The Singapore Armed Forces Cardiac Fitness Centre (SCFC), established since 2012, is the premier one-stop cardiac screening facility to screen and manage cardiovascular conditions for pre-enlistees, active personnel, and operationally ready NSmen (ORNS) from our nation’s defence force. The SCFC ensures that the heart health of every Singaporean son is assessed to be fit and safe to undergo the necessary physical training and combat assignments during their tour of duty. Launched officially in 2015 by the Second Minister for Defence, SCFC has since evolved progressively in scale, sophistication and complexity of operations. 

The SCFC was launched by then Second Minister for Defence Chan Chun Sing in January 2015.

From a simple clinic to a full-fledged centre 

The genesis of SCFC took place in the previous premise of NHCS, Mistri Wing on SGH Outram Campus. To address the growing demands for clinical services for the SAF servicemen referred for cardiovascular screening, SAF initiated the project to launch a dedicated centre to meet this need. Prof Terrance Chua (then Medical Director of NHCS) and the late Ms Lim Suh Fen (then Deputy Director of Nursing) led a team to set up SCFC which initially operated out of a simpler set-up at Cardiac Clinic E (CCE) in Mistri Wing. In 2014, SCFC secured a footprint in the new NHCS building during its commission, with a dedicated clinic space to provide a comprehensive suite of consultations and investigations.

(L-R): CCE versus SCFC – much has changed but the close camaraderie remains. Pictured in left image (clockwise from left): Patient Services Associate Executive (PSAE), Grace Guevarra Esquierdo; Nurse Manager Ann Chan; Ron Ng, Executive; Senior PSAE, Wong Ang Eng; and temporary staff Lim Zi Jun. Pictured in right image (from left): Senior Patient Service Associate (SPSA), Koh Tze Seng; SPSA Recto Jennifer Magistrado; PSAE Grace Guevarra Esquierdo; Asst Prof Koh Choong Hou; Senior PSAE, Wong Ang Eng; and PSAE Ong Chin Chin. 

Optimising workflow

Over the years, together with SAF, the SCFC team have made various improvements to the administration and care processes. For example, previously, cardiac investigations could only be ordered after the doctor’s review at SCFC which resulted in patients making multiple visits to the clinic and thus, resulted in increased, unnecessary workload. Working closely with SAF, the SCFC initiated frontloading of selected cardiac investigations where SAF would order suitable tests for the patient to be done at their first visit at SCFC, with the test results ready for review at their next visit with the doctor. This enhancement has elevated patient experience and optimised the overall workflow.

SCFC also worked closely with Ministry of Defence (MINDEF) and SAF to enable medical reports and cardiac investigation results to be issued and made available to patients directly. Michelle Chew, Manager, Corporate Planning and Performance, member of the SCFC said, “Previously, national servicemen had to submit requests through MINDEF to obtain their reports. Now, with the streamlined process, they can get their reports directly from NHCS or authorise a third party to do so, and this saves significant turnaround time both patients and SCFC.” 

Besides medical reports and results, the SCFC also rolled out digital medical certificate for consultation visits. In addition, an abbreviated overview of the SAF Health Screening Programme has been made available on NHCS website to allow pre-enlistees and enlisted servicemen to be aware of the SAF’s cardiac screening requirements prior to their visits. Such initiatives not only simplified the entire cardiovascular screening process at SCFC but also reduced our carbon footprint significantly. 

(L-R): Michelle Chew and Josephine Ng from Corporate Planning and Performance, together with Asst Prof Koh Choong Hou, work closely with SAF to bridge operation, performance, and communication matters behind the scenes, ensuring that the service runs smoothly. 

Capability development 

A vital component of the SCFC service is to have seamless two-way medical record exchanges with the referring entities from SAF such as through referral letters and investigation results. NHCS Cardiovascular Information System (CVIS) is an essential enabler for digitisation of electronic medical records for SCFC. Victor Effendie, Senior Manager, Solutions Integration and Data Analysis who played a key role in building a referral module in CVIS shared, “We teamed up with MINDEF and Defence Science and Technology Agency (DSTA) in setting up the referral module. The process was challenging and complex as it involved the compliance to network and IT security, accurate flow of information between systems, and user-friendliness of the module.”

As part of the digitisation endeavor, SCFC also made the transition to paperless clinical consultation notes in 2021. Driven by Asst Prof Daniel Chong, the immediate past Director of SCFC, the move was in tandem with national and ministry-level efforts to transform the medical health records landscape. The digitalisation move came timely to customise the system between SAF and NHCS clinical interfaces which paved the way for enhanced end-to-end communication and improved team-based care.

Improvements were also made to the clinical evaluation of pre-enlistees with the incorporation of cardiac magnetic resonance imaging (MRI) as a modality to detect subtle cardiac conditions that might otherwise been missed by basic first line tests such as electrocardiograms (ECGs). Previously, pre-enlistees with certain abnormal ECG findings (for example, unusual T wave inversions) would undergo ECG screenings and be discharged if the scans were considered normal. Asst Prof Koh Choong Hou, Director of SCFC, shared, “With the introduction of cardiac MRI as a secondary screening tool, some patients who were previously thought to be normal eventually turned out to have subtle cardiac conditions. This enhancement has enabled SCFC to advise the appropriate combat fitness status accordingly, through strengthening the sensitivity of the entire cardiac screening process and improving the detection rate.”

During the COVID-19 pandemic period, SCFC continued its care service and rolled out various IT initiatives including telemedicine services and mobile registration. Ron Ng, Executive, Cardiac Clinics shared, “Initially, patients had difficulties understanding how telemedicine worked. However, with greater awareness and familiarity, patients saw the benefits such as safety and convenience during uncertain times.” 

Upskilling and Empowering Our People

While there are ongoing efforts to enhance SCFC services, it is imperative to provide the necessary skills and knowledge to the staff in view of the rapidly changing healthcare landscape. Patient Services Associate Executive, Grace Guevarra Esquierdo (pictured below), a pioneer member of SCFC, is a prime example. 

Grace used to be a Clinic Assistant at the Cardiac Clinics where her primary duties were to chaperone doctors during consultation, prepare patients for physical examinations and attend to enquiries. She underwent the Cardiac Clinic’s upskilling and training programme (read more) and is now well equipped to perform multiple roles at SCFC. 

“I am fortunate for the trust given to me to perform more than what my job scope required. At SCFC, I enjoy working closely with different stakeholders, communicating and coordinating patient care with both internal and external teams,” shared Grace. 

From its humble beginnings at Mistri Wing to a comprehensive turnkey facility for cardiovascular care for our Singaporean sons, SCFC has come a long way. With its team of dedicated staff and a clear vision to deliver excellent care, it can only grow from strength to strength.