新加坡卫生部：健康SG计划的数据已共享，医护人员能更好的照顾病患

卫生部兼通讯及新闻部高级政务部长（普杰立医生）：赛义德哈伦医生询问支持健康SG计划的医疗数据计划。为了给医院和社区护理环境中多个医护人员提供的全面的数据，我们需要简化医护人员访问和共享数据的方式。许多家庭医生强调了数据与系统支持的重要性。

国家电子健康记录（NEHR）是支持全面和整合护理的关键工具。它作为关键健康信息的集中存储库，医疗专业人员可以访问并更新，其功能将得到升级，更安全可靠的方式满足更广泛的医护人员，使不同护理环境中的医护人员在照顾患者时能够做出更好的决策。

针对初级护理，我们已经支援家庭医生诊所及其资讯系统供应商升级其IT系统，简化行政流程，改善数据传输，同时确保数据共享安全。例如，在健康SG计划的支持下，我们已经推出了初级护理诊所的诊所管理系统（CMS）分级框架，以确保私人家庭医生诊所使用的资讯系统系统与国家计划整合，以更无缝地提供护理服务。

我们还增强了国家数字健康应用程序HealthHub，以赋予居民管理自己的健康能力。通过HealthHub，居民可以注册健康SG计划，查看他们的个性化健康计划，管理医疗预约，查看他们的健康筛查结果和疫苗接种记录。我们计划在未来扩展通过HealthHub可用的健康记录类型。

林伟杰医生和佳馥梅女士建议利用AI来优化医疗服务，以实现成本效益和改善患者结果。我们的医疗机构广泛使用经过验证的、具有成本效益的技术，来自动化手工任务并增强临床决策。例如，门诊药房自动化发药系统（OPAS）有助于自动化药房药物的包装和发放。

患者还可以利用HealthHub安排药物补充和管理他们的医疗预约。所有这些都有助于减少等待时间并增强患者体验。卫生部还正在探索利用AI辅助放射诊断系统进行病理检测，自动分析医学图像，支持临床医生识别有紧急护理需求的患者，并帮助放射科医生生成放射学报告。

文礼佳博士建议利用人工智能来改善心理健康护理的可及性。目前，Mindline利用一款AI聊天机器人，人们可用匿名分享他们的情感困扰，并在需要时指导他们获取帮助，如心理治疗练习和咨询服务。尽管我们欢迎创新并利用技术，但患者安全仍然是至关重要的。卫生部将继续评估这些新技术在临床和成本效益方面的效果，并评估它们在我们的医疗系统中各种用途的安全性和适用性。

佳馥梅女士要求更新已进行试点的价值导向护理计划，并询问这些计划是否已在整个医疗系统中扩展。自2015年以来，卫生部一直在加大对价值导向护理工作的重视。这些努力旨在以可持续的方式提高健康结果，同时管理随之而来的成本增加。这些计划范围从国家系统计划到针对个别医生和特定程序的计划。

自癌症药物清单（CDL）实施以来，该清单将终身健保和综合保障计划的覆盖范围重点放在经临床验证和成本效益高的癌症药物治疗上，公共部门的CDL药物价格平均降低了30%，某些药物甚至降低了超过60%。这也使我们能够补贴更多的药物，并提高了可负担性。从长远来看，我们预计这将缓解癌症药物的成本压力。我们正在将焦点更多地放在上游，并将价值导向护理应用于支付模式，例如定额制和通过健康SG计划进行的预防工作。

为了让大家更健康，这将是一个长期的措施。政府和医护人员将为居民提供优质的医疗保健，但个人责任至关重要。我们每个人都必须对自己的健康负责，采取更健康的行为，与家庭医生建立联系，并主动干预慢性疾病。与此同时，医护人员将重新调整为预防性护理，而政府则建立系统、项目和激励措施，支持医护人员在社区为居民提供护理。

在未来，政府加强预防保健，居民为健康做出行动，我们的目标是每个人都能将定期家庭医生作为首要联系点，并持续得到全面的支持。在多样化的初级保健环境中，将提供一致且以证据为基础的护理，我们所有人都可以采取积极措施，保持个性化的健康计划。团结起来，我们所有人，每个人，都可以在改善我们的健康方面发挥作用。

: Senior Minister of State Janil.

The Senior Minister of State for Health (Dr Janil Puthucheary):Dr Syed Harun asked about systems integration plans to support Healthier SG. To facilitate holistic, integrated and coordinated care provided by multiple healthcare providers across hospital-based and community care settings, we need to simplify how our healthcare providers access and share data. The importance of a well-integrated and reliable IT system to connect healthcare providers has been highlighted by many GPs.

The National Electronic Health Record (NEHR) is a key tool for supporting holistic and integrated care. It serves as a centralised repository of key health information that healthcare professionals can access and can contribute to. Its capabilities will be enhanced to cater to a wider spectrum of care providers in a safe and secure manner, enabling healthcare providers in different care settings to make better decisions when caring for their patients. 

The upcoming Health Information Bill will also establish the framework to govern the collection, access, use and sharing of selected health information across various settings to facilitate the continuity of care. 

Specific to primary care, we have supported GP clinics and their IT vendors to upgrade their IT systems, to simplify administrative processes and to improve data flows, while ensuring data sharing is secure. For example, under Healthier SG, we have rolled out the Clinic Management System (CMS) Tiering Framework for Primary Care to ensure that IT systems used by private GP clinics are integrated with national programmes, for a more seamless delivery of care. 

We have also enhanced our national digital health app, HealthHub, to empower residents to manage their own health. Through HealthHub, residents can enrol for Healthier SG, view their personalised health plans, manage medical appointments and view their health screening results and vaccination records. We plan to expand the type of health records available through HealthHub in the future. 

Dr Lim Wee Kiak and Ms Mariam Jaafar suggested making use of technology and artificial intelligence (AI) to optimise healthcare delivery for cost effectiveness and improved patient outcomes. Our healthcare institutions use proven, cost-effective technology extensively to automate manual tasks and augment clinical decision-making. For example, the Outpatient Pharmacy Automation System (OPAS) helps to automate packing and dispensing of pharmacy medication.

Patients can also utilise HealthHub to arrange for medicine refills and manage their medical appointments. This all helps to reduce waiting times and enhance the patient experience. MOH is also exploring the use of AI-assisted radiology diagnosis systems for pathology detection, to automate the analysis of medical images, support clinicians to identify patients with urgent care needs and help radiologists to generate radiology reports.

Dr Wan Rizal suggested utilising AI to improve the accessibility of mental health care. Currently, Mindline employs an AI-enabled chatbot that allows people to share their emotional struggles anonymously and guides them to self-help resources such as psychotherapy exercises and counselling services where needed. While we embrace innovation and leverage technology, patient safety remains of paramount importance. MOH will continue to evaluate these new technologies for clinical and cost effectiveness and assess their safety and suitability for various uses in our healthcare system. 

Ms Mariam Jaafar asked for an update on value-based care initiatives that have been piloted and whether these initiatives have been scaled up across the healthcare system. MOH has been placing increasing emphasis on value-based care efforts since 2015. These efforts aim to improve health outcomes while simultaneously managing the attendant cost increases in a sustainable way. These initiatives range from national system initiatives to programmes that target individual doctors and specific procedures.

Since the implementation of the Cancer Drug List (CDL), which focused MediShield Life and Integrated Shield Plan coverage on clinically proven and cost-effective cancer drug treatments, CDL drug prices in the public sector have been brought down by an average of 30%, and over 60% for some drugs. This has also allowed us to subsidise more drugs and improve affordability. In the long run, we expect this to moderate the costs of cancer drugs. We are shifting our focus more upstream and are applying value-based care to payment models, like capitation and preventive efforts through Healthier SG.

Sir, it will be a long-term, multi-year effort to work towards a healthier population. The Government and healthcare providers will provide quality healthcare to residents, but individual responsibility is crucial. Each of us must take charge of their own health, adopt healthier behaviours, build relationships with our family doctors, and proactively manage any chronic diseases. Concurrently, healthcare providers will re-orientate towards preventive care, while the Government sets up systems, programmes and incentives to support healthcare providers in delivering care to residents in the community.  

In the future, through the Government's efforts in strengthening preventive care and a shift in residents' health-seeking behaviour, the aim is for all of us to visit a regular family doctor as a first point-of-contact and for ongoing support to holistically manage our own health. Consistent and evidence-based care will be delivered across the diverse primary care landscape, and all of us can take proactive steps to keep to a personalised health plan. Together, all of us, everyone, can play a part in improving our health.

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