SMART Nation, SMART Health · Home and Community Care services is a top priority... By 2020, we...

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SMART Nation, SMART HealthBuilding a Future-Ready and Sustainable Healthcare System

Session 42, 12th February 2019 Dr Jason Cheah

Group Deputy CEO (Transformation), National Healthcare GroupCEO, Woodlands Health Campus

Dr Stephen Chan

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Dr JasonCheah,MDMPHHasnorealorapparentconflictsofinteresttoreport

Dr StephenChan,MBBS,MMedHasnorealorapparentconflictsofinteresttoreport

ConflictsofInterest

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• SmartNationandDigitalGovernmentOffice(SNDGO)• IntegratedHealthInformationSystems(IHiS)• CentreforHealthcareAssistiveandRoboticsTechnology

(CHART)• NationalHealthcareGroup(NHG)• NationalUniversityHealthSystems(NUHS)• SingaporeHealthServices(SHS)

Acknowledgements

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SMARTNation,SMARTHealth:BuildingaFuture-ReadyandSustainableHealthcareSystem

• Background:Statistics• Singapore:TransformingSingaporethroughTechnology• SMARTHealth:KeyProjects&Pilots• WoodlandsHealthCampus:SMARTCampusInitiatives• Challengesandopportunities• Conclusion:Frompresenttofuture

Agenda

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• Background:Statistics• Singapore:TransformingSingaporethroughTechnology• SMARTHealth:KeyProjects&Pilots• WoodlandsHealthCampus:SMARTCampusInitiatives• Challengesandopportunities• Conclusion:Frompresenttofuture

SMARTNation,SMARTHealthBuildingaFuture-ReadyandSustainableHealthcareSystem

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SingaporeFactsandFigures

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• Background: Statistics• Singapore: Transforming Singapore through Technology• SMART Health: Key Projects & Pilots • Woodlands Health Campus: SMART Campus Initiatives • Challenges and opportunities • Conclusion: From present to future


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Singapore’sDigitalisationJourney

Delivered>90%servicesonline

Automationofdata,processesandsystems

Integratedservicedelivery,breakingdownagencysilos

Transformationalchangeswithfocusonthecitizens

1980s 2000s 2010s 2015- ongoing

Automation e-services Efficiency Digitalisation

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SmartNationisournext-gennation-buildingeffort

“SmartNationisaboutSingaporetakingfulladvantageofIT.UsingITcomprehensivelytocreatenewjobs,newbusinessopportunities,tomakeoureconomymoreproductive,tomakeourlivesmoreconvenient.TomakeSingaporeanoutstandingcityinwhichtolive,workandplay.”

– PrimeMinisterLeeHsienLoongattheNationalDayRallyon20Aug2017

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TheSmartNation&DigitalGovernmentGroupwasformedinMay2017

SMARTNATION&DIGITALGOVERNMENTGROUP

DigitalGovernmentDirectorate

GovernmentTechnology

PolicyDepartment

SmartNationProgramme

Office

GovernmentTechnologyAgency

(GovTech)

BeforeMay2017

May2017

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Singapore’sSmartNationInitiative

DIGITALECONOMY#1 DIGITAL

GOVERNMENT#2 DIGITALSOCIETY#3

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ADigitalEconomyFrameworkforActiontoDriveIndustryTransformation

SINGAPOREASALEADINGDIGITALECONOMYWHICHCONTINUALLYREINVENTSITSELF

ACCELERATE COMPETE TRANSFORM

Acceleratedigitalisationofexistingsectors

Fosternewecosystems,enabledbydigitaltechnologies

Developingthenextgendigitalindustryasanengineofgrowth

DIGITALISINGINDUSTRIES

INTEGRATINGECOSYSTEMS

INDUSTRIALISINGDIGITAL

TALENT

RESEARCH&INNOVATION

POLICY,REGULATIONS&STANDARDS

PHYSICAL&DIGITALINFRASTRUCTURE

GOAL

STRATEGICPRIORITIES

ENABLERS

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2 PRINCIPLES

3 STAKEHOLDERS

6 OUTCOMES

6 STRATEGIES

Digital Government Blueprint 2018 - 2023

SCANTOACCESSDigitalGovernmentBlueprint

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Digital Readiness Blueprint A Smart Nation for all Singaporeans

SCANTOACCESSDigitalReadiness

BlueprintInfoBooklet

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Strategic National Projects

SmartNationSensorPlatform

NationalDigitalIdentity

MomentsofLifeE-Payments SmartUrbanMobility

CODEX:Re-engineeringGovernment

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Long-termTrends

Source:https://www.opengovasia.com

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HealthcareFactsandFigures


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The3Beyonds

Source:https://www.facebook.com/sghealthministry

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SustainableHealthcare


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NationalSmartHealthInitiatives

SmartWardandSmartLogisticsHospitaloftheFuture

HospitalOperationsCentreDashboards

GraphicalinterfaceVideoanalytics

RobotsRoboticMiddlewareFrameworkAutonomousmobilerobots

Assistiverobots

ArtificialIntelligenceImagediagnostics

Chatbots

GoingDigitalHealthHub

NationalElectronicHealthRecords

TeleHealthElderlymonitoringsystems

VideoconsultationsTelerehabilitation

Vitalsignsmonitoring

HealthMarketplaceMatch-A-Nurse

Servicesandsupplies

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INCREASEDELDERLYLIVINGALONE

RISEINTECH-SAVVYSENIORS

BURGEONINGSILVERECONOMY

Isolated elderly face higher mortality risk

3 in 4 seniors want digital options to manage their health remotely.

By 2016, Singaporean elderly are projected to spent $13.7 billion –more than twice the spending power of those under 34 years old.

ElderlyYoung consumer below 34

Populationtrends

HealthMarketplaceBridgingMarketFailureinProvisionofHomeCareServicesandProducts

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Unmetpatientneedsandlackofawareness


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HomeandCommunityCareservicesisatoppriority...By2020,wewillincrease

homecareplacesbysome50% to10,000places

MinistryofHealth,2015

“

”

Challengesinscalinghomecare

61%ofallnursesworkina

publichealthcareinstitution

123disparateorganisationsinhomecaresectors

13%shortfallofnursingmanpower

by2020


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ConnectShare

AwareTransact

Options

An e-platform that aggregates home care demands and supports

care at home

HealthMarketplaceUber-likePlatformforHomeCareProductsandServices

27SUBSIDISED|NON-SUBSIDISED

I need home care services

MOBILE | WEB PORTAL

PATIENTS&CAREGIVERSORGANISATIONS&AGENCIES

PRIVATE | VWOS • Choosefromacuratedselectionofservicesbasedonprofilesorneedsassessments

• Accessaholisticsetofinformation

• Nudgesbehaviourtowardsselfcareandaging-in-place

• Oneplatformtoapplyforgrants,subsidies,servicesanddevices

• Removesintermediarybetweenconsumersandserviceproviders

• Improvesstandardsandqualityofofferingsbyallowingmarketcompetition

• Serviceproviderscanaugmentofferingsthroughcollaborationwithotherservicepartnersorsuppliers

HealthMarketplaceGoalStateofthePlatform

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SMARTHEALTHCAREFACILITIES

Data-drivenresourceallocationwillenablemanpower,equipmentandsuppliestobecoordinated

SMARTHOMES+COMMUNITYENABLED

SUPPORT

SMARTWARDS+SMARTCAREPODS

Centralisednursingresponsesystemwilladdressfalls,pressuresoreprevention,medicationprepanddelivery,multi-lingualtranslators

CommunityHealthButlersorpersonalcarerobotslinkpatientsandcaregiverswithhealthcareprovidersandofferhealthservices

RoboticMiddlewareFramework(RMF):Asetofhealthcarestandards&controlstocommunicateandmanagealllayersofhealthcarerobotics,fromintegrationtohealthsystems&healthsensors,aswellasfleetmanagementandlocalnavigation

RoboticMiddlewareFrameworkTowardsaSmartandConnectedSensorNetwork

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FALLSPREVENTION&MONITORING

Proactivelyassessandpredicttopreventfalls

ReducenursingworkloadImprovedpatientsafetyandoutcomes

IMPROVINGPATIENTTRANSFERS

Facilitatespatienttransferandotheractivitiessuchasshowering,safelyandeffectively,whileminimising physicalrequirements

Reduceworkplace-relatedinjuriesImprovedpatientsafety

PRESSURESORESPREVENTIONINNON-AMBULANTPATIENTS

Ensurespatientsreceiveregularandtimelyattentioninrelieving

pressureareas

Reduceworkplace-relatedinjuriesImprovedpatientoutcomesReducelengthofstay

AssistiveroboticsSensors

Actuation&Automation

Bedsidethermal&motionsensorsPredictionalgorithms

AssistiveroboticsSensors

Manipulationtechnology

PATIENTRESPONDERContinuouslymonitor,identifyandmitigaterisksinthewardaswellasattendingtonon-clinicalneeds

ReducetimeawayfromclinicalcareConsistentservicelevels

SMARTBEDSIDECARE&SERVICES

Providescontinuousandautonomousmonitoringand

educationforself-help

ReducenursingworkloadEarlydetectionofdeterioration

IntelligentvitalsignsandincontinencemonitoringSmartbedsideeducation

Non-intrusivesensors

InteractionrobotsAutomatedrounding

Last-miledelivery

SMARTRESOURCEALLOCATIONTracksusageofbedsandpatientsintelligently

ImproveefficiencyOptimisesresources

Real-timelocationtrackingSensors

Predictivealgorithms

SMARTHEALTHCAREFACILITIES

RoboticMiddlewareFrameworkKeytoEquippingHealthcareInstitutionsandCommunityProviderstoDeliverQualityandSeamlessCareamidManpowerConstraints

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Decreaseinpatientwaitingtimebyupto50%

AUTOMATINGMEDICATIONPICKANDPACK

Combinesmulti-disciplinaryroboticcomponentstohandlethepicking,packingandlabellingofavarietyofdosageformsincludingbox/blister/loosepills;non-standardmedications.

POTENTIALSAVINGS

38,000to95,000preventableAdverseDrugEvents,oranequivalentofuptoS$8.5mperyear

Reductioninprescriptionreworkratesrangefrom 30%to8%-5%atthedispensingend

Morethan90%traceabilityofdrugsdispensed,fromzeropreviously,

intheeventofanydrugrecallactivation

Enhancedaccuracyandworkflowefficiencythroughautomatingatleast80%ofworkload

Enabledupto50FTEmanpowersavingsperyear;staffredeployedtofrontlineareasanddirectlyatclinics

forbetterstaff-patientinteraction

OutpatientPharmacyAutomationSystems(OPAS)IntegratingandTailoringHealthcareandManufacturing

SolutionstoOldandNewHospitals

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Primarycareclinics,equippedwith18retinalcameras,

covering≈100KDMpatients

2readingcentres

• Enablesearlydetectionofdiabeticretinopathy(DR)andothereyeconditions.Turnaroundtimeforscreeningresultshassince2010beenreducedby>10timesto1day(from2-4weekspreviously)

• Increasedscreeningcapacityby>5times,whileadheringtostandardisedscreeningassessmentandreferralguidelines

• Moreeffectiveuseofmedicalmanpower

Centralising DiagnosisofDRbyaccreditedtechniciansatthereadingcentres

SingaporeIntegratedDiabeticRetinopathyProgrammeATele-CollaborationPlatform

ConsolidatingDiagnosisinTwoLocations

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• Utilising machinelearningtechniquestotrainimages

• Co-developingnewSingaporeIPthatcanbeexported

• Inprocessofoperationalising theAIdiagnostictoolonSiDRP

• Canpotentiallyreduce80%ofworkloadofgradersandoptometrists

SingaporeEyeLEsioN Analyzer(SELENA)LayeringonAItoincreasemanpowerproductivity

Prognosticatingdiabetesrelated

complicationswithAI

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Nationwidepredictivemodelforadmissionprevention

HOSPITALCARE COMMUNITYCARE

Patientadmittedtohospital

Riskpredictiongenerated

H2HCareteamassessesthesehigh

riskpatients

Providesuitableinterventionto

patients

Patientdischargedtimelyandremainsin

community

Anypatientwithanunscheduled

admissionintothehospital

Thetoolflagsouttheriskofhavingasubsequentormultiplereadmissions

Clinicalteamenrollsinto3tiersfor

timely/safetransitioncarefromHospitalto

Home(H2H)

Arrangesforpost-dischargemedical,nursing&social

communitysupports

H2HCommunityteamsreview,track,monitorandreportoutcomes.Thiswillenhancethepredictive

model

• DeployedatallpublichospitalsinSingaporesinceApr2017

• Todate,~2,000patientsareenrolledeachmonthintheH2Hprogramme

• Thepredictiontoolflagshigh-riskpatientsfromthehospital’sdailyinpatientadmissionslistandisabletoreducecasemanagerassessmentworkloadby90%

• Enablescareteamtoperformearlyinterventionandpreventdeteriorationofthepatient’shealth

Hospital2Home(H2H)withPredictiveModelRiskProfilingtoTarget

thetop2-3%ofFrequentAdmittersforIntervention

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UnusualMeasuresforUnusualTimes

BackgroundAsthelatestgreenfieldhospital WoodlandsHealthCampus

ispresentedwithanunprecedentedopportunity totransformcaredelivery

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TheWHCAppVirtualClinicsandSchedulingOptimizationAlgorithms

BackgroundAppsandvirtualservicesarelackinginthecurrentoutpatientclinicsetting• Caredeliveryrequiresbothpatientsandproviderstobephysicallypresent• Thisleadstowastedtimewaitingandperformingtaskswhichcouldhavebeendoneoffsite• Facilitiesarealsocrowdedleadingtoapoorpatientexperience

ObjectivesDevelopasuiteofvirtualandonlineservicesthatallowcaredeliverywithoutphysicalinfrastructure• Coveracompleterangeofservicesincludingreferral,triaging,scheduling,registration,consultation,payment,andmedication• Allowpatientstocompleteanentirevisitoutsidethehospital• Improveefficiencyanddecreasecrowdingintheoutpatientclinics

ScopeUnderstandbothpatientandstaffrequirementsforvirtualandonlineservices• ExtensivepatientandstaffinterviewsDesignanapptofulfillobjectives• Multiplefunctionalitieswithaneasytonavigateinterface• DrivenbyschedulingalgorithmswhichoptimizehospitalresourcestopatientloadPilotwithbothpatientsandcaregivers• Startwiththetechnologicallysavyy group• Encourageadoptionandspreadwithbehavioural interventions

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BackgroundPatientsaredisempoweredinhospital• Theyhavenovisibilityoftheircareplans andbecomepassiverecipientsofcareSignificantnursingtimeisspentonrepetitivetaskswhichhavelowvalue• Someexamplesaremonitoringofvitalsignsandotherparameters,excessivedocumentation,andattendingtounnecessarynursecalls

ObjectivesRedesigntheinpatientcarespacefocusingonprocessesandworkflows,apatientbedsideinformationsystem,fittingsandfurniture,andanartificialintelligencelayer• Increasepatientengagementandempowermentviainformationvisibilityandeducation• Improvestaffproductivitybyfreeingthemuptodelivervalueaddedservices• Optimising theprecioususeofspaceandservices

ScopeUnderstandbothpatientandstaffrequirementsaroundthebedspace• ExtensivepatientandstaffinterviewsandbothmockupandliveenvironmenttestingCreateastandardised andmodularCarePod• Thattakesintoaccountpatientneeds• WithoutcompromisingonclinicalandstaffrequirementsPoweredbyanartificialintelligencelayer• Intheareasofclinicaldocumentation,predictivemedicine,diagnosticmedicine,andcosting

TheCarePodHolisticCareSpaceDesignforTheHospitalofTheFuture

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A Call To Action

FragmentedDatafromMultipleSourcesunderDifferentGovernancesDataneedstoflowbetweenagenciesandcompaniesinaregulatedmanner

Technological

HorizontalPlatformsNeedtobeDevelopedDevelopplatformsinanagilemanner

ASmoothHumanMachineInterfaceisLackingFocusonNaturalLanguageProcessingandUI|UX

CollaborateCloselywithIndustry DealwithEthicalandLegalIssues

SupportInnovationandExperimentation

BehaviouralHealthcareBehavioural EconomicsRemainsaBasicScience

Behavioural Interventionsneedtoembeddedinandstudiedextensivelythroughoutallprojects

NudgeProviderstowardsBetterCare NudgePatientstowardsBetterSelfCare

Humanistic

StartaCultureofMoralandIntellectualBravery

Leaderstomakeinformeddecisionswithdata

Stafftosupporttheirleaders

FearoftheNewandUnfamiliarmakesChangeManagementDifficult

LeadersmakesafechoicesPatientsandstaffadoptinnovationsslowly

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Questions

• DrJasonCheah• [email protected]• linkedin.com/in/Jason-cheah-a9b11531

• DrStephenChan• [email protected]• linkedin.com/in/stephenchanyw

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