ASIA News

Counties Manukau Health/District Health Board (DHB) in New Zealand has gone live with electronic medication management in its emergency department, aged care facilities and medical wards. CM Health clinical sponsor and director of allied health Sanjoy Nand said MedChart electronic medication management was rolled out to inpatient services from April this year. The next stage of the project is to implement across surgical, with 80 per cent of these services due to be live with electronic medication management by the end of 2019. The DXC Technology system includes an electronic medication chart, ePrescribing, pharmacy review, decision support and medication administration. Counties Manukau conducted a pilot in some aged care wards last year in order to understand the training and device needs and how much support staff needed to go live with the electronic system. “We used that information, along with a benefits analysis, to get the business case to the board for roll-out to the rest of the organisation,” said Nand. The business case was approved at the end of 2018 and the DHB chose to implement first in ED, then across the rest of inpatient services, after discussions with other DHBs that have already gone live such as Southern, Canterbury and Waitematā. “Implementing MedChart aligns with our Healthy Together Services objective of improving the delivery of safer patient care achieved through a reduction in adverse drug events and prescribing errors,” he added. Starting in ED meant the team had to look closely at patient flows throughout the hospital. “One of the biggest challenges was making sure that whenever a patient comes in, we only move from electronic to paper once, so we’re not creating a mismatch by going from electronic to paper then back to electronic,” Nand explained. “We did a lot of work to make sure staff were aware when to use paper and when to use MedChart.” He said another key challenge is ensuring there are enough devices available for staff on the floor to ensure clinical workflow is not affected. The DHB plans to go live with MedChart in maternity in 2020. This article first appeared on eHealthNews.nz.

According to the CBSi B2B Cybersecurity Study, Asia Pacific 2018, one of the biggest challenges faced by an organisation’s cybersecurity framework is aligning cybersecurity with business priorities. Jega Ponnudurai, Industry General Manager, Healthcare & Life Sciences, Asia, DXC Technology, recommended that healthcare organisations tackle this challenge by linking the costs and benefits of cybersecurity to the value of regulatory compliance.  This is especially critical for certain segments which are more linked to patient safety and patient data confidentiality and calls for more investment on security frameworks within application parameters. These segments include clinical documentation, pharmacy and medication management, tests and investigations and critical care support systems. Ponnudurai, who has more than 25 years of experience in the telecommunication and healthcare industries, shares his insights on the cybersecurity threat and risk landscape in Asia Pacific.  Most common cybersecurity threats/risks to healthcare organisations in APAC Specific to healthcare organisations, issues like Electronic Medical Record (EMR) data leakage, especially sensitive operational (like billing disputes, patient dissatisfaction) and clinical (like sensitive diseases HIV/STD etc.) data with the purpose to malign private/public health settings or get hold of VIP patient data are some of the cybersecurity threats/risks these organisations face. However, Ponnudurai explained that they had not come across cases where a security threat on data leakage has ended in ransom demand but it could happen.  Network and workplace-related security threats are no different from those of other industries – these include ransomware, endpoint attacks, phishing and many others. Key lessons from a series of healthcare-related data breaches/leaks in Singapore Some of the key lessons learnt are the importance of having security, not only from the outside but also from within an organisation. There is also a need for independent cybersecurity auditors to be put in place and such audits to be carried out more frequently.  “Internet separation models and the design of data security zones is becoming more and more pertinent in terms of de-risking data in rest,” said Ponnudurai. There also needs to be a diligent scoping of cloud data assets and for cross-application landscapes, data security/accessibility should be governed/designed by information area at a corporate level, not at an individual application level.  From within an organisation, human (contractor or internal employee) inflicted local threats needs to be closely controlled and monitored. Blind spots in the management of cybersecurity threats/risks One of the areas/aspects that is usually overlooked by healthcare organisations in the management of cybersecurity threats/risks is application security in clinical applications. Most large healthcare organisations have a mesh of clinical and operational systems – Patient Administrative System (PAS), EMR, Finance, Billing, Ancillary systems for pharmacies/laboratories, Radiology Information System (RIS)/ Picture Archive and Communication System (PACS) etc. Often these systems need to exchange information – and security breaches are potent in a) data in motion, such as interfaces and message queues and more importantly b) context switching, such as accessing an application logic/data/screen from another application.  “A robust Development, Security and Operations (DevSecOps) Strategy should be imbibed early in the life-cycle for health application design,” Ponnudurai added. Managing increased cybersecurity threats with reduced budgets and lack of trained experts Chief Information Security Officers (CISOs) or Chief Information Officers (CIOs) are constrained by reduced budgets and lack of trained professionals to deal with the ever-increasing cybersecurity threats and incidents and Ponnudurai’s suggestion to tackle the issue is to study the impact of cybersecurity breaches, both from a financial and personal trauma (for the impacted parties) perspective. The concern of most healthcare providers about cybersecurity has resulted in their hesitation to venture into cloud-based services. This, in turn has a direct cost impact in the running of a healthcare service provider. Increasingly, cloud adoption should be backed up by cyber defense and orchestration strategies including intelligent security operations and continuous threat monitoring using a leveraged Security Operations Centre (SOC) model which reduces upfront capital expenditure (CapEx). This provides best-of-class protection at a spread out cash-flow, he concluded. For more information on DXC's security services and solutions, visit their website here.

Ping An Smart Healthcare (PASH), a subsidiary of the Ping An Group (Ping An) in China, has introduced AskBob, an artificial intelligence (AI)-based medical decision support tool, to Singapore through collaborations with SingHealth and the National University Health System (NUHS). AskBob, developed by Ping An, provides critical and up-to-date medical information to clinicians when dealing with patients at the point of care and for medical research and self-learning such as case discussions. WHY IT MATTERS At the point of care scenario, AskBob provides precise diagnosis and treatment recommendations for more than 1,500 diseases. Unlike other clinical decision support systems (CDSS), AskBob is a “knowledge + data” two-wheeled drive intelligent CDSS based on millions of anonymous patient medical records, clinical guidelines and a core medical knowledge graph covering tens of millions of medical data. The treatment recommendations AskBob provides are authoritative, personalised and patient-centric. For medical research and self-learning, AskBob makes use of Ping An’s leading medical knowledge graph and advanced natural language processing technologies (NLP) to perform more user-friendly, intuitive and precise online searches and literature analyses. AskBob can provide up-to-date literature analysis summaries and predict scientific research trends. It can also track the scholar team network in a certain research field to connect researchers around the world. COLLABORATIONS WITH SINGHEALTH AND NUHS The collaboration with SingHealth, one of Singapore’s largest public healthcare groups, started in April this year. It aims to provide doctors with personalised treatment recommendations for Type 2 diabetes patients at the point of care. Diabetes is a serious health issue in Singapore, with one in nine Singapore residents aged 18 to 69 having diabetes. AskBob’s recommendations can potentially help achieve better diabetes control and health outcomes, including reducing diabetic complications such as stroke and kidney failure. NUHS, an academic health sciences centre in Singapore, is piloting AskBob with clinicians for smart literature search and medical research trend analysis. ON THE RECORD “We are delighted to cooperate with SingHealth and the National University Health System. They are both authoritative healthcare institutions in Singapore,” said Dr. Xie Guotong, Chief Healthcare Scientist of Ping An Group in a statement. Dr. Bee Yong Mong, Head of the SingHealth Duke-NUS Diabetes Centre said: “An AI-based clinical decision support system could potentially help doctors increase the accuracy and efficiency of diabetes treatment. With the tool, we hope to better predict risks of complications and offer more personalised treatment recommendations to patients.” Prof. Ngiam Kee Yuan, Group Chief Technology Officer from NUHS, said: “More than a search engine, AskBob uses a medical knowledge graph and a natural language processing engine to empower precise literature analysis without giving you information that you don’t need. This is the power of using AskBob. I believe it will be extremely helpful for clinicians in medical research and case discussions.”

Chinese healthcare ecosystem platform Ping An Good Doctor has reached strategic cooperation with nearly 50 hospitals across China, including the Aviation General Hospital of China Medical University, Sichuan Second Traditional Chinese Medicine Hospital, and the Fourth Affiliated Hospital of Nanchang University, to jointly develop a new “internet hospital” model, the company recently announced. DEVELOPMENTS LEADING TO THE INTERNET HOSPITAL MODEL Since 2018, the Chinese State Council and the National Health Commission have issued policies such as the Opinions on Promoting the Development of “Internet + Healthcare” and Measures for the Administration of Internet Hospitals (for Trial Implementation), among other policies, pursuant to which, permission is granted for the development of internet hospitals by relying on medical institutions, application of internet technology for provision of safe and proper medical services, launch of online follow-up consultation for some common diseases and chronic diseases, and launch of online medication prescription for some common diseases and chronic diseases. As such, clear regulation and guidance have been provided with regard to the development of internet hospitals. Last month, the State Council issued the 2019 Major Task List on Deepening the Medical and Healthcare System Reform, which clearly indicates that the National Healthcare Security Administration shall by the end of September 2019 complete the drafting of the policy document regarding fees and charges of internet diagnosis and treatment and medical insurance payment. WHAT’S THE IMPACT The “Hospital Cloud” system of Ping An Good Doctor will be connected to the HIS system of cooperative hospitals to form the three-in-one internet hospital management platform featuring online diagnosis platform, prescription sharing platform and health management platform. This new “internet hospital” model can help hospitals resolve such problems as absence in outpatient appointments, overcome geographical constraints, and expand the scope of hospital service. In addition, internet hospitals will also serve as a data integration and sharing platform to facilitate information exchange and real-time sharing among entities, forming a full-fledged, closed-loop system combining online and offline medical services. THE LARGER TREND Since the start of this year, Ping An Good Doctor has been partnering with different companies such as China Everbright Bank and Wyeth to provide more value to their clients and to build their ecosystem outside of the traditional healthcare domain. Developing the internet hospital model with local hospitals has the enormous potential of reducing data/information silos – something that has plagued healthcare providers all over the world. The integration of healthcare data, if done correctly, will give both Ping An Good Doctor and the partner hospitals the opportunity to provide a better quality of care for patients/clients, particularly for those outside Tier 1 cities. ON THE RECORD “The uniform management platform to be developed by both parties could achieve a seamless connection between patients, hospitals, internet hospitals and supply chains, providing patients with integrated healthcare services such as online follow-up consultation, prescription circulation, drug delivery and chronic disease management, etc.” a Ping An Good Doctor spokesperson said in a statement.

Capital and Coast District Health Board (DHB) in New Zealand is piloting the Resident Guide app for onboarding junior doctors. The six-month pilot begins in mid-August and involves all resident medical officers (RMOs) at Wellington Hospital. Junior doctors are rotated around hospitals four times a year and need to quickly upskill on the way things are done at each new location, such as how to book tests and consults with other specialties. The cloud-based Resident Guide app provides access to a combination of local operational and clinical guidelines. 3DHBs (Capital & Coast, Hutt Valley and Wairarapa DHBs) chief clinical information officer Steve Earnshaw said the aim of introducing Resident Guide is to make access to essential information easier for RMOs to find and engage with. Earnshaw added that local information is already being loaded into the app and the August start date will provide time to fine tune and make improvements before the transition period in November when a new group of RMOs arrive. “Change-over is always a difficult time and this will help the new RMOs by providing them with everything they need to know on an app on their phone,” he said. MedApps co-chief executive Tom Collins said the regular movement of junior doctors is like starting a new job every few months. “The information is all site specific, so they have to start from scratch every time,” said Collins. “Resident Guide means that when you rotate you are not making mistakes and it’s a confidence builder for junior doctors who are trying to do the best for themselves and their patients.” The platform is already live at 28 facilities in Queensland, Australia, where it is also being used by nursing staff. This article first appeared on eHealthNews.nz.

Thailand’s population is ageing rapidly with almost half of its electorate above 50 years old by 2025. Healthcare costs are rising and it is not tenable in the long-run to keep building hospitals. One possible consideration for the country is the shift towards value-based healthcare (VBHC), which is about improving healthcare outcomes at lower cost. It focuses on what patients value and allocates resources according to the health outcomes delivered by the system, rather the traditional model of a volume or visit-based healthcare system. While VBHC sounds promising, the reality is that it is challenging to achieve as transforming a health system that is truly patient-centred and outcome based requires a lot of work. According to an article by the World Economic Forum, the transformation to a value-based health system requires:  - Sufficient technical expertise about VBHC to design and implement its core features. - Leaders committed to trying ideas and willing to accept the risks involved. - Cooperation among different organisations working together to improve outcomes for patients. The same article offers four key lessons for a successful switch to VBHC. Firstly, it is to focus on outcomes that matter to patients, rather than merely focusing on processes or costs. In the context of Thailand, this could mean bringing care to people especially in rural areas in which healthcare is not easily accessible. In that regard, Thailand has begun development of its telemedicine programme at 32 hospitals located in rural areas in eight provinces since March this year. Telemedicine services will be offered by the initial 32 hospitals as soon as by the fourth quarter of 2019. Another key lesson for a successful switch to VBHC is to engage partners from across the whole health system. In order to achieve meaningful system-wide change, transformation efforts have to include organisations from across the entire system, including the private sector. The unique advantage that Thailand has is its advanced development of the private healthcare sector, given the country’s reputation as a regional medical tourism hub. However, the challenge lies in how government institutions such as the Ministry of Public Health (MOPH) can meaningfully engage the private healthcare sector in moving towards VBHC. Next, stakeholders need to acknowledge that systems change is going to be hard, and they need to adopt a long-term perspective rather than looking only for “quick wins” or easy answers. eHealth is one of the tools that could be used towards achieving VBHC, and the MOPH has a long-term strategy to drive the growth and development of eHealth from 2017-2026. At its core, the aim is to develop a capable and interoperable health information system as well as digital health technologies to bring about value and improved standards of care. The last lesson is to take a problem-driven approach. In healthcare, it is often easy to ‘cut and paste’ solutions from other health systems but sometimes the answers or successful models may lie within. Telemedicine policies, for example, are still being studied in Thailand and the government is looking into more investments and getting the timing right to provide on-demand digital care to locals, expats and tourists, according to an article by Healthcare Asia.  With the theme of “Empowering Value Creation”, the upcoming HIMSS AsiaPac19 conference will be held in Bangkok, Thailand from October 7 to October 10 2019, featuring five main tracks: (i) Sustainability and growth (ii) Patient experience (iii) Unlocking the value of AI (iv) Value-based care (v) Health 2.0 Learn more about the HIMSS AsiaPac19 event here and those who are interested to speak or present at the event can sign up here. 

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.

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. 

Aged-care provider Ryman Healthcare in New Zealand has built its own electronic care planning system that runs on 3,500 tablets deployed in residents’ rooms across its residential aged-care villages. The myRyman application has removed paperwork for both care planning and rostering and improved staff and resident satisfaction. The $20+ million project has seen wi-fi deployed across all Ryman’s villages and the organisation’s IT team grow from three to 60 people since 2015, when work first started. Clinical nurse specialist Victoria Brevoort said myRyman directs the care delivered in a resident’s room. When a staff member logs into the tablet they are presented with a schedule of tasks that need to be completed that day, as well as information about the resident, such as their interests and family. “People know much more clearly what they have to do and when they have to do it and it’s more accountable because they have to complete the task in the system,” she said. “It has freed up our staff to spend more time with the residents, one on one. They can record what they talk about in the system, so we see the resident as a person, rather than a collection of tasks we need to do for them.” Ryman corporate affairs manager David King said the organisation’s audit results have significantly improved since implementing the system, as 81 per cent of its villages now have four-year accreditation. The technology project is also generating a wealth of data that is being mined for insights. “We’ve discovered a whole load of data that we’ve never had before, and it’s a gold mine because it provides a closed loop between tasks and clinical outcomes,” King added. A central dashboard of information allows Ryman’s business intelligence team to identify any anomalies quickly, such as a spike in falls, which can then be investigated. Differences in performance between villages can also be interrogated in order to improve performance across the network, he explained. Chief executive Gordon MacLeod said that “not only has it done what it set out to do – get rid of paperwork – but the data we’re collecting from it means we better understand care outcomes and allow us to lift our standards of care even higher’’. This article first appeared on eHealthNews.nz.