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COLUMNS
Digitising Primary Healthcare Services in Singapore
Private and public partnerships are essential for the successful implementation of healthcare strategies. Technology should not be seen as an inhibitor, but rather an enabler, towards reaching worldwide healthcare goals.
by Michelle Tan Min Shuen

Imagine being able to skip snaking queues for the neighbourhood clinic on a dreary Monday morning, and instead receive a diagnosis from a doctor through video call, in the comfort of your bed. Opening the front door, you notice that a plethora of colourful medicines have been delivered to your doorstep. Should you require assistance, a qualified nurse is only a click away. Futuristic as it may seem, this has already become a reality in our country, yet its establishment is only the tip of the iceberg to the larger digital transformations that are to come in the primary care industry in Singapore.

To define primary care, it is the first level of care that patients receive, and is largely focused on patient wellness and disease prevention. Primary care providers are typically patients’ first point of contact when they have medical concerns or needs - they most commonly refer to General Practitioners (GP) in your neighbourhood. Apart from primary care, healthcare can further be categorised into secondary healthcare and tertiary healthcare, which usually deals with illnesses that require more specialized treatment.

For the same amount of time and money invested, the primary care industry has the highest potential for transformation within the healthcare sector. This can be attributed to the fact that primary care is delivered at one’s most urgent time of need and has the largest patient base, with every Singaporean having seen a GP at least once in their lives.

In light of renewed goals of attaining Universal Health Coverage across ASEAN countries, the fact that primary care service providers have the network and capability to connect more people is especially appealing. Most importantly, the primary care industry has the highest potential for growth and innovation as it is the most scalable among all others within the healthcare sector. “And the good thing about being involved right at start, primary care, is that you’re able to continue the journey with the user into secondary care, tertiary care and step-down care. And you can even move one step back, which is understanding what’s the need [for] wellness healthcare … to target them before they sink into primary care issues.” Said Wai Mun Lim, founder of Doctor Anywhere. The rising trend in chronic disease patients in Singapore is testament to the fact that digitising primary healthcare is the way forward.

In recent years, there have been significant changes to the healthcare landscape in Singapore. Our ageing population and aforementioned increased chronic disease prevalence have led to a growing need for new care models and coordinated team-based care across healthcare providers, be it in the public or private sector. To meet the increasing demands of the community, medicine and health technologies have been implemented as part of wider efforts to digitise healthcare in Singapore.

An example of this would be the implementation of the National Electronic Health Records (NEHR) database. Introduced progressively by the Ministry of Health (MOH) since 2011, the NEHR is a secure system that provides healthcare professionals with a consolidated view of patients’ health records, allowing healthcare professionals to quickly access patients’ medical history for faster and more efficient treatments. However, the success of the NEHR was hindered by the lack of cooperation from the private sector. As of 2017, NEHR lacks the bulk of patient information from the private sector – while 27 percent of private licensees have access to the NEHR, only about 3 percent are contributing. Drawing from this incident, we can infer that seamless and interoperable public and private partnerships play a critical role in the journey to achieving our healthcare goals.

Companies in the private sector have an edge over public bodies as they have the capacity to innovate freely. Innovation in the private sector is rewarded – it provides the company with an advantage over its competitors in the global market and leads to increased profits. Meanwhile, in the public sector, there is no imperative to innovate as their main focus is on ensuring affordability of healthcare services for its citizens. As Sarah Yee, industry consultant of the Digital Transformations Office in Cisco systems remarked, technology companies in the private sector are “Creating new and different approaches to healthcare using [their] technology that they can then offer to governments to help integrate into the healthcare systems.” Only through close partnerships between public and private bodies, can Singapore’s healthcare system rise to greater heights.

Private company Doctor Anywhere has been spearheading the digital transformation of the primary healthcare industry since 2015. Doctor Anywhere bypasses long clinic queues and connects patients to doctors instantly through video call, allowing patients to receive a diagnosis instantly and have medication delivered to their doorsteps within three hours of prescription. Such an approach towards primary healthcare benefits both parties. From a doctor’s perspective, they are able to optimise their free time by doing online consultations away from the rigour of their workplace. Users also benefit from this arrangement, as they can focus their time and energy into recuperating in the comfort of their homes, as well as pay less for their diagnosis as GPs who are on Doctor Anywhere in their free time can expect lower charges for their services. Through telemedicine, Doctor Anywhere is able to tackle the longstanding issue of cash containment, as well as optimise time and resources for both parties.

However, many GPs are still entrenched in traditional brick-and-mortar business mindsets and are less inclined towards new technologies. With the perception that technology is inhibiting and disrupting their businesses, they remain apprehensive towards folding new technologies into their practices despite the apparent rewards. Limitations on insurance coverage towards malpractice in newer forms of telemedicine also deter GPs from incorporating technology into their work.

In the words of Minister of Health, Singapore, Mr Gan Kim Yong, “Disruption can sometimes be painful. The workforce will have to adapt to new ways of carrying out their jobs. But if the disruptions have the potential to bring about meaningful benefits to patients and their families, and to our healthcare system, we must not be afraid to allow them to take place.” Indeed, using IT to change the landscape of the primary care sector has the potential to bring out tremendous transformations in a positive direction. But first, healthcare workers must be willing to embrace it.

References:

ABOUT HEALTHCARE SERVICES ACT (HCSA). (2019, May 2). Retrieved November 19, 2019, from https://www.moh.gov.sg/hcsa/about-hcsa.

FAQ: What is the difference between primary nursing care and acute nursing care? (2019, July 1). Retrieved from https://www.onlinefnpprograms.com/faqs/acute-care-versus-primary-care-nursing/.

Khalik, S. (2017, May 31). Private health sector urged to digitise records. Retrieved from https://www.straitstimes.com/singapore/health/private-health-sector-urged-to-digitise-records.

This article was derived from a panel discussion, Digitising Primary Care: Here and Now held at the SFFxSWITCH conference 2019

 

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