COVID-19 Community Care Facility at Expo, Powered by HealthTech Page Content On 5 April, the Ministry of Health (MOH) announced Singapore Expo Convention Hall as a Community Care Facility (CCF) to house COVID-19 patients who are clinically well but still test positive and newly confirmed cases with mild symptoms who do not require extensive treatment. This would free up hospital capacity for COVID-19 patients with serious symptoms to receive urgent medical care, which could be the difference in keeping them alive.With the announcement, the wheel began to accelerate. Within a day, hundreds of people from various agencies gathered to begin setting up the first hall. Led by Woodlands Health Campus, staff from MOH, MOH Office for Healthcare Transformation (MOHT), IHiS, Parkway Pantai, SAF, SingEx, SingHealth, National Skin Centre, the Institute of Mental Health, Resorts World Sentosa, Temasek Holdings, Surbana Jurong, Certis CISCO, Health Promotion Board, NCS and more were intimately involved.Working around the clock, the group turned an empty hall into one that could care for 480 COVID-19 patients within five days. This included the construction of makeshift rooms, the moving in of thousands of beds, cabinets and chairs, and the setting up of many medical, communication and HealthTech devices. There were also many workflows, processes, and registration and security protocols that were devised on the go. Dr Jason Cheah, Chief Executive Officer, Woodlands Health Campus (WHC), summed it up: “The multi-agency team has worked extraordinarily hard to get things up and going. Much has been asked of them and they have responded over and above what was asked. They are absolutely critical in ensuring that we have enough capacity and capability to house recovering COVID-19 patients for the next few months.” After the first hall went live, work did not stop there. As the need for more halls grew, they began setting up other halls, taking a learn-and-adapt approach to become increasingly efficient. As of 22 April 2020, a total of six halls with a capacity to house close to 5000 COVID-19 patients have been set up in 17 days – an average of 1 hall every three days. Work is underway to set up an additional four halls. This is a great testament to their dedication, professionalism and efficacy. We salute everyone who has been involved in the fight against this pandemic. We take a look behind the scenes at how HealthTech has made the caring of these patients safer and more efficient. HealthTech Enablement at the Expo Community Care Facility (CCF) In a place as large as the Expo, teching the halls up required the moving and setting up of a significant number of devices such as laptops, printers, barcode scanners and labellers. In discussions between IHiS and healthcare staff, it was determined that having quick and mobile access to laptops would be very useful, especially when there are many COVID-19 patients in a large area. Hence, IHiS brought in laptop carts, or what are known as Computers on Wheels (COWs). COWs make it easy for laptops to be wheeled around, improving laptop mobility. They also have large rechargeable batteries to power up the laptop placed on them, ensuring that the laptop is able to remain functional for a long time. As of 22 April 2020, more than 100+ COWS, printers, laptops and barcode scanners have been configured and deployed in the six halls so far.Managing Patient Workflows in a CCF Setting with GPConnectA key setup question asked was what IT system can best support the care workflows in a CCF setting and be deployed in a timely manner. While conventional wisdom pointed to traditional hospital systems, the downside is that hospital systems are complex and may take a longer time to deploy. CCF@Expo needed a solution that was relatively easy to teach, learn, provision and deploy and scale up quickly when needed. The solution came in the form of GPConnect, an integrated Clinical Management System (CMS) and Electronic Medical Records (EMR) system currently being used by 200+ General Practitioner clinics in Singapore. GPConnect is an integrated system that can handle patient registration and storing of the patient's medical records, including the dispensation of medicine. It can be deployed quickly and provides efficiency through its features for both administration as well as clinical consult workflows, such as its ability to access National Electronic Health Record (NEHR) for COVID-19 patients’ continuity of care, followed by contribution of key patient data after the consult. More than 400 GPConnect accounts have been provisioned to allow Woodlands Health Campus (WHC), Parkway and SAF medics to use GPConnect. More than 20 training sessions were conducted for 400+ staff, both onsite at Expo and via teleconferencing. IHiS also provided 24 by 7 tech support and troubleshooting to support the healthcare staff’s use of the GPConnect system. As GPConnect is a system designed for the General Practitioner clinic setting, IHiS worked closely with Woodlands Health Campus (WHC) clinical leaders to adapt the solution to support inpatient care at Expo. For example, GPConnect did not support the assigning and tracking of COVID-19 patients with bed numbers. IHiS came up with a fuss-free solution – by modifying a seldom used field to assign bed numbers instead. Related article: IHiS mobile kiosks boost effiency at community care facilities (CCFs)Another key adaptation was to leverage the system’s ability to tag the patient’s status. More system tags were created to facilitate the tagging of key milestones in the patients’ journey such as “New admission”, “Recovery”, “Discharge”. This allowed the nurses and doctors to e-tag the COVID-19 patients at each point of care and facilitated the generation of daily reports to support the overall operations management in the CCF. The team also innovated by adding “hospitalisation leave” into the medical certificates “reasons” field, to allow the issuing and printing of hospitalisation leave for COVID-19 patients who discharge from the CCF. This avoided the need to do up another MC template that would have cost the team time and resources.Another advantage to using GPConnect was its seamless transmission of key patient information to the NEHR. This made it easy for authorised healthcare staff to monitor nationwide COVID-19 data and support a patient’s continuity of care. The NEHR has also been enhanced to include swab tests results from private labs. Given this unprecedented usage of GPConnect, the team continues to journey to optimise the solution to fit the workflow at Expo.Remote Vital Signs Monitoring (VSM) Expo houses COVID-19 patients who are mostly well and are able to carry out daily functions by themselves. In consultation with healthcare staff, a decision was made to guide the patients with written and pictorial instructions on how to take their own vital signs readings. This involves taking their own temperature, blood pressure and oxygen saturation readings and entering them into a tablet. The tablet then sends the data to a central dashboard, where healthcare staff monitor it centrally and remotely. When a COVID-19 patient exhibit signs out of the normal range, staff will be alerted via the Vital Signs Monitoring (VSM) dashboard which will display readings for such patients in red and these patients will be displayed at the top of the list. Related article: New AI-driven temperature screening device by KroniKare and IHiS to save time and manpower Did You Know? A usual IHiS-issued vital signs monitoring kit does not include an oximeter. However, oxygen saturation level is one of the important vital signs monitoring in patients with COVID-19, as the saturation level typically starts declining before a patient begins to feel breathless. Hence, IHiS worked closely with MOHT to include oximeters into the kits issued at Expo.There are many benefits to central and remote monitoring, such as minimizing staff exposure to the virus, and saving them precious time. For example, it takes a nurse an average of three minutes to administer the taking of three vital signs to one patient. This has to be done thrice a day. Caring for 2,000 COVID-19 patients would require a platoon of 30 nurses working a 12 hour shift to accomplish this. However, with remote vital signs monitoring where COVID-19 patients take and submit their own vital signs, significantly less manpower is needed to do this, and staff can focus on other urgent tasks at hand. Professor Tan Chorh Chuan, Executive Director of MOH’s Office for Healthcare Transformation, said, “Everyone at Expo has been working round the clock but instead of fatigue, what I felt was a real sense of energy and purpose among all the colleagues I met. It was teamwork at its very best, across groups, across institutions. I was really impressed at how quickly the vital signs monitoring system was set up and processes improved along the way, all while managing the big influx of cases.” Dr Gerald Koh, who is Clinical Director at MOH’s Office for Healthcare Transformation and led the vital signs monitoring effort, said, “Tele-Medicine is the next frontier of medical consultation, and its use in pandemics or outbreaks is relatively undeveloped. Through the ongoing operations, we have learned that it is an extremely efficient and excellent way to maximise our limited healthcare resources as well as minimise risks to staff. The teamwork displayed by dozens of disparate staff in setting this up and improving the processes along the way was phenomenal. I’m very proud of the team.”IHiS also deployed Robotic Process Automation (RPA) to help with the mass creation of patient profiles in the vital signs monitoring system. RPA is a process automation of software that mimicks human actions. In this case, it was data entry – the software robots, termed “Digital Workers”, were taught how to read the data file for incoming patients, register and activate their profiles, and deactivate them after they have been discharged. This automation not only completes the job much faster than humans can, it also freed up the equivalent of six full time employees doing data entry on a daily basis, allowing them to channel their efforts to other tasks. Related article: IHiS creates an isolation facility in four daysFrom Kits to Kiosks, from Kiosks to TOWs (Telehealth on Wheels) The evolution of vital signs monitoring at Expo is a journey of continuous adjustments and innovation to adapt existing solutions to fit evolving workflows and overcome emerging constraints. Initially, as COVID-19 patient numbers were still relatively small, they were each handed a vital signs monitoring kit with a tablet to key in their vital signs. However, as the numbers swelled, staff had to ration the limited number of tablets and devices. This was done by setting up vital signs kiosks that could each cater to about 30 patients. Hence, instead of individual kits, COVID-19 patients now walk to a nearby kiosk in the hall to take and key in their vital signs. In setups of subsequent halls, the team improved on this process by mounting wheels on these tables, which quickened the deployment of what has been dubbed Telehealth on Wheels (TOWs). This way, if more kiosks are needed in the hall, it is easier and safer to assemble them outside the hall and wheel them in, rather than assembling them in the hall itself while donned in personal protective equipment.To set up TOWs, staff were deployed at short notice to source for tables, wheels and all sorts of mounting hardware within a day. It was then all hands on deck to assemble, configure and set up the kiosks. We would like to acknowledge volunteers from NCS who helped with the setting up of VSM accounts and packing of the kits, as well as Telehealth team and NUS for the translation of the VSM instructions into other languages. By 22 April 2020, 1,600+ devices have been deployed for vital signs monitoring.As the battle against COVID-19 continues, IHiS stands resolute and united with you – Singapore’s extraordinary healthcare staff. We will do our best to support your tech needs every step of the way. As the saying goes, walk on, walk on with hope in your heart. You’ll never walk alone.