In 1995, the Singapore Armed Forces (SAF) Medical Corps introduced a large scale Electronic Medical Records (EMR) system, the first of its kind in Singapore. In less than a decade, the improved second generation of the EMR was implemented and most recently, the latest generation of its EMR system was rolled out in April 2016.

In an interview with Healthcare IT News Asia Pacific, RADM (Dr) Tang Kong Choong, Chief of the SAF Medical Corps, gave an update on the recent developments at the organisation as well as some of the lessons learnt behind the implementation of the third generation EMR system.

Could you share with us briefly about your role as Chief of Medical Corps (CMC)? How has it been thus far since your appointment in May 2015?

As the Chief of the SAF Medical Corps (CMC), I am overall responsible for the provision of quality healthcare services to all SAF servicemen and women and robust medical support to enable the SAF to conduct safe and realistic training.

Since assuming the appointment of CMC in May 2015, I have had the privilege of setting the vision and driving the implementation of projects and initiatives to improve the quality of care and medical support provided to our servicemen and women. In April 2016, the 3rd generation of the SAF’s Electronic Medical Records System, known as the PAtient Care Enhancement System 3 or PACES 3, was rolled out. PACES 3 is an entirely new EMR system that connects seamlessly with Singapore’s National Electronic Health Records (NEHR) system. PACES 3 contains clinical decision support features and enhances patient safety by allowing the SAF to share allergy information and other key medical information with Singapore’s healthcare providers through the NEHR. Its user-friendly mobile eHealth portal has allowed our soldiers to conveniently book their own medical review appointments, retrieve information about their health visits and investigations, and enabled greater health ownership amongst our soldiers.

In 2017, the SAF Medical Corps reviewed the SAF’s approach to the promotion of health. We collaborated with external partners such as the Health Promotion Board on useful national-level health initiatives such as the National Steps Challenge (Corporate) and introduction of healthier dietary choices for the SAF. The SAF Medical Corps also hosted the 3rd Asia Pacific Military Health Exchange, which saw more than 500 participants from the military medical services of Asia-Pacific nations gather in Singapore to share and learn from one another in the field of military medicine.

We also enhanced our cooperation with the Singapore Civil Defence Force (SCDF), with the SAF Medical Corps embarking on a pilot partnership with the SCDF; 12 SAF medics were deployed to work alongside SCDF personnel on their ambulances for three months from October to December 2017.

The SAF’s new Electronic Medical Records (EMR) System – PAtient Care Enhancement System (PACES) 3 was launched in April 2016 and was the winner of the “Digitalised Care to Support One Healthcare System” category at the National Health IT Excellence Awards 2017.

Unlike its predecessors which was hosted internally on the SAF intranet, PACES 3 is now also connected to national healthcare systems such as the National Electronic Health Record (NEHR) and Critical Medical Information System (CMIS). What were some the considerations and challenges behind implementing an EMR that could easily integrate with other health systems/infrastructures?

The key impetus for hosting PACES 3 on an Internet-facing platform was to integrate our medical care records with that of the national healthcare system. Introduced in 1995, PACES was upgraded to PACES 2 in 2005 to have networked capabilities over a secured intranet system.

The Ministry of Health’s articulation of the national vision of “One Patient, One Record” and the introduction of the National Electronic Health Record (NEHR) in 2011 was a strong impetus for us to develop PACES 3 onto an Internet-facing platform that is integrated with the national healthcare system. This provided a seamless and safe transition of medical care between healthcare providers.

The choice of the health IT solution and the partner agencies was a key consideration in the SAF’s EMR System. After an open tender and robust evaluation process, the SAF Medical Corps awarded the contract jointly to Allscripts and National Computer Systems (NCS). Prior to this partnership with the SAF, Allscripts had partnered Singhealth for their electronic medical records system and had a strong presence in Singapore, while NCS had worked with the SAF Medical Corps for both earlier versions of PACES.

With PACES 3 on an Internet-facing platform, we had to ensure the security of the medical data. To address this challenge, the project team built in multiple layers of protection and defences to ensure the robustness of the system against cyber threats.

A second challenge was the migration of 20 years’ worth of electronic medical records stored over the lifespan of PACES and PACES 2, to PACES 3. The project team worked closely with our vendors to ensure the fidelity of data transfer as this was important in patient care and safety.

Looking to the future, even as PACES 3 was rolled out in April 2016, it is necessary to start thinking about PACES 4 and the next generation of EMR systems for the SAF. I am cognisant that PACES 3 will need to be upgraded or refreshed to meet the health needs of the SAF in the next decade. The SAF Medical Corps will keep abreast of the developments in medical IT through participation in relevant medical IT events and conferences, development of our people in medical IT literacy, and also putting in place a system of continual review and improvements.

Are there any collaborations /projects between SAF and other medical organisations with regards to health IT?

The SAF Medical Corps is currently in dialogue with the Singapore Ministry of Health to better understand the development and implementation of Smart Healthcare initiatives for Singapore. We want to ensure that the SAF’s future developments in medical IT continue to be aligned with the nation’s push towards Smart Healthcare.

RADM (Dr) Tang Kong Choong is a speaker at the inaugural International Military Health IT (IMHIT) track at HIMSS AsiaPac 18 in Brisbane this November.