An IT shot at error-free prescription

My associate editor Vivian Yeo returns with another post this week in which she discusses the state of healthcare data management, still largely untouched by technology, in Singapore.

I remember writing about the government's plans to digitize medical records and its dreams of a paperless healthcare system, where private clinics and major hospitals can easily share a patient's medical data and establish a single consolidated view of that patient's healthcare history.

That was 10 years ago. Today, most private clinics still rely on paper and I'm pretty sure most still lack the relevant resources to tap into a patient's hospital records with a mouse click.

Granted it's not an easy path, to take an industry that has one of the longest histories--hence, biggest legacy issues--and completely revolutionize it, digitally. But, if done right, the benefits would be ginormous.

Singapore celebrates its 46th year of independence next week. I must state upfront I'm not the patriotic type--I forget when was the last time I watched the National Day Parade or wore red and white to celebrate the occasion, and I had to think for a good minute to recall how many years the country has been independent as I began this post (and don't even try to suggest my math is bad). I've have my fair share of grouses about the rising cost of living, inconsiderate dwellers and sardine-packed trains during peak hours.

Nonetheless, I am certainly proud of how much the city-state has achieved, especially for a tiny nation with a short history. I truly believe we have one of the most, if not the most, efficient and comfortable airports in the world. If I were stuck in an airport because some volcano which name I cannot pronounce disrupted air traffic in Europe, being at Changi Airport would ease the pain--a lot. And while we're at that, Singapore Airlines also has one of the best reputations in the world, notwithstanding a recent dent due to a Web site revamp gone wrong.

Healthcare, and its related pharmaceutical and biotechnology industries, is also another area that makes me pink with pride (pun intended).

Although there have been serious concerns about affordability to the extent that some elderly folks grumble it's better to die than be sick, the country is making good progress as a biomedical hub and at the forefront of medical innovation.

But if I could make one wish for this sector, it would be that the country's vision to have a single, integrated digital record for each patient was a reality.

Twice in the last several months, my GP (general practitioner), who still relies on paper records, had prescribed medications that were unsuitable for nursing even though he makes it a point every visit to enquire about my young daughter.

The first time it happened, I casually asked the clinic assistant--while making payment--to check back with the doctor as I realized he had failed to mention to me that the meds he was prescribing were safe for breastfeeding (he normally does). I had expected to be chided for my paranoia and that these pills were indeed baby-friendly, but to my horror, they instead were changed.

The second time, the same lack of "don't worry, these medicines are safe for breastfeeding" utterance by my family physician triggered a mental alarm in spite of my grogginess. True enough, one of the meds had to be replaced, again.

This experience made me wonder, how many people ingested wrong medication because they simply assumed that the doctor would prescribe appropriately? You might think it's probably not a big deal since any misdiagnoses that lead to serious consequences usually make the news and we don't hear about them often. But when a pregnant woman, for example, takes meds that are too strong for her fetus, the effects may be subtle or worse, only show up in later generations.

While doctors can be held accountable for negligence and lack of professionalism, they are humans, after all, and mistakes are inevitable. Technology has the ability to play a crucial role here, where important data will always be displayed prominently and built-in controls will trigger off system alerts of inconsistencies.

For instance, my husband is allergic to a group of drugs known as NSAIDs (non-steriodal anti-inflammatory drugs). When he goes to a GP, he or she should be able to know this immediately by looking at his e-medical record. Better still, if a doctor tries to prescribe him Ibuprofen, the system will automatically flag a problem and the dispensary will not receive the prescription.

Of course, it would be simplistic to conclude that having everyone on board or complete digitization will lead to an error-free healthcare system. There are other factors such as whether inputs are clear and detailed, and the possibility of system downtime. But if there is a way where mistakes due to human carelessness can be avoided, let's have it now rather than later.

And so, there is the all-important question of when.

The actual completion of Singapore's multiple-year e-health journey is still nowhere in sight, yet, even though the National Electronic Health Record system was launched in June. The Ministry of Health (MOH) told me in an e-mail that access to the NEHR is progressive, starting with public healthcare institutions under SingHealth and NUHS (National University Health System). "By June 2012, all public healthcare institutions, selected community hospitals and GPs should be on the NEHR system," an MOH spokesperson noted.

No GP I've visited in recent months has made the leap to digital records. And with private practitioners forming 80 percent of the country's primary care providers, I very much doubt that the June 2012 timeline can be met. Still, I am hopeful, for this is the Singapore that prides itself on progress, among other qualities embodied in a pledge that its people faithfully recite every year on Aug. 9.

To all our Singapore readers, happy National Day!