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In the book Affordable Excellence: The Singapore Healthcare System by William A. Haseltine published in 2013, the author noted that Singapore “ranks sixth in the world” in terms of healthcare outcomes, while “spend[ing] less on healthcare than any other high-income country”. When compared with other countries, Singapore ranks high on value-based indices - A 2014 EIU white paper that looked at health outcomes and costs across 166 countries ranked Singapore second after Japan, noting that it had achieved similar outcomes to Japan’s but with a significantly lower investment. One of the key pillars behind Singapore’s remarkable success in delivering affordable and high-quality healthcare since its independence in 1965 is the government’s approach to healthcare improvement and care as an integral and inseparable part of the overall development planning for the country, Haseltine explains in the first chapter of his book. In November 2017, the Ministry of Health introduced the ‘3 Beyonds Strategy’ to keep healthcare in Singapore good and affordable. They are: (i) Beyond Healthcare to Health (ii) Beyond Hospital to Community (iii) Beyond Quality to Value With an aging population and increasing costs and burden of healthcare in Singapore, the “Beyond Quality to Value” strategy becomes essential to retain or increase quality of care while ensuring value for money. The Agency for Care Effectiveness (ACE) was set up in 2015 to research treatments that provide the best value for money. For instance, three drugs may offer the same results, but have very different prices. Or a drug may be more expensive, but offer outcomes that are far better than cheaper alternative drugs. Webinar: Compliance as code: Automate compliance using open source technology In the long run, the conventional method of fee for service-based care that works on a basis of volume and treating illnesses and injuries as they occur is also not tenable – hospitals and healthcare organisations cannot expand their capacities indefinitely and there is already an existing manpower crunch of qualified professionals in the healthcare sector.   Treating illnesses and diseases when they occur is often expensive and unpleasant for patients – therefore, the proverb, “prevention is better than cure” is especially relevant. The “Beyond Healthcare to Health” strategy has seen the Health Promotion Board (HPB) ramping up efforts for people to become healthier and more active, through initiatives such as the National Steps Challenge (currently in its forth season) and Healthier Dining Programme. Value-based care prioritises health outcomes that matter to patients relative to the cost of achieving those outcomes. This is also related to “Beyond Hospital to Community” strategy in which patients can receive appropriate care community or at home so they can stay well and avoid frequent hospital admissions. This is better for them in terms of health and convenience, and for the healthcare system too, as hospital care is very expensive. The transition from a fee for service-based to a value-based healthcare system may not be an easy journey for many healthcare providers and organisations but it also presents many opportunities to relook existing approaches to healthcare, not just in the delivery of patient-centric care but also in aspects such as financing models and leveraging technologies such as AI to provide value to both patients and clinicians while reducing costs. With the theme of “Disruptive innovation for Value-based healthcare”, the HIMSS Singapore eHealth & Health 2.0 Summit held from 23-24 April 2019 at Marina Mandarin Singapore will feature six main topics related to achieving value-based healthcare: (i) Population health (ii) Healthcare revenue cycle (iii) Patient outcomes (iv) Acute-to-community (v) Cybersecurity; and (vi) Artificial intelligence The HIMSS Singapore eHealth & Health 2.0 Summit will be a great opportunity for like-minded healthcare leaders and professionals in Singapore and abroad to come together to tackle some of the major challenges and opportunities in moving towards a value-based healthcare system.

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A recent article from China Daily stated that IT investment in the country’s hospital system will reach 65.7 billion yuan ($9.47 billion) in 2022, surging 53.5 percent from 2017 and boosting the digitalisation of the Chinese medical system, based on a forecast report by Analysys. The Beijing-based research consultancy’s report also noted that the Hospital Information System has almost achieved full coverage in China’s tertiary hospitals, which is the largest in the country’s three-tier system. Coverage in primary and secondary hospitals, the lowest two tiers, is currently at 80 percent. Statistics from the Chinese Hospital Association indicated that in 2017, hardware investment accounted for 44 percent of total hospital digitalisation investment, while spending on software and services represented 56 percent. Chen Qiaoshan, a medical analyst at Analysys said that software and services as the core of hospital digitalisation will a have higher growth potential than compared to hardware. From 2017 to 2018, 17.43 percent of the country’s hospitals greatly expanded their investment in hospital digitisation, and 29.78 percent slightly increased their investment, showing that in the future, the overall investment into hospital digitisation will continue to rise, according to the same report by Analysys. Webinar: The EHR App Store Is Open - What Is on the Shelf? Based on the latest statistics from HIMSS Analytics, China has 36 EMRAM Stage 6 validated hospitals and 10 EMRAM Stage 7 validated hospitals. EMRAM is the acronym for Electronic Medical Record Adoption Model by HIMSS Analytics, which incorporates methodology and algorithms to automatically score hospitals around the world relative to their Electronic Medical Records (EMR) capabilities. This eight-stage (0-7) model measures the adoption and utilisation of electronic medical record (EMR) functions and Stage 7 represents a remarkable achievement in which paper charts are no longer used.   Huangshi General Hospital in Hubei province and Children’s Hospital of Shanghai are two such hospitals to achieve EMRAM Stage 7 validation in the first quarter of 2018. In the same China Daily article, Qu Jing, another medical analyst at Analysys, said, “Although most hospitals attach great importance to information gathering, they do not have a clear development strategy. Statistics from the Chinese Hospital Association showed that while 97.25 percent of China’s hospitals have a specialised information and technology department, 56.29 percent of them lack thorough digitalization development planning.” Qu also added that hospitals lack regional connectivity, which is important for the development of hospital information platforms, with only 49 percent having a regional information platform.

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The U.S. Department of Health and Human Services has announced the winners of a new challenge to develop software for identifying and reporting safety and usability issues in EHRs in a way that doesn’t disrupt clinical workflow. The winning tools aim to make it easy to report IT issues within the healthcare workflow: giving feedback to developers and guiding the formation of best practices. The hope is to targeting usability challenges before they become major problems. Three winners were announced: The James Madison Advisory Group came in first, with a hotkey that allows a clinician to document an issue without leaving their EHR and which simplifies the process of reporting issues. Pegwin, in second place, developed an intuitive reporting system that allows a user to document an issue “in as few as three clicks.” Jared Schwartz and team came in third with a Google Chrome plugin which integrates with common IT ticketing platforms, making it easy to work into existing systems. The winners received $45,000, $25,000, and $10,000 respectively. WHY IT MATTERS Like any software, EHRs sometimes have flaws or malfunctions. An already busy clinician who is trying to manage a full patient load, perform diagnostic work and enter data usually doesn’t have time to document and report safety or usability issues to his or her IT department. Webinar: Improving Patient Matching in your EHR: A Case Study Finding a way to work tools into the care workflow that allow practitioners to capture and share potential safety and usage concerns results in greater efficiency without disrupting a clinical workflow. "Improving the safety of health IT remains an important priority," said Dr. Andy Gettinger, ONC chief clinical officer. "We believe that making it easier for end users to report will help in that goal." THE LARGER TREND EHRs have the potential to be the first point of data capture in a new landscape of precision care. First, though, they need to win over physicians who see them as cumbersome and byzantine replacements to the old pen and paper methods. Some healthcare systems are focusing on identifying those problems and addressing them to enhance the value of their EHR systems. Practitioners are experiencing EHR burnout – something ONC has also recently been working to help combat – where poor usability or other IT safety concerns can have a detrimental impact on effective patient care. ON THE RECORD "Helping reduce the burden of health IT continues to be a key area of focus at the Office of the National Coordinator for Health Information Technology, and we anticipate the winning submissions to the Easy EHR Issue Reporting Challenge will help with those efforts," said ONC chief Dr. Don Rucker. Benjamin Harris is a Maine-based freelance writer and and former new media producer for HIMSS Media. Twitter: @BenzoHarris.