National healthtech agency Integrated Health Information Systems (IHiS) faced challenges during the COVID-19 pandemic, driving them to accelerate its information technology (IT) initiatives to address Singaporeans’ growing needs. As a step to future-proof public health care, it developed and deployed its in-house system known as Health Discovery Plus (HD+), which runs on the Microsoft Azure platform. With the implementation, IHiS empowered more patients to take ownership of their health using HD+, which supports different vital signs monitoring programs across various settings such as polyclinics, hospitals, and senior activity centres.
Integrated Health Information Systems (IHiS) is the national healthtech agency for Singapore's public healthcare sector. Established in 2008, the technology partner’s mission is to digitise, connect, and analyse the nation’s health ecosystem.
IHiS powers IT systems for some 50 public healthcare institutions, helping over 70,000 healthcare workers.
IHiS supports the Ministry of Health (MOH) Singapore through technology, delivering telehealth services to patients' communities or homes. These services minimise frequent hospital visits and are in line with MOH’s strategy of “Beyond Hospital to Community”. The use of telehealth services accelerated with the COVID-19 pandemic.
Patient empowerment via technology with HD+
During the pandemic, demand for remote healthcare services surged amid lockdowns and safe distancing measures. The elderly, for example, needed regular clinic visits to monitor their blood pressure (BP). Doing so at the height of COVID-19 would have exposed them to the virus, thus creating a need for remote services. IHiS designed a telehealth solution, Health Discovery Vital Signs Monitoring (HD VSM), to meet this need. With HD VSM, non-critical COVID-19 patients in Community Care Facilities can independently monitor their vital signs using the tool, allowing the on-site medical team to tend to patients with more urgent medical needs.
“With COVID-19, we realised the importance of the HD VSM platform, where people were empowered to take care of their well-being by monitoring their own vital signs from home. As these submissions triggered threshold alerts for patients who require medical attention, the care team was able to timely intervene for these patients. This results in a new model of care for COVID-19 patients,” says Torres Arifin Oey, Deputy Director, Software Engineering Department of IHiS.
IHiS advanced their work on HD VSM with the development and deployment of Health Discovery Plus (HD+) in Azure. “To build something fast, we need to be on the cloud. We chose Microsoft Azure as the technology stack as it was already on Microsoft platforms; hence it saved us time and effort onboarding Health Discovery+,” notes Torres, who has experience working with Azure for the last seven years prior to joining IHiS.
HD+ caters to health care outside of COVID-19 to monitor chronic diseases and is deployed to hospitals, polyclinics, and eldercare facilities, including the Primary Tech-Enhanced Care (PTEC)- hypertension (HT) programme. The deployment trials the use of a home monitoring kit for hypertensive patients within an integrated care delivery system that brings about better management and outcomes. “We felt that we had to strike while the iron was hot. We built a cloud platform and made it national so that we could cover as many use cases as possible. This made it easy for more people to measure their vitals at home with a smart system. It also enabled their care team to remotely monitor their health and alert them to provide care interventions when appropriate in between physical visits,” stresses Torres.
The main challenge of implementing this system was aligning the multiple care providers’ requirements. IHiS had to ensure that data, protocols, and features across entities matched. “Alignment for success was critical. All of the clusters needed to match their needs. They have to agree on the clinical protocol for treating each type of condition, such as hypertension, cardiac rehabilitation, or post-stroke. We also have to make sure that every new feature or iteration makes sense for all of the groups,” explains Torres.
HD+ was initially rolled out to the country’s senior activity centres and polyclinics. “In the community, we deployed kiosks that many people can access. In polyclinics, a patient can securely access the system using a mobile app linked to Singpass, the national digital ID, which is further secured with mobile devices’ biometrics features where applicable,” says Torres.
To date, over 3,400 registered patients have downloaded and used the mobile app across different care settings. The version deployed for the polyclinics and hospitals also sends push notifications or nudges that encourage patients to track medication and vital signs. The system even sends pre-call surveys so that nurses get relevant information before having a call with patients,” shares Torres.
Better health condition management
Compared to the past, the HD+ platform has increased the number of people that the healthcare sector looks after. The elderly can easily follow the visual cues and conveniently upload their BP readings to the VSM kiosk system. Readings are then transmitted to the SingHealth Electronic Medical Record, allowing the care team to access the patient’s updated medical data and history for better care management.
Since February 2021, 222 residents have used the VSM kiosks and submitted nearly 3,000 BP readings. SingHealth Community Nursing reported that 73 percent of surveyed residents felt that the kiosks have helped them to better manage their hypertension. “The VSM kiosk makes it convenient for residents to self-measure their BP and follow the programmed messages advising next steps to take based on their BP readings. As a result, they have better awareness of their condition,” notes Imma Harliny Binte Abdul Rahim, Assistant Nurse Clinician, Community Nursing, Changi General Hospital.
With more residents self-monitoring their BP, Community Nurses can spend more time on those with more complex conditions. The system also features an interactive and colour-coded dashboard that triages patients with abnormal readings, so that Community Nurses can follow up on them.
“At the polyclinics, the graphs and tables help doctors easily explain health trends and data to patients. The dashboard also allows us to quickly identify patients who may need earlier intervention before the next clinic visit,” shares Dr. Emily Lee, Family Physician, Clinical Lead for Remote & Tech-driven Care Workgroup, SingHealth Polyclinics.
In a patient satisfaction survey conducted earlier this year by Ministry of Health Office for Healthcare Transformation (MOHT) for the PTEC-HT programme, 95 percent of patients reported that they were motivated to self-monitor their BP weekly. “It is great to hear that this programme empowers our patients to self-monitor, as this allows them to better manage their condition and prevent or delay the onset of complications,” says Lee.
Similar feedback was also echoed by staff at the National University Polyclinics and National Healthcare Group Polyclinics on the usefulness of the HD+ platform. “There has been closer and accurate monitoring of our patients’ blood pressure at home, thanks to the HD+ dashboard. It fosters a stronger bond between patients and their care teams. When alerted by the HD+ dashboard, care managers can also intervene in a timely manner by calling patients and managing their blood pressure conditions via telephone consultations,” notes Evon Oh, Nurse Clinician, Clementi Polyclinic, National University Polyclinics.
“Patients feel reassured that a member of the care team is monitoring their blood pressure. Patients are also empowered to play an active part in managing their medical conditions,” says Dr Valerie Teo, Family Physician, Head of Kallang Polyclinic, National Healthcare Group Polyclinics.
Next: More agility and patient-centricity for an inclusive, resilient future for health care
Moving forward, IHiS will scale the system to help as many patients as it can. Using Azure architecture makes HD+ highly scalable and secure. The use of Azure Bot Services has helped move away from Short Message Service chats, which in turn increases service efficiency and cost savings. “With platforms like Azure Kubernetes Service, Elastic Pool, and Azure Bot Service, we can scale and serve a growing base in a very agile manner,” says Torres. ”So far, HD+ has over 3,400 patients on board across all care settings such as polyclinics, hospitals, and senior activity centres. HD+ has also collected around 209,000 vital signs submissions and generated more than 13,000 alerts that prompted clinical interventions.
Having more users is not the only goal. The IT provider is also planning to expand beyond current use cases to include more vital signs and health facilities. “We are developing the inclusion of diabetes management into HD+. As soon as the protocols are developed and the programme is launched, the hospitals can start their recruitment,” affirms Torres. The system currently supports PTEC (Hypertension), Acute Myocardial Infarction: Allied Health-Oriented, Patient-Centred Technology-Enabled (AMI-HOPE) care, Cardiac Rehabilitation and Post Discharge programmes for patients. According to MOHT, AMI-HOPE offers relationship-based care support by speciality-trained pharmacist clinicians via technologies that facilitate remote tracking and delivery of drug optimisation and lifestyle modification following acute myocardial infarction (AMI).
Torres believes that being agile, progressive, and patient-centric are key elements for success. “When we develop a tech solution, it is important to put ourselves in the shoes of the patients and medical staff we serve. We must be bold in sharing our ideas and making the solution intuitive and useful; evolve along the way through agile and iterative processes while measuring each iteration to ensure the best outcomes for the patient,” he concludes.
“With platforms like Azure, we can scale and serve a growing base in a very agile manner.”
Torres Arifin Oey, Deputy Director for Software Engineering Department, IHiS
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