Abstract
Background: In Singapore, there have been efforts to enhance the collaboration between acute hospitals, primary, intermediate, long-term, and home care sector to provide right-sited and accessible care. However, the accessibility of accurate patient data across providers in different care settings remains a challenge, leading to difficulties in tracking the patient journey and coordination of care. Together with service providers, we co-designed One Care Plan (OCP), a secure data-sharing application that facilitates sharing and aggregation of patient information to provide a holistic view of the patient, and support collaborative care. Through our pilot, we found that while the application was well-designed to meet the users’ initial set of requirements, they faced other challenges adopting it in their daily work. This resulted in sub-optimal usage, and the potential for OCP to enable collaborative care was not maximized.
Approach: We continually engaged users in user testing and feedback sessions to understand how OCP could be improved to align with their workflows. We also connected with new providers to explore different care models and better understand the challenges of information sharing and collaborative care. This allowed us to curate further requirements and iteratively enhance the application to meet evolving needs.
Results: Through our engagements, we discovered challenges in three areas and took steps to address them.
User experience and ground processes - Users shared that they had to juggle multiple IT systems and it was not sustainable to manually enter information into another supplementary application like OCP. Additionally, information on OCP was buried behind too many clicks and scrolls, requiring significant effort to access the desired information.
As such, we re-designed a dashboard to provide a single page summary of each patient’s essential information required for providers to go about their work.
Data governance - Data compliance, privacy, and accountability guidelines at the national level were inadequate to enable effective information sharing among health and social care providers, while data sharing agreements between providers were programme-specific and limited in scope. To address this, we established governance through a Software-as-a-Service agreement and patient consent form, enabling providers to share information safely and confidently via OCP.
Evolving ecosystem - Driven by an emphasis towards population health, the integrated care ecosystem is also rapidly developing, with numerous pilots, ground up initiatives, and IT solutions being launched, creating more fragmentation. This created challenges with planning for costly enhancements such as integrations, and uncertainty in further development of OCP.
Implications: Our journey with OCP has provided valuable insights to navigate the evolving ecosystem. Firstly, continuous engagement and understanding the landscape is essential in refining a Minimum Viable Product into a Minimum Lovable Product. It is also necessary for data governance and approvals to be in place to allow for smooth onboarding and wider reach. Finally, our engagement with users across different providers highlighted a need for priorities and direction to be set at a national level, and a more systematic approach in terms of funding, digital infrastructure, governance, capacity building, and towards a unified care model.