The usability, usefulness and use of a national collaborative IT platform for the purpose of continuity of care.

Abstract

In 2015, the Ministry of Health (MOH) Singapore embarked on an initiative to create a national IT collaborative platform whereby entry of and access to patient information are limited to those who have been identified as part of the patient’s Care Team, which may comprise of doctors, nurses, and allied health professionals such as social workers and therapists. This was initially used to address one of the six regional health systems (RHS) priority areas in Singapore of managing frequent readmissions which has subsequently expanded to address other national programme themes such as transition care and care-coordination. The core principle behind this IT platform is to enable information sharing between members of the care team for the purpose of continuity of care. In the current state, once patient care is handed over to community partners, there is no avenue for care coordinators in the tertiary hospital to follow up on the progress of their patients apart from direct communication via phone call or email correspondence. In addition, there are certain instances whereby community partners face difficulty in care of patients due to lack of information being flowed down to them. This IT platform aims to bridge this gap between members of the tertiary centre with community partners as well as GPs to allow for information sharing and update between both parties. Through this platform, a personalised care plan can be formulated for each patient which may comprise problems, intervention, assessment and goals. This is on top of the ability to assign care team member for the care of the patient to increase practice efficiency. There is oversight of patient into other programmes across different healthcare clusters in the nation. This is beneficial in terms of preventing duplication of care plans or tasks and accurate and timely information flow to all members of the care team. This poster aims to articulate the usability, usefulness and use of a national collaborative IT platform to formulate an individualised care plan for each patient comprising of multi-disciplinary care team members assigned with specific task to allow for continuity of care as well as efficient care delivery to improve patient health outcome.