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Data, Digital Technology, AI


Background

The Data, Digital Technology & AI (D2A!) Core provides data infrastructure, data governance and aims to develop machine learning (ML) and data analytics expertise, focusing on structured and non-imaging unstructured data, within NHCS and NHRIS. D2A! supports NHCS research groups with the initiation, execution, analysis and governance of their data-related/data-science projects and provides essential biostatistical services. It is a one-stop platform for external partners (e.g., industry collaborators) to interface with for data-related projects.

 

The core also provides clinicians/scientists with access to resources such as SingCLOUD, Singapore Cardiac Data Bank (SCDB), ODySSEy and the upcoming National Supercomputer Centre (NSCC) @ Outram. The goal of the core is to develop data science projects and promote new collaborations between NHCS, industry and research institutions in the digital space. D2A! is supported by the Singapore Cardiac Data bank (SCDB), a national registry collecting epidemiological and clinical information on cardiovascular diseases and procedures such as percutaneous coronary interventions (PCI), coronary bypass surgery, electrophysiology and pacing as well as heart failure admissions. All restructured hospitals in Singapore contribute to SCDB.

 

D2A! is headed by Clinical A/Prof Yeo Khung Keong, senior consultant cardiologist and Deputy Medical Director (Data Science and Innovation). He is also SingHealth’s Deputy Group Chief Medical Informatics Officer (Research), Deputy Chairperson of SingHealth Innovation Council and Chair of the Data and Emerging Technologies focus area of the SingHealth Duke-NUS Academic Medicine Innovation Institute.


Clin Assoc Prof Yeo Khung Keong.png                Assoc Prof Gao Fei.png             Assoc Prof Gao Fei.png

          Clinical A/Prof Yeo Khung Keong                   Assoc Prof Gao Fei                               Miss Wendy Tan


Expertise

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In the data-driven/data-informed landscape, new digital technologies and associated artificial intelligence (AI) will play a significant role in the future management and treatment of our patients.

These technologies have the potential to accelerate, streamline and optimize clinical procedures and reduce costs. The core has three work streams:

  1. Providing structure, governance, and processes for NHRIS data-related activities
  2. Building and driving the development of digital technology projects
  3. Building AI and machine learning expertise

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Methodology

It is important to establish and develop a strong and highly trained team to manage and analyze the rapidly increasing and complex data. D2A! will build expertise and capabilities to organize data with more coherence to elucidate meaningful research answers and give NHCS an edge in this space. This will poise the institution/cluster to create more customized, informed, and personalized treatment strategies for future patients. D2A! is also positioned to be a conduit and integrated platform for discovery of possible collaboration within and beyond the institution (e.g., with IHL and industry players), fostering an eco-system which allows for future innovations and initiatives.

 

Our four main strategies include:

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Research Area

1. Singapore Cardiac Data bank (SCDB)

SCDB was established in 2000 as a national data bank of cardiovascular diseases and procedures. It is a rich source of data with 80% of hospital care delivered in public institutions. Current modules include cath/PCI, adult cardiac surgery, ICD, pacemaker, electrophysiology studies, ablation and heart failure admissions. The data is utilised for a number of audit/quality reporting purposes and research projects. Biennial data quality audits conducted by a 3rd-party auditor to assess data validity and reliability have shown data agreement of ~97% for both cardiac surgery and Cath/PCI data. A list of the focus areas and participating institutions can be seen in the figure below:

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2. Singapore Cardiac Longitudinal OUtcome Database (SingCLOUD) Study

 

SingCLOUD is a research project initiated by NHCS and its participating institutions which includes MOH, all restructured hospitals and polyclinics.

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List of participating institutions in the SingCLOUD programme


It aims to perform data extraction, integration and analysis across multiple clinical, administrative, financial and pharmacy databases in the participating institutions. The key data components will include cardiovascular specific data, procedural data, financial and administrative data (e.g. cost of medications and supplies, length of stay, diagnosis codes etc.), short-to-long term clinical outcomes (including hospital re-admissions, cardiovascular events, death), and quality-of-care indices (e.g. compliance to guideline-recommended therapy and medications). SingCLOUD leverages on BRAIN (Business Research Analytics Insights Network), formerly known as Health Data Grid, which is a virtual repository that enables access to anonymised and merged data from disparate databases at multiple institutions. The structures of BRAIN will preserve patients’ privacy and confidentiality, ensure IT security and allow access only by authorised persons. The building of BRAIN has been completed and SingCLOUD is currently at the stage of data analysis. Plans for SingCLOUD 2.0 are underway, and once it’s live, it will have data updated till 2021, which will allow more meaningful research to be conducted.

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3. SingHEART

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SingHEART is a 20-year study on a cohort of relatively healthy individuals, using comprehensive clinical information, advanced imaging, cardiovascular exercise physiology, metabolomics and genetic analysis. These findings will be correlated with adverse clinical outcomes including death, stroke and myocardial infarction. In selected cases, follow-up imaging and biomarker samples will also be obtained. This longitudinal study will enable us to address a critical gap in our knowledge as to how cardiovascular disease develops in previously healthy individuals.

Being in collaboration with NHCS Biobank, SingHEART recruit volunteers from the Biobank cohort. As of December 2021, 1007 healthy volunteers were recruited into SingHEART and has completed all baseline procedures.

Leveraging on SingHEART's extensive collection of phenotypic data, we were able to work with the SingHealth Duke-NUS Institute of PRecIsion Medicine (PRISM), which is the Academic Medical Center's flagship initiative in precision medicine. SingHEART has contributed to their signature program, SPECTRA, where its aim is to collect a multi-dimensional database of healthy Asian normality incorporating genomic, clinical, lifestyle, and imaging data. This therefore serves as an invaluable reference database for disease-oriented studies at SingHealth/Duke-NUS and across the nation.

 

Apart from SPECTRA, SingHEART has ongoing collaborations with a nationwide level "SG100K" project and AI.SG.


Data Available in SingHEART

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4. External collaborations

 

There are several ongoing collaborations with national entities, academics institutions, pharmaceutical and technical companies. These collaborations include but not limited to the National Registry of Disease Office (NRDO), Singapore Consortium of Cohort Studies (SCCS), Singapore Eye Research Institute (SERI), Agency for Science, Technology and Research (A*Star), National University of Singapore (NUS) and AstraZeneca.


Achievement

Grants/Awards:

  1. NMRC NIG Grant (HSRNIG12nov012): "Long-term clinical outcomes, cost-of-care, quality-of-care, and re-admission rates in patients with coronary artery disease, congestive heart failure in Singapore (SingCLOUD): Proof of Concept", 22 August 2013 – 31 August 2015.

  2. NMRC HSRG Grant (HSRG-OC17Nov007): "Long-term clinical outcomes, cost-of-care, clinical characteristics, re-admission rates, outpatient care and mortality in patients with coronary artery disease, congestive heart failure, or atrial fibrillation in Singapore ("SingCLOUD" for Singapore Cardiac Longitudinal Outcomes Database Study)", 01 November 2019 – 31 October 2022.

  3. COVID Top Up Grant (COVID19TUG21-0072): "Long-term clinical outcomes, cost-of-care, clinical characteristics, readmission rates, outpatient care and mortality in patients with coronary artery disease, congestive heart failure or atrial fibrillation in Singapore ("SingCLOUD" for Singapore Cardiac Longitudinal OUtcomes Database Study)", 01 December 2021 – 31 October 2022.

  4. "SingHeart: A long-term longitudinal study on the cardiovascular health of normal people with biobanking, deep phenotyping, cardiac MRI and physical activity", April 2022.

  5. RIE2020 Health and Biomedical Sciences (HBMS) Industry Alignment Fund Pre-positioning (IAF-PP) (H20C6a0032):"Artificial intelligence in Medicine Transformation (AIMx) program", 30 June 2021 – 29 June 2024

  6. AI Singapore Grand Challenge Funding Scheme (Stage 2A) (AISG-GC-2019-001-2A): "JARVISDHL: Transforming Chronic Care for Diabetes, Hypertension and hyperLipidemia with AI", 01 November 2021 - 31 October 2023.


Selected Publications

  1. Low ZK, Gao F, Sin KYK, Yap KH. Modified ultrafiltration reduces postoperative blood loss and transfusions in adult cardiac surgery: a meta-analysis of randomized controlled trials, Cardiopulmonary bypass, Meta-analysis. Interactive CardioVascular and Thoracic Surgery 2021 Jan 20; 1–12. doi: 10.1093/icvts/ivaa330.

  2. Ng M, Tan HJG, Gao F, Tan JWC, Lim SH, Ong MEH, Ponampalam R. Comparative prospective study of the performance of chest pain scores and clinical assessment in an emergency department cohort in Singapore.J Am Coll Emerg Physicians Open2020 Sep 5;1(5):723–729. doi:10.1002/emp2.12242.

  3. Lim SL, Lau YH, Chan MY, Chua T, Tan HC, Foo D, Lim ZY, Liew BW, Shahidah N, Mao DR, Cheah SO, Chia MYC, Gan HN, Leong BSH, Ng YY, Yeo KK, Ong MEH. Early Coronary Angiography Is Associated with Improved 30-Day Outcomes among Patients with Out-of-Hospital Cardiac Arrest. J Clin Med. 2021;10(21):5191. Published 2021 Nov 6. doi: 10.3390/jcm10215191

  4. Wong JJ, Umapathy S, Keh YS, Lau YH, Yap J, Idu M, Chin CY, Fam JM, Liew BW, Chin CT, Wong P, Koh TH, Yeo KK. Coronary Intravascular Lithotripsy Versus Rotational Atherectomy in an Asian Population: Clinical Outcomes in Real-World Patients. Korean Circ J. 2022;52e9. Forthcoming. Published online 2021 Nov 29. doi:10.4070/kcj.2021.0155

  5. Wang ZS, Yap J, Koh YLE, Chia SY, Nivedita N, Ang TWA, Goh SCP, Lee CS, Tan LLJ, Ooi CW, Seow M, Yeo KK, Chua SJT, Tan NC. Predicting Coronary Artery Disease in Primary Care: Development and Validation of a Diagnostic Risk Score for Major Ethnic Groups in Southeast Asia. Journal of General Internal Medicine 2021 Jun;36(6): 1514-1524. doi: 10.1007/s11606-021-06701-z.

  6. Yap J, Keh YS, Shen T, Lam CSP, Chia SY, Jaufeerally FR, Ong W, Sim D, Ching CK. QRS duration and cardiovascular mortality in Asian patients with heart failure and preserved and reduced ejection fraction. Cardiol J 2021;28(1):166-169. doi: 10.5603/CJ.a2020.0041.

  7.  Koh LJ, Teo SH, Jiang Y, Hwang EHJ, Lee ES. Difficulties faced by patients with chronic diseases in the primary care setting in Singapore: a cross-sectional study. Singapore Med J 2021; 62(9): 466-471. doi: 10.11622/smedj.2020062.

  8. Choo JCJ, Kwek JL, Lim CC, Mok IY,Chua HR, Jiang Y, Gao F, Tan KJY, Crespo-Avilan GE, Jafar TH, Hausenloy DJ. The Effect of Remote Ischaemic Conditioning on Blood Pressure control in patients with Chronic Kidney Disease: the ERIC-BP-CKD Pilot Study. Conditioning Medicine 2021 (in press).