Roy Chiang

As part of the slew of improvements that the National Electronic Health Record (NEHR) will receive, more healthcare institutions within the country will also be brought on board to contribute to the NEHR. Majority of these security enhancements and upgrades will be expected to be completed by the end of this year. This involves both technical and process enhancements as well as a thorough external review which will be conducted independently. The contribution of patients’ electronic health records to the NEHR will also be mandated in the future. Such measures have been implemented following an unprecedented cyber-attack on SingHealth’s IT system. In light of the COVID-19 pandemic which has escalated globally, the upgrades of the NEHR system will also enable it to meet the requirements for COVID-19 vaccination display, reporting and alerts as well. Healthcare experts will also be able to have easy access to their patients’ COVID-19 test results as well as their existing medical conditions prior to the vaccination via the NEHR. THE LARGER TREND Cybersecurity statistics have indicated that there has been a huge increase in the number of occurrences of hacking as well as breached data from sources such as mobile devices as well as IoT devices which are becoming increasingly common in medical facilities.  A reported 68% of business leaders have also expressed their opinions that cybersecurity risks are increasing. As such, it is imperative for healthcare organizations to ramp up their efforts to strengthen their technical as well as security infrastructure within their systems in order to ensure that the sensitive healthcare data of patients remains secure.  ON THE RECORD “Data security remains a key priority” Dr. Puthucheary, the Senior Minister of State explained and that the NEHR system has also been a “key enabler” in facilitating the provision of medical care during this pandemic by serving as a repository of patients’ medical records.

HealthCerts, an amalgamation of cryptographic hashes, blockchain technology, privacy protection and proof identity, is a set of open-source digital standards which is utilised for the issuing of digital COVID-19 test result certificates. Developed jointly by the Government Technology Agency of Singapore (GovTech) and the Ministry of Health (MOH), this new standard will help facilitate and hasten the clearing of travellers at immigration checkpoints both locally and internationally. HOW IT WORKS From March 10 onwards, travellers who go through a pre-departure COVID-19 test at selected authorised clinics in Singapore will receive their results digitally in the form of a certificate that is automatically loaded into HealthCerts. This can be manifested in the form of an attachment or URL link to the digital certificate. Subsequently, these travellers will have to upload their digital certificate to a separate website called Notarise. This website enables locally-issued certificates to be formally endorsed by the MOH so that they can be recognised at Singapore’s Changi Airport as well as foreign airports.  Upon successful completion of this process, travellers will receive another digital pre-departure test certificate containing a QR code via email and/or the SingPass mobile application. Every local in Singapore has a SingPass which stands for Singapore Personal Access and is the digital identity of every Singaporean, allowing each Singaporean to gain secure access to a plethora of government and private sector services both online and in person. Upon reaching the immigration checkpoint at airports, travellers can then present the notarized certificate displaying the QR code either in a hard copy format or as a digital copy for verification purposes. By utilising the platform Verify, airline crew and immigration authorities will be able to check on the authenticity of the digital certificate simply by scanning the QR code. The in-built system within the platform can then determine if the certificate was tampered with or notarised by the MOH. THE LARGER TREND In the wake of COVID-19, countries all around the globe have tightened healthcare measures at their borders, requiring passengers to provide proof of a negative COVID-19 test or in some cases, a COVID-19 vaccination record took prior to the flight before being allowed to board the plane. However, in certain countries in Europe, such as Brazil, France and the UK, there has been a sharp rise in the number of fake COVID-19 certificates available on the black market. This undermines the efforts of governments to put a tight rein on healthcare checks in an effort to mitigate the spread of the disease. As such, it is inevitable that digital systems such as HealthCerts would become increasingly popular over time as globally, governments would seek out ways to eradicate such issues and eventually be able to safely open up air travel once more. ON THE RECORD GovTech mentioned that it has  “open-sourced the HealthCerts schema, and the code for the issuance, verification, certificate storage and display modules, which facilitates wider adoption by private sector companies or other governments”, allowing for other countries to adopt similar systems.  “Only this hash is needed to check the authenticity and validity of the digital certificate” Smart Nation and Digital Government Group added, emphasizing that the individual’s data will remain secure as only a hash which will serve as a digital fingerprint is published to the blockchain once it is issued.  

In this trial run, Air New Zealand airlines will require passengers to utilise the International Air Transport Association’s (IATA) Travel Pass application to prove that they have been vaccinated against the COVID-19 virus before they are allowed to board the plane and continue with their journey. This will aid in the facilitation of clearance for travellers at border health checkpoints in both New Zealand and Australia.    HOW IT WORKS The Travel Pass smartphone app will provide passengers with updated information about the tests and vaccines which they need to receive before being granted entry to their destination. This streamlines the health verification process by informing customers of the steps needed to take their next international trip safely. When an individual is inoculated, the medical centre securely sends the information to the smartphone application which can then be cross-checked against the vaccination requirements for the country which the individual is trying to enter. Subsequently, based on the passenger’s travel itinerary, the application sends an “Ok to travel” notification to inform both the airlines and immigration authorities that they meet the country’s COVID-19 health requirements. This health information is kept confidential and secure as the customer would have to grant permission prior to the sharing of this information with the airlines company or border control. THE LARGER TREND Similar health passport systems have already been developed in several other countries around the globe. For instance, Immunitee, a health passport system has also received approval in Singapore and will allow Malaysian tourists entry into Singapore once they have been verified and cleared via the digital platform.  With this, it is likely that other nations around the world would also gradually introduce plans to develop similar digital vaccine passport systems to ensure that they maintain a tight rein on the health checks at their borders whilst being able to welcome travellers into their country. Such systems would likely proliferate globally as governments would also be eager to welcome visitors into their respective countries in order to revitalise their damaged tourism industry.   ON THE RECORD Australia’s Department of Health released a statement announcing that “The Australian government is supportive of ways to ensure the safety of the Australian community through the efficient collection and verification of traveller data whilst adhering to strict privacy provisions.” “Reassuring customers that travel is, in fact, safe is one of our priorities. By using the app, customers can have confidence that everyone onboard meets the same government health requirements they do” Air New Zealand’s chief digital officer, Jennifer Sepull explained.  

The vaccine which was developed by Chulalongkorn University showed promising results in prior trials with mice and monkeys. The University’s Centre of Excellence in Vaccine Research and Development is utilizing new mRNA technology and its clinical testing on transgenic mice showed that the vaccine was able to prevent clinical symptoms and viremia after two shots. The university is looking to enroll 72 participants in the first phase of the human trials and subsequently increase the number to 300-600 participants in the second phase. The university has also begun research on a second-generation vaccine that will help grant additional protection to its citizens against the UK and South African variants of the COVID-19 virus. Why it matters The impact of COVID-19 has been both far-reaching and devastating, causing numerous economic and social issues. The number of undernourished individuals is estimated to be at a staggering 690 million and could even rise to 132 million by the end of the year. Both business owners, as well as global corporations, have also had to bear the brunt of this pandemic and suffered tremendous losses, with most of them being unable to carry out their usual operations. Many others are also living on tethers, with an estimated 3.3 billion of the global workforce at risk of losing their jobs. The border closures and confinement measures put in place to mitigate the spread of the virus have prevented farmers from harvesting crops and selling their produce, thus disrupting the global food supply chain and making safe, healthy diets more inaccessible. As food security is threatened globally and individuals are losing their earning power, those living in less developed nations are hit the hardest, especially those marginalized populations.  Many other countries are also seeking to develop a vaccine for COVID-19. After successfully inoculating entire Thailand, the government could potentially provide international aid by importing the vaccine to other countries.  The larger trend  As of 22 February 2021, there are currently 112,100,856 confirmed COVID-19 cases and 2,480,686 deaths. However, there is still light at the end of the tunnel as the number of newly diagnosed COVID-19 cases has declined by 16 percent worldwide over the past week despite having more virulent strains of the virus break out in multiple regions. Additionally, the number of global deaths over the past week has also shown a reduction by 10 percent.  On the record “The two-dose vaccine will be administered three weeks apart and will be enlisted for a rolling review with the Thai drug regulator,” Kiat Ruxrungtham, head researcher at Chulalongkorn University’s Centre of Excellence in Vaccine Research and Development stated.  “By year-end we should have a production capacity of 1 to 5 million doses annually,” Kiat added, hinting that this number could later rise to about 20 million doses per year.

Ascom is a global technological solutions provider which specialises in healthcare information communication technology and mobile workflow systems. Ascom Telligence is a Patient Response System that is a modular, scalable patient response system that elevates the call of nurses, allowing them to provide unprecedented patient-centric care. With this system in place, healthcare professionals can now be equipped with the patient’s medical information throughout the entire care process. Built on the Ascom Healthcare Platform that collects information from multiple sources, it integrates seamlessly with the healthcare facility’s current devices and applications. This provides clinicians with a more comprehensive view of the patient’s existing status as compared to that of a traditional nurse call. As such, caregivers are better informed when responding to patient requests, leading to better patient outcomes. Ascom Telligence also possesses other unique features such as an In-Room Presence Automatic Capture and Nurse Rounding Recognition that would help streamline workflow and increase operational efficiency within the organisation.  THE LARGER TREND The global nurse call system is projected to rise from USD1.7 billion in 2020 to USD 2.7 billion by 2025, driven primarily by factors such as the growing ease of communication around the world, the increasingly diverse applications available in nurse call systems as well as their technological advancements. The COVID-19 pandemic has also caused a huge disruption in the healthcare systems globally with hospitals being overwhelmed with patients as well as an increasing need for a better communication system between healthcare facilities both locally and internationally. This has served as an impetus for the creation of an all-encompassing infrastructure that also facilitates communication between nurses and patients.  ON THE RECORD “We're introducing Ascom Telligence, which has a history as a market-leading brand in North America, Asia, and the Middle East. The Ascom Telligence Nurse Call system will define workflows in a new way by providing easy access to relevant information at the point of care, so patient needs are handled promptly”, said David Williams, Country Manager, Ascom Australia.   

For digital health services to work well, building community confidence in its usage through extensive testing is essential.

In this eighth episode of HIMSS Australia Digital Dialogue Series hosted by Tim Kelsey Senior Vice President of HIMSS Analytics International and guest speakers-  Steve Hambleton (Deputy Chair of the Primary Healthcare Reform Steering Committee and Adjunct Professor), Martin Bowles AO PSM (National Chief Executive Officer, Cavalry Health Care), Dr Louise Schaper (Chief Executive, Australasian Institute of Digital Health) and Prof Mary Foley (Managing Director, Telstra Health) share more about the implications which COVID-19 has had on digital health as well as the obstacles encountered whilst implementing telehealth across Australia. DIGITAL CHALLENGES FACED BY AUSTRALIA DURING THIS PANDEMIC Healthcare in Australia, as compared to other industries has taken a much longer time to digitalize. Hambleton referred to this phenomenon as “clinical inertia” within Australia and added that, “we certainly get things set up things in a way which we like to practice and it is very difficult to move from there unless there is a burning platform.”   As such, there is a need to deduce what the various drivers are in order to remove this inertia. This includes funding which is currently lacking in the healthcare industry in Australia as well as the ease of access and usability of new technology. Healthcare providers often have to rely on software providers to make it seamless and ease their transition into telehealth.  In addition, in order to reap the best possible results from telehealth, there is a need for video conferencing between patients and healthcare providers. However, majority of such telehealth interactions are over the telephone and this results in connections between the parties which are not as rich a communication vehicle as compared to video. There is also a need to make such digital opportunities accessible and user-friendly for the elderly in Australia.  Hambleton said, “Australia has the second highest penetration of smartphones around the world and that we need to use those tools to connect with our patients.” With telehealth, it is now easier for patients to have a consultation with their healthcare professionals with e-prescribing services.  A token can be generated which patients transit to a pharmacist and subsequently, the medicine can be delivered straight to the patient’s home.  HOW AUSTRALIA CAN BETTER MANAGE THE EFFECTS OF THIS PANDEMIC “Manage the pandemic as a business continuity issue. Put clear leadership in place and make sure that we use the structures around that to manage the crisis,” Bowles added. Businesses who were unable to transform their operations or business models into a digital model inevitably suffered during this pandemic. “Telehealth will enable virtual care”, he explained as “we have to be strategic and use digital technologies to enable us to actually meet the needs of consumers and healthcare professionals within the country.” Dr Schaper elaborated that in Australia, they were able to achieve ten years’ worth of innovation within ten days as “We (they) were motivated by improved patient outcomes .and improved working conditions for clinicians”. She further commented that there should be a shift towards “not just models of care that are very different but also outcome- based workforce redesign” and making sure that the infrastructure as well as the training and specialist workforce are all in place in order to fully support this version of healthcare.  Agile teams were swiftly developed and worked together to develop new software in order to accommodate the swift technological changes in the healthcare landscape as well as provide digital services all around the country. “Major digital implementations were deferred because whole workforces, administrative and clinical in both public and private hospitals sectors had to completely remobilise and therefore the sort of engagement and change management and need for strong digital implementation of core systems was not in ideal circumstances,” Prof Foley said.  Quick fixes were quickly developed by the healthcare providers to mitigate these limitations and software developers worked tirelessly around the clock on shifts to accelerate and rethink design of healthcare technology around policies developed by the government.   

In the seventh episode of HIMSS Australia Digital Dialogue Series hosted by Tim Kelsey Senior Vice President of HIMSS Analytics International and guest speakers- Dr Zoran Bolevich (Chief Executive of eHealth NSW), Emma Hossack (CEO of Medical Software Industry Association & Director of Australia Digital Health Agency), George Margelis ( Independent Chair of Aged Care Industry Information Technology Council), Kate Quirke (Chief Executive Officer and Managing Director , Alcidion) and David Williams (Country Manager of Ascom Australia) discussed New South Wales’ transformation of their healthcare landscape through their three pronged framework to embed, accelerate as well as innovate through insights derived from data driven approaches. SALIENT LESSONS GATHERED FROM THE COVID-19 PANDEMIC “We have seen a significant shift in societal expectations and consumer expectations as a result of this pandemic,” Dr Bolevich stated. Fortunately during this outbreak, there was an increased acceptance and adoption of telehealth services amongst consumers within the New South Wales as they realized that it was not only a necessity in such trying times but also a convenient way to access healthcare services. This further motivated clinicians and healthcare providers to utilize digital healthcare tools to provide their services via online means in numerous healthcare fields, ranging from pediatrics to rehabilitation and chronic disease management. The implementation of digital health in New South Wales was also a result of the collaborative effort between the healthcare facilities and the government as well as the various other industries. Hossack added, “We need to have everyone involved, not just the sick people. We also need the clinicians, the consumers and every part of the community involved in this.” The Australian government introduced a new project in New South Wales which centered around e-prescribing. This involved a joint partnership between the government and all of the dispensing software systems, prescribing software services as well as the digital health agencies.  HEALTHCARE ISSUES BROUGHT TO LIGHT AMIDST THIS CLIMATE “One thing COVID has done is highlight the challenges associated with delivering care to the aged community in Australia’’, Margelis pointed out. There is a lack of coordination and integration within the various facets of healthcare delivery within the country especially when it comes to the delivery of such services to the elderly. Access to the medical information of some of these elderly patients is sometimes close to impossible to retrieve as these medical records can date back to 80 years ago. As such, this serves as an impediment to the development of new drugs or vaccines that can be catered specifically to the elderly.  ENABLING THE DELIVERY OF DIGITAL HEALTHCARE SERVICES Alcidion brought forth their cutting-edge resources to help ensure the smooth monitoring and delivery of healthcare services to patients inflicted with COVID-19. Through the use of an arm-band and their mobile devices with the EMR application installed, healthcare professionals were able to provide healthcare support to patients situated in healthcare facilities as well as those held in isolation in their homes.  Quirke explained that they managed to do this through the “use of their mobile device to access the EMR data which was extremely positive of infection control as there were no shared keyboards and they could get the data on their phones.” She added that “the next thing we (they) did was to move to using the platform to create a dashboard to monitor COVID positive patients both within the hospital and at home.”  This live data of the patients was displayed alongside any pre-existing/chronic information about the patient to create a longitudinal record which was critical to enabling the delivery of comprehensive virtual care.  Williams further elucidated on the role which Ascom had played in enabling the digital transformation of healthcare in Australia: “Ascom plays a very important part in the enablement of elements of the digital transformation” through its “ability to deliver rapidly in the current COVID pandemic.” It provides a connectivity solution across the disparate landscape of structured, unstructured and formatted data through multiple different interfaces.  The data is then extrapolated and orchestrated into a meaningful and actionable fashion so that healthcare caregivers are enabled. Ascom strives to support healthcare facilities and provide them with the best mix of technology to enable them to provide the necessary healthcare responses at rapid speeds.   

At the HIMSS APAC Malaysia Digital Health Summit session titled “Digital Health - From Innovation to Adoption” by guest speakers Wilson Choo (Chief Executive Officer of Sunway Medical Centre Velocity) and Dr Ng Xin Jun (Manager of Sunway Group Healthcare), both shed light on the various technological healthcare advancements made at Sunway Medical Centre Velocity (SMCV) as a case study. At SMCV, an integration project between its patients’ monitoring devices and electronic medical record was developed in order to achieve a seamless and wireless transfer of patients’ vital signs with “Early Warning Scores”.  A key feature of the new implemented EMR at SMCV is its Computerized Physician Order Entry (CPOE) which allows doctors to order medicine or laboratory/ radiology services via the system whilst being able to check the status of these orders. Similarly, nurses would also be able to key in their orders for medication as well as the respective procedures which they have carried out on each patient.   Clinical Decision Support is another feature embedded within the EMR which allows healthcare providers to gain access to the drug allergies as well as medications administered to patients. This results in better healthcare decisions and effectively prevents any medication errors. A system aptly named “Early Warning Score” was developed for scoring the physiological measurements of patients and routinely recorded at the patient’s bedside. Its purpose was to allow for early identification of acutely ill patients and recorded information such as a patient’s temperature, systolic blood pressure and urine output. A key success factor underlying the success of this integration project was due to the efforts of a governance committee. Frequent meetings were held every month to discuss any ambiguities or to resolve any issues within the system. Priority was given to resolve issues pertaining to patient safety and system enhancements. Relevant key stakeholders such as management personnel or members of the clinical team and vendors were brought into these meetings whenever necessary. Digitalization and innovation was also amalgamated within the hospital’s daily operations as well. Sunway Medical Centre was one of the earliest companies who adopted tele-consultation during Malaysia’s Movement Control Order (MCO) period (a form of countrywide lockdown due to COVID-19), which allowed patients to continue to consult doctors even when they were at home. A patient portal was also developed which facilitated the booking of appointments and retrieval of radiology results online.  Patients were also encouraged to download the hospital app on their mobile devices which allowed them to check the queues at the hospital to reduce their waiting times at the medical facility. Insurance integration is also in the works, which will enable patients to make electronic payment, billing and payment integration with major insurers. This will also provide greater transparency to patients as they will also be able to track the status of their insurance applications. A long term direction for the hospital was also put in place with plans to include progressive initiatives to make crucial patient information more accessible and timely, even allowing doctors to have real time visibility of vital signs on their mobile devices.

The COVID-19 global crisis has undoubtedly brought about huge changes in healthcare systems all over the world. One of the major impacts which it had would be its role in serving as an impetus to accelerate the digital transformation of healthcare globally. At the HIMSS APAC Malaysia Digital Health Summit session titled “Accelerating the Digital Transformation of Healthcare” hosted by Tim Kelsey (Senior Vice President HIMSS Analytics International), Christian Besler (Chief Digital Officer of Ayala Health Philippines) and Dr Fazilah Shaik Allaudin (Senior Deputy Director of Ministry of Health Malaysia), the panelists discuss the various approaches which the Philippines and Malaysia have taken to continue providing online healthcare services to their citizens amidst this global crisis. Steps taken by the respective governments In the Philippines, a huge amount of emphasis was placed on corporate health. This was done in a bid to help employees detect and effectively manage chronic diseases at an early stage which would in turn help to greatly reduce medical insurance costs that will be borne by employers eventually. Primary care clinics were built within large corporations themselves, greatly facilitating employees’ visits to the clinics. With the onset of COVID-19, doctors were open-minded and fast thinking which allowed for the smooth and swift transition to telehealth. With this continued provision of medical services to employees, they could continue working from the safety of their homes whilst receiving the appropriate medical assistance.  Similarly, Malaysia was able to quickly put together a COVID-19 digital response with 6 main focus areas: Strategic Risk and Communication Community Engagement Operational Efficiency  Insights and Foresights Infrastructure and Upgrade Research and Clinical Trials  Mainstream media coupled with social media were the key online platforms which were utilised to provide constant updates about new cases or any cluster outbreaks within the country. Contact tracing applications such as “MySejahtra” and “MyTrace” were set up using a QR code digital log system. Each store/restaurant would have a unique QR code which stores the phone number of each individual entering when the user scans the code. In the event that someone who enters the store gets positively diagnosed with the virus, this information can then be promptly disseminated to other visitors of the store and appropriate quarantine actions meted out if necessary. Virtual clinics and electronic appointments were also made readily available to the public so they can continue to receive the required healthcare services even from their homes.  Numerous operational systems were also deployed in order to manage the sudden influx of infected patients. Queue management systems and facility based systems were set up to aid in crowd control and enforce social distancing measures, effectively mitigating further spread of the virus. eCOVID19, a data collection system comprising of analytical tools and various dashboards served to help monitor new COVID-19 cases and changes on the ground which paved the way for better government decision making in their policies. On the record “COVID actually made us realise that a proper data collection tool/system is very important” said Dr Fazilah Shaik Allaudin. She postulates that Malaysia should continue to strengthen  redesign the healthcare systems as well as enhance digital technology and innovation in healthcare even with the passing of COVID-19. All these, coupled with the collaboration and coordination of the various sectors of the country will be sufficient to help “revitalize the Malaysian economy which was badly impacted by COVID-19”. To gain access to the on-demand video of the keynote dialogue, please email Evelyn.Wee@himss.org.