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The IT journey in clinical systems in Singapore dates back to the 1980s and by the early 2000s, two distinct electronic medical record (EMR) systems emerged from the two integrated clusters. However, this meant that sharing of patient information, especially those moving from different clusters, was a big challenge. In 2008, the National Electronic Healthcare Record (NEHR) was conceived out of a “one patient, one record” vision based on a concept paper. Critically, NEHR differs from previous EMR systems as it is a repository of visit summaries specific to an individual. While EMR systems contain detailed information of a patient in their respective institutions, NEHR collects key subsets of health information from these multiple healthcare encounters. NEHR went live in 2011, with the successful uploading of healthcare information from public hospitals in the same year. By the first year, all restructured hospitals, specialist centres and polyclinics, six community hospitals, eight nursing homes, and an increase from an initial 50 to 250 GP clinics had access to NEHR. HealthHub, a one-stop portal and mobile application for Singaporeans to access a wide range of health content, rewards and e-services was launched in 2015. Users can also log-in to HealthHub through their SingPass to view their health records and medical appointments across different polyclinics, public hospitals and other public health institutions. The information from HealthHub is drawn from a few IT systems, which include the NEHR, the School Health System, School Dental System and National Immunisation Registry. As of November 2017, only three percent of the more than 4,000 private healthcare providers – including specialist clinics, nursing homes and hospices – contribute to the NEHR scheme. Additionally, a study of private healthcare institutions done by the Integrated Health Information Systems (IHiS), the national technology agency for healthcare, found that two in 10 private GPs and specialist clinics still use written medical record systems, rather than an electronic one. At the time of writing, the Ministry of Health (MOH) website has a list of 1230 healthcare institutions/organisations (public and private) who are participating in NEHR. Due to the slow uptake by private healthcare sector in the NEHR, MOH wants to make it compulsory for all healthcare providers to upload data to the NEHR. Early adopters who start contributing data by June 2019 will be able to claim a one-off from MOH to offset their costs of upgrading their systems and a S$20 million fund has been set aside by the ministry for this purpose. One of the unique developments is that the latest generation of the Singapore Armed Forces (SAF)’s EMR system, Patient Care Enhancement System (PACES) 3, which was launched in April 2016, connects to healthcare infrastructure outside of Ministry of Defence (MINDEF)/SAF via the internet, such as the NEHR. This helps to provide more holistic care for SAF servicemen. Traditionally, the first two generations of PACES operated independently on their own with no ability to connect to external healthcare infrastructures. While there has been a progressive development in health IT in Singapore in terms of the NEHR and HealthHub, the nation-state suffered a setback in its goal to becoming a Smart Nation when a cyberattack occurred to SingHealth, Singapore’s largest group of healthcare institutions, which consists of 4 public hospitals island wide, 5 national specialty centres and a network of 9 polyclinics in July 2018. Described as one of the worst cyberattacks in the country, the incident saw the personal information of 1.5 million SingHealth patients being copied and stolen. Plans for compulsory contribution to NEHR has been suspended temporarily after the SingHealth incident and a four-member Committee of Inquiry (COI) was set up promptly to look into the events and factors that led to the attack. In response to the incident, Prime Minister Lee Hsien Loong shared, “If we discover a breach, we must promptly put it right, improve our systems, and inform the people affected. This is what we are doing in this case. We cannot go back to paper records and files. We have to go forward, to build a secure and smart nation.” PM Lee’s response reflects Singapore’s ongoing journey in continually advancing healthcare IT infrastructure – in fact, there are already plans to develop and implement the Next Generation Electronic Medical Record (NGEMR) by 2020.

Penn Medicine is pursuing a new initiative it says will innovate electronic health records for 21st Century medicine. The goal, officials say, is to make the technology more interactive and responsive to clinicians – nudging the EHR into a new era where it's not just a documentation system but a crucial tool for care delivery. WHY IT MATTERS Since EHRs have become ubiquitous over the past decade, they've grown into an intrinsic part of the ways healthcare is administered. They've also earned no shortage of annoyance, if not downright scorn, from many clinicians frustrated by how they impact their jobs. As Penn Medicine explains, many physicians simply see EHRs as "static, digital remakes of paper charts that can increase workload, contribute to burnout and create barriers to delivering high-quality patient care." And oftentimes that's exactly what they are. But as is often the case, much depends on how such tools are used. So Penn Medicine leadership has undertaken a multi-pronged approach to making EHRs more responsive to clinicians and streamlining them to work better for better outcomes in the era of precision medicine and population health management. The Penn Medicine Nudge Unit – billed as the first behavioral design team developed at a health system – is key to the mapping of these new approaches to the EHR experience. For instance, it has devised new tweaks for Penn's Epic system designed to help ensure clinicians prescribe statins for their cholesterol patients, get cardiac patients referred for rehab after heart attacks and only order advanced imaging tests for the patients who need them most. David Asch, MD, executive director of the Penn Medicine Center for Health Care Innovation, has previously explained how behavioral economics and psychology are key to engaging patients to make meaningful changes. The same holds true for physicians, he says, which is why he's advocated for EHR customizations that, among other things, enable and encourage doctors to "subscribe" to their patients' clinical data, gaining social media-like updates in real time when certain interventions are needed. "Ultimately, we need to move past the idea that the EHR is just an administrative tool, and see it as a clinical tool – like a scalpel, or a medication, or an X-ray machine," Asch said in a statement announcing the new project. "We judge these tools by the degree to which they facilitate good patient care, and we should be judging the EHR against the very same standard." THE BIGGER TREND Much has been said, here and elsewhere, about the "post-EHR era," but Penn Medicine's efforts appear to be intent on making it a reality there – boosting the ability of IT systems to deliver enhanced care in the 21st Century. No longer just a data repository or a glorified billing system, the EHR – when properly designed, configured and used – could have a huge impact on how care is delivered, especially as the complex new era of connected devices, patient-generated health data, genomic medicine and artificial intelligence continues to come into focus. A chief goal at Penn Medicine, officials said, is to alleviate if not eliminate the need for clinicians to spend undue time looking for needles in data haystacks, getting pertinent patient information in a more "actionable, tailored manner." That's why the health system has also launched a new innovation contest designed to get teams from across Penn Medicine to identify the lowest-hanging fruit for EHR transformation. IT professionals, data scientists, educators and others will work with clinicians and staff to help conceive and refine various design and usability improvements. In addition, new so-called "sprints" – collaborative clinical workgroups to help to streamline and improve EHR interactions and engagement with email and  digital media – will be a key component of the new initiative going forward. ON THE RECORD "We recognize that EHRs are no longer just part of how clinical care is documented, but they are central to how clinical care is delivered," said J. Larry Jameson, MD, dean of Penn's Perelman School of Medicine, in a statement. "Increasingly, health information technology plays a foundational role in each domain of our work: patient care, educating the next generation of physicians and scientists, and biomedical research." Ralph Muller, CEO of the University of Pennsylvania Health System added: "Everything that shapes patient care should be designed to support the best possible outcomes. Electronic health records are a natural focus because they connect to everything we do." Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com

Keeping software up to date without disrupting care delivery requires a plan for regular patching – and responding to emergency alerts when necessary.

Healthcare IT News Asia Pacific hears from Marcus about what healthcare organisations can learn from National Geographic's consumer engagement experience.

As part of National Health IT Week, two HIMSS Davies Award winners share advice and best practices for putting technology to work fighting the abuse epidemic.

HITRUST launched a security program to help start-up companies bolster their privacy and security foundations, including the adoption of the most comprehensive risk management, compliance and security services. WHY IT MATTERS The goal is to support startups in adopting best practices as they grow. HITRUST is working closely with those small businesses to ensure these security features are baked into their products from the beginning. To accomplish this, HITRUST is bundling and pricing its programs to align with small businesses that have been in business for less than three years, have fewer than 50 employees and less than $10 million in annual revenue. The program will streamline HITRUST adoption. ON THE RECORD “Navigating risk management and compliance requirements can be costly and a strain on internal resources and can be daunting for any company, but it can be compounded in start-ups that are focusing on bringing their vision to market,” Mike Parisi, HITRUST’s vice president of assurance strategy and community development, said in a statement. THE TREND HITRUST was formed in 2007 and is seen as one of the industry’s gold standards for security. In May, it launched a certification program for the NIST Cybersecurity Framework for hospitals and health systems to ensure security compliance. The RightStart Program will ensure these startups embed these security standards into “their evolving business models,” Parisi added. HITRUST officials stressed that often these types of security measures are seen as a barrier to adoption. And as a result, companies will add programs in an ad hoc way, which leads to a loss of time and money, without a guaranteed improved risk posture. To Hoala Greevy, Paubox CEO, the hope is that the program will give the company the ability to adopt a security framework that will scale with the organization. “HITRUST provides us with the tools for secure, compliant growth needed to increase our bottom line,” Greevy said in a statement. “Our customer focus demands we have security, compliance, and risk management in place by design and not as an afterthought.” .jumbotron{ background-image: url("http://www.healthcareitnews.com/sites/default/files/u2231/cybersecurity-jumbotron-712.jpg"); background-size: cover; color: white; } .jumbotron h2{ color: white; } Focus on Cybersecurity In October, we take a deep dive into security strategy and pressing threats. Twitter: @JF_Davis_ Email the writer: jessica.davis@himssmedia.com

This case study shows how clinicians reduced the number of orders for one specific test from roughly 90 per month to five – helping with antimicrobial stewardship along the way.

A researcher discovered the North Carolina-based tech vendor is leaking protected patient data through its Amazon S3 bucket twice in a month.

As HIPAA was written when most providers still used paper charts, the framework today has plenty of room for improvement.