Dean Koh

Singapore-founded house call doctor app Speedoc and private ambulance operator Comfort Ambulance announced a partnership that allows Speedoc users to hire Comfort’s fleet of 25 ambulances for transport to more than 100 healthcare institutions across Singapore directly through their app. Since September 2018, Speedoc has been a participant of the Ministry of Health’s regulatory sandbox – Licensing Experimentation and Adaptation Programme (LEAP), which allows the safe development of new and innovative healthcare models to be piloted in a controlled environment. HOW IT WORKS Charges for booking an ambulance via the Speedoc app will range from S$120-S$170, depending on timing, location and day. Additional charges for services such as the use of oxygen therapy or stretchers will also be clearly listed in the app for users. WHY IT MATTERS The Singapore Civil Defence Force (SCDF) announced that it will stop dispatching ambulances for non-emergencies from April 1 onward, so as to better focus on life-threatening cases. According to SCDF’s latest statistics, non-emergency and false alarm calls made up 9.6% (17,954 calls) of all emergency medical service (EMS) calls in 2018. This means that on average, SCDF responded to around 50 non-emergency and false alarm calls each day. Users who need a private ambulance can now either contact over 20 operators individually or call the 1777 hotline, but waiting times can take as long as two hours compared with around 30 minutes with the app, according to Speedoc. Speedoc is currently working with other ambulance operators to get more of them on board the app.

Seoul St. Mary’s Hospital, which was established in 2009 and part of the Catholic Medical Centre (CMC), recently announced that it has been operating a digital pathology system that aids in the diagnosis of cancer since last month. The system, known as the Philips IntelliSite Pathology Solution, allows the hospital’s pathology team to obtain accurate diagnosis results through a digitalised method. The system automatically creates, visualises, and manages digital pathology images based on an image management system, including a slide scanner, a server, a storage device, and a viewer. The digitalisation of pathology images will allow pathologists to make diagnoses through computer monitors. In addition, clinicians from other departments in the hospital can digitally access the digital pathology images easily, increasing efficiency and opening more opportunities for collaboration. THE LARGER TREND In 2017, the Philips received FDA clearance to market its IntelliSite Pathology Solution for primary diagnostic use in the US. The solution also received the green light from South Korea’s Ministry of Food and Drug Safety in June 2018. In the US, Mount Sinai and LabCorp announced last month that they would collaborate to establish the Mount Sinai Digital and Artificial Intelligence-Enabled Pathology Centre of Excellence. LabCorp, has implemented the Philips IntelliSite Pathology Solution in four of its laboratories and plans to introduce it to additional laboratories, will use its experience and expertise to lead the integration of digital pathology into clinical practice across Mount Sinai’s hospitals. A report by Frost & Sullivan in February 2019 “sees wider use and better management of the clinical datasets owned by major medical institutions as a major boon for developers of digital pathology tech.” ON THE RECORD “Through the establishment of a digital pathology system, we will be able to shift from previous ways of interpreting analog microscopic image to a more digitalised technology, which will boost efficiency and productivity,” said Lee Youn-soo, a professor at St. Mary’s Department of Pathology in a statement.

The Australian Digital Health Agency (ADHA) is partnering with Australian software organisations to design world leading software for specialists. ADHA has provided nine specialist software vendors with A$40,000 each to complete designs that seamlessly and securely integrate the My Health Record (MHR) into their current systems to bring benefits to specialists, such as cardiologists or anaesthetists.  In addition to funding, ADHA will provide design expertise to work with each vendor’s design teams to co-produce improvements in design with their users.  The nine specialist software vendors are:  Best Practice Software Clinic to Cloud Clinical Computers Genie Solutions Intrahealth Medical-Objects Medical Wizard Software for Specialists Zedmed The software organisations will work with ADHA and specialists to develop these designs over the coming months. ADHA ran an expression of interest process in May 2019, where software developers with a clinical information system being used in at least 10 private specialist practices in Australia at 1 May 2019 were invited to apply. MHR DEVELOPMENTS Some parts of the health sector have enthusiastically embraced the MHR – such as community pharmacy which has increased registrations from 20% in June 2018 to 86% in June 2019. ADHA is now turning its focus to increasing use by specialists over the next 12 months. The agency announced that in February 2019 that 9 out of 10 Australians have a MHR following the conclusion of the opt-out period. Last month, the pathology departments of South Australia and Northern Territory have connected to MHR to provide better patient and clinician experience through the seamless flow of pathology reports. ON THE RECORD “Australian specialists are world leaders in innovation – whether in clinical techniques, robotics, or medical engineering. We want to support our local clinical information system vendors to integrate the MHR into their software in a way that encourages specialists to embrace these systems in the same way they’ve embraced other technology. We won’t be specifying what changes should be made to systems. Instead, we will work vendors and their customers – the specialists themselves – to come up with designs that specialists and their practice staff will love to use, and which will benefit from the rich data provided by the My Health Record,” said Ms Bettina McMahon, Chief Operating Officer, ADHA in a statement. 

Malaysian Health Minister Datuk Seri Dr Dzulkefly Ahmad said that it would cost up to RM1.5B to implement an EMR system for the 145 hospitals nationwide in Malaysia over the next five years, according to an article by The Edge Markets. Dr Dzulkefly last mentioned in November 2018 that it would take about three years to implement an EMR system across the country. Currently, 35 or 25% of the 145 government hospitals are already equipped with Hospital Information System (HIS), while 7% or 118 out of 1,703 government clinics have been equipped with Clinical Information System (CIS). He said that among the HIS products being used currently are Cerner, iSoft, Fisicien, Profdoc, and Patient Management System for hospitals while clinics are using CIS products such as Teleprimary Care (TPC), Oral Health Care Information System (OHCIS) and TPC-OHCIS integrated system. “Implementing this EMR System will directly improve the quality of service delivery by taking into account the confidentiality requirements of patient information. This is the reason why EMR as the foundation / pillar of Digital Healthcare is my goal and ambition as I lead the Ministry of Health,” said Dr Dzulkefly in a recent post from his Facebook page. The same post also stated that the proposed implementation of the nationwide EMR will be under review for the next three to five years based on the availability of options. Elsewhere in the Southeast Asia region, Vietnam is slated to deploy a nationwide EHR this month. 

Buzzwords like Artificial Intelligence (AI) and machine learning are commonly heard at conferences and industry events and they often conjure up images of robots or killing machines from the Terminator. However, panelists from the Innofest Unbound conference in Singapore all felt that technologies such as AI should not replace humans as it is commonly imagined – rather, they should augment the work of clinicians and hopefully, even enhance the patients’ interactions with their doctors. Human-centric AI A medical doctor by training and also the founder of MEDGIC, a startup which utilises AI to detect skin conditions, Dr Reid Lim feels that the use of AI should always involve doctors and not replace them. “Healthcare systems are becoming unsustainable and we need AI to help automate some things and to help alleviate the burden on doctors. AI is not new and it seems strange that some people are only beginning to grasp the use AI.” “A lot of radiologists are already using Computer Aided Diagnosis (CAD) for mammography and it has been happening for some time. So the idea is for us as a tech startup to pursue what we call human-centric AI. We try to make AI as explainable as possible and we always want humans to be involved in the whole process,” he added. Dr Philip Wong, a practicing cardiologist and founder of WEB Biotechnology, concurred that as doctors, there is a sense of compassion and empathy to want to help patients regardless of their health condition, and that is something AI cannot do at the current moment. “Anything thing (or tech) that is adopted by the hospitals, we always have qualified specialists or ‘men/women in the loop’. For instance in radiology, even though a lot of analysis is done by AI, in the end the person who signs off is the radiologist or specialist radiologists who have to sign off the report.” “We’re not afraid of losing our jobs as healthcare providers, and in this respect, what I think most people or most healthcare providers don't understand is the benefit that you get from the first problem I pointed out, right? The problem is we have a whole huge plethora of data, which we're trying to analyse but we haven't got a sense of it. So you pop up the electronic health records, right, I see two computer screens with approximately 1000 fields. I've looked at this, analysed all this and this is where I think AI can really help the doctor, the patient as well,” said Dr Wong. Meaningful and novel applications of tech Mr Chua Chee Yong, Emerging Services & Capabilities Group, iHIS, the IT agency for the Health Ministry in Singapore, shared that there are possible concerns about specialists being ‘replaced’ by AI even after years of training and practice. However, he stressed that it is about how to meaningfully apply technologies so that it makes a difference. “We all know today that AI is not quite explainable, not quite there yet. What do we do? We can choose to ignore it and only use it when AI reaches a point that it is explainable. Or we can choose to apply it in a safe way that allows us to improve our productivity.” “The example in this case is retinal image scanning. We use a simple AI to do a simple classification of ‘normal’ vs ‘abnormal’. Guess what, 70% of the normal cases got eliminated by AI and the leftover 30% are read by the human being – productivity suddenly increases and the person just focuses on the very complex 30% abnormal cases. The accuracy also improves – you see how we apply it? Despite the constraints and limitations of AI, if we apply it meaningfully, we can harness value out of it,” he explained. Looking into the future According to Dr Wong, what he sees in the future is that data is becoming more ‘fluid’, for example from the Spyder wireless ECG monitor that he invented. For example, even if someone is wearing the ECG monitor in the US, the ECG data can be acquired by the doctor back in Singapore almost instantaneously.  Another future development that is very exciting for Dr Wong is that the smartphone will become the ‘replacement’ of healthcare in many respects, becoming the apparatus and interface to make an appointment to see a doctor, collect health information and do much more.  He concluded with a wish as a doctor for a ‘digital health persona’ for patients, to get a lot more health information from them and try to solve their problems. With the digital health persona, health information is being collected continuously, even outside the hospital and the information can even be front-loaded to the doctor before the patient sees him/her. This gives the doctor a broader picture of the patients’ health. 

German pharma giant Bayer, in partnership with NUS Enterprise, the entrepreneurial arm of the National University of Singapore (NUS), recently launched the Healthy Hearts, Healthy Aging Asia Pacific Report at Innovfest Unbound 2019. The report examines the cardiovascular (CV) health imperatives aligned with population aging in the Asia Pacific, and highlights the important shift in the region’s health systems from a traditional acute care model to one with an increased focus on preventive, value-based care. Across the Asia Pacific region, socio-economic, geographic, demographic, and ethnographic differences create unique challenges for each country when dealing with the growing impact of CVD and aging. Experts in CVD and health policy from across eight countries (i.e. Australia, South Korea, Taiwan, Singapore, Malaysia, Thailand, Vietnam, and the Philippines) were consulted for the report to: a) establish the current and predicted future burden of CVD on the region’s health systems, b) examine the role of health innovation in addressing the unmet needs in CVD prevention and care, and c) gather recommendations on how different stakeholders can collaborate to enhance the adoption of health innovation in the long-term preventive care of CVD patients. FOUR BROAD AREAS OF NEED The four areas identified for policy makers to focus on to address the challenges of aging and CVD are: • The need for health systems to shift from a traditional acute care model to one with increased focus on preventive, value-based care. This includes earlier detection and better management of patients at risk of developing CVDs and its related complications at the community level. • The need to improve education of the public, primary care physicians, patients and policy makers to achieve optimal control of CVD risks. • The need for speedier adoption and greater access to innovative therapies and technologies to improve patient outcomes, particularly for the prevention of serious CV incidents such as strokes and heart attacks. • The need for data in understanding current disease burden and planning for the future. One area in particular where a shortage was noted was for local, regional and ethnic specific data from drug trials, which would make it easier to demonstrate the relevance of novel therapies to particular populations. As health systems focus on value-based care, there is a need for more socio-economic data to support the cost effectiveness of new innovations. THE LARGER TREND Although medical advances have significantly reduced death rates due to major CV events such as strokes and heart attacks, the broader challenges of coping with their related disabilities, frequent hospitalisations and intensive long-term care remain for many survivors of these events, according to a 2014 article published in the International Journal of Stroke. Beyond direct healthcare costs, it was projected in the The Global Economic Burden of Non-communicable Diseases report that CVD will be responsible for $15.6 trillion worth of lost economic output globally between 2011 and 2030, as it can cause both those affected and their caregivers to miss work or drop out of the workforce altogether.  In Europe, there are also similar pain points – new models of care that incorporate existing technologies have not been created because there is no shared strategy among national legislators, industry, hospitals, physicians and patient organisations, according to a position paper published in the European Journal of Preventive Cardiology. ON THE RECORD “To address the mounting challenges with population aging, it is imperative for health systems to shift from a traditional acute care model to one which focuses on maintaining health and keeping people out of hospital. Care for elderly CVD patients must be integrated into communities and the home to support better adherence to preventive lifestyle measures and medical therapies which are geared towards prevention of disability-causing major cardiovascular events such as strokes and heart attacks.  Health systems must also embrace innovations across the ecosystem of medicines, technology, and elder care to support this transformation,” said Associate Professor Angelique Chan, Executive Director of the Centre for Ageing Research and Education at Duke-NUS Medical School in statement. Associate Professor Chan is a key contributor to the report.

During the ‘Promoting the implementation of electronic health records’ Seminar that took place in Ho Chi Minh City, Vietnam last week, the Ministry of Health announced that Electronic Health Records (EHRs) will be deployed nationwide from July this year. WHAT’S THE IMPACT “The collection of health information will help the Vietnamese manage their health better. This will also raise their self-awareness of disease prevention and the potential risk of diseases affecting health and life,” emphasised Nguyen Truong Son, Deputy Minister of Health, Vietnam. From the doctors’ and caregivers perspectives, the deployment of EHRs will be an important tool in the prevention and treatment of diseases for the community. The availability of EHRs will also prove invaluable in helping the decision-making processes of doctors, especially during emergency cases in which time is of the essence. Currently, there are 24 provinces implementing EHRs in Vietnam, of which 6 are officially considered as the 'piloting EHR provinces'. The 6 piloting provinces met in Hanoi on June 13-14 for a workshop to share their learning experiences and for further planning. “The EHRs will be the basis of a national health data system as each citizen from birth to death will be granted a social insurance code. The construction of medical identifiers based on social insurance codes almost never misses anyone, except for citizens who are born but for some reason, have no birth certificates,” said Associate Prof. Dr. Tran Quy Tuong, Director of the Information Technology Department, Ministry of Health, Vietnam. LONG TERM PLANS “In order to achieve the goal of 90% of the population being managed for health by 2025, the Ministry of Health is urgently working towards the implementation of EHRs,” said Deputy Health Minister Nguyen. The Health Ministry has already approved the application of IT at commune and ward health stations in the period of 2018-2020. The Ministry of Health has numerous policies based on the EHR and data and health information standards – more specific guidelines, especially those around interoperability, will be issued in the coming months. 

Severance Hospital, one of the oldest and biggest university hospitals in South Korea, has signed a Memorandum of Understanding (MoU) with Korean startup MediBloc to build a blockchain-based medical information platform.  Based on the MoU, MediBloc will build the medical information platform, an insurance claims billing platform and a medical data forgery detection system to facilitate the sharing of medical information via individuals. Severance Hospital plans to establish a certificate document issuance system and e-card issuance system for patients. Both parties will also cooperate actively by jointly utilising their facilities, human resources, and cooperation networks. THE LARGER TREND Last November, Korea’s Myongji Hospital signed an agreement with BICube to co-develop a blockchain-based medical information exchange. Both parties plan to commercialise the blockchain-based service by 2019. In December 2018, Massachusetts General Hospital in the US announced that it will be working with MediBloc on a three-year blockchain pilot to co-develop new methods for security and interoperability, with a focus on patient engagement. ON THE RECORD “We are delighted to build a patient-centred platform with MediBloc, which is leading the blockchain-based medical information platform,” said Lee Byung-seok, General Director, Severance Hospital in a statement. “By working with MediBloc, we will be able to provide personalised medicine and digital healthcare to patients at Severance Hospital through the establishment of an integrated medical information system.” “We will continue our comprehensive consultation for building a platform with Severance Hospital, which is recognised for its excellent medical team and service,” said Allen Kho, Co-CEO, MediBloc. 

KK Women’s and Children’s Hospital (KKH), the largest hospital specialising in healthcare for women and children in Singapore, has partnered with French multinational electric utility company ENGIE and end-to-end Internet of Things (IoT) solutions company UnaBiz on a smart facilities management project with digitisation of temperature and humidity monitoring using low-power sensors. WHAT’S THE IMPACT The project enables remote monitoring of temperature and humidity levels while providing a better patient experience and enabling timely intervention of anomalies. Over 100 temperature and humidity sensors by ENLESS WIRELESS have been deployed around KKH in areas such as the intensive care units, outpatient clinics, patient wards and pharmacies. Initial feedback from the Facilities Management (FM) Department was positive as their staff can quickly respond to the temperature alarm if the set point is exceeded. By deploying sensors to collect data of room temperature and humidity, KKH staff no longer have to maintain manual 24-hour daily temperature logs and can now avail more time to look after patients.  In addition, digital records are much faster, accurate and better for audit purposes. ON THE RECORD “As KKH’s facilities management partner, we strive to create and enhance the best possible environment for the well healing of patients. With the successful implementation of this innovative initiative to monitor the environmental conditions in near real-time and hassle-free, it is a progressive step for KKH in achieving their mission of being a healthcare leader for Women and Children,” said Yeo Kong Nee, Managing Director, ENGIE Services Singapore in a statement. Jonathan Tan, Managing Director, UnaBiz said, “We are especially pleased to support KKH with this pilot. The project is a great example of how IoT can be used to value add the way people perform their jobs.”

Following Northern Territory Department of Health’s announcement that it will soon become the first pathology provider to link the online test results it is sharing via My Health Record (MHR) with Lab Tests Online, South Australia (SA) Pathology, the statewide pathology provider for the public health sector, has also connected to the MHR. WHAT’S THE IMPACT SA Health patients will be able to conveniently access their pathology reports, and clinicians will be able to get pathology results faster. South Australians can now take any pathology request form to any SA Pathology collection centre and their report can be uploaded to their MHR, giving patients timely access to their pathology results. Having pathology results on an MHR brings about several benefits, such as being able to keep track of tests and know when they were carried out, the ability to monitor results over time and improved access to health information for clinicians and individuals. ON THE RECORD “This connection is a great development for SA Pathology and means our customers will now benefit from being able to access their pathology results through MHR. This also will benefit GPs who will be able to have up to date pathology information for their patients,” said SA Pathology Clinical Services Director Dr Tom Dodd in a statement. Dr Chris Moy, Adelaide General Practitioner and Clinical Reference Lead for the Australian Digital Health Agency, said, “As a GP who is often forced to waste valuable time chasing down pathology results, especially for a new patient, this will make my job easier and the patient's care safer. If that patient had their test carried out by SA Pathology, I will be able to view it immediately on MHR, even if it was ordered by another doctor and not addressed to me. This removes the need for the traditional but dreaded phone around to all the local labs to find these out.”