Quality assurance in medicine: research and evaluation activities towards quality control in Singapore

Quality assurance and medical audit requires a good Health Management Information System (HMIS) to support it. In Singapore, there is a well developed HMIS built on the routine reporting of utilisation and activity statistics from public sector and private sector hospitals, government clinics and support services. In addition, there is a computerised national surveillance system for disease monitoring, which includes the disease condition, operations done and the physician and surgeon responsible for managing any inpatient or day case admitted into any hospital in Singapore. This forms the basis for the computerised national health system known as Medinet. Supplementing this are ad hoc surveys on quality of service, medical audit studies and supplementary information systems such as the Births and Deaths registration system and the Census of Population. Such a well developed HMIS greatly facilitates medical audit in Singapore. Indicators for audit can be generated from existing health databases, which point to areas requiring further inquiry and investigation. The use of a unique National Registration Identity Card (NRIC) for every Singaporean enables healthcare utilisation at all levels to be linked, further enhancing the capability for medical audit here.