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PanellistsDr Jason Yap, chief knowledge officer, Agency for Integrated Care (AIC)Professor Philip Choo, deputy group CEO (regional health), National Healthcare Group, and CEO, Tan Tock Seng HospitalAng Bee Lian, director of social welfare, Ministry of Social and Family DevelopmentFarhana Nakhooda, healthcare and life sciences executive, public sector, growth markets, at IBMModeratorAmit Roy Choudhury, technology editor, The Business TimesTHE healthcare system's biggest challenge today is providing efficient and affordable healthcare to Singapore's rapidly ageing population.迷你倉 The government is responding by building more hospitals and other care services. While these serve their purpose, the ageing problem is a complex one and no one solution will solve all problems. Fortunately today's healthcare professionals have access to a plethora of technologies that can help them to dispense holistic and sustainable healthcare. To understand the issue as well as the potential solutions, BizIT brought together a team of experts at a roundtable to discuss the challenges as well as solutions. Below are excerpts from the discussion:Amit Roy Choudhury: An ageing population is a major problem from the healthcare perspective for developed countries like Singapore. What solutions are being looked at?Jason Yap: Singapore is ageing rapidly, just like many other developed countries. We expect the number of seniors aged 65 years and above in Singapore to triple to 900,000 by 2030. An ageing population will obviously need more care services. Ageing needs are often complex, so the solutions must be multi-pronged and, as far as possible, enable seniors to age within their homes and in the community. We need to promote fitness, mental wellness and social interaction to delay the onset of serious illness (that is, active ageing); to develop more aged care facilities as well as home-based health and social care services; and to strengthen caregiver support. Changing family structures will also affect the provision of health and social care services. In 2012, there were 35,000 seniors living alone; we expect the number to be 83,000 by 2030. Smaller family units will mean that there will be only 2.1 younger people supporting each old folk in 2030, compared to today's "old age support ratio" of 5.9. There are many ways of delivering more integrated and client-centred care, and technology can be one enabler that, if properly implemented, will allow the delivery of more services of better quality to more clients and using less resources.Philip Choo: Singapore today - where one in every 10 people is aged 65 years or older - has arrived at the stage where the health impact of the elderly population is significant. By 2030, one in five people in Singapore will be 65 years or older. Even within Singapore, there are areas - such as the central region - where ageing is more pronounced and has a greater impact on the healthcare and social services. We need a better understanding of the medical issues facing our seniors, the way healthcare is delivered to them, and ways to grow expertise in the professionals caring for them. It is high time for us to quickly reorganise our healthcare and social services before critical ageing occurs. Our focus should be on the following areas: Prevention and health promotion; management and maintenance of those with chronic illnesses; integrating care for the frail elderly; shifting focus from hospital to community; and integrating health and social services for ease of use.Farhana Nakhooda: While Singapore is continuing to build new hospitals to meet the growing demand for hospital beds, this is not a sustainable solution to address the needs of the ageing. A number of long-stayers in hospitals and patients who tend to be readmitted frequently, are the elderly, who could be taken care of at home if given the right holistic care plan. The focus needs to be on home care for the ageing, out of the hospital, as much as possible. This will free up space for beds to be used by acute care patients and those who need them the most. This is what Singapore calls "right siting" - providing the right care for the right patient at the right time.One needs a holistic view of both the health and social needs of the elderly to really address their issues. For example, an elderly person with a hip fracture may repeatedly get re-admitted to the hospital not because of his or her medical condition but because she has no help at home and keeps falling down. A 360-degree view of the patient including her health and social needs, and the creation of a care plan with a multi-disciplinary team addressing both social and healthcare needs through case management, will give her the holistic care and support she needs outside the hospital and in her home. Another area which will become key over time is the use of mobile devices for the care of the elderly. Asking adult children to update the caregivers of their elderly parents on medical adherence as part of a care plan is a great example of how technology can positively assist the care of the ageing. Another example is sending reminders to elderly patients on their mobile phones to take their medicine.Ang Bee Lian: An ageing population is a reality for developed countries. From a health and social care perspective, it can pose challenges in terms of health issues and disability. The most emergent concern is the potential demand for different forms of care and the cost of care giving. However, the challenges need deeper understanding and analysis as an ageing population which is relatively healthy and able to moderate its care needs and continue to participate in community life or mutual help can be a possibility. Healthcare professionals increasingly adopt a preventive approach towards handling the issues of ageing and will pay more attention to the nexus between acute healthcare and social care. The post episode handling of rehabilitation and the immediacy with which return to normality is facilitated will make a significant difference to improved outcomes. The challenge is to call attention to these areas of connections and to support families and caregivers more deliberately. Traditionally, attention is given to acute care and interventions and rightly so. It is now that we see focus on integrating care and facilitating the transition from post acute intervention to step down care to return to the family and community. There is now a greater acceptance that it is good for families and households to be prepared ahead of time to be ready to provide care to a member who is affected by severe illness or disability.Amit: There are a number of technology solutions that are available, like Big Data and analytics that can help map the problems and requirements. At the same time technology advances are making possible or will soon make possible wearable devices which can connect via the Internet to hospitals and healthcare centres and give out an alert when a patient shows signs of abnormality while at home or at an outside location. How is Singapore doing in applying these solutions - both analytics as well as devices?Bee Lian: There are now lots of tried and tested technologies that can be deployed for sending alerts when the wearer of the devices shows signs of abnormality. The challenge is the deployment of responses when these alerts are sent out. Beginning with family, friends and peers, the response system still needs to be worked out and these may best be customised for groups of mutual help. We should encourage groups to explore these response systems from the mutual support perspective. The other challenge with deployment is that of cost. If there are intermediaries that are able to aggregate numbers to make devices more affordable and accessible, it will help. This is a space where technology, logistics and customer needs can benefit from someone helping to ensure the seamless application of any devices. We all know too well how gadgets and devices lie around after they are acquired as they are not intuitive to the users or those who need to respond to them.Farhana: Singapore is very advanced in terms of technology adoption in healthcare and there is growing interest from hospitals in Singapore to look at advanced analytics tools such as predictive analytics which can help them with risk stratification of the population and determine high risk patients who are likely to be readmitted or likely to become long-stayers in the hospital. In addition, there are a number of pilots and technology trials going on for wearable devices in Singapore with a number of hospitals.While analytics and wearable technologies exist, the same challenge remains - how do you use this data to create actionable insight? All parties in the care ecosystem, from healthcare providers to medical researchers to social services, have the capacity to collect and analyse vast quantities of information. What's missing from all these points of view is a fully integrated and holistic approach to meet specific needs of individuals. In other words, which data counts? Which data explains the needs of a worker injured on the job and recuperating at home? Which combination of medications and rehabilitation services can help a stroke victim regain independence? In short, how can you effectively manage and use the vast amount of available data to drive better outcomes for individuals and society and to reduce costs?We've known for decades that health and social systems are interdependent and have a critical impact on each other. Yet the complex matrix of public and private stakeholders in the health and well-being of citizens still operate largely within silos, providing separate and disparate care. An environment needs to be created which can identify an individumini storagel's needs across all dimensions of care - clinical, social and behavioural. Making this information readily available to health and case workers allows them to spend more time in the field where they are needed the most. The move to create a national database for the social services sector by the Ministry of Social and Family Development is a great step forward in this direction, recognising that those who need help have multiple needs, such as financial assistance, counselling, housing or employment issues. Greater coordination and collaboration mean delivering faster and more seamless services to those who really need assistance.Philip: In public healthcare, we are working on building the common Electronic Medical Records or EMR platform, linking all care providers. Part of the National Healthcare's role as the Regional Health System for central Singapore involves studying population health. So we are also using analytics to help us to: (a) decide what and who to focus on; (b) monitor trends and detect patterns; and (c) review real time status and real time outcomes. Everything is still very much work in progressThe traditional hospital-based model of care can no longer serve our ageing population so we have to innovate and rethink our model of care in order to meet the changing needs of our patients. The existing care models have worked well thus far, but to meet future needs, geriatrics has to constantly evolve, innovate and improve. There is also a need to bridge ourselves to the elderly out there so that we can educate, prepare and equip both the seniors and caregivers with ways to embrace active ageing - healthily, independently and positively.Jason: Generally speaking, technology is available and can be readily applied, but what is not often understood is that the new care delivery approaches that this technology enables are themselves complex and part of a larger ecosystem. A simple telemonitoring device (for example, to detect falls of the elderly) requires substantial system support to make operational (there must be a monitoring centre, onsite responders to falls and other support mechanisms), and there must be a critical mass of users/customers to be business-viable. This is the hard part.Currently, we are working on creating awareness and spreading knowledge on a wider range of technology options to service providers in the community care sector. AIC is also partnering the sector to encourage more trials and pilots of new technology and equipment so that a wider range of software and applications can be developed for patients' rehabilitation and recreational needs at local eldercare institutions. There are also plans to link up service providers with suppliers for products ranging from rehabilitation equipment, virtual recreation and social engagement games, to small assistive aids for independent living.Recently, we partnered Temasek Cares and Singapore Polytechnic to roll out a suite of new technology-assisted equipment to improve rehabilitation for the elderly and the disabled. The new equipment - Bilateral Limb Manipulator, Floor Projection System, Augmented Reality Games for Therapy and Computer-based Cognitive Training - uses virtual reality and robotic technologies to assist clients in Day Rehabilitation Centres (DRCs) in their rehabilitation process. Hopefully, greater use of these technology-assisted solutions will improve the functional outcomes, reduce dependency and enable elderly clients to reintegrate with the community after their rehabilitation, and raise their overall quality of life. We hope the pilots at AWWA Readycare Centre and St Andrew's Community Hospital's DRC will lead to more standardised rehabilitation processes and programmes for common conditions.Amit: Technology is getting heavily integrated into healthcare. Does this pose challenges for healthcare professionals who are traditionally trained for healthcare duties and are not expected to be very IT savvy? Is there a training or re-training issue involved here?Philip: Not really.Jason: It would not be fair to say that healthcare professionals are not tech-savvy. The younger generation of healthcare professionals, from doctors to nurses to other health professionals, are very much so. It isn't easy to even start their careers without at least some level of proficiency; if nothing else they need to apply online to go to school! Some of the older generation do need some retraining, but this has been ongoing for many years.Bee Lian: As technology is integrated into healthcare and social care, there is savings in terms of devoting the time of the professionals on patient care. This is when technology is an enabler and helps to speed up care to the person in need. Attention to the design of technology is important so that the use of the devices and adoption of the technology will be far more intuitive. It will also mean that there is less need to re-train and the need is more on orientation and application to provide better service.Farhana: Current healthcare technologies are becoming more intuitive, practical, and can actually improve patient quality/care. These technologies are being incorporated into clinicians' workflows, making it much easier for healthcare professionals to embrace these new technologies. For example, analytics tools incorporated into a clinician's workflow can help in clinical decision-making. If a doctor is treating a patient and the system is able to prompt the doctor and provide evidence-based guidance which is visually easy to understand - at the point of care - this may be much more easily adopted than a standalone system.Training or re-training is important, but it's only one piece of the puzzle. Having the right tools is also critical. Today's data discovery solutions on the market can be challenging for everyday, non-IT users, and furthermore don't provide deep, meaningful insights that are immediately actionable. However, new data discovery and visualisation software capabilities are changing analytics for the masses, enabling users to visually interact with and apply advanced analytics to their data without specialised skills. These will help close the analytics skills gap that makes current data discovery tools inaccessible for the everyday business user - making it possible to go from raw information to answers hidden deep within structured and unstructured information in minutes.Amit: In an ideal world what would healthcare professionals want from technology companies in terms of technologies that would help the most in taking care of patients and how would it be possible to make their use simple and intuitive?Philip: NHG's Institute of Geriatrics and Active Ageing (IGA) based in Tan Tock Seng Hospital will be a focal resource point for local and regional healthcare professionals. In addition, it will be a platform for medical professionals, and eldercare providers in the community to share knowledge and exchange ideas on ageing research and education. The IGA aims to work collaboratively with gerontologists and relevant experts in local and overseas institutions to catalyse the development and sharing of knowledge and expertise in geriatrics.Here's our wish list for tech companies:Help our population - including the techies themselves - to stay healthyHelp patients to manage their own careLink patient and providers via technologyProvide substitutes for manpowerJason: In an ideal world, the design and production of such technologies would be done in close partnership with healthcare professionals, facilities and the patients themselves from the very start, and designed with the clinical and personal circumstances of the patients and care services in mind. Meeting the challenge is not about technology companies making their technology better, but rather that the healthcare providers recraft their care delivery services for the ageing population, and using the right technology where appropriate. Technology holds much potential but only if the clinical services they support are actually better for the patient and the population.Bee Lian: Professionals would value it if technology helps them to save on repetitive tasks and activities that do not require evaluation and assessment. This will enable them to focus on interpreting the data from analytics and make informed recommendations. Technology is only one aspect of enabling. Increasingly, good designs can make the cutting edge difference in adoption. Simplicity and intuitiveness are part of good designs. Having "sufficient enough" and at time of need technology is key to making technology affordable and sensible.Farhana: Whichever technology is deployed, it must fit in to healthcare professionals' current workflows, be fast and easy to use, visually intuitive at the point of care, and ultimately provide even better outcomes than the professional could have done without it. In addition, clinicians currently want to view their patients' data, including high resolution images, anywhere, anytime. Sometimes making a swift medical decision can be a matter of life or death, and this is where the ability to access medical information on mobile devices is increasingly becoming a key necessity for healthcare professionals.In some cases, certain technologies today could be considered a huge blessing for healthcare professionals as in the case of data driven insights. In fact, given the exponential growth in the volume of medical data, it's impossible for human medical students to be expected to memorise every technical journal and text book available. Based on current estimates, the amount of medical information doubles every five years and 81 per cent of physicians have indicated they spend, on average, less than five hours a month just keeping up. This series is brought to you by IBM儲存