Novel technologies can enhance Singapore's healthcare system: Masagos

A polyclinic nurse using the smart triaging system on an iPad to help assess if a patient with chest pain has coronary heart disease.
A polyclinic nurse using the smart triaging system on an iPad to help assess if a patient with chest pain has coronary heart disease.PHOTO: SINGHEALTH

SINGAPORE - A virtual "doctor" analysing the heart readings and medical history of patients with chest pain at triage has become a common sight at a couple of SingHealth polyclinics.

All the attending nurse has to do is key in the details of the patient's condition and medical history, and the iPad doctor does the rest.

After assessing any risk of coronary heart disease, the computer algorithm in the tablet may recommend diagnostic tests and a follow-up with specialists at the National Heart Centre Singapore (NHCS).

The computer's help with immediately booking tests and referral appointments can save about 30 minutes of the patient's time in the clinic, and ensure timely intervention at the heart centre.

But, of course, the polyclinic doctor, who will assess the patient, has the final say in accepting the computer's recommendations.

The use of such virtual systems to predict patients' health is the start of similar roll-outs at SingHealth institutions as part of Singapore's ambitious plans to provide smarter healthcare.

Similarly, before an appointment, patients at the Singapore General Hospital's Diabetes and Metabolism Centre can use a feature in SingHealth's Health Buddy app to fill in a questionnaire to update their doctors on their condition and concerns.

This allows the doctors to tailor their patients' treatments, and this app feature - called MyVisit - will be expanded to NHCS outpatients next month.

The use of such technologies is one way to sustain the healthcare system as it deals with Covid-19 and the increasingly ageing population, said Second Minister for Health Masagos Zulkifli on Tuesday (Aug 3).

He was speaking at the opening of the 11th Singapore Healthcare Management Congress, which brought together online more than 1,800 healthcare leaders in various countries to discuss best practices and innovations.

In his opening address, Mr Masagos outlined various ways to keep the nation's healthcare system affordable, accessible and at its peak. They involve using technology and home care to optimise treatment for patients, easing healthcare workers' workload and taking care of their well-being.

He said: "Even as we continue our fight against Covid-19, we must not lose sight of our long-term focus to strengthen our healthcare system and ensure its sustainability."

He explained how technology can now be used to monitor acute patients remotely at their homes.

He cited a programme by the National University Health System (NUHS) in which patients with acute conditions, who will otherwise need to be hospitalised for intravenous treatment and monitoring, can get treated in their homes.

The patients are fitted with wearables that send real-time vital signs to the care team in the hospital. A multi-disciplinary medical team can visit the patients, and also use telemedicine.


Patients can use a feature in SingHealth’s Health Buddy app to fill in a questionnaire to update their doctors on their condition and concerns. PHOTO: SINGHEALTH 

The NUHS @ Home programme, which started last October, is being piloted in a partnership with the Ministry of Health's Office for Healthcare Transformation.

Mr Masagos said more than 70 patients have been part of the pilot to date, including many who are elderly and feel more comfortable staying at home rather than in hospital.

He added that the medical fees for these home patients were lower by 20 per cent, compared with those hospitalised.

"While further studies are warranted before such programmes can be scaled up, it is certainly a good start and vision to see how technology can enable us to create alternatives to hospitalisation."

Commenting on the polyclinics' computer algorithm for patients with chest pain, Mr Masagos said the smart technology also helps to free up healthcare professionals' workload, so that they can channel more of their time towards caring for patients.

"Traditionally, these (booking of referral appointments and tests) are done very manually and in a time-consuming manner for both patients and patient service associates."

The smart system has been piloted in Bukit Merah and Outram polyclinics since August 2019, and it has collectively saved more than 1,180 hours of waiting time for patients, and more than 315 man-hours for staff.

The system has facilitated 2,900 appointments at NHCS.

In addition to identifying people with heart disease and getting them to NHCS earlier, the system has helped to reduce more than 260 unnecessary specialist visits so that more appointment slots are available for urgent cases at the heart centre, SingHealth said in a statement.

"With the success of the pilot, plans are under way to review the triaging algorithm and to extend its implementation to the rest of the polyclinics in SingHealth," added the healthcare cluster.

The aim is to introduce the smart system to other polyclinics within a year, said Associate Professor Yeo Khung Keong, SingHealth's deputy group chief medical informatics officer of research.

Mr Masagos said: "When scaled up, this initiative can potentially save patient service associates up to about 14,000 hours and patients 50,000 hours annually."

SingHealth is also looking to develop more of such patient assessment and appointment-booking systems for those with eye and dental conditions.

"As with the adoption of any new technology, there will always be some initial hurdles, especially for the early adopters. But as long as we tackle these challenges systematically, in a step-wise manner, we will be able to pivot in our shift towards digital transformation readily," said Mr Masagos.

On the topic of improving healthcare workers' well-being, Mr Masagos said that even as manpower constraints within the sector persist, the country's healthcare needs will continue to grow.

"We must therefore not neglect our existing workforce - for example, by making their work easier and looking out for their well-being. This will contribute towards building a more resilient workforce."

Improving the affordability of the healthcare system requires funding mechanisms that create an impetus for providers to come together in delivering integrated care for patients, he added.

To enable that, he noted that the Ministry of Health has started two financing innovations.

One of them is called "bundled payments" - where funding is tied to a patient's entire period of care, even across multiple hospitals and clinics.

"This encourages providers to optimise care, reduce costs and pass on savings to patients," explained Mr Masagos.

"Singapore's healthcare expenditure has been and will continue to increase as our population ages rapidly."