Behind the scenes in Singapore General Hospital (SGH), a bot or software robot is quietly transforming processes. Known as Robotic Process Automation (RPA), the bot has proven invaluable, helping to save more than 52,000 man-hours in laborious and repetitive work. This significance may not be immediately obvious for patients as it is for staff who have been relieved of mundane tasks. Nevertheless, digitalisation and process automation using the bot have led to some important improvements for patients, including more time with their physiotherapists, and receiving their medication deliveries and surgical bills more quickly.

Mr Geoffrey Gui, Director, Future Health System (FHS), SGH, said: “We take the lead in weaving smart technologies into the fabric of our hospital processes, all while cultivating a culture of technology adoption among our healthcare staff. We anticipate that RPA bots will become a crucial component in enhancing the healthcare experience, streamlining services such as appointment scheduling, medication dispensing, and the management of financial transactions and post-care follow-ups. In addition, RPA is set to play a key role in the background, optimising data analytics, automating data entry, and significantly improving the hospital’s operational efficiency.”

The FHS’s Artificial Intelligence and Automation Unit (AIA) is the main driver of RPA. It works closely with different departments to automate their time-intensive processes. “Bots can be programmed to autonomously execute high-volume, repetitive and monotonous tasks by seamlessly interfacing with various systems and applications,” said Ms Chan Wai Ching, Assistant Manager, AIA, and RPA Lead, SGH. RPA is very “low-code”, she added, and so requires only simple IT knowledge and skills to use.

SGH started exploring RPA use in late 2020, with the hospital’s Call Centre and Telecommunications Services being the first to adopt it. Since then, more than 36 projects have been automated. For instance, the human resources (HR) division has been harnessing the power of bot technology for mass communication tasks, including the personalisation of staff emails and HR notices through SMS texts. “Looking ahead, RPA shows immense promise in revolutionising clinical settings, with potential applications spanning from clinical workflow management and data transcription to analytical assessments and reporting, said Ms Chan.

Besides saving time, RPA also helps reduce costs. Manpower cost alone accounts for at least 60 per cent of healthcare costs in Singapore. Yet, traditional processes, especially in hospital operations, comprise huge amounts of rules-based, repetitive and manual tasks that can be more efficiently undertaken by a bot. Automation also reduces the pressure on hospitals to recruit new staff in a tight labour market, while enabling current staff to focus on meaningful and purposeful work that boosts their job satisfaction.

More physiotherapy time

At the Physiotherapy Department, patients with musculoskeletal problems are asked to complete a health assessment questionnaire before their consultation to find out whether their pain, mobility and quality of life have worsened or improved so that it can quickly offer treatments to the patients.

The physiotherapists take an average of eight minutes to process the responses to get a score. That amounts to 1,070 times, or 143 hours, each month. The physiotherapists began using the RPA to send a questionnaire via SMS for patients to complete prior to their appointments. The RPA also extracts and analyses patients’ responses to derive a score, which is then ready for the physiotherapist to use when the patients visit the next day.

“Between 13 March 2022 (when automation was rolled out) and the end of last year, we saved 81,488 minutes simply by eliminating the need to manually calculate and document the data,” said Adjunct Assistant Professor Philip Cheong, Senior Principal Physiotherapist, Physiotherapy Department, SGH. “We use the time saved to provide the patient-centric quality care that SGH is known for.”

The physiotherapists worked with AIA on the project, which makes use of a standardised, validated questionnaire known as Patient-Reported Outcome Measures (PROMs) to measure the patient’s health status and monitor his progress. “PROMs is very important as it allows therapists to hear from the patients themselves about their symptoms, their functional status, and their health-related quality of life. It also allows healthcare professionals to track what type of interventions works well for each patient. Each patient is different, so it’s important for us to tailor their management plan or intervention based on their own perceived needs as well as their functional goals,” said Adj Asst Prof Cheong.

Before automation was used, PROMs was given to patients to complete during their consultations. This time-consuming process is still being used as, within the physiotherapy department, the RPA bot is only used to automate repetitive, high-volume tasks for musculoskeletal (MSK) disorders like arthritis and lower back pain. For now, the department is working to increase the response rate among MSK patients from the initial 25 per cent. It is planning to enhance the forms to include other languages, and roll out RPA PROMs collection to patients with non-MSK conditions like amputees and those undergoing rehabilitation. There is also potential to enhance the RPA bot to flag patients with low scores so that greater care can be given to them quickly.

Faster med deliveries

Hospital pharmacy services also benefit from digitalisation and automation.

Currently, patients are encouraged to have their medications delivered instead of waiting at the hospital’s pharmacies to collect their prescriptions after consultations. Those on repeat medications can ask for their prescription to be delivered at home or to be picked up at nearby Guardian pharmacies.

For the Pharmacy Department, improving and refining processes to reduce waiting time for patients while enhancing accuracy and work processes for staff has been ongoing. The medication delivery service (MDS) for patients was meant to ease long queues and waiting times.

However, COVID-19 threw things into disarray as demand for MDS increased seven-fold, placing heavy pressure on manpower and other resources. Transcribing the orders and delivery schedule manually into the system for processing led to delays and inefficiencies, said Mr Hwang Yi Kun, Senior Pharmacist, Pharmacy Department, SGH. With less physical patient interactions, there is also a greater risk of making errors when executing the laborious, repetitive work, such as packing the wrong medications, labelling the wrong address, and scheduling the wrong delivery time.

The pharmacists worked with the AIA team on using the RPA bot to retrieve orders electronically and transcribe them to the pharmacy systems. “The results were impressive,” said Mr Hwang, noting that the bot had no transcribing errors when processing almost 600 orders every day — or about 74 per cent of the daily MDS daily workload — since RPA was implemented in September 2021. The bot was also able to alert the team when an urgent delivery such as for antibiotics was required. Assuming 2.5 minutes are required to schedule delivery and related processes, the time saved on this backroom procedure is 25.6 hours a day or 128 hours a week. For pharmacy staff, nearly 80 per cent felt automation made their job easier.

Bill accuracy

Another department that benefited from the use of RPA bot is the hospital’s Pre- Admission Centre (PAC).

According to Ms Thirvchelvi PK, Executive, Pre-Operative and Admitting Services, SGH, each patient typically undergoes several investigations as part of their pre-surgery examinations. “Each patient is billed for five to eight tests, or more than 500 services to bill each day,” she said.

The Centre sees an average of 90 patients a day, and an administrative clerk used to check and key in the patients’ charges after each visit. For example, the clerk had to ensure the forms received are correct and valid (that patients have indeed undergone the blood tests ordered, for instance) and check whether any forms are missing (patients underwent three tests but only two forms are received). The process relied heavily on paper forms and took three hours every day to complete. Working with AIA to digitalise and automate the charging process has resulted in a 66 per cent reduction in time taken.

The RPA now generates a daily report of tests performed the day before, checks for missed or double billing, posts the charges to the patients’ accounts, and indicates which bills cannot be posted — which are then manually checked and posted. The bot takes about an hour each day to do this. The clerk who used to perform this task has been reassigned to cover frontline duties, said Mr Goh Ze Wei, Assistant Director, Pre-Operative and Admitting Services, SGH. “She’s happy with her new assignment,” he said.

The move towards automation involved discussions with other departments such as Finance. More importantly, it was a chance for staff rethink their processes and to envision a new and improved workflow. “The entire process was smooth as the benefits were clear to other departments, and they came on board the project quickly. However, it was time-consuming as we had to understand everyone’s role in the charging process, and how best to change and consolidate the procedures involved,” said Mr Goh.

No errors have been reported with the move to automation, versus about 15 unbilled services daily before automation. Describing the bot as having “amazing potential”, Ms Thirvchelvi said the department is looking to complete other finance-related processes, like form completion and generating insurance letters of guarantee ahead of patients’ visit to the PAC.

Get the latest updates about Singapore Health in your mailbox! Click here to subscribe.