A pressing need. Singapore’s population is ageing rapidly, accounting for the increased prevalence of chronic diseases such as diabetes and high blood pressure. The healthcare costs attributed to care for patients with chronic conditions are massive and are projected to rise in the years ahead.
Today, both community and institutional care providers face problems with continuity of care due to poor flow of patients’ vital health information in the patient care cycle. Wide variation in EMRs and the level of adoption between hospitals, institutions and clinics contributed to the predicament. In Singapore, as in elsewhere, limited resources in manpower and physical beds meant that there is a compelling need to decant patients into step down care and to place patients in the right site of care. It is this shared vision between the government and the healthcare community, in partnership with private corporations, that has led to the pilot of the Community Care Management Solution (CCMS) at the Singapore General Hospital (SGH).
A Breakthrough Solution
CCMS is a solution developed by HSA Global (HSA) to provide integrated electronic patient medical records from multiple healthcare organisations to facilitate continuity and consistency of care in the healthcare continuum. This solution incorporates clinical management tools and business process applications founded on Wagner’s Chronic Care model which is a proven clinical framework for managing care of chronic illness at both individual and population level.
Delivered as a fully managed and hosted solution by Singapore Telecommunications Limited (SingTel), it is offered to healthcare organisations for a monthly subscription fee through the software-as-a-service model (SaaS) which eliminates the need for upfront capital investments in infrastructure. This innovative technical and commercial value proposition allows even small healthcare instituitions to afford enterprise-grade solutions.
A Pioneering Initiative
SGH, the flagship hospital of Singapore Health Services, took the initiative to pilot this next-generation healthcare information solution in partnership with SingTel and HSA. Led by the SGH Nursing Division, CCMS was piloted for more than six months across four inpatient wards, four specialist outpatient clinics (SOC), two polyclinics and in community settings. A nursing workgroup was formed to review how the quality and delivery of healthcare services could be improved for her patients, especially those with chronic conditions, through better integration of information, redesigning of clinical IT processes and optimisation of technology.
Applying stringent selection criteria, SingHealth nurses recruited 214 patients for the pilot. From the pilot, CCMS is proven to enable the following:
Continuity of Care
Consistency of Care
Management of Care
This pilot has shown that the use of CCMS can facilitate continuity of care for patients by streamlining clinical management processes, care coordination and case management. The flow of care information across hospital ward, SOC, polyclinics or at homes made a real difference to patient care as care is now consistent and continuous. CCMS has helped SGH Nursing Division to extend the reach of nursing care beyond the walls of hospitals into the community to improve care outcomes, leading the way towards seamless care in the integrated healthcare continuum.
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