunnel.
8. I must also thank all the officers at the MOH and our partners managing the COVID-19 operations. This include contact tracing, conveyancing of patients, and also those running the Home Recovery Programme.
9. They are in turn supported by HealthTech professionals and clinical informaticians, who equipped our operations with the right IT tools, systems and infrastructure. You play such a critical role but all the way in the background. I thought this event is a good occasion to recognise your quiet but decisive contribution. Thank you.
Potential of Digital Transformation
10. Today, let me talk about the importance of digital technology. It has disrupted many industries, such as telecommunications and entertainment, where the digital medium has displaced the analogue.
11. But as time goes by, digital technology redefines operations and drives everything we do, just like the IT systems at the heart of our COVID-19 operations. So industries from retail, hotels, taxis, and travel, to security, education and financial services are all being redefined.
12. Healthcare will not be an exception. The revolution is happening at many levels. In research and development, medical science and IT inevitably converge, when we realised that the basic building blocks of living organisms are lines of nucleotide source codes. This in turn propelled the development of mRNA vaccines over the last 30 years. COVID-19 brought about a further breakthrough, as BioNTech and Moderna took less than a year to develop their mRNA vaccines against COVID-19.
13. An equally disruptive change is happening at the level of healthcare delivery. It will change the way we look after our own health and disrupt care models. The information highway enables functions such as reading of X-rays to be outsourced. Telemedicine is becoming more commonplace.
14. Social media sites have been using data generated in a person’s life-course to nudge you to buy things and watch video clips. That AI technology is now being used to nudge you to do something good for your health, to fob off serious disease in the future.
15. The convergence of digital technology and healthcare can and will be a huge contribution to humankind. Healthcare will increasingly live up to its name – to enhance health, rather than just to treat sickness.
16. However, I do not think the digital disruption to healthcare will happen as quickly and as sudden as other industries. Why? In entertainment for example, if I can pay a monthly subscription so that I can access thousands of movies and shows streamed through my device or TV, I will not want to own a DVD or a video cassette player. The value proposition is obvious, and the change in market demand will be decisive and immediate.
17. Healthcare is much more complex. As consumers, we need to be confident that any alternate care model is good for ourselves and our loved ones. When we are ill, we may want second, third opinions from doctors. We are a lot more sensitive with our healthcare data, than with the data such as our browsing history. Governments want to be assured of public safety and efficacy of all treatments. Insurers will want a say as they are a major payor of medical bills.
18. There are therefore significant policy, regulatory, public confidence, market and commercial issues to be addressed, before digital technology can be fully harnessed to transform and improve healthcare systems around the world. So today, let me briefly talk about three matters of public policy that need to be addressed.
Addressing the Public Policy Concerns
19. First is the policy on population health. As population ages, societies increasingly realise the need to shift the centre of gravity of disease management away from acute hospitals, to the community.
20. The management of chronic illnesses in particular, should be preventive, and done at the primary care level. Because by the time a patient has severe chronic illnesses and need acute hospital care, it is too late, too expensive and too big a burden to his or her family.
21. This is a conceptually very sound approach, but it requires the Government to rethink its approach to design and resource the healthcare ecosystem. It also means that patient care will need to be carried out seamlessly across different settings, in the community as well as institutions, in social agencies and also in hospitals.
22. And in preventive care, we will need more than medical information. We also need timely and sufficient data of the wider determinants of health, such as lifestyles, home and work environments, so that we can design the right interventions ahead of time.
23. A population health strategy will require the right information-sharing infrastructure. This leads to the second area of concern, which is the healthcare IT infrastructure.
24. The challenges to healthcare data sharing are significant. There are legacy IT infrastructure issues, which led to data remaining siloed within individual healthcare organisations, unable to interoperate. This happens in every country in the world.
25. In Singapore, we recognised back in 2011 the need to bring together and share clinical summary records from different healthcare providers, so that they can deliver safer and better, integrated care for patients. We therefore introduced the National Electronic Health Records (NEHR) with the vision of “One Patient, One Health Record”.
26. So today, we have a technical and system solution to break down the information silos across care providers and settings. Participation is mostly from public healthcare institutions, with some private healthcare providers involved as well.
27. We are working to enhance this current IT infrastructure. Beyond summary records, the sharing of care teams’ assessments and patients’ care plans will enable a common understanding of the condition and the needs of the patient. This will enhance patient care.
28. Beyond sharing information between care providers only, we are using apps to allow patients to also take ownership of their own care, through adopting healthier lifestyles, having ready access to their own health information, and generating personal information to share with their care providers.
29. This leads to the third issue, which is data privacy. Notwithstanding the benefits I just mentioned, as patients, we can be sensitive about personal health information.
30. We do not want it to be used like our contact numbers, email addresses or browsing histories, for purposes of marketing and advertising. When that happens, we may change our phone numbers, or our credit card number if someone tries to cheat us.
31. But healthcare information is different – our medical history is intrinsic to us. We cannot just change that, they are factual. There has therefore been a longstanding ethos in the health profession to treat patient data with confidentiality, in order to maintain trust in the individual doctor-patient relationship, and the social compact.
32. It is therefore important to respect the sensitivity of health information. In the US and the EU, there are laws that specifically protect health information from being shared without the consent of the individual. In Singapore, we have in place a general data protection and privacy regime that has worked well for most types of data.
33. However, with the advent of digital technology, there are also immense opportunities and public good in ensuring health information of patients can be shared across healthcare institutions and settings, so that we can enhance health, improve care, advance medical science, and ultimately, save lives.
34. A mindset of absolute medical confidentiality is no longer suitable. We need to develop our policies and regulations on sharing personal health information, in a controlled way that serves the noble objectives of better healthcare, but prevents misuse. A new balance is required.
Conclusion
35. What I have raised are some of the immediate policy-related concerns as we seek to harness digital technology to improve the health of our population. It is one aspect of this exciting universe of opportunities. The pandemic has made some of these opportunities very evident, such as the use of telemedicine, the importance of primary and preventive care, the primacy of self-responsibility.
36. And so we are at a crossroads in the use of Healthcare IT in the digital transformation of healthcare. Much of what I have spoken about will be subject to further discussion, and I wish everyone plenty of fruitful takeaways from this Conference. Thank you.