Supporting Singapore Healthcare Systems During COVID-19 Page ContentAs the COVID-19 situation evolved rapidly over the past month, healthcare workers across public healthcare have worked tirelessly to manage the outbreak. During this critical time, the need to mobilise resources productively and enable the delivery of new services efficiently require rapid deployment of technology infrastructure and innovative solutions. NHG, NUHS and SingHealth, are working round-the-clock with IHiS staff who have been providing on-site IT support, enabling systems and co-designing solutions to meet increased patient-loads, and emerging needs since January.Improving Operational Efficiencies for PatientsBacking the need to meet overflow from hospital emergency departments and at polyclinics, the public healthcare institutions have been working closely with IHiS to enhance technology and systems to support ongoing COVID-19 operations at the various institutions. IHiS worked with vendors to provide technical support and enable hardware and devices for systems set-up and 4G-network connectivity at additional screening areas. These ensure access to critical patient information in electronic medical records like medications, laboratory or radiology results and other forms of documentation continues seamlessly. The three clusters and IHiS also raced against time to mobilise capabilities at unique locations, for instance, at a multi-storey carpark, on a link bridge, under a stairwell and tentages set up at various PHI locations. IHiS ensured that tech-enabled new areas or facilities have necessary integrations back to core systems that are in place. Working with the teams, IHiS accelerated configuration, test environment, approval and deployment of systems in a matter of days and in the instance of Tan Tock Seng Hospital (TTSH), even overnight.Some 3,500 tags would also be progressively on-boarded to the Real Time Location System (RTLS) for the National Centre for Infectious Disease (NCID) and Sengkang General Hospital (SKH) to meet patient, visitor, staff and asset load increases. The RTLS is a critical system to track patient movements, staff deployments and hospital assets in real time. Over the past two weeks, IHiS has set up close to 1,000 devices and 400 new network points at PHIs across the island, including sites at the Agency for Integrated Care (AIC), as part of efforts to techenable new areas or facilities.As the national system that holds summary patient health records across different healthcare providers, the National Electronic Health Record (NEHR) was also identified as a crucial platform in the COVID-19 battle. As an immediate priority, IHiS focused efforts to ensure that COVID-19 laboratory test results of patients at the PHIs (acute hospitals and polyclinics) are contributed to the NEHR. Currently, such tests are performed by the National Public Health Laboratory (NPHL) and the results have to be transcribed into the ordering PHI’s Laboratory Information Systems (LIS). This ensures that the results are accessible via the respective EMRs, and contributed to NEHR at the same time. Communications and change management will be crucial in ensuring such consistency in the workflow, while ensuring that the various laboratories label all COVID-19 related tests in a standardised manner. This will benefit all healthcare providers who can then view such test results. IHiS also worked to enable patients to be able to view these test results in HealthHub. In the next phase, IHiS would be progressing to close the gaps for NEHR contributions of COVID-19 test results from private healthcare providers (e.g. private laboratories).As a key lever in IHiS’ primary care sector IT enablement plans, the GPConnect system, one that has over 200 General Practitioner (GP) partners, was enhanced on 8 February 2020 to facilitate MD131 digital reporting of COVID-19 cases to MOH. Previously submitted via fax or the CDLENS web-portal through a separate login, the MD131 form is now pre-populated within GPConnect to facilitate a seamless submission of information to MOH.Partners on the SmartCMS programme who implemented this web service are also in progress of uplifting their Clinic Management System (CMS) to enable MD131 digital reporting of COVID-19 cases for over 700 GP clinics island-wide. With the planned soft-launch of GPConnect Mobile app in mid 2020, patients will also have the ability to register and make appointments at clinics that are using GPConnect ahead of visiting the clinic and receive SMS alerts when it is near their turn, thereby minimising their waiting times at the clinic premises.Innovating Solutions to Heighten Administration and Patient ConveniencesCorresponding enhancements to a number of systems are in progress with MOH’s announcement on 14 February 2020 of the special subsidies for patients with respiratory illness who present themselves at the re-activated Public Health Preparedness Clinics (PHPC) and Polyclinics. Configuration of billing systems and integration testing with clinical and pharmacy systems at Polyclinics commenced within two hours upon notice by MOH. Systems at 12 Polyclinics were ready by 17 February 2020 to apply the special subsidies for all eligible patients who present themselves there. The remaining Polyclinics would rely on manual computation as they progressively come on-board. The enhancements will be implemented for all Polyclinics by March 2020. IHiS is also actively reaching out to SmartCMS partners (whose products were previously enhanced with the PHPC web service) to brief them on the special subsidies and the corresponding technical specifications, so that they can operationalise the capability uplift of their products in close coordination with MOH Healthcare Claims’ Portal (MHCP)’s readiness.Since late January 2020, the Command, Control and Communication (C3) system at TTSH/ NCID has been progressively enhanced to strengthen situational awareness for COVID-19 operations at TTSH/ NCID, including monitoring of bed status and allocation, number of suspected cases, wait time for laboratory and radiology results, and burn-rate of consumables. Leveraging information management tools and techniques, IHiS has also been able to provide TTSH/NCID with near-real-time (hourly) status reports of bed status, emergency department status, and patient outflow status. To date, IHiS deployed the first wave of 20 Disease Outbreak (DO) priority widgets on C3, and is on track to deploy more DO widgets over the next few months, including enhancement of the video analytics module to support both crowd counting and contact tracing. Enabling Business Continuity During an OutbreakTo meet a growing need for remote outpatient medical reviews, the IHiS Telehealth team supported in the creation of more than 120 Smart Health Video Consultation accounts for doctors, clinicians, Allied Health professionals and support teams across public healthcare. With multi-device and multi-party connectivity, SHVC offers an alternative channel for the delivery of patient care and provider collaboration during the COVID-19 situation. To enable PHIs and MOH to centrally monitor and detect possible outbreak situations early, IHiS accelerated the deployment of the Staff Surveillance System (S3), used by SingHealth and most NHG institutions, to be ready for all remaining institutions by March 2020. Meanwhile, the Temperature Recording System (TRS) was deployed to Alexandra Hospital, Yishun Community Hospital, Woodland Health Campus and the NUHS Corporate Office within two days to support their staff temperature monitoring efforts while the S3 is progressively made available to them. As contact tracing remains a critical part of ring fencing the virus by rounding up patients who may be infected, information provided by the hospital is vital. To facilitate the collection of patient whereabouts more accurately and strengthening ongoing screening measures on patients who have returned from overseas, SingHealth and IHiS refined the fields in the Symptoms and Travel History Screening Form and travel advisory checklist to prevailing conditions. When a COVID-19 patient is warded, the hospital draws up an activity map of everything the patient had done and the people he or she had been with over the previous two weeks.Over 40 IHiS staff have been mobilised to help with contract tracing work at the two MOH contact tracing centres. Currently, there are seven teams with 10 contact tracers each working on two shifts from 8.00 am to 10.00 pm seven days a week to call and check if, the individuals are considered “close contacts” with patients.While IHiS continues to support the Public Healthcare Clusters to enhance systems and solutions, efforts to strengthen public healthcare’s cybersecurity will continue, including the implementation of the 18 Cyber Security Measures and COI recommendations. With the recent alert issued by the Cyber Security Agency of Singapore (CSA) on malicious cyber activities leveraging the COVID-19 situation, IHiS has stepped up on its detection capabilities, and reminded the user community to be extra vigilant, especially towards phishing emails.