Real Time Research in a Singapore Public Primary Care Institution
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Real Time Research in a Singapore Public Primary Care Institution
- 1. Real Time Research in a Singapore Public Primary Care Institution: Opportunities & Challenges Dr Tan Ngiap Chuan Director, Department of Research, SingHealth Polyclinics 1
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- 3. Source of information: http://www.moh.gov.sg ingapore Healthcare System S
- 4. Public Healthcare System in Singapore Secondary/ Tertiary Healthcare People Primary Healthcare Continuing Healthcare Wellness Care 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.
- 5. 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
- 6. 3 Hospitals 9 Polyclinics 5 Specialty Centres Members of SingHealth
- 7. 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 J
- 8. Roles of SHP • Primary Healthcare Services • Emergency Preparedness • Sentinel Surveillance for Epidemics • Primary Healthcare Professional Training • Signature Research Programmes
- 9. Patient Attendances: 2009 - 2013 Patient Attendances for Year 2013 : 1.72 million 2.9% 2.5% 2.5% (in‘000s) 1.6%
- 11. Hypertension 15.9% Top 5 Conditions Seen Patient Health Conditions 2013 1 Hyperlipidemia 15.8%2 Upper Respiratory Tract Infection 8.9%3 Diabetes Mellitus 8.0%4 Other Screening or Monitoring 6.7%5
- 12. A typical visit to the polyclinic PAST• Walk-in for all services • Manual Processes • Paper-based • Segmented Patient Experience - Seamless Flow NOW !
- 13. System Re-design Decision Support Self Management Support Clinical information system
- 14. What is next initiative at the Health Monitoring Station? 14 HMS CAT screenshotHMS CAT screenshotPPIS HMS screenshotPPIS HMS screenshot
- 15. EHR systems in SHP 15 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)
- 16. Integration of Databases in SHP 16 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
- 17. National Electronic Health Records (NEHR) 17 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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- 22. Multiple Functionalities: One Stop Health Portal 22
- 23. Health@SG: Accessibility & Diagnostics 23
- 24. Other Databases for Research in SHP 24 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
- 25. Other Databases for Research in SHP 25 The SingCloud is a Singapore Cardiac Data Bank linking major public hospitals and polyclinics opportunity to evaluate outcomes of cohort of patients such as those with cardiovascular (post-AMI and CCF) and concomitant respiratory diseases
- 26. Challenges 26 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)
- 27. What is in the horizon? 27 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
- 28. 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!
- 29. Acknowledgement 29 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
Notes de l'éditeur
- The private sector is responsible for most of Primary care, accounting for 80% of the work. The reverse holds through for hospital care, where 80% of the work is done in public hospitals. The reason is because hospital care is more expensive than primary care, and therefore most Singaporeans utilize the public sector if they need to be hospitalized.
- The Singapore Health Service is the larger of the clusters, being responsible for 55% of the public healthcare work. Each healthcare cluster provides for the continuum of healthcare needs, from primary, to secondary and tertiary. Healthcare in the private sector is provided by individual clinics, group practices and private hospitals and centers.
- SingHealth Polyclinics is a member of Singapore Health Services. The other members of the cluster are: Singapore General Hospital and KK Women’s and Children’s Hospital etc. SHP as an organization consists of 9 clinics and the Head office.
- This slide shows the various locations of our clinic. They are sited mainly at the Southern and Eastern part of Singapore. Each polyclinic is sited to serve the various housing estates in Singapore. They are of varying sizes and configuration. The National Healthcare Group Polyclinics also have 9 polyclinics and they serve the people at the Northern and Western part of the country.
- Our main roles in SHP are: 1) Medical Care where we provide care management for Chronic and Acute diseases, women’s health, children’s health and health screening. 2) Emergency preparedness where we provide emergency care during national crisis/ emergencies. 3) Sentinel surveillance for epidemics where we gather data and submit to MOH for surveillance eg. figures for URTI. 4) Primary healthcare training where we provide training to medical students and doctors. 5) Research – projects which our staff are involved to improve the care of our patients.
- The large proportion of our patients (ie. 46%) is aged between 30 and 64years old. 28% were the elderly aged 65years and above.
- The top 5 conditions seen in SHP in 2013 are these: Hypertension, Hyperlipidemia, URTI, Diabetes and other screening or monitoring. Out of these 5, Hypertension ranked the highest with 15.9%. In SHP, out of the total population, 61% of the patients were seen for their chronic conditions and 28% for acute.
- Patient Experience – as we have covered earlier, in the past, everything was manual, paper-based and segmented. Here’s a flow of a typical visit to the polyclinics.