Digital technology and data are rapidly transforming healthcare today. With Singapore’s rapidly ageing opulation, there is a strong focus on harnessing these innovations to deal with healthcare challenges and help senior citizens live healthy, independent lives, in their homes. But while using technology, it is important not to lose sight of the humans who it is meant for, whether it is the patients, the doctors and nurses or caregivers in
the community.

On the sidelines of IoT Asia 2018, OpenGov had the opportunity to speak to Ms Tamsin Greulich-Smith who established and currently leads the Smart Health Leadership Centre (the ‘Centre’) in  NUS-ISS (National University of Singapore-Institute of Systems Science) about some of these issues.

Ms Greulich-Smith described the mission of the Centre as transforming the future experience of health through the use of data, digital technology and design. This is done through training, applied research and collaboration models, involving industry, public healthcare, as well as players in the broader health ecosystem.

“In order to ensure that what we teach in the classroom remains relevant, we focus on  applied rather than academic research, and we carry out research projects with industry partners. This ensures we are looking into areas that are genuine pain points or opportunities for industry players in the broad health sector,” Ms Greulich-Smith explained.

The Centre also provides advisory consulting services, working with organisations to help them frame their challenge, defining and understanding what the problem actually is. The Centre provides just-in-time training and mentoring to the organisation,  building employee skills so that they can not only fix the problem at hand, but also sustain the impact of that solution and know how to solve new problems as and when they arise. “We effectively write ourselves out of a job,” Ms Greulich-Smith said.

Working with all stakeholders

The Centre works with public healthcare providers, such as the Ministry of Health, and agencies like the Integrated Health Information System (IHiS) which oversees the public health IT system.

Furthermore, it seeks to connect the healthcare sector with social care and collaborates with the Ministry of Social
and Family Development (MSFD), and also the voluntary welfare sector and charities, to support a more integrated approach to care.

Ms Greulich-Smith said that there are many challenges in trying to integrate the voluntary welfare sector, the social care sector and the health care sector together, to achieve true integrated care.

For instance, sharing data is a big challenge. It is challenging to share information between these different stakeholders in a way that is relevant for everyone and will make sense for them. Even within healthcare, there are different kinds of terminologies depending on which area of healthcare you operate in. When we bring in the social sector, it is difficult to speak the same language, Ms Greulich-Smith explained.

“A large part of our focus has been on public healthcare, however we are also actively involved in social care and at voluntary welfare fields, as well as looking at how to support  commercial players in realizing their role in the future of health.”

The commercial players, such as medical technology providers, insurers, and healthtech start-ups want to collaborate with public care providers, be that healthcare or social care. There will be concerns regarding what information each party has access to. But Ms Greulich-Smith believes that that there is real opportunity here in terms of creating a model that will be viable into the future.

“The burden of care at the moment falls very heavily on healthcare and we can look at how we can start to share that burden in a controlled manner,” Ms Greulich-Smith said. “Primary care is a good example. 80% of primary care providers are private organisations.”

Primary care in Singapore is generally delivered by sole traders or small practice GPs (general practitioners) operating in the heart of HDB blocks (public housing). Many of them are not yet contributing to Singapore’s National Electronic Health Record (NEHR; the Government is mandating that all healthcare licensees have to contribute to the NEHR by December 2020).

Some of them felt that connecting to the NEHR is an expense they couldn’t see the value of. They didn’t feel the NEHR was required for the kind of cases they were handling, and it does not appear to align with the way in which many GPs provide care to their patients. However, there are great benefits to be had if everyone comes on board the system, which becomes more beneficial the more people use it.

Evolving the NEHR by bringing in more user design inputs, such that the value proposition is stronger for users, and tweaking NEHR so that it feelsmore relevant, intuitive, and accessible might help in achieving this objective.

Human-centric design

Expanding on the theme of understanding the needs of users and of human-centric design, Ms Greulich-Smith said, “Sometimes we try so hard to create solutions that can meet every possible need, that we end up over-designing. Something that can accommodate every option may not be what is required by people working in a busy healthcare setting, who need something very intuitive, quick and relevant. As such, the over-designed solution can fail to be adopted as there’s an imbalance between the value it brings the user and the effort required to gain that value”

So, to design solutions that will be adopted and used, we have to start by understanding the humans who will be
using them, their aspirations, and their pain points.

Lack of user input is one of the main causes for the failure of many IT/ digital projects. One of the common problems is that we try to manipulate solutions to problems around available technology, rather than trying to understand the problem fully, first. For example, getting in a technology provider at an early stage in a project might result in everything being tailored to fit that company’s solution. A better way would be to start by looking at the people at the heart of the problem, designing a solution around them, and only then looking at the opportunities for bringing technologies in.

Ms Greulich-Smith gave a couple of examples of how the best of intentions can go awry when users’ needs are not properly understood.

She said that a healthcare provider in Singapore had the wonderful idea of creating a digital dashboard for their patients, enabling healthcare workers to get all the critical data in one glance. The IT team also knew the importance of user input, hence they went to the most complex department in their institution to find out what the care providers would need from such a dashboard. They wanted to ensure the dashboard could meet every need of the most challenged department, and hence designed the dashboard to meet all of their complicated needs. However, the majority of departments need a mere fraction of that information. They found it much easier
to scribble things down rather than use the over-designed dashboard. So, the team had to go back to the drawing board to create a new version that would work for a wider range of users.

Another similar situation arises as healthcare and social care organisations provide their community-based care workers with iPads for them to collect notes at the patients’ houses and directly update it to the database.

However, when the workers go into people’s homes, they find sometimes that there is no Wi-Fi to enable live updates. Even if the connectivity is there, they might find it awkward to enter data on to an iPad. Because normally they can scribble very quickly with pen and paper, and can maintain eye contact with the patient whilst they do so, which is important.

To use an iPad they have to look away from the patient, which creates a barrier to engagement. Moreover, they might lose contact with the tablet screen without realising it, if they don’t keep their eyes on the screen.

Providing field workers with iPads offers great potential benefits. But once implemented in the real world, a number of unforeseen problems arise.

“That’s why we need a design thinking informed approach, where you would prototype and test that. Then some of these issues would come out and before you scaled it you would have tried to find solutions to some of these problems, that help us unleash the powerful potential of technology in care, rather than grappling with its challenges” Ms Greulich-Smith said.

In the second part of the interview, Ms Greulich-Smith talks about how the Centre is applying the human-centric approach in an integrated care pilot project.