Dean Koh

Last week, Thailand began development of its telemedicine programme at 32 hospitals located in rural areas in eight provinces, according to an article by the Bangkok post. The eight provinces are Chiang Rai, Kamphaeng Phet, Kanchanaburi, Kalasin, Phetchabun, Surin, Songkhla and Surat Thani. The telemedicine programme is a joint effort of the Public Health Ministry and the National Broadcasting and Telecommunications Commission (NBTC). The integration and promotion of the use of appropriate digital technologies for telemedicine is also part of the Thailand 4.0 plan to increase access to healthcare with digital technologies, as stated in the eHealth Strategy by the Ministry of Public Health (2017-2026). A budget of 180 million baht has been allocated to purchase and install digital equipment for telemedicine in the initial phase, according to NBTC secretary-general Takorn Tantasith. The budget is part of the NBTC’s five-year funding for the operation of hospitals. Mr Takorn added that telemedicine services will be offered by the initial 32 hospitals by the fourth quarter of 2019. The programme will also focus on four main illnesses: high blood pressure, diabetes, heart disease and skin disease as they account for more than 70% of hospital cases. The initial 32 hospitals involved in the telemedicine programme consist of 15 subdistrict health-promoting hospitals, five community hospitals, eight provincial hospitals and four primary health clusters. Elsewhere in Thailand, the Khon Kaen Smart Health project, which was a winner under the Public Health and Social Services category for the 2018 IDC Smart City Asia Pacific Awards (SCAPA), saw a collaboration between local hospitals, businesses and academia with support from government agencies to provide better health services, especially for elderly residents with chronic conditions. Earlier this month, Samitivej Hospital Group, a private hospital brand in Thailand with a network of eight hospitals and owned by Bangkok Dusit Medical Services (BDMS), launched a one-stop Virtual Hospital app, which provides services such as teleconsultation and medicine delivery. The services of the Samitivej Virtual Hospital do not require appointments to be made in advance.

Cambridge-headquartered InterSystems today announced that MediWay Technology, a China-based healthcare software company, has built and deployed its new iMedical Cloud healthcare IT ecosystem platform using InterSystems IRIS for Health. IRIS for Health was launched in October 2018 and is built upon the InterSystems IRIS Data Platform (which was made generally available in February 2018), combines transaction processing and analytics with embedded interoperability to offer a fast development platform for building mission-critical applications at scale. Some of the IRIS for Health data platform’s features include: An application framework for rapid development of solutions using Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR), including FHIR Server and SMART on FHIR capabilities. Out–of-the-box support for every major U.S. and regional l healthcare interoperability standard and certification, including HL7 Versions 2 and 3, Consolidated CDA (C-CDA), integrating the Healthcare Enterprise (IHE), ASTM International, X12, NCPDP, DICOM, and others. A normalised and extensible healthcare data model that allows for seamless transitions between standards. Why it matters MediWay’s iMedical healthcare information system (HIS) is used by around 500 healthcare organisations, including more than 300 tertiary hospitals and 30 top-100 hospitals in China. To accelerate the digital transformation of healthcare, however, MediWay and its partner Tencent Cloud require higher levels of accessibility, scalability and interoperability. Two iMedical Cloud applications, available to all healthcare stakeholders hosted on Tencent Cloud, have been launched with two core functionalities – transactional cloud collaboration (Cloud HIS) and data cloud collaboration (HealthChain). iMedical Cloud can be used within a region for real-time healthcare information exchange, centralised management control and unified allocation of resources. IRIS for Health supports the vastly increased data volumes required with features like sharding. This distributes data across a number of cloud-based servers to provide flexible, inexpensive performance scaling. IRIS for Health’s support for cloud-first development using container technology also allows MediWay Technology to take full advantage of the strategic partnership between its parent company, DHC Software, and Tencent Cloud. This enables MediWay to continue to integrate technologies such as AI, blockchain, and speech input with its cloud-based healthcare solution. On the record “A cloud solution solves many pain points in healthcare,” said William Han, Chairman and CEO of MediWay Technology. “For example, it can provide a healthcare information system for county clinics, community healthcare centres and small-to-medium sized hospitals without the need for computer rooms, local servers or maintenance staff. By supporting our strategic pivot, InterSystems and its IRIS for Health technology have yet again shown the true partnership we’ve come to expect after 20 years of collaboration.”

The Health Sciences Authority (HSA), a statutory board under the Ministry of Health (MOH) in Singapore, said in a statement on March 15 that one of its vendors, Secur Solutions Group Pte Ltd (SSG), had failed to properly secure a HSA database against access over the Internet. The database contained registration-related information of 808,201 blood donors which includes name, NRIC number, number of blood donations, dates of the last three blood donations and in some instances, blood type, height and weight. According to the HSA, the database did not contain any other sensitive, medical or contact information. A cybersecurity expert discovered the vulnerability on March 12 and alerted the Personal Data Protection Commission (PDPC) on the next day - HSA worked with SSG immediately to disable assess to the database. A police report has also been made by HSA and is in contact with the expert on deleting the information. Investigations are pending and preliminary findings indicate that other than the cybersecurity expert who raised the alert, there were no other unauthorised access to the database. The information provided to SSG was placed on an unsecured database in an internet-facing server on January 4 this year and the vendor did not put in place adequate safeguards to prevent unauthorised access. “We sincerely apologise to our blood donors for this lapse by our vendor. We would like to assure donors that HSA's centralised blood bank system is not affected. HSA will also step up checks and monitoring of our vendors to ensure the safe and proper use of blood donor information,” said Dr Mimi Choong, CEO of HSA in a statement. Including this latest case as reported by HSA, the Minstry had experienced four IT-related incidents since the SingHealth cyberattack which happened from June to July 2018. The other two incidents occured in January 2019 in which the confidential information of 14,200 HIV-positive individuals were leaked and last month, MOH said that a computer error had resulted in 7700 people receiving inaccurate CHAS healthcare subsidies.

Last month, Indonesia’s Ministry of Health (MOH) announced the launch of their Sehatpedia app to facilitate the public’s access to health information. The app (currently only available on Android platforms) has an interactive consultation (live chat) feature and provides access to health articles, medical journals and health policies. Users can also register for outpatient appointments through the app but this is only limited to hospitals under the MOH. With the live chat feature, the public can consult doctors on health information needs such as disease complaints, health tips, and other medical consultations. “Sehatpedia can be accessed by all Indonesian people. Physicians from 32 vertical hospitals of the MOH will respond to the consultation queries,” said Secretary of the Directorate General of Health Services, Dr. Agus Hadian Rahim, Sp.OT (K), M.Epid, MH. Kes. In terms of the content for health articles, Sehatpedia is assisted by three communities: Health for Junior Indonesia (Kejora), which produces health articles relevant for young children, GARASI KITA community, and the FKG UI Teaching Staff Association. According to the MOH, about 8000 people have downloaded the app as of mid-February 2019.

The Belt and Road Initiative (BRI), also known as One Belt, One Road, is the Chinese government’s development strategy that was introduced in 2013 to build ties along the overland Silk Road Economic Belt and the naval trading route known as the 21st Century Maritime Silk Road. Although health is not at the core of the initiative, Ruwei Hu and his colleagues at the Sun Yat-sen University in Guangzhou and from the University of Utah in Salt Lake City, US, state that the BRI provides a common platform for regional public health emergencies through epidemic information sharing, exchange of preventive and interventional methods, and training health professionals. In China, there are both start-ups and big companies (including jianke.com, a Chinese B2C internet drug company, see featured image) looking to expand their knowledge and expertise in healthcare through internationalisation and collaboration with foreign companies, making the country a potential global innovator in healthcare, which is the theme of the latest HIMSS Insights eBook. The full article on China’s digital health Silk Road project can be found here.

Samitivej Hospital Group, a private hospital brand in Thailand with a network of eight hospitals and owned by Bangkok Dusit Medical Services (BDMS), recently announced the launch of its one-stop Virtual Hospital app, offering three key services: Teleconsultation – a remote telemedicine consultation service that provides round-the-clock medical advice via a video call with Samitivej’s doctors and nurses. Test@Home – patients can have their blood samples taken in the comfort of their home and blood samples will be sent to the laboratory immediately. Medicine Delivery – medication will be delivered to patients with absolute data security as Samitivej adheres to the data protection standards mandated by the Health Insurance Portability and Accountability Act (HIPAA). Samitivej Virtual Hospital will be available on April 1, 2019, with services 24 hours a day, seven days a week. The consultation fee is 500 baht (approx. US$15.78) per 15 minutes, and patients using the service will receive a 20% discount on medications. In addition, the services of the Samitivej Virtual Hospital do not require appointments to be made in advance. Samitivej Hospital Group teamed up with six leading companies to launch the virtual hospital services: Advanced Info Service, Line Thailand, Muang Thai Life Assurance, Siam Commercial Bank, Sansiri and SCG Cement-Building. There is also a Samitivej Virtual Hospital control room (see featured image) located at Samitivej Srinakarin Hospital that has been designed with the specific purpose of enhancing the Samitivej Virtual Hospital experience. “A significant challenge in today’s healthcare industry is to move beyond digital disruption and service providers need to keep up with trends, innovate and develop new service models to continuously meet the needs of consumers in all sectors,” said Chairat Panthuraamphorn, Managing Director and Chief Executive of Samitivej Hospitals and BNH Hospital, in a statement. There are also plans to expand the Virtual Hospital service to BNH Hospital in the future, he added. Last month, BC Platforms announced that it will be providing its genomics platform to Bumrungrad International Hospital, a private multiple-specialty medical centre founded 1980 in Bangkok. In January this year, the Thai government added medicine, medical supplies and medical services to its price control lists. While there has been outcry from the private hospital industry that the price controls would adversely affect Thailand’s reputation as a medical tourism hub, the effects of the price controls remain to be seen.

According to a blogpost by Symantec, the cybersecurity company’s researchers has identified Whitefly as the hacker group behind what is known as Singapore’s worst case of cyber breach, with more than 1.5 patient million records being stolen over a period of June-July 2018. The post said that Whitefly has been operating since at least 2017 and has targeted organisations primarily based in Singapore across a wide variety of sectors with the intention of stealing large amounts of sensitive information. To date, Whitefly has attacked organisations in the healthcare, media, telecommunications, and engineering sectors. The hacker group compromises its victims using custom malware alongside open-source hacking tools and living off the land tactics, such as malicious PowerShell scripts. As described in the findings of the SingHealth COI report published earlier in January this year, “the attacker was a skilled and sophisticated actor bearing the characteristics of an Advanced Persistent Threat group” and this corroborates with what the blogpost wrote: “Whitefly usually attempts to remain within a targeted organisation for long periods of time—often months—in order to steal large volumes of information. It keeps the compromise alive by deploying a number of tools that facilitate communication between the attackers and infected computers.” In addition, it appears that the SingHealth breach was not a one-off attack and was instead part of a wider pattern of attacks against organisations in the region. There were also more technical details on the malware and methods used by Whitefly revealed in the blogpost- these include Trojan.Vcrodat, Hacktool.Mikikatz and Trojan.Nibatad. The Singapore government said in January that it was able to identify the hackers behind the SingHealth incident but had declined to reveal the identity of the perpetrators in the interest of “national security”.

"Cultivating medical talent requires the joint efforts from departments of education, health, finance and development and reform," said Fang Laiying, VP of the Chinese Hospital Association.

Hong Kong’s Food and Health Bureau (FHB) announced on March 1, 2019 the establishment of the Primary Healthcare Office (PHO) to oversee and steer the development of primary healthcare services at the bureau level. “It is high time for us to actively promote primary healthcare services to change the present treatment-oriented healthcare system. The PHO will focus on the development of District Health Centres (DHCs) as a new model to leverage on public-private partnership and medical-social collaboration in providing primary healthcare service, to cater for the needs and characteristics of the districts and enhance public awareness of healthy living, disease prevention and self-management of health,” said a spokesperson for the FHB. The first DHC in Kwai Tsing is expected to start operation around the third quarter of this year. With the experience gained from the first DHC, the PHO will plan and set up DHCs in all 18 districts progressively. “The PHO will be responsible for monitoring the performance of DHC operators and driving DHC service development based on evidence and data as well as developing standards. It is also tasked to review the role of different key service providers in primary healthcare and to enhance cross-sectoral and inter-organisational co-ordination, as well as to oversee development and promotion strategies on primary healthcare,” the spokesperson added. Origins of the Primary Healthcare Office In her 2017 Policy Address, Chief Executive Carrie Lam said that the government “will set up a committee on primary healthcare development and its work will include drawing up a model for district-based medical-social collaboration, using big data to identify areas of medical services.” She also mentioned in the same address that the FHB should set up a DHC with a brand new operation mode in Kwai Tsing District within two years. In November 2017, the FHB established the Steering Committee on Primary Healthcare Development to formulate the development strategy and devise a blueprint for primary healthcare services. It also established the Working Group on DHC Pilot Project in Kwai Tsing District, to provide advice on the planning, implementation and evaluation of the DHC pilot project. The launch of the DHCs will likely alleviate the manpower and capacity crunch of Hong Kong’s public hospitals, which often operate beyond capacity during winter periods and patients have to endure with long lines and waiting times.

Yesterday, Icon Group (Icon), Australia’s largest dedicated private provider of cancer care, officially signed an agreement with China’s Sanbo Brain Hospital Group (Sanbo) to deliver radiation oncology services, which are set to open later this year in their Chang’an hospital in Chongqing. Sanbo is a group of Chinese hospitals internationally recognised for delivering specialist neurological services, including treatments for brain cancer. The group operates six brain hospitals in Beijing, Chongqing, Kunming, Fuzhou and Jinan. The agreement will see Icon operate the Chang’an Chongqing centre, with the site already in initial stages of development. Why it matters Icon will manage the facility in partnership with Sanbo, embedding a blend of international expertise to deliver a high-quality approach to cancer care. The centre will have the capacity to treat 900 patients annually. Through the partnership, Icon will be sharing their expertise in radiation therapy, including remote radiation therapy planning with Sanbo. Icon’s centralised remote planning function, performed by a specialist, highly-skilled workforce of radiation therapists, uses advanced software systems to create individual, high-quality radiation therapy treatment plans for patients regardless of location. What’s the trend In June 2016, Icon signed a joint venture with China-based Yibai Healthcare to provide world-class radiation therapy services to 50 cancer centres across China. Yibai Healthcare is part of the Shanghai-listed GuiZhou YiBai Pharmaceutical company which engages in the research, development, production, and sale of pharmaceutical products in China. The joint venture saw the launch of Icon’s newest arm – Icon Plan. Icon Plan is a centralised, remote radiation therapy dosimetry function for radiation oncology. Dosimetry involves data obtained during the planning consultation with a radiation oncology patient and uses that data to plan how the machine will target and deliver radiation to the tumour. On the record “The collaboration with Icon Group will increase Sanbo’s capacity in radiation therapy and chemotherapy, improve comprehensive cancer treatment, and provide an exceptional service to patients,” said Yang Zhang, General Manager of Sanbo. Icon Group CEO, Mark Middleton said, “Cancer incidence in China alone are expected to increase by 70% by 2025, we are dedicated to helping reduce that burden. Icon is the first Australian healthcare company to export Australian cancer expertise into China, further providing training and education for local clinicians and staff and helping China deliver the best possible care to their people.”