ASIA News

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.”

MidCentral District Health Board (DHB) has published one of New Zealand’s first district-wide digital health strategies. Called Te Awa, the five-year strategy is collectively endorsed by the DHB, Central PHO, Manawhenua Hauora, the Clinical Council and the Consumer Council in the region and was developed after extensive district engagement and consultation. An introductory message says that developing and using digital technology “will help us to improve access to services, to address and minimise health inequality, to improve the quality and safety of our services, and to increase the control people in our district have over their own health”. The strategy has four guiding principles, which are: people-powered; one district; information sharing; and being a good digital health steward. The objectives of the strategy are to digitise the consumer, families and whānau experience with improved access to information and to digitise end-to-end processes, allowing the smooth flow of information between services and across organisational boundaries. It aims for better interconnected communications and collaboration, as well as better use of data for planning and decision making. Also, inclusive information management and stable and secure ICT services. Steve Miller, chief digital officer MidCentral DHB, said Te Awa is a people/ whānau – centred strategy with a focus on wellness, which makes interagency collaboration key to its success. “With over 60 percent of a person’s heath being attributed to various social determinates, it’s important we collectively engage in collaborative co-design as a system to enable quality living, healthy lives and well communities,” he explained. The strategy has seven strategic portfolios with multi-year funding pathways, allowing a more agile delivery method for the projects within them. “We are seeking to take a more ‘learn and adapt’ approach to accelerate value delivery and better manage risk by breaking initiatives into smaller three-monthly cycles,” Miller said. The portfolios are; consumers, families and whānau-centred; workforce management; innovation; data and analytics; knowledge management; business management; infrastructure and IT services. Miller said the strategy seeks to rationalise a large number of existing suppliers and applications and to develop a co-investment partnership approach with industry to accelerate the district’s digital transformation. MidCentral DHB has been chosen by the Ministry of Health to pilot four HIMSS digital maturity assessments from August this year. Miller says the results will help determine the organisation’s areas of focus to get the best results. This article first appeared on eHealthNews.nz.

According to a report by Meticulous Research, the global Vendor Neutral Archive (VNA) market & Picture Archiving and Communication System (PACS) market is expected to grow at a CAGR of 7.2% from 2018 to 2023 to reach $3.87B by 2023. In China, the demand of PACS & VNA is growing, as 70% of the medical procedures need images, including CT, X-ray, and magnetic resonance imaging. Esteban Rubens, Global Enterprise Imaging Principal, Pure Storage, shared his insights on the PACS market in the Asia Pacific market and thoughts on the developments of AI in medical imaging. Trends and developments in the Asia Pacific PACS Market “I think cloud plays a large part of what people are looking at in Asia Pacific, even more so than in the US and Europe. In the US, there's some resistance to moving the traditional areas of healthcare imaging (PACS and VNA) to the public cloud. In Asia, there’s much more interest in leveraging the cloud for imaging and I think the region is more advanced along that journey,” said Rubens. In China, there is massive investment from both the government and the companies specifically around imaging but the focus is more on access to healthcare and bringing healthcare to people who are underserved. Outside of tier one or tier two cities in the country, the healthcare experience can be complicated with long waits and queues. For the case of Japan, there is access to good healthcare but the emphasis is more on early detection and tackling issues related to a rapidly aging population.  “There are a lot of new players in imaging, but they seem to be only capturing the low end of the market. The high end is dominated by the big players from the US and Europe. Looking at the region, GE Healthcare made huge investments in China for decades and are now reaping the rewards. In Japan, Fujifilm dominates their home market. Outside of those two companies, its fragmented elsewhere in Asia and we expect some consolidation to take place in the coming years,” he added. Helping healthcare organisations manage their increasing appetite for data Due to the large volumes of imaging data as well as storage and accessibility concerns, Rubens believes that the best approach for healthcare organisations is a hybrid one, keeping some images on-premise and others in the cloud.  “We have solutions that essentially run in the cloud such as Cloud Block Store, which allows the customer to duplicate the experience they have with a Pure FlashArray on-premise in the cloud regardless of their cloud provider. There is also ObjectEngine, the result of a recent acquisition we made, that allows people to put their backup copies in the cloud with up to 90% data reduction, which is unheard of. This has made it really viable for organisations to do backup and restore to the cloud.” Backup for healthcare organisations is important because of regulatory requirements. Due to the on-going threats from hackers, they would also want to keep as many backups as possible. However, this can get expensive especially if they have to backup petabytes of images. ObjectEngine integrates the client’s backup application and the backup is sent to the cloud where data reduction is applied, which results in lower costs and also the flexibility to restore that data. “Backups are only as useful as the restores, which is where the rubber meets the road. We believe that focusing on the rapid restoration of data from backups is crucial, especially in healthcare. If you get hit by ransomware, for example, you can't afford to wait days or weeks to restore your data and applications, especially on the clinical side,” shared Rubens. AI developments in medical imaging According to Rubens, AI is really good at is detection and segmentation, especially of images and thus a natural fit for medical imaging. In addition, there is a worldwide shortage of radiologists – there is an exponentially growing set of images but not enough trained people to interpret them. “The only way to bridge that gap is technology and AI is such a perfect fit. We’ve trained computers to do triage, take accurate measurements and identify lesions. There are very specific applications for each algorithm and it’s a big job to decide which images to send to which algorithm. So the challenge is now bringing all of that from the research side to the clinical side,” he explained. Leveraging data and reaping the benefits of automation  Regardless of their size, healthcare organisations are holding data and that is very valuable both for patients in terms of improved care as well as for the organisations themselves in terms of efficiency and cost savings. However, approaching data may be a daunting task, especially for smaller healthcare organisations or hospitals. Rubens’ advice for them was to start small: “You don't have to be a huge research hospital with a medical school attached, or an engineering school, to do this kind of research. It's all very democratic, you can download these models from the internet, go to GitHub, open source stuff and then you do tutorials on Coursera so you can start training models with your own data.” “Every organisation has someone who is interested in AI, so it's important to support those people and recognise that what they want to do is important to the organisation's development and goals,” he concluded.

The National Neuroscience Institute (NNI), the national specialty centre for the management and care of neurological diseases in Singapore and Iota Medtech, a local medtech company specialising in AI and surgical robotics, signed a Memorandum of Understanding (MoU) to develop a system to sort brain scans of head injury patients in order of urgency. What’s it about Currently, there is a significant waiting time for head injury patients requiring urgent treatment, especially when scans were received after radiologists' working hours. The 70 to 100 brain scans received daily are interpreted by radiologists in chronological order. The development of the priority sorting system will help ensure that patients requiring immediate medical attention receive the care they need. Radiologists will be able to interpret brain scans faster and their work will be more efficient. NNI will develop the algorithm to sort brain scans using a “triage system”, with each scan labelled red, amber or green according to the urgency of medical attention. The system will also be tested in a clinical setting, with its accuracy compared against that of radiologists in NNI. Before being implemented in hospitals, it will have to go through regulatory approval processes by the Health Sciences Authority, the national regulator for health products, which will take some time. In the future, the system developed by NNI and Iota Medtech can be modified to treat other common conditions such as stroke and glioma (a type of brain tumour).  On the record “Head injury was chosen as the initial focus of the system in accordance with current patient demands”, said Mr Benjamin Hong, CEO of Iota Medtech in a statement. Associate Professor Ng Wai Hoe, medical director of NNI said, “Iota Medtech's algorithm has already passed laboratory tests for accuracy and NNI will be providing data of brain scans to continually increase the accuracy of the system. The sharing of the data will be in accordance with guidelines in the Personal Data Protection Act.”

NSW Health, the University of Sydney and the Digital Health Cooperative Research Centre (CRC) have partnered to deliver a new Massive Open Online Course (MOOC) which shows how clinical health data can be harnessed for better patient care. Members of the existing and future health workforce can now access this new foundational curriculum, which the state’s digital health agency eHealth NSW developed in collaboration with the University of Sydney and NSW Health’s Health Education and Training Institute (HETI). What’s it about To complete the course, learners will use more than 30 videos and associated learning resources in 12 to 25 hours of self-directed learning, over an estimated four to five weeks. Access to the MOOC via the online learning platform Coursera is free, with learners having the option to purchase a certificate of completion. Around the end of June, staff of NSW Health will have free access and certification through its state-wide learning platform My Health Learning. In development for the past 18 months and featuring input from Monash Health Partners in Melbourne, the MOOC is being launched as international reports predict that clinical staff will need the skills to navigate an increasingly data-rich healthcare environment. For instance, by 2039, 90 percent of all jobs in England’s National Health Service (NHS) will require some element of digital skills, according to the Topol Review, a recently released independent report delivered on behalf of the UK’s Secretary of State for Health and Social Care. The MOOC is guided by the eHealth Capability Framework, which outlines foundation-level expectations for health graduates and workforce, as well as the workforce expectations for clinical and non-clinical staff, as outlined in the NSW Health Analytics Framework. On the record The ‘Using clinical health data, information and knowledge for better healthcare’ MOOC provides a rich and context-relevant experience for all students undertaking health and medical degrees, the NSW Health workforce, as well as teaching staff who seek quality curriculum resources, said Adjunct Professor Annette Solman, Chief Executive of HETI in a statement. The MOOC explores how digital health is transforming health service delivery in clinical practice “and the tremendous potential offered by growing pools of data being captured in our digital systems,” said Dr Tim Shaw, Professor of eHealth at the University of Sydney and Director of Capacity Building at the Digital Health CRC. Dr Zoran Bolevich, eHealth NSW Chief Executive and NSW Health Chief Information Officer said, “NSW Health alone creates over 100 terabytes of clinical and corporate data each month. Increasingly, skills and knowledge in basic data analysis are required of our workforce to inform practice, and this MOOC will help to demystify an area that is growing in importance.”

In New Zealand, fourteen percent of general practicioners with a portal are offering patients online access to their medical notes. Latest figures from the Ministry of Health show that 610 practices out of 970 across the country offer a patient portal. Of those, 86 practices offer Open Notes, up from just 50 in the first quarter of 2017–2018. Ministry of Health chief medical officer Andrew Simpson says the Ministry encourages general practices to give patients access to their clinical notes. “Having access to their health information empowers people to be more involved in their healthcare,” he said. “On a practical level portals can help them understand their health condition better, and remind them of their care plan and their medications.” The Ministry figures show that four PHOs have all practices offering a portal and around 800,000 people are registered with a patient portal across the country. Twenty-one practices now also offer video-conference consults. “Primary health organisations are starting to see that patient portals are enabling practices to remain sustainable by doing more consultations online, leaving face-to-face consultations for those people who really needed them,” said Simpson. Bryan MacLeod is GP owner of a rural practice, the Coromandel Family Health Centre, and has been offering patients online access to their medical notes for about five years. MacLeod believes that by giving patients access to their medical notes, they are more informed about their care and can share this information with family members or other health professionals if they wish. “The more open we are about what we do and share information that belongs to the patient the better,” he said. “I haven’t seen a downside to it.” MacLeod is keen to start offering video consults and is considering having a separate room set up at the practice for this purpose, but believes the greatest value will be in connecting patients from his practice with tertiary care services. Broadcaster Toni Street has used a patient portal for the past three years and finds it hugely helpful in managing her autoimmune disease. She has also a different portal page for each of her three children. “I noticed about six months ago that I could read the [medical] notes and thought that’s really great because it means you have got a lot of accountability on the doctor’s part as well,” she said. This article appeared on eHealthNews.nz.