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EXCLUSIVE - Transforming health systems through Data

EXCLUSIVE – Transforming health systems through Data, Digital technology and Design – Part 1

Digital technology and data are rapidly transforming
healthcare today. With Singapore’s rapidly ageing population, there is a strong
focus on harnessing these innovations to deal with healthcare challenges and
help senior citizens live healthy, independent lives, in their homes. But while
using technology, it is important not to lose sight of the humans who it is
meant for, whether it is the patients, the doctors and nurses or caregivers in
the community.

On the sidelines of IoT Asia 2018, OpenGov had the
opportunity to speak to Ms Tamsin Greulich-Smith
who established and currently leads the Smart Health Leadership Centre
(the ‘Centre’) in  NUS-ISS (National University of
Singapore-Institute of Systems Science) about some of these issues.

Ms Greulich-Smith described the mission of the
Centre as transforming the future experience of health through the use of data,
digital technology and design. This is done through training, applied research
and collaboration models, involving industry, public healthcare, as well as
players in the broader health ecosystem.

“In order to ensure that what we teach in
the classroom remains relevant, we focus on  applied rather than academic research, and we
carry out research projects with industry partners. This ensures we are looking
into areas that are genuine pain points or opportunities for industry players
in the broad health sector,” Ms Greulich-Smith explained.

The Centre also provides advisory consulting
services, working with organisations to help them frame their challenge,
defining and understanding what the problem actually is. The Centre provides just-in-time
training and mentoring to the organisation,  building employee skills so that they can not
only fix the problem at hand, but also sustain the impact of that solution and
know how to solve new problems as and when they arise. “We effectively write
ourselves out of a job,” Ms Greulich-Smith said.

‍Credit: Smart
Health Leadership Centre, NUS-ISS

Working
with all stakeholders

The Centre works with public healthcare
providers, such as the Ministry of Health, and agencies like the Integrated
Health Information System (IHiS) which oversees the public health IT system.

Furthermore, it seeks to connect the
healthcare sector with social care and collaborates with the Ministry of Social
and Family Development (MSFD), and also the voluntary welfare sector and
charities, to support a more integrated approach to care. 

Ms Greulich-Smith said that there are many
challenges in trying to integrate the voluntary welfare sector, the social care
sector and the health care sector together, to achieve true integrated care.

For instance, sharing data is a big
challenge. It is challenging to share information between these different
stakeholders in a way that is relevant for everyone and will make sense for
them. Even within healthcare, there are different kinds of terminologies
depending on which area of healthcare you operate in. When we bring in the
social sector, it is difficult to speak the same language, Ms Greulich-Smith
explained.

“A large part of our focus has been on
public healthcare, however we are also actively involved in social care and at
voluntary welfare fields, as well as looking at how to support  commercial players in realizing their role in
the future of health.”

The commercial players, such as medical
technology providers, insurers, and healthtech start-ups want to collaborate
with public care providers, be that healthcare or social care. There will be
concerns regarding what information each party has access to. But Ms Greulich-Smith
believes that that there is real opportunity here in terms of creating a model
that will be viable into the future.

“The burden of care at the moment falls
very heavily on healthcare and we can look at how we can start to share that
burden in a controlled manner,” Ms Greulich-Smith said. “Primary care is a good
example. 80% of primary care providers are private organisations.”

Primary care in Singapore is generally
delivered by sole traders or small practice GPs (general practitioners)
operating in the heart of HDB blocks (public housing). Many of them are not yet
contributing to Singapore’s National Electronic Health Record (NEHR; the
Government is mandating
that all healthcare licensees have to contribute to the NEHR by December 2020).
Some of them felt that connecting to the NEHR is an expense they couldn’t see
the value of. They didn’t feel the NEHR was required for the kind of cases they
were handling, and it does not appear to align with the way in which many GPs
provide care to their patients. However, there are great benefits to be had if
everyone comes on board the system, which becomes more beneficial the more
people use it.

Evolving the NEHR by bringing in more user
design inputs, such that the value proposition is stronger for users, and
tweaking NEHR so that it feelsmore relevant, intuitive, and accessible might
help in achieving this objective.

Human-centric
design

Expanding on the theme of understanding the
needs of users and of human-centric design, Ms Greulich-Smith said, “Sometimes
we try so hard to create solutions that can meet every possible need, that we
end up over-designing. Something that can accommodate every option may not be
what is required by people working in a busy healthcare setting, who need
something very intuitive, quick and relevant. As such, the over-designed
solution can fail to be adopted as there’s an imbalance between the value it
brings the user and the effort required to gain that value”

So, to design solutions that will be
adopted and used, we have to start by understanding the humans who will be
using them, their aspirations, and their pain points.

Lack of user input is one of the main
causes for the failure of many IT/ digital projects. One of the common problems
is that we try to manipulate solutions to problems around available technology,
rather than trying to understand the problem fully, first. For example, getting
in a technology provider at an early stage in a project might result in
everything being tailored to fit that company’s solution. A better way would be
to start by looking at the people at the heart of the problem, designing a
solution around them, and only then looking at the opportunities for bringing
technologies in.

Ms Greulich-Smith gave a couple of examples
of how the best of intentions can go awry when users’ needs are not properly
understood.

She said that a healthcare provider in
Singapore had the wonderful idea of creating a digital dashboard for their
patients, enabling healthcare workers to get all the critical data in one
glance. The IT team also knew the importance of user input, hence they went to
the most complex department in their institution to find out what the care
providers would need from such a dashboard. They wanted to ensure the dashboard
could meet every need of the most challenged department, and hence designed the
dashboard to meet all of their complicated needs. However, the majority of
departments need a mere fraction of that information. They found it much easier
to scribble things down rather than use the over-designed dashboard. So, the
team had to go back to the drawing board to create a new version that would
work for a wider range of users.

Another similar situation arises as healthcare
and social care organisations provide their community-based care workers with
iPads for them to collect notes at the patients’ houses and directly update it
to the database.

However, when the workers go into people’s
homes, they find sometimes that there is no Wi-Fi to enable live updates. Even
if the connectivity is there, they might find it awkward to enter data on to an
iPad. Because normally they can scribble very quickly with pen and paper, and
can maintain eye contact with the patient whilst they do so, which is important.
To use an iPad they have to look away from the patient, which creates a barrier
to engagement. Moreover, they might lose contact with the tablet screen without
realising it, if they don’t keep their eyes on the screen.

Providing field workers with iPads offers
great potential benefits. But once implemented in the real world, a number of
unforeseen problems arise.

“That’s why we need a design thinking
informed approach, where you would prototype and test that. Then some of these
issues would come out and before you scaled it you would have tried to find
solutions to some of these problems, that help us unleash the powerful
potential of technology in care, rather than grappling with its challenges” Ms
Greulich-Smith said.

In the second part of the interview, Ms
Greulich-Smith talks about how the Centre is applying the human-centric
approach in an integrated care pilot project.