Thanks to a major e-health initiative, Singapore, already a healthcare leader in Asia, may soon join the short list of countries with nationwide electronic health records. In April 2011, Singapore launched the first phase of its National Electronic Health Record (NEHR) system, which by June 2012 will link all of the country’s public healthcare institutions, as well as a number of community hospitals, general practitioners and long-term care facilities, to a central repository of electronic patient information at a cost of S$176m (US$146m). Doctors and nurses at these institutions will be able to access a wealth of data, including clinical diagnoses, medication histories and lab results for about 70% of Singaporeans, no matter where a patient was last treated.

Although many of Singapore’s public hospitals have been sharing patient data since 2004, the introduction of the NEHR represents a major step towards the goal of improving health outcomes and the efficiency of Singapore’s health sector, which faces many of the public health challenges common to developed countries: a rapidly ageing population, increase in chronic disease and rising demand for healthcare services. As successful e-health initiatives in places like New Zealand and Denmark (see box below) have shown, the widespread digitisation of Singapore’s health sector promises to help healthcare providers and policymakers make better decisions about care, streamline the delivery of services and manage demand.

Singapore has already achieved much in the way of electronic patient information exchange, an important goal of national e-health strategies, but its existing platform, the EMR eXchange (EMRX), has critical limitations. In addition to connecting only public institutions, the EMRX exchanges unstructured documents. This means that x-rays, for example, cannot be shared between facilities that use different imaging systems and patient data, which follow no particular format, cannot be analysed to support clinical decisions, research or disease management.

EMRX has played an important role in improving the continuity of care for many patients, but the NEHR will be a considerable step up, ultimately allowing sharing of detailed, integrated data across all of Singapore’s healthcare institutions, says Sarah Muttitt, chief information officer at MOH Holdings, the holding company that manages Singapore’s public healthcare institutions and a main architect of the NEHR.

“Regardless of whether you’re a public-sector provider or privatesector provider, there will be access to relevant patient information so that in any setting there would be sufficient information for [patients] to receive good care,” says Dr Muttitt.

The NEHR will also make national health planning, disease management and resource allocation easier. In its second phase, the NEHR will incorporate technology to analyse clinical, financial and usage data in order to measure the impact of care, the cost effectiveness of medications and procedures, and overall performance—information that should allow policymakers a strategic view of the strengths and weaknesses of the sector.

The NEHR project is expected to take five to ten years to complete, a process the Ministry of Health is reluctant to rush. Each phase of the project will incorporate lessons learned, IT training for healthcare providers and clinician feedback—an incremental, multi-stakeholder approach that was critical to the success of the Danish model.

The viability of Singapore’s e-heath endeavour will probably owe much to other important similarities with Denmark, such as the role of a single organisation in guiding the development of the national healthcare IT architecture. In Singapore’s case this is MOHH, which provides leadership on overall IT strategy. And then there is Singapore’s small size, a distinct advantage when it comes to implementing a nationwide project.

“Size and scale in Singapore have allowed us to accelerate the pace [of the project],” says Dr Muttitt, who also cites the government’s strong political vision and backing for e-health, and the city-state’s existing e-health infrastructure. “All of those things are very important to setting an environment that is conducive to this kind of project.”