SHIFTING CARE BEYOND HOSPITAL WALLS
There are three key elements that need to be in place to shift care from within to beyond the hospital walls.
The first is infrastructure. Singapore, armed with foresight of the power of digital, embarked on centralising patient data over a decade ago. Today, more than 2,300 healthcare institutions participate in the National Electronic Health Record system (NEHR) which consolidates patients’ key health information from across the healthcare system.
This ensures continuity of care. Patients recently discharged from hospital will be able to continue seeing their family doctor, who will be abreast of changes in their health condition through the NEHR system. Some may even be discharged earlier: Instead of staying admitted to wait for improvements in blood test results – which can take days as organ functions take time to normalise – they can choose to go home and visit their family doctor for the blood test in a few days, who will then be able to review against in-hospital tests.
The second element is talent and education. Upskilling current talent and training new practitioners to deliver home care will require a new playbook and approach.
For example, the SingHealth cluster has been conducting research using artificial intelligence powered technology Us2.ai – a Singapore-founded health tech start-up – and found that people with no prior experience can be trained to perform accurate heart scans. With two weeks of training, people without experience were able to produce accurate readings of complete echocardiogram reports for 96 per cent of patients, in an average of about 11-and-a-half minutes compared to an hour at the hospital, not including appointment wait and travel time.
Third, shifting the centre of gravity of a nation’s entire healthcare system invariably requires substantial funding, both in rolling out new programmes and subsidising the out-of-pocket costs of participating patients to shape new behaviour.