First healthcare cluster to onboard the Next Generation Electronic Medical Record (NGEMR)

In the wee hours of 26 February 2022, whilst many were asleep in the dark of the night, a hive of activities was abuzz in several public healthcare institutions under the National University Health System (NUHS). Spread out over seven locations, more than 1,400 staff from NUHS, NHG and IHiS clusters and vendors worked in one accord, deeply focused on bringing about the successful transition of multiple HealthTech systems to the Next Generation Electronic Medical Record (NGEMR).

The hustle and bustle culminated to the successful NGEMR go-live officially declared at the crack of dawn at 6.30am, where cheers in unison broke out across the different healthcare institutions in celebration of the collective hard work over many months that had borne fruit.

At a glance

• A complex operation involving more than 10,000 users and 9,900 workstations
• Strong support and teamwork between IHiS and our healthcare partners, leading up to a successful go-live of NGEMR
• NUHS achieving One Cluster, One Patient and One Record status

The achievement of this major milestone marked NUHS as the first cluster to fully transit all of its institutions to the NGEMR, together with its partner, St Luke’s Hospital (SLH), the first Voluntary Welfare Organisation (VWO) to do so. The move was aimed at bringing about more seamless patient care, enabling smarter care and better health outcomes with deeper insights, improving collaboration between healthcare professionals and patients, and increasing patient empowerment and participation.

In the months before the go-live of NGEMR, there was intense preparation work across the various functional teams. An estimated 10,000 end users were involved in the transition, with more than 400 workflows and 9,900 workstations to be adjusted and tested as a result of the change in healthcare system. In addition, staff intervention was required to integrate about 700 medical devices with NGEMR. Process redesign, training, table-top exercises and full-dress rehearsals, were performed in the seven healthcare institutions, namely the National University Hospital (NUH), National Cancer Institute Singapore (NCIS), National University Heart Centre Singapore (NUHCS), National University Centre for Oral Health (NUCOHS), Alexandra Hospital (AH), Urgent Care Clinic @ Bukit Panjang (UCC@BPJ) as well as their partner, St Luke’s Hospital (SLH).

These healthcare institutions join the other NUHS establishments, Ng Teng Fong General Hospital, Jurong Community Hospital and the National University Polyclinics, which were onboarded to NGEMR earlier.

Photo credit: National University Health System

Why is the Next Generation Electronic Medical Record (NGEMR) necessary?

The transition to NGEMR is necessary for our healthcare institutions as the Electronic Medical Record (EMR) systems in NUHS and NHG clusters comprise more than 190 connected healthcare systems which have been added progressively since 1998. The evolution of health technology over the years has led to a variety of standards, causing some interoperability issues and hampering meaningful exchange of clinical data at times.

NGEMR also records the entire patient journey from the point of admission to discharge, including both medical and administrative data. The single unified EMR will enable more seamless care across the healthcare clusters. Moving forward, NGEMR will be interfaced to a secure AI (Endeavor) platform. This will allow for more creative use of its data for clinical decision support in the area of pharmacogenomics and population health. The implementation of NGEMR would also mean that there would be a harmonised referral criteria across healthcare clusters, allowing the healthcare system to be used to increase scheduling efficiency and reduce appointment wait times for patients.

NUHS’ journey of migrating to the Next Generation Electronic Medical Record (NGEMR)

Providing adequate training and support to users

With the NGEMR go-live taking place amidst the pandemic, robust planning and strong support from various NUHS staff were instrumental in ensuring a smooth go-live of the healthcare system across all sites. From the start, process analysts, subject matter experts, readiness owners and department heads facilitated workflow conversations with their departments to identify the risks and change impact arising from the transition. They also engaged the users on the upcoming changes and mitigation plans to overcome the risks identified, where these users participated in NUHS change management events such as the Workflow Walkthrough Event, Operations & Clinical Readiness Day, Institutional Readiness Day and Patient Movement Day. These events were a useful platform to users to prepare them for the upcoming exercise and an avenue for them to clarify their queries if any.

The NGEMR team also had a time frame of about six weeks to train the trainers at NUHS, and ensure that they had the pre-requisite skills before conducting their own training. These Credentialed Trainers (CT) & Specialists-Train-Specialists (STS) were nominated by their respective healthcare institutions to lead and deliver training to super-users (who were identified to be trained earlier in view of their roles) and end-users. These trainers also provided close support to the end-users during the NGEMR go-live. In all, more than 80 training tracks had to be scheduled and conducted for the NUHS staff over a period of sixteen weeks, with more than ten events organised to familiarise them with the new workflows and systems before the NGEMR go-live. A Simulation Lab at NUHS was set up to mirror the staff’s actual job environment to help them build confidence in preparation for the transition to NGEMR.

Ensuring IT readiness

In order to prepare for the transition to NGEMR and taking into account lessons learnt from past NGEMR exercises, the NGEMR team had to ensure hardware readiness and the completion of the following tasks, covering all angles of site IT readiness:

• Upgrade all non-NGEMR compatible equipment through technical refresh;
• Procure new end-user devices (EUD) such as laptops;
• Configure, deploy, test and Technical Dress Rehearsal (TDR) all 9,900 workstations in NUH and AH;
• Install more than 1600 network points in NUH.

There was also a need to provide strong and efficient IT support to our partners in the immediate period before and after the NGEMR go-live. As such, a NGEMR Command Centre comprising more than 400 colleagues from NUHS CIO Office and IHiS was established at NUHS to look into reported issues promptly. Due to the nature of hospital operations, the NGEMR team had to stretch and split its manpower to support NUHS staff during office and extended hours. The NGEMR team also worked long hours to ensure 100% testing of end-users’ devices and TDR revalidation, in preparation for the go-live and boost user confidence.

Challenges during NUHS’ transition to the Next Generation Electronic Medical Record (NGEMR)

The team faced manpower resourcing challenges while transitioning to NGEMR amidst the pandemic. For example, the emergence of Omicron and peak in COVID-19 cases nearing launch date made the NGEMR team’s preparation work challenging as they had to work through a constant resource movement and possible shrinkage of manpower. In addition, colleagues from other IHiS central teams were roped in to assist with the transition or with the task-force when approached by NUHS CIO colleagues. The teams had to learn the cross-functional End User Computing (EUC) and Technical Dress Rehearsal (TDR) skills within a short period of time to be equipped with the necessary skills to perform onsite support. As a result, there were minimal on-site IT infrastructure issues reported post NGEMR go-live.

After a month of post NGEMR go-live support, the NGEMR Command Centre at NUHS was stood down on 25 March 2022, with the NGEMR team successfully meeting more than 20 business indicators such as system stability. By the same day, the team had also resolved more than 91% of tickets raised by users during the NGEMR go-live, with only a small volume (9 tickets) requiring more time for resolution.

This successful deployment of NGEMR could not have been possible without the partnership and joint efforts of NUHS CIO Office and IHiS central colleagues.

Photo credit: National University Health System

Conclusion

The success of this NGEMR exercise is a result of the strong partnership and strong teamwork between NUHS, NHG, MOH, IHiS and Epic in facilitating the smooth NGEMR go-live. IHiS would also like to thank all 38 members of the Wave 3B Cutover Go-No-Go Committee across NUHS and NHG for their leadership and guidance, providing direction, and assessing risks and operational impact for the NGEMR go-live. The transition to NGEMR has also resulted in a “One Cluster, One Patient and One Record” outcome for the NUHS cluster, with a smoother flow of patient data between healthcare clusters and better work efficiency for staff which will enhance the quality of care for our patients.