How Singapore Health uses AI to track its elderly care


Interview with Bruce Liang, CEO of Singapore’s technology agency for healthcare IHiS.

Across Singapore, healthcare providers are using cutting-edge tech to cope with a manpower shortage. Tan Tock Seng Hospital built an ‘artificial brain’ to manage 1,700 beds. The upcoming Woodlands Health Campus will be a “pioneer” in the use of tech for patient care. And one day, Changi General Hospital’s robotics research may even lead to robot bedside nurses.

Underpinning these developments is Singapore’s health IT provider, Integrated Health Information Systems (IHiS). The next step, says CEO Bruce Liang, is to use AI to see whether these new technologies are making a difference in the quality of care.

“The Ministry of Health is forking out funding to the hospital, the home programmes, preventive care programmes, and so on. How do we know we are actually doing well in those?” Liang points out. He adds that there will be “quite a fair bit of analytics involved” in looking at “cause and effect”.

The BRAIN behind it all

Over the next few years, Singapore’s health ministry is going to transform the healthcare system in three major ways, it was announced. Broadly, the ministry wants to help Singaporeans to lead healthier lives, enable Singaporeans to receive appropriate care closer to home, and give every Singaporean best value in care while keeping the system sustainable.

“Performance analytics” will help the Ministry to better gauge the effectiveness of their efforts in these areas, Liang explains. Healthcare is currently both a knowledge-intensive and labour-intensive industry, Liang says, so “technologies including AI can play a very big part in changing that”.

AI will also be used in “disease-specific strategies” where the ministry will zoom in on, say, “the war on diabetes”, Liang says. “We’re embarking on a national diabetes database [project] and that comes with a wide range of analytics, including predictive modelling to identify diabetic patients for early intervention programmes, support research to design improved care pathways for different cohorts of patients, and more.”

To support the three shifts in healthcare, IHiS has developed several platforms for health data collection and analysis. One of the platforms that IHiS developed, the Business Research Analytics Insights Network (BRAIN), allows IHiS to “pull a lot of information together from disparate sources more speedily for all sorts of profiling needs”, says Liang.

In the case of diabetes, BRAIN will allow the health ministry to figure out those people most at risk of developing the condition, and intervene with preventive measures. “For those who are at risk, what are the intervention strategies like? There’s a fair bit of machine learning in that space,” Liang says.

BRAIN will also display the demographic information of these diabetics, Liang adds. “Based on where they are located – that’s where the service capacity planning comes in – we know where to [locate] our facilities”.

There will also be a focus on smart wards, which will be manned by assistive robots. These robots could help patients with “all sorts of rehabilitation” to get them back to fighting shape as soon as possible. “That will be the main thing to regain body functions,” Liang says. “Rehabilitation can be a very high intensive, manpower-intensive thing if you don’t design the service properly,” he adds.

Profiling the population

But first, the ministry will build up a “foundation” of “population profiling” data, says Liang. IHiS platforms will link healthcare and non-healthcare data sources, and analyse all of that data to build a comprehensive, multi-faceted profile of the population for better decision-making.

Factors such as lifestyle and socioeconomic status can have a bearing on people’s health, and will be taken into account, Liang explains. “Profiling answers two kinds of questions: one, who needs what kind of help? Two, what is the appropriate intervention?” he says. “The intent is to look at multi-dimensional data.”

To carry out the health ministry’s objectives, IHiS will work with the local tech industry, according to Liang. “We’re trying to solve new problems collectively,” Liang says. IHiS will provide industry players with opportunities to come up with their own solutions to “problem statements”.

How will this work in practice? Social media companies are a good example: “If you tell them, ‘how could I have early intervention for those people who might be depressed’, those guys may have a way to tell these things,” Liang explains.

It is “not easy” to be able to work with healthcare systems of a country, Liang notes, and industry players could benefit from such a partnership. “The essential thing that we try to tell them is this: we are trying to solve new problems in healthcare, and IHiS can be the bridge between them and the healthcare system,” he adds.

Boosting startups

Working with IHiS could also allow smaller companies to ‘scale up’, particularly in a small market like Singapore. “The biggest problem for private guys trying to work with healthcare is that they can’t get the scale, then they cannot sustain, then they close their business,” Liang says.

Market failure affects the healthcare system as a whole. Liang shares the example of a company that sold tech solutions to hundreds of general practitioner clinics, and then folded — leaving those clinics stranded. “Some of [the GPs] said ‘I will never go back to technology again’. Then, we lose the opportunity to digitise,” he remarks.

AI is likely to be an integral part of Singapore’s healthcare landscape in the future, just as much by a patient’s bedside as behind the scenes, ensuring that things run smoothly.

Nurses Play a Bigger Role in Singapore’s Healthcare Setting

A senior staff nurse, Chow Peck Foong preparing to administer an IVT injection on patient Han Boon Huat. Photo credit: Straits Times/Marcus Tan

Nurses have always been an essential element of healthcare but with the increasing patient load these days, they have a greater role to play in the healthcare setting for more efficient care delivery.

IVT injections in nurses’ hands

A 68-year-old patient, Mr Han Boon Huat, has to receive an intravitreal (IVT) injection monthly at the Tan Tock Seng Hospital (TTSH) to treat his age-related macular degeneration. However, unlike other patients who obtain this injection, Han is among the first few at this establishment to have his injections administered by a nurse.

Prior to this, only doctors did the procedure but Han does not mind the change. He said, “As long as they are trained, it doesn’t really matter if the injection is carried out by a nurse or a doctor, as I felt no significant differences during the injection.”

Some conditions that warrant the IVT injections are such as wet age-related macular degeneration, diabetic maculopathy and retinal vein occlusions. Many of these eye diseases are linked to diabetes – a condition affecting one in nine of Singaporeans. One third of diabetic patients would experience some type of diabetic retinopathy prevalence, threatening their vision.

Two nurses have been trained thus far and have administered roughly 30 injections under supervision of doctors. There has been a growing demand for these shots with 6,508 jabs given in 2016 compared to 528 jabs just three years prior to this. Current trends indicate that these numbers are bound to increase.

Meeting rising demand and freeing up doctors’ time

At TTSH’s current capacity of 6,500 injections a year, which is normally administered by doctors, the hospital’s eye clinic is not able to meet the increasing demand. Hence, training nurses to conduct this procedure will lead to less waiting time for the patients as well as frees up time for doctors at the eye clinic to see more new cases. At the moment, the standard waiting time for an appointment is about one to two weeks. In fact, clinicians are occasionally required to conduct the procedure after clinic hours.

Nurses here go through thorough training to be qualified for this. They must be selected to be part of the service and undergo a specially designed curriculum including e-learning, lectures, hands-on sessions and even tests.

Ms Chow Peck Foong, 59, a senior staff nurse who has been working for over 30 years relayed her thoughts on this, “I was really glad and excited to be given the opportunity to learn something new, and I believe that taking on bigger responsibilities is a trend for nurses to go into for the future.”

An expansion of nurses’ roles

Some nurses have called for an expansion of their roles in various healthcare avenues. Lee Kay Yan, wrote in to the ‘Straits Times’ saying, “The overall costs of health screening could be cut significantly by having qualified nurses take over some roles of doctors in subsequent consultations.”

She added that the National Heart Centre, for example, has started to allow senior nurses and even pharmacists to conduct consultations and follow-up for warfarin monitoring.

Another writer to the ‘Straits Times’ expressed, “Health screening is often routine and repetitive, and can be time-consuming. It is not necessary to have only a doctor perform any medical consultation associated with the screening. Many health screenings are conducted by trained nurses, who flag abnormal results to doctors for further testing and evaluation. Using allied health professionals, instead of doctors, can decrease the cost of screening without adversely affecting the quality of the screening.” MIMS

Sources:
http://www.straitstimes.com/singapore/health/eye-jabs-by-nurses-free-up-docs-time
http://www.straitstimes.com/singapore/health/eye-injections-now-administered-by-nurses-for-eye-diseases-free-up-time-for-doctors?login=true
http://www.straitstimes.com/forum/letters-in-print/change-mindsets-on-nurses-roles
http://www.straitstimes.com/forum/letters-in-print/nurses-can-conduct-health-screenings-consultations

https://today.mims.com/topic/nurses-play-bigger-role-in-sg-healthcare-setting

The True Cost Of Healthcare In Singapore That Every Singaporean Should Be Aware Of

IT IS CHEAPER TO DIE THAN FALL SICK IN SINGAPORE

The above is a phrase all so familiar amongst Singaporeans.

According to a study by AON, the medical inflation rate of Singapore stood at a high 15% in the year 2015 and 10% in the year 2016. Both numbers exceeded the global rate.

source: AON

Most of us Singaporeans grew up knowing that healthcare is expensive, yet, little of us can really put an exact number on those costs and better plan for these unfortunate circumstances.

How expensive is expensive? Enough to wipe out my bank account?

Hospitalisation Bills As A Whole

For a start, we take a look at the average hospital bills that Singaporeans. We derive this number from looking at all the average cost of hospitals in Singapore to give Singaporeans a good range. Do note that we remove hospitals that are more niche in a certain area, such as KK hospital for children and women for better estimation of the general cost.

The chart below shows the average hospital inpatient bill size for public hospitals as of the year 2015. Given our medical cost inflation, each cost needs to be multiplied by 1.1 for higher accuracy of today’s cost.

The average hospital inpatient bill size for private is without a doubt more expensive.

source: Ministry Of Health

Zooming In On The Specifics

Top 5 Reasons Of Hospitalisation For Singaporeans

Singaporeans have a higher chance of getting hospitalised due to these following reasons:

  1. Accident, poisoning and violence
  2. Cancer
  3. Ischaemic heart diseases
  4. Intestinal infectious diseases
  5. Pneumonia

source: Ministry Of Health 

From here, we take a look at the breakdown on some of the costs for cancer and ischaemic heart diseases. The two most common specific diseases affecting Singaporeans.

Cancer

Every year, 12.7 million people around the world discover they have cancer. 7.6 million people will die from the disease. Every day, 36 Singaporeans will be told the bad news of them having cancer, making cancer the number one killer in Singapore.

Despite, cancer being the number one killer in Singapore, information on the average cost of treatment is not easily available online. We can, however, give a good estimation of S$100k-S$200k in terms of cost per year, assuming a patient in the later stage of cancer. The exact cost will ultimately depend on the types of drugs used for the treatment and the procedures.

If one is diagnosed with lungs cancer with complications, the chance of hospitalisation is higher. Each stay can last from 9-14 days and cost up to S$16,000 if one chooses A Ward, or S$3,000 for C Ward.

Should one decides to get some of the best private treatment in Singapore, we take a look at Johns Hopkins. The average hospitalisation bill for Johns Hopkins is at S$22,357, with 10% of the patients paying S$62,686 and more.

Ischaemic Heart Diseases

An ischaemic heart disease is a condition where blood vessels are narrowed or blocked due to the deposition of cholesterol on their walls.

One such treatment will be the procedure to enlarge a narrowing in a heart vessel with a stent. According to Ministry Of Health’s past records, the cost can range from S$4,087 to S$12,657 for B2 Ward, depending on the hospital.

A Ward can range from S$15,744 to S$35,976 for the same treatment.

Conclusion

The median income of Singaporeans is at S$4,056. Which means if your monthly salary is higher than S$4,056, you are earning higher than half of Singapore’s population.

Assuming, after contribution to CPF, your take home will be at S$3,244 monthly, S$38,928 each year. Assuming zero insurance, MediShield Life or Medisave deduction from your hospital bills. Do you think it is possible to handle those costs we just mentioned?

Rising number of healthcare freelancers prompts call for better support

SINGAPORE — The number of freelance healthcare workers has soared in recent years, based on figures from industry players.

Caregiving portal CaregiverAsia, for example, started out with about 20 active freelance caregivers in 2015. The number has grown to more than 1,000. Home-care provider Jaga-Me has also seen the number of freelance nurses on its books jump from between 20 and 30 to more than 200 over the past year.

While the growing freelance pool is helping to ease the perennial manpower crunch in healthcare, providers and Members of Parliament (MPs) cited the lack of support in providing freelancers with training and the need to ensure quality of care as among the issues that must be tackled.

The freelance roles that had the largest increases are among nurses, counsellors dealing with family, mental health and other issues, as well as care companions.

At home-care and nursing provider Homage, its caregiving pool has grown from 50 in July last year to more than 300, co-founders Gillian Tee and Lily Phang said.

Comfort Keepers’ pool of part-time and full-time caregivers has also risen from 200 to 250 two years ago to between 250 and 300 now, said Ms Joy Soh, case management director at its Queenstown and Clementi office.

A study of the healthcare sector, released last month by the National Trades Union Congress’ (NTUC) Future Jobs, Skills and Training (FJST) department, found that there was a rising use of mobile applications and platforms that match providers to patients, enabling them to age in place.

This “gives rise to freelance opportunities for healthcare workers”, said NTUC assistant secretary-general and the FJST department’s director Patrick Tay.

The sought-after freelance roles include caregivers, confinement nannies, doctors and medical companions, the study showed. By 2020, the Republic is projected to require another 4,200 nursing home beds and 4,700 centre-based care and home-care places.

As the pool of freelancers grows, MPs said the need to ensure quality of care, basic competence in caregiving and build awareness cannot be ignored. Dr Chia Shi-Lu, who chairs the Government Parliamentary Committee (GPC) for Health, said the question is how to ensure quality and recourse for users should things go awry.

As such services become more prevalent, he believes some form of licensing or regulatory framework governing providers would take shape.

Just as the Government has put in place a licensing regime for the private-hire car industry, and mulls over new rules on short-term rentals in a nod to home-sharing providers such as Airbnb, so will caregiving “see the same trend” once demand reaches a critical mass, said Dr Chia, who is also an MP for Tanjong Pagar GRC.

MP (MacPherson) Tin Pei Ling, who also sits on the Health GPC, said awareness of such services offered by freelance caregivers, which is “not very high yet”, needs to be drummed up by providers and in the community.

Saying that all for-profit caregivers should have the “basic competence” to carry out their duties, she noted that the Government could consider a training road map or support under the SkillsFuture movement for such freelancers.

Providers, too, could devise training maps for freelancers. Since they have “scale”, they are more well-placed to negotiate better training packages compared with individual freelancers, who may “lose sight” of this, Ms Tin added.

Right now, care providers and portals offer various forms of training for their part-time and freelance workers.

For instance, Comfort Keepers’ caregivers undergo formal training of about a week before they are deployed. At Homage, those who are not trained in nursing receive certified caregiver training.

Jaga-Me recently also teamed up with HCA Hospice Care to hold a workshop on palliative care for its nurses – at no cost to them.

However, Mr Julian Koo, Jaga-Me’s chief executive, said there is a lack of support for freelance nurses to tap training subsidies outside the confines of public and community healthcare, making it difficult for them to receive training.

Caregivers TODAY spoke to said they were drawn by the flexibility of freelance work.

Registered nurse Ong Lay Ching, 43, joined Jaga-Me in February. Formerly a full-time nurse at places such as a gynaecology specialist clinic, Ms Ong said she was worn out by “constant fatigue” and did not get to see her elderly mother on weekdays because of her working hours.

Now, she occupies herself with cases four or five days each week, and earns more than S$3,000 each month, which is “sufficient”. “I don’t want to go back to full-time nursing… Clinics are very hectic.”

For many, freelance or part-time healthcare work is steadily becoming a financially viable option. At Homage, for instance, its part-time care professionals who often work “after hours” can earn between S$1,000 and S$2,500 monthly, compared with its full-time workers, who often receive between S$2,000 and S$5,000.

Singapore to remain attractive for healthcare IPOs

It is home to one of the world’s biggest healthcare groups, IHH.

Whilst the consumer and the professional services sectors are seen to rise and continue their uptrend, Singapore will see a new potential with the healthcare sector.

According to a new study by the PwC, healthcare is one of the more well-developed sectors in the city-state with one of the world’s largest healthcare groups, IHH Healthcare being listed in the local bourse.

“Singapore’s strong reputation as a medical centre of excellence in the region and the attractive market trading valuation for this sector, which sees the price-earnings ratio hovering in the range of 30 to 40 times, making it more attractive for healthcare players to list,” PwC explained.

Meanwhile, the study also noted that the city-state is expected to remain the choice listing destination for REITs and business trusts with notable interest from Chinese-based real estate players.

“With the public consultation for dual class shares ending earlier this year, Singapore could become a more attractive location for listing in Asia. But with HKEx looking to introduce a third board with dual class shares, this has become a race to see which bourse is faster to the market,” PwC said

How Singapore provides high-quality health care at low costs

 

Commuters walk to the train station during evening rush hour in the financial district of Singapore, March 9, 2015.

Credit: Edgar Su/Reuters

After weeks of closed-door meetings, Senate Republicans on Thursday unveiled a draft of their plan to overhaul the US health system.

This story is based on a radio interview.Listen to the full interview.

As the debate in the United States continues, we looked at another country that some commentators admire as a model for its ability to maintain high-quality care, while controlling costs: Singapore.

We turned to William Haseltine, author of “Affordable Excellence: The Singapore Healthcare Story,” to explain.

How does Singapore’s health care system work?

Singapore’s health care system is fundamentally a government-controlled system. People pay for their primary care out of pocket, but they’re forced to save for that eventuality through mandatory savings accounts. If you have a catastrophic illness and you are hospitalized, you get heavily subsidized hospital care. The government also assures that no one in the country is left without health care. For example, if you can’t afford hospital care, the government may add money to your private savings account.

How does the country keep health care costs down?

Singapore controls the type of equipment used in hospitals, as well as drug prices. Eighty percent of the hospitals are, by law, public. Hospitals are also heavily subsidized (while primary care is mostly delivered by the private sector). The system is set up so that public hospitals compete with each other. There are five hospital groups in the system, and they all compete with each other. That competition helps keep costs down.

What lessons can we learn from Singapore’s success?

The first lesson is that you can deliver high-quality health care at about 25 percent of the price that the United States does. Other developed countries also deliver much better quality health care than the US does at half the price. The second lesson is to keep costs down by having people pay for minor health issues — like sore throats — out of pocket.

Could this model work in the United States?

It could. But it would be a real stretch. I think the idea of a mandatory savings account would be a difficult one for us to swallow. The idea that 80 percent of your health care hospitals will be publicly owned and managed would be also difficult. I think those are difficult concepts.

Credits to PRI The World Staff