NEHR : In Layman’s Terms
The reason for embarking on the electronic health record journey in Singapore is the stark recognition that by 2030, 1 in 5 Singaporeans will be over the age of 65.By 2050, Singapore will be among the world’s demographically oldest countries with a median age of 54 years.
This means having to adopt a different pattern of healthcare.
Fundamental to this transformation, our government has recognized that the healthcare system needs to be better integrated with the ability to seamlessly exchange health information.
Although Singapore has been investing in healthcare IT for years,SingHealth Cluster and National Health Group (NHG) Cluster have both developed their Electronic Medical Record (EMR) systems independently, and this led to problems when patients moved across clusters.
- Electronic Medical Records Systems
- Clinical Decision Support System
- Laboratory Information System
- Radiology Information System
- Pharmacy & Medication Management Systems
- Mobile Health & Mobile Apps
- Tele-Health & Tele-Consulting
- Remote Home Monitoring Devices
- Health Analytics
- Patient Billing, Registration, Appointment Scheduling Systems
- Bed Management System
- Internet, Intranet, Social Media
- Patient Relationship Management System
- Financial, Human Resource & Materials Management Systems
- Workflow & Process Management
- Business Analytics
In 2004, an interim system called Electronic Medical Records Exchange (EMRX) was implemented to allow secure exchange of patient data between clusters,where unstructured documents such as lab investigation reports,discharge summaries etc can be viewed.However, there were drawbacks to the EMRX system – it is essentially a document-level exchange with no standardised or structured data.
In order to realize the vision of “One Patient – One Medical Record” and support the delivery of integrated care across the healthcare continuum, Singapore is promoting IT adoption by its public and private healthcare providers and implementing a National Electronic Health Record (NEHR) for health information exchange.
The EHR is an integrated healthcare record centered on each person. It extracts and consolidates in one record, all clinically relevant information from their encounters across the healthcare continuum throughout his/her life.
In June 2010, MOHH awarded the US$144 million NEHR contract to a consortium made up of Accenture, Oracle,Orion Health, Initiate (an IBM Company) and Hewlett Packard. The go-live is the first phase of the effort and was deployed 10 months later in April 2011.
The first phase implementation is expected to last until June 2012.
By June 2012, all public healthcare institutions (restructured hospitals,specialist centres,polyclinics), selected community hospitals and selected GPs will be on the NEHR system.
Fundamental to the development of the NEHR has been clinician involvement via advisory groups and taskforces. Over 200 clinicians were involved in developing the business and clinical requirements for the system.
A national standards-based enterprise architecture is in place to support the NEHR deployment. While its deployment will be purpose-built to suit an integrated Singapore healthcare system, it reflects the same tenets as Canada’s Infoway architecture – international standards based to enable secure data exchange and data sharing among local and enterprise clinical systems. In fact, the vendors implementing the NEHR are all very familiar to the jurisdictions in Canada, namely Accenture, Orion Health, Oracle, Initiate (an IBM Company) and HP.
Like Canada,Singapore has a low rate of IT adoption and use in primary care – about 15% to 20% of GPs have an electronic medical record (EMR) system. As a result, this sector, together with intermediate and long term care, will receive focused IT enablement with linkages to the NEHR.
The Ministerial Committee for Ageing aim to build up on integrated care for the chronically ill, so their treatment will be managed on an ongoing, rather than episodic basis. To do this, the Health Ministry will further exploit technology to make it easier for patients to move seamlessly between providers.
One of the technologies introduced is the CLEO system (Clinic Electronic Medical Record and Operation System) which will facilitate the sharing of patient information among GPs.
With the CLEO system, GPs will have have access to the NEHR system which will provide them with an array of patient data. These include their current care received at other healthcare institutions, medication histories, drug allergies, laboratory investigations, clinical diagnoses and X-ray reports.
In mid-2011,MOHH awarded the contract for the GP clinical information management and electronic medical record system to SingTel. About 50 general practitioners will be equipped with a standardised IT system during the first phase of implementation.
The system will start rolling out by the second quarter of 2012 and by 2013, some 50 GP clinics will be equipped with it
NEHR : Deep Dive
Moving Forward : Beyond 2012
NEHR Brochure By MOH
NEHR Perspectives:Singapore By Dr Sarah Muttitt, CIO MOHH Mar 2011
MOH To Keep Healthcare Affordable, Expand Infrastructure – ChannelNewsAsia.com
HIMSS12 – S’pore’s NEHR The Journey to 2012 & Beyond By Dr Sarah Muttitt , CIO MOHH
Singapore’s National EHR Roadmap By Dr Sarah Muttitt, CIO MOHH Oct 2011
MOH Holdings is the sole holding company of Singapore’s public healthcare assets & other wholly owned corporate entities :