NSC Implements First Fully Integrated Electronic Medical Record System in Singapore
Prof Goh Chee Leok / Loo Swee Cheng
NSC rolled out Electronic Medical Record system – the first fully integrated system in Singapore, on 20th March 2004, to provide a seamless and paperless patient care in NSC. Truly a state-of-the-art software system, it has helped to improve productivity, and has a high potential to reduce medical error.
All 250,000 case records consisting of 2 million pages of records were digitised/scanned in three years. Patient transactions are now done electronically, including on-line patient appointment system, self-registration kiosks, electronic medical recordings, order entries for laboratory tests, and prescriptions. The system also allows management to monitor patient load, waiting time in real time and a job stack module for our doctors. All these modules are integrated with its administration modules including inventories, purchase orders and acquisition and financial system.
Medical Records used to be shelved
in the Medical Records Room
| 
Medical records are all now in the server |
NSC – Vesalius System Overall Workflow Diagram |
How does the system work ?
Online internet appointment system
Through the new system, patients now can log on to the NSC website at www.nsc.gov.sg 24 hours a day to book, change or cancel an appointment.
On the day of consultation visit
2 days prior to the appointment, the system sends a reminder via SMS, email or telephone. The patient can then confirm, change or cancel the appointment.
Registration
On the day of the appointment, patient registration waiting time is reduced significantly through the use of the self-registration kiosks where patients scan their NRIC or outpatient card. A queue slip will be issued, with instructions on where to go and what to do next.
Assistance over the counter is available for first-visit patients or patients with referral letters. Referral letters will be scanned immediately into patients’ electronic records.
Consultation Queue
In the consultation room, a queue list of registered patients enables our doctors to select patients according to appointment time. The screens also identify patients with special needs, monitor their arrival and waiting times. The queue list will also alert the doctor of any patient left unattended for too long.
Patient Support Electronic Medical Record System (EMR)
Before calling up the patient, the doctor can retrieve the patient’s digitised past medical records from the EMR system.
New self-registration kiosk |
Prescription Online |
During consultation, the doctors can perform the following functions:
- Update patient records,
- Order investigations and
- Order prescriptions on-line. The drug allergy and medical alert system will warn the doctors of any cross reaction between the drug he prescribes and those that patients are allergic to.
- Enter ICD diagnosis codes, issue medical certificates, referral letters, referral to our MSW and request for follow-up appointments.
Pictures of patients’ skin conditions are captured using digital camera and stored in the EMR folder for instant visual comparison of before and after treatment condition.
If treatment or procedure is to be done on the day itself, all the information will be routed electronically to the next station with the doctor’s comments and instructions.
The prescription is sent electronically to the pharmacy. The electronic prescription allows the pharmacy to prepare the medication as the patient proceeds to the pharmacy. Patients without follow up appointments can proceed directly from the clinics to the pharmacy for one stop payment.
The system captures all prescription patterns of doctors in NSC. The data collated can subsequently be used to create an artificial intelligence system that will prompt for the most cost-effective treatment options of various diseases.
The clinic monitoring system
The Clinic Executive uses the system to monitor and manage patients' waiting time in various consultation rooms. Patients who waited for too long are re-assigned to other rooms.
Job Stacks
This module captures all follow-up actions required by the doctor. Where tasks like reviewing abnormal laboratory reports, medical report writing, GP referral replies, statutory disease notification etc have been time consuming to track previously, the NSC system now allows our doctors to clear their administrative work at day end. Letters can be dictated using its digitized voice activation system.
Other modules
The fully integrated system includes backroom functions like medical records coding, referral replies and a full purchase and inventory system. Purchase requisitions are now raised and approved on line for conversion to purchase orders, while departmental requisitions for supplies have also gone paperless.
Down Time EMR
A down time EMR module is available, where patients’ medical transactions and records are downloaded into the doctors’ PC every night. Should the system server break down, the doctors will still have access to basic information.
Reports and Surveys
The new electronic system allows customization of reports including waiting time for appointments, waiting time for consultation, lab tests, prescriptions, etc. Integration with our SPSS statistic software allows our staff to mine all relevant data.
Conclusion
NSC management has always made it a top priority to harness IT to improve staff productivity and enhance patient care. This paperless electronic system has impressed many patients. The user-friendly design has won over all the staff. The 100% participation among our doctors is evidence that the system has successfully engaged the variable and complex nature of medical care within NSC.
Dr Lawrence Khoo, Consultant:
I have enjoyed using the computer system very much as my notes are neater now and the IT team members are cheerful, helpful and dedicated. |
Mr Lim Keok Meng, Patient:
I am impressed. [NSC] initiated a new computerised system before the other hospitals. |
Dr Audrey Tan, Associate Consultant:
Convenience at its best. I can check prices, send prescriptions online and access my patients’ medical case notes at the click of the mouse. |
Ms Han, Patient:
The new scanning machine is excellent. Saves a lot of time in the distribution of queue numbers. |
Mr Lee Sau Chuen, Laboratory Manager:
The LIS (Laboratory Information System), which connects our machines to the Versalius System, has shortened the turnaround time for immediate test requests tremendously. |
Mr Daniel Chan, Patient:
I got my medication from the pharmacy without much wait. The new system is definitely faster. |
Sister Kong, Clinic Executive:
Waiting time can now be easily tracked with the new system. This way we can ensure that the patient would not be kept waiting. |
Ms Geng, Patient:
I can now collect medications at the pharmacy the moment I come down from the clinics without a prescription chit. Excellent. |
Ms Valerie Chan, Senior Pharmacy Technician:
Patients’ e-prescriptions are sent ahead of their arrival in the pharmacy, so that we can prepare them in advance. We love to see the look of amazement on some of our patients’ faces when their numbers are flashed even before they sit down! |
Mdm Jessie Chai Ah Moy, Patient:
Everything seems faster since the computerisation of the Centre. |
Ms Valerie Chin, Patient:
I was surprised that I no longer need to get a prescription slip from the doctor to get my medication in the pharmacy.
|
|