Shared Electronic Medical Records

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

Since 1 April 2004 the Ministry of Health has implemented an EMR Xchange (EMRX), a new computer platform that allows sharing of electronic medical records across all public hospitals and polyclinics in Singapore.

Purpose of health policy or idea

Over the last decade, Singapore's corporatized hospitals have been at various stages of computerizing their medical records, but working independently of each other and using various platforms. Since 1 April 2004, the (EMRX) has linked all restructured hospitals, polyclinics and national centres in Singapore. This means the two main competing health care clusters, Singapore Health Services (SingHealth) and National Healthcare Group (NHG) are now electronically linked by this single exchange,

EMRX allows the doctor treating a patient at a particular hospital or polyclinic to view the EMR of the patient that were created in hospitals of either cluster.

Today, about 240,000 patients are referred between public healthcare institutions annually, of which about 24% are inter-cluster. All these patients can potentially benefit from EMR sharing both within and across cluster.

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

The sharing of medical records across all public hospitals and polyclinics in Singapore is the first step to the creation of a National Medical Records System for Singapore.

For a start, EMRX will only share Hospital Inpatient Discharge Summaries (HIDS). which contain information of a patient's recent hospitalisation episode(s) including his drug allergies where applicable, diagnoses, medication prescribed and response to treatment. The list of information items to be shared will be gradually expanded to include laboratory test results and radiology reports, Outpatient Discharge Summaries and Polyclinic Discharge Summaries.

To protect the confidentiality of the information being shared and ensure that it is used in a responsible and appropriate manner for the sole purpose of treating their patients, strict access and audit controls are in place to deter and detect any unauthorised access to the data. Only doctors and healthcare staff who treat the patient will have access to the shared records. They are bound by law and professional codes of conduct. Plans are also in the pipeline to extend this sharing platform to doctors in the private sector (hospitals and GP clinics).

Political and economic background

Between 1985 and 2002, every single public sector hospital has been systematically corporatized -- the latter term referring to the granting of autonomy in operational matters to inject private sector-style efficiency and financial discipline, but with the government retaining 100% ownership of the hospitals.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Stakeholder positions

The corporative hospitals, although owned and managed by a monolithic government company, the Health Corporation of Singapore, competed with one another for market share of patients. The competition was often counterproductive. Relevant to the present topic of electronic medical records, each developed its own electronic medical records system, including signing separate contracts with the same vendors, even though it was clear that patients would be better served if they all adopted a common platform that enabled interoperability of systems and sharing of records, and if they cooperated to exploit economies of scale.

The hospitals and specialist medical institutions underwent further reorganization in 2000, splitting into two competing clusters - the National Healthcare Group and the Singapore Health Services. Each cluster became vertically integrated with its own group of primary-care polyclinics. The individual hospital boards were replaced with two overarching cluster boards, but both clusters remained answerable to the MOH. The hope was that the competition between the two clusters would become more manageable. However, the IT systems of the two clusters continued to go their separate ways and it was only in 2004, under intense pressures from the Ministry of Health, that they finally accepted the idea of an exchange to enable sharing of medical records.

Expected outcome

The main benefits of EMRX are that it:

• Improves quality of care, since quick and easy access to the medical history, and laboratory and other test results of a patient will allows more thorough assessment in less time and with greater accuracy. This is especially important in the Accident & Emergency setting where a patient could be unconscious when admitted and immediate, accurate access to vital information such as pre-existing medical conditions, drug allergies and current medications can significantly aid treatment.
• Improves patient safety since ready access to drug allergies and current medications enables doctors to prescribe medication accurately and reduce unnecessary side effects.
• Enables hospitals to provide better co-ordinated care, especially when a patient moves across different hospitals and levels of healthcare delivery.
• Reduces costs as ready access to information such as laboratory test and x-ray results will eliminate unnecessary repeat orders for identical tests by doctors in different institutions.

References

Author/s and/or contributors to this survey

Meng-Kin Lim

Empfohlene Zitierweise für diesen Online-Artikel:

Meng-Kin Lim. "Shared Electronic Medical Records". Health Policy Monitor, 14 October 2004. Available at http://www.hpm.org/survey/sg/a4/3