Transform

Don't you think that we should take our COVID-19 innovation further?

I was quite taken aback when Jing Fang asked me this question in end-2021. You see, just several months back, Singapore was in the thick of the COVID-19 pandemic. Borders were closed and travel was unfathomable. The key obstacle preventing the safe reopening of travel was the implementation of tamper-proof vaccine certificates to enforce safe travel.

Back then, Jing Fang, Dr Tan Hwee Jia and I were part of a special projects team looking into how to design a digital solution that was interoperable across borders; negotiate for multilateral adoption with our neighbours; and ensure that border operations could scale. Coordination was a wicked problem – I remember having to speak to no fewer than eight government agencies, countless international counterparts and their airline companies, and countless private clinics across Singapore, all with varying digital capabilities.

Blockchain solutions provided an excellent product-market fit then. Together with the software engineers from GovTech, we designed a novel solution called Healthcerts, where the government essentially minted a hash of healthcare records against the blockchain. When the hash was retrieved from the blockchain, this allowed anyone in the world (in particular, border control authorities) to independently verify that the healthcare record in question was indeed issued by a recognised healthcare authority in Singapore.

But we were moving into 2022, with COVID-19 to be declared an endemic disease. Surely there was no more need for Healthcerts in future?

Jing Fang, are you referring to Healthcerts? I'm not sure for how long more this technology will be required. Seems to me that it was a product fit for its time, but...

No, I'm not referring to Healthcerts. I'm talking about this whole idea of decentralisation - that's what you're really excited about right? Who cares if we still use Healthcerts or not!

Well she got one thing right. I was truly excited about the concept of Web 3.0 - not so much cryptocurrency and blockchains, but the whole idea that we could own our personal credentials on our personal devices, where issuance and verification of such credentials could be decentralised. I mean, it didn't even have to be blockchains. It was my "public service" dream of sorts. I had been serving in the education and healthcare sectors for 7 years, and public service globally had generally relied on building expensive and large centralised IT systems to manage credentials of all sorts.

But what if we re-imagined residents owning their own credentials? Suppose we suspended any doubts on how this was technically possible (or whether we wanted to place this burden on residents), wouldn't this solve the age old problem of care coordination? You see, when we visit social- or healthcare providers, in order for them to craft a care plan for us or advise us on follow-ups, they require a myriad of personal care data from us. Healthcare by itself was pretty solid, with the National Electronic Health Records (NEHR) acting as a single source of truth - but the real problem came if there were care providers who did not have access to the NEHR (or if healthcare providers required care information that didn't reside within the NEHR). It would then be an endless cycle of back-and-forth between various providers to obtain the necessary information.

And trust me, I don't think building another centralised IT system for all non-healthcare providers is a good solution. Imagine the coordination and bespoke engineering required - it would most definitely result in a big mess.

But now imagine a resident owning his own socio-healthcare records, just like how he owned his own COVID-19 vaccine certificate. We could digitalise the entire process of care record issuance, so that care providers could issue credentials directly to residents. A resident could carry his care credentials from provider to provider and act as his own mini source of truth! We wouldn't have to build any complex centralised IT system to link up the thousands of providers across the socio-healthcare spectrum. Across different sectors, providers could simply access the care information of the resident they required from the resident himself! In fact, it shouldn't be too difficult to implement a similar technology that allowed for decentralised issuance and verification of care records.

Heck. We could save millions of dollars, and maybe even hundreds of coordination hours.

And you know what Jing Fang, this doesn't even have to be at odds with the National Electronic Health Records! Centralisation and decentralisation could co-exist! We could design for it to preserve the centrality of the NEHR!

Indeed, such an application could be seen as complementary to the NEHR. It would not necessarily mean truth leaks from the NEHR, because we could engineer the relevant data integrations backend, and in fact, strengthen the NEHR for the Ministry of Health!

By this time, I knew that I was truly excited about implementing such a solution in healthcare.

Hey, but... who's gonna help us design this, and build this? It's easy for us to say... but to truly create something that preserves the centrality of NEHR, and also something that meets the needs of residents... And seriously, we have got to build this in a way that can integrate back into Healthhub, how are we going to...

Aren't you going to GovTech? Why don't you go find someone there who believes in us? Find someone who believes that decentralisation can co-exist with centralisation, and find a group of people who have the necessary design and engineering skillsets to make this thing for healthcare?

I thought Jing Fang was really pulling my leg hard back then. How was a single man to go to GovTech, to create his own workplan, and rally folks towards such a ludicrous idea?

Well, if you really believe in this, then you should do all you can to test whether it works for healthcare. You don't have to build a complex system right? You can always build a prototype, and test your idea first - and if it fails, well, it fails. But no damage done.

Haha Jing Fang, you speak as if it's going to be really easy finding engineers to build this for healthcare. I'm sure GovTech has its own priorities set. And seriously... I'm not sure we're gonna be able to find engineers and UX designers who are interested in messy healthcare...

And almost by fate, a few months later, I would find myself in GovTech, meeting Hoon Ling, Alex, Shaina and many others who had a passion for healthcare.

But at this point, all I knew was that I had a new job of transforming government grant portals in GovTech. How would I ever link my work back to healthcare?