Winter 2020 Newsletter - Digital Transformation of Healthcare: A Global Matter

By Dr. Mary Anne Schultz

Digital health, like public or population health, is a global affair. In the United States, healthcare spending is substantially higher while significantly worse population outcomes are realized, even when compared to those of other wealthy nations (Harvard Global Health Institute). Coupled with bold gains in human longevity, a similar trend has emerged worldwide prompting decision makers to question what, if any, gains are being obtained for these rising expenditures. A potential answer is being propagated in the single most important disruptive change in healthcare to date: the entrance of Artificial Intelligence (AI) tools which promise to make care provision more precise, more efficient, more impactful.

This trend in Digital Health, defined as the convergence of digital technologies with health, healthcare processes, living and society, has come to be associated to the adjacent terms and concepts of digitalization of care processes, Big Data, predictive analytics and The Patient Experience. This article briefly describes selected incipient trends across China, Europe, the Philippines and various parts of Southeast Asia in the area of digital transformation in healthcare. This content is derived from the empirical literature, the gray literature, numerous sources from the Health Information and Management Systems Society (HIMSS) website and the author’s experiences as an informatics consultant in Thailand.

Simon Lin, Vice-President, of Asia Pacific HIMSS, speaks of what is driving growth of digital health markets in Thailand, Indonesia and elsewhere when he says, “Except for Singapore, every other country in Southeast Asia is poised for adopting the EMR (Electronic Medical Record).” He attributes this to investments from major healthcare players worldwide, the (consumer) demand for technology in this space and medical tourism. Some examples of innovations include these:

  • An emerging hot market for digitalization is in Indonesia with their rapid plans for expansion of digital health record-keeping and sharing at scale and a showcase of its first paperless hospital, OMNI Hospital, Pekayon
  • Derived directly from healthcare consumer demand, The Philippines is adopting a retail-based “one roof” approach for “all-needs” visits based largely in pharmacies and private clinics across the country. Beginning in hundreds of existing facilities with new ones under construction through AC Health’s Ayala Health subsidiary, these primary care settings, coupled with app-based digital platforms, promise to deliver improvements in specialty care, on-time medication delivery and appointment keeping as the country’s first cancer-care specialty hospital opens in Makati City soon. These innovations will solidify Thailand as the medical hub and center for medical tourism of the ASEAN (Association of Southeast Asian Nations) Community.
  • The Ministry of Health (MoH) in Malaysia is rolling out 145 EMR hospitals in 2021 in an aggressive governmental plan to standardize their digital health agenda through use of LOINC, SNOMED CT and other terminologies to unite the nation’s EMR system within 3-5 years.
  • Thailand is poised to be the fastest growing digital health market in Southeast Asia, especially because of healthcare tourism that is driving competition within the private health system. According to Mr. Lin, “…every other day we are hearing about a new hospital project…acquisition of a new hospital…Dusit Medical service, the largest private health system in Thailand, ….every day…adding more hospitals to the system…”. The country’s Global Health Strategic Framework (2016-2020), calls for a system-wide information and technology management system which is intended to contribute to a major initiative therein: to contribute to national and global health through digitization of care processes.
  • Hospitals in the National University Health System (NUHS) in Singapore just began to use facial recognition and AI driven predictive analytics to speed the admissions process by working through a console which distributes patients to the appropriate waiting room and provider based on digitized records matched to age, medical diagnoses, co-morbidities and current complaints—in a paperless fashion. To be rolled out in phases across NUHS facilities, including Ng Teng Fong General and Jurong Community hospitals, this transformation of the identification process extends both the speed and accuracy of the diagnostic and treatments processes.

The European eHealth Digital Service Infrastructure (eHDSI), under the Connecting Europe Facility (CEF), is witness to more and more EU (European Union) Member States which have been setting up National Contact Points for eHealth (NCPeH) that act as technical and semantic “adapters” between healthcare IT infrastructures of different Member States. For example, in January 2019, Finland and Estonia were the first EU Member States to be able to exchange prescriptions. This is a healthy start along Europe’s path to interoperability that, as is the case everywhere, suffers roadblocks of lack of financial resources or sound policy and provider resistance.

  • The new ePrescriptions, visible to participating pharmacists in the receiving country (via the new eHDSI), are initiated by the prescriber with the entire process, including patient/consumer pick-up, paperless
  • Patient Summaries, providing a thumbnail sketch of important health touchpoints such as allergies, current medications and history of surgeries, are being made digitally accessible in the instance of emergency visits to neighboring countries. The eHealth Network (the eHealth authorities of the EU) have “greenlighted” this change for Czechia and Luxembourg with a rollout to Finland, Estonia, Portugal, Croatia, Malta, Cyprus & Belgium slated to commence soon.

These abstractions are merely part of a larger collection of health data in the eventual European Health Record, which will result in widespread sharing of health data across EU borders as the European EHR exchange format is unveiled. This movement, fueled by public/private partnerships such as the IMI (Innovative Medicines Initiative), has a stated goal of harmonization of 100 million health records (2018-2023) which is 20% of the European population. The Scientific Director of Janssen Clinical Innovation, Nigel Hughes, stated there is a “…need to improve the speed of the answer without affecting the quality of the answer” as he writes and speaks of three pillars of needed clinical and electronic change: a Common Data Model, research outcomes of care demonstrated through various platforms and devices, and community building through the EHDEN (European Health Data & Evidence Network) Academy of Bioinformatics and Data Science worldwide. These changes are made as a natural consequence to the EU adoption of Directive 2011/24 (European Union law, April, 2011) which assures continuity of care to European citizens across borders as well as the introduction of the GDPR (General Data Protection Regulation) (European Union Law, April, 2016) underscoring the citizen’s right to access their data within said legal framework of protection.

As China transitions from a manufacturing infrastructure towards a market producing specialized technological output, Made in China 2025 (MIC, 2015), centralizes this vision under its Ministry of Industry and Information Technology pushing for leadership in robotics, information technology and clean energy.

  • China’s first “smart hospital” opened in Guangzhou (April, 2019) featuring an online medical profile filtered by facial recognition identifier protection, an AI-diagnostic system which reduces wait times by 50% and robotic delivery of medications and supplies. The Guangdong Second Provincial General Hospital also boasts a voice-to-text EMR with a high accuracy rate and a seamless electronic billing system.
  • Shanghai hospitals are beginning to use tools from a Beijing-based company, Airdoc, aimed at gleaning a number of physiologic indicators from human eye examination to yield diagnostic impressions.
  • AI assisting in the medical imaging enterprise has become the most commonly used of all AI deployment in Chinese healthcare with most products in the trial stage in large hospitals. Notably, in Tenecent’s 2017 launch of AIMIS, an AI-powered diagnostic medical imaging service boasting 95% accuracy for select disease entities such as lung sarcoidosis, more than 100 Chinese hospitals have now cooperated in this research and application endeavor.

The Healthy China (2030) Blueprint, released in October, 2016, has innovation as one of its foundational concepts. Billed as one of the most expansive and far-reaching public health plans of all time, it outlines 15 major health campaigns aimed at both prevention and control of major diseases and incorporates the use of Big Data as a necessary theme. In the past three years, the Chinese government has released significant amounts of Big Data in alignment with the United Nation’s sustainable health development goals and, as such, has laid a good foundation for the development of AI in their healthcare sector.

As is the case with diffusion of innovation throughout history, advances may occur simultaneously--cast at great distances--occurring in “pockets” which are geographically disparate. The digitalization of healthcare is just one such change with some pointed imminent trends abroad offered here. This digital transformation is unstoppable, ubiquitous and may be aligned with a nation’s social or public policy. It will be interesting to observe how healthcare providers and decision-makers plan for episodic and compartmentalized change to become the true sustainable wave of socioeconomic innovation worldwide that we reasonably expect.


Sources

Bringing the Flow of Health Information into 21st Century, HIMSS Health 2.0. https://himsstv.brightcovegallery.com/detail/videos/latest-videos/video/6048432271001/bringing-the-flow-of-health-information-into-21st-century?autoStart=true#

Digital Health Markets in SE Asia Poised for Growth, Singapore eHealth Summit, 2019. https://himsstv.brightcovegallery.com/detail/videos/singapore-ehealth-summit-2019/video/6034316591001/digital-health-markets-in-se-asia-poised-for-growth?autoStart=true

Ministry of Public Health, Thailand. Thai Global Health Strategic Framework, 2016-2020. http://www.bihmoph.net/userfiles/file/GHS%20ENG.pdf.

Tan, X., Liu, X. Shao, H. (2017). Healthy China 2030: A vision for health care. Value in Health Regional Issues, 12C, 112-114. 


Dr. Mary Anne Schultz is a Professor teaching nursing research, evidence-based practice and informatics at California State University, San Bernardino and a Big Data consultant in a private practice. Contact her at: https://www.advisorycloud.com/profile/Mary-Anne-Schultz.