When IT and healthcare come together

The associate professor, who splits his time between serving as the chairman of Changi General Hospital's medical board, and as chief medical informatics officer (CMIO) of healthcare cluster, SingHealth, is excited about the future of EMR (electronic medical record) systems.

Dr. Low spoke to ZDNet Asia about how his two roles are beginning to converge, the challenges around his work and the promise that young doctors hold for the medical industry.

Q: How do you split your time between the two roles you hold?
Low: I split my time equally. As chairman of the medical board, one part of the work involves running medical operations such as healthcare policies and quality issues. Another part involves staff welfare improvement, training, teaching and research, as well as communicating with the ministry, public and other healthcare providers.

In SingHealth, I deal with the roll out of a cluster-wide EMR system. Both roles are different, but there is convergence, because while the EMR rollout is project-based, a lot of the implementation impacts our doctors. So I am in the unique role of being a clinical leader but also an implementer.

Do you think your dual role gives you better insight in implementing IT projects?
Servicing both sides puts me in a good position. Sometimes, you have the situation where management wants to implement an EMR system, but the clinical leaders are not on board. There have been dramatic failures where tension is stirred up from both sides going in different directions.

So representing both sides can help make things easier.

How do you manage IT change within the organization?
Right now, it's getting easier [to get buy-in] for new IT systems, because we have a bigger and [expanding] group of young doctors that are comfortable with technology and electronic media. This group also demands IT tools, and when it matures, that's really going to push the [medical IT] industry faster.

Most of the senior doctors are not as quick with technology as the young ones, but they are there to provide clinical domain knowledge. It is up to the young healthcare professionals--doctors, nurses, pharmacists--to interpret that domain knowledge and translate it into IT systems, so IT people can write [the appropriate] logic modules into the EMR software.

Right now, we're at the early part of the exponential curve, where this group and the IT systems that will benefit [from their insight] are set to get much more intelligent.

So when will we get intelligent systems?
It's already happening now, hence the impetus to put the infrastructure in place for this group of people and translate all the good ideas and innovation and best practices into the IT system.

The analytics systems today are very powerful, and with the higher-level EMR systems you can really draw a lot of quality insight. That will eventually help senior clinicians look at the way they are practicing medicine, and validate their own knowledge.

The potential of where IT can enable the clinicians is immense. In the past, you needed people to help check up the case sheet--a process taking several days. With a proper EMR system, information is real-time.

Beyond this, there is research and genomic data. When you tie in these systems to personalized healthcare, you can start more predictive medicine. It will be extremely powerful once the structure is in place.

What do you feel are some challenges in your job that have changed, over the last five to 10 years?
Ten years ago, the landscape was very different. [The hospitals] had just started restructuring into clusters. And along with that, brought along disparate systems. It was a different ballgame at the time. Technology wasn't advanced, high speed Internet wasn't there, and the Web wasn't as developed.

At the time, people were also very reluctant to adopt new technology. Now, with new technology, people want new applications and devices--fast.

Today, the problem is making sure all of this new technology works [in an interoperable fashion] with one another, and holding [implementations] back to make sure that they all work with standards, to ensure a very focused delivery of care.

Was there a focus on interoperability before?
[In the past], nobody talked about that. They just cared that each system could work. At the time, having an EMR was not a focus. People thought: "As long as my doctors can see the data, it's okay."

So systems were built in silos at the time. But now, everybody talks about patient information. Not just within a hospital but within a cluster. We're also talking about a national system, to help information flow from different caregivers.

It's exciting where we're going.

Are there areas of disconnect between IT vendors and their understanding of your needs as a healthcare provider?
Every IT vendor will tell you that they are standards-compliant. But you have to test these claims. There are subtleties within the IT industry, where even though there is one standard, [the IT vendor] will say "ours is version 2.0".

For example, everybody wanted to exchange X-rays across clusters at one point. All the vendors said they were DICOM (Digital Imaging and Communications in Medicine) standards-compliant. But when it came to implementation, we found many tasks couldn't be achieved, and it took many years to finally resolve the disconnects.

So while you have interoperability guarantees, you really need to know the industry and the risk when you invest in technology.

Is there a formula to suss out these "subtleties"?
Networking is very important. You need to know what can be delivered by looking at all the different track records and overseas case studies. Some vendors may say that they can't deliver on a request, or have problems interfacing with some products, but in the United States these systems are successfully in place. So knowing this gives us a little bit more clout when we negotiate.

With globalization and Internet access [enabling] easy communication [and] social networks, we are now in better contact and can make better decisions.

Where is the rest of Asia in all this globalization?
Asia is fast ramping up, because of several factors. Patients are more sophisticated, traveling a lot and medical tourism is up and coming. You find that all these big sites that have a high volume for medical tourism are very IT-dependent and are leading the way in IT innovation.

Nobody is going to go an institution where prescriptions are still handwritten. Patients expect a certain amount of sophistication in your care and delivery system. Singaporeans, for example, are expecting their medical information to be available and digital, and they expect your system to know before they tell you.

And governments are driving the quality standards of healthcare.

For now, the majority of EMR implementations will focus on making the system more robust and intelligent, to fill up the gaps that people miss.

The way we transform our clinical practice must come through the transformation of our practitioners. Change is coming, and if the doctors don't embrace it, technology will just become an automation process, but not a transformation tool.

Dr. Low spoke to ZDNet Asia at the Hospital Build Asia 2009 exhibition.