The NEHR is a long-term and difficult undertaking for Singapore healthcare sector. Our earlier studies alerted us to the dangers of running huge budget and project delays due to inability to tightly manage the complexity and scale of delivery across different stakeholders groups. As such, Singapore took a cautious approach that has been based on established precedents, international best practices and, most importantly, the engagement of key stakeholders throughout the process. A clinical advisory group and multiple taskforces were introduced to inform and validate the strategy and design of the NEHR. More than 200 clinicians were engaged in driving the business and information requirements of the NEHR system. The form and function of the NEHR has therefore been defined by clinicians for clinicians with the objective of using the system to help them provide the best care for their patients.
In addition, to support the eHealth agenda, standards that are clinically driven, easy to use, and internationally recognised have been established in order to ensure that clinical data can be safely exchanged for the monitoring and care of patients and used meaningfully for secondary purposes. The relevant government authorities and agencies in Singapore have established principles and policies to address access control, consent of the data shared and security standards to ensure the availability, integrity and confidentiality of data.
At the onset, the approach to NEHR has been to leverage as much as possible on what already exists in the Singapore healthcare IT landscape, maximising all investments. To this end, the NEHR builds on the existing EMRX, thus minimising any system incompatibility issues. Synchronisation and integration of the NEHR system with all the legacy systems of the respective clusters took place early this year and, currently, the data loading exercise is underway, with the focus on populating the system with patients’ historical information that would be relevant to clinicians from the various healthcare institutions. Such information includes medication history, laboratory results, radiology results, emergency department notes and hospital inpatient discharge summaries.
In order to fully realise the benefits of the NEHR, information must be captured and shared beyond the public sector acute care facilities. However, systemic issues arise when a patient goes outside these public institutions and into private care settings. This issue is not unique to Singapore though and is also faced by other countries. To this end, IT implementation and adoption strategies are being developed for the intermediate and long term care (ILTC) and primary care sectors. At the primary care level, the IT adoption rate is still low with the major barriers to GPs’ use of computers for clinical documentation being related to funding to adopt IT, limited computer and keyboarding skills, and broadband access in their medical offices. Therefore, over the next 12-18 months, IT enablement among Community Hospitals and GP practices will progress with linkages to the NEHR.
The use of IT will support patients’ critical medical information flow from the acute hospitals to the primary and intermediate long term care sectors. In the long run, healthcare providers will be able to better develop, integrate and coordinate shared care plans to provide better quality care. The end goal is for patients to enjoy a hassle-free healthcare delivery service, with fewer repeat tests and reduced medication errors when they move from one care setting to another, with the NEHR linking up providers in the community who currently do not have electronic access to patients’ medical records.