ASIA News

Given the increasing complexity of clinical care and massive amounts of data being collected through different medical devices, healthcare professionals can end up spending excessive amounts on time on documentation and often, have a lot of critical information but in a fragmented or siloed manner.  Fragmented data creates information gaps, which can potentially impact decision-making, coordination, and workflow. One way to address this challenge is to bring together the disparate sources of data onto an integrated platform, and this is where Ascom’s Healthcare Platform comes in. The modular approach of the platform means that healthcare organisations can begin their process of data consolidation regardless of their stage of development. Due to its built-in interoperable features, existing hospital information systems and devices can also be integrated into the Healthcare Platform. One practical use case of the Platform is that of patient alerts – with Ascom’s ability to analyse, filter and channel alerts to specific clinicians, they do not need to ‘chase’ the data and can respond more appropriately based on the nature of the alarm. This results in fewer needless interruptions for the clinicians.  Sengkang General Hospital is one of the first hospitals in South-East Asia to have implemented the end-to-end suite of Ascom Healthcare Platform solutions. “We are pleased to be working with the Ascom Telligence Nurse Call System as part of our integrated solutions under the new hospital infrastructure. Having the ability to bridge the information flow seamlessly with various business applications has helped to drive towards greater workflow coordination and productivity for our staff particularly in current times of manpower constraints” as shared by Lee Puay Chuan, Deputy Director Strategic Projects, Sengkang General Hospital, Singapore.  Purpose-built devices for care delivery While an integrated platform can bring about better healthcare data visibility and actionable insights which are beneficial for both clinicians and patients, the hardware or devices must also be up-to-task in terms of providing access to vital information, as well as facilitating the communication between clinicians and care teams. The Ascom Myco™ 2 is an example of such a purpose-built device which connects its users with colleagues, patients, labs, pharmacies, porters, cleaners, medical devices, patient monitors, and nurse call systems. Crucially, it merges data from these multiple sources and displays it as meaningful information to help frontline staff make the best decisions while on the move. Designed for the delivery of personalised care, the recently released Ascom Myco 3 is a versatile purpose-built Android™- device which features multiple care delivery and monitoring functions. It works with apps to integrate with nurse/call alert systems, wander management and monitoring solutions and data collection systems. To facilitate more efficient care at the bedside, the Myco 3 allows the user to perform single-entry registration of vitals to EMRs/EHRs, barcode scanning of patient IDs and point-of-care access to and management of clinical information.  Users can choose from using either the Myco 2 or Myco 3 on their own or even combine the use of both purpose-built devices within the same facility. Regardless of the device use combination, they can be easily integrated into the Ascom Healthcare Platform, enabling seamless access, sharing and tracking of information across care teams and locations. Android is a trademark of Google LLC.

Ping An International Smart City Technology (PAISCT), a subsidiary of Ping An Insurance (Group) Company of China, has signed a research agreement with Medical Artificial Intelligence Lab Program (MAIL) of the Department of Diagnostic Radiology at the University of Hong Kong (HKU) to clinically evaluate their AI-based optical coherence tomography (OCT) retinal disease screening system. OCT is a high-resolution, non-contact and non-invasive diagnostic technique that renders an in vivo cross-sectional view of the retina. The AI OCT system is a screening and referral system for eye diseases, combining the analysis software employing AI trained on input from clinical experts, OCT eye imaging technology and colour fundus photography. What’s it about The one year research project will commence from May 2019 to April 2020. All clinical studies will be led by MAIL, under Professor Michael D. Kuo, Director of (MAIL) Program, together with Dr. Vince Vardhanabhuti, Clinical Assistant Professor from the Department of Diagnostic Radiology, HKU, and its clinical partner Dr. Jasper Wong, Clinical Assistant Professor from the Department of Ophthalmology, HKU. The project initially involves the recruitment of 500 patients, with continuous enrollment of consenting subjects. Both eyes OCT and fundus data generated by PAISCT’s OCT and fundus AI tools will be collected. PAISCT provides AI models to do screening and generate reports. MAIL will be responsible for the clinical study design, implementation and analysis.    This cooperation aims to estimate the effectiveness of AI algorithm based on OCT multimodal imaging and fundus photography for disease screening and diagnosis and jointly explore the new workflow of patient management. What’s the trend In January this year, Deqing county hospital in Guangdong Province, China launched free consultations featuring AI cameras to detect ocular fundus diseases. Co-developed by Baidu and Sun Yat-sen University, the instrument is capable of diagnosing three types of fundus disorders -- diabetic retinopathy, glaucoma and macular degeneration. In India, Google and its sister organisation Verily, the life sciences division of Alphabet, have been developing a new machine learning algorithm to help expand access to and efficacy of screening for diabetic retinopathy and diabetic macular edema. The algorithm has been refined and is now in clinical use at the Aravind Eye Hospital in Madurai, in the southern state of Tamil Nadu.

New Zealand’s Ministry of Health is going to Cabinet this June to get approval to develop a detailed business case for a national Health Information Platform. The Ministry has moved away from the idea of building a single Electronic Health Record, towards developing a national HIP that will enable data about a single patient to be shared, said deputy director data and digital Shayne Hunter. Hunter was a keynote speaker at the Emerging Tech in Health conference in Christchurch on May 21. “We are moving beyond the agenda of ‘we will drive for a single EHR in a physical sense’,” he told attendees. Rather, the Ministry is focusing on joining up data services to provide information about a patient via a national Health Information Platform (nHIP). “This is intended to be not just a technical platform, but a range of other components to enable us to support better information sharing across the sector,” he said. The plan to build a national EHR was expected to take three to five years when first announced by government at the HiNZ 2015 conference. An indicative business case was developed and presented to the Cabinet Committee on State Sector Reform and Expenditure Control in July 2017.  The committee requested further information on the costs and benefits of an EHR and these were expected to go back to Cabinet for approval in December 2017, but the Ministry has since re-focused its efforts on building a business case for a nHIP. Ministry group manager digital strategy and investment Darren Douglass said that interoperability is core to the new platform, which will “have the ability to assemble a virtual electronic record on an ‘as required’ basis from multiple trusted sources, and provide access to data and services”. The nHIP will be a key enabler for real-time clinical decision support, empowering patients to self-manage their health and wellbeing and data driven healthcare, he explained. The Ministry is planning a phased approach to implementation with investment in tranches and avoiding ‘lock in’ to a single technology solution.   Hunter, who took up his new role in March this year, said the Ministry’s vision is that “data, digital services and technology power the health and wellbeing of New Zealanders”. He argued that in order to move from an episodic model of care to a wellbeing model, “we need to get patients really and truly engaged”. This includes the need for social license to use patient data to inform decisions about the system. He said the current way of doing things in health is not sustainable and “we all have to own that problem going forward”. Over the past year, an extra 588 staff were employed in the health system at a cost of $27 million, but what exciting things could be done with a $27 million investment in digital and data? he asked. Hunter said that many of the issues health is struggling with are shared across government departments, such as how to invest in modern technologies under current procurement rules. He also said there is a lack of leadership and those who want to lead and make change within their organisations can find themselves hitting barriers. “I seek to step up to that,” he said. This article first appeared on eHealthNews.nz.

The personal data of 4,297 people has been compromised after a website hack, according to a statement by the Singapore Red Cross (SRC) on May 16.  Last Wednesday (May 8), SRC said it was alerted by its web developer to an incident of unauthorised access to the part of its website which supports the recruitment of interested blood donors. Information of 4,297 people who registered their interest on the website was compromised. Their names, contact numbers, e-mails, declared blood types, preferred appointment dates and times and preferred locations for blood donations were leaked.  Investigations to determine the cause of the incident are ongoing but preliminary findings show that a weak administrator password could have left the website vulnerable to the unauthorised access, said SRC. A police report was made on the same day and the incident was also reported to the Personal Data Protection Commission and Health Sciences Authority (HSA), a statutory board under the Ministry of Health.  “Our immediate priority is to ensure affected individuals and partners are notified, while working with the relevant parties to restore and strengthen our IT systems, safeguard our data, and mitigate any future risks,” said SRC CEO Benjamin William in a statement. SRC has temporarily disconnected the website from internet access and replaced it with a temporary webpage until security checks are completed. External consultants have been engaged to conduct a forensic investigation on the hack. The latest healthcare-related data breach at the SRC comes after a series of similar events in Singapore earlier this year – in January, the confidential information of more than 14,000 HIV-positive individuals were leaked and in March, the HSA reported that the personal information of 800,000 blood donors were left exposed by their vendor.

[Correction: An earlier version of this article misstated that Bumrungrad launched the Foundation One CDx panel. The system developed its own panel. The article is now updated. We regret the error.] Bumrungrad International Hospital, a private multiple-specialty medical centre founded 1980 in Bangkok, Thailand, announced the launch of its own genomic profiling panel for cancer treatment. A Core Genomics Facility has been established to produce validated panels in-house. Since all patients are different, specific individual treatments, often called targeted therapies or precision medicine, are customised to each patient and can be more effective than standard cancer treatments. What’s the trend Earlier in February this year, BC Platforms, a company which specialises in powerful genomic data management and analysis solutions, partnered with Bumrungrad International Hospital to provide its customisable end-to-end Software-as-a-Service (SaaS) platform to enable Bumrungrad to offer personalised healthcare solutions for their patients in the clinic. Bumrungrad will also participate in providing its extensive Asian data and samples to BCRQUEST, providing additional sample diversity and data resources for researchers. On the record “It is a misconception that cancer is mostly hereditary. In many cases, personalised cancer treatment is better. Everybody has a different genetic make-up which makes us susceptible to different diseases therefore medication can work in different ways for different people. In some cases, we can use targeted therapy to help control the cancer,” said Dr Surasit Issarachai, an Oncology Specialist at Horizon Regional Cancer Centre, Bumrungrad International Hospital in a statement.

Private hospitals in Thailand will have to display the price of medicines so that consumers can make better-informed decisions prior to purchase, starting from this week. According to a report by the National News Bureau of Thailand, the country’s Ministry of Commerce has implemented a new measure after announcing medicine and medical supplies as controlled items, requiring hospitals to display pricing of some 3,000 items via QR codes allowing the general public to make comparisons. Deputy Minister of Commerce Chutima Bunyapraphasara said that the central committee on pricing of goods and services’ meeting has agreed to authorise the Department of Internal Trade to implement control measures for pricing of medicine, medical supplies and medical services. The measure will require private hospitals, manufacturers, importers and wholesalers to report sales prices to the department, which will then later be published on the department’s website. Any changes to pricing must be informed 15 days in advance. On January 9 this year, the Ministry of Commerce approved plans to put medical-related fees, including drugs, supplies and service charges, on the price control list of the government’s central committee on prices of goods and services. The order for private hospitals to display prices of drugs is a direct follow-up from the subcommittee formed to work out measures to control medical-related fees. Failure to comply with the new measure will result in up to 1 year imprisonment or up to 20,000 baht fine, or both. Private hospitals, which refuse to issue prescriptions to patients for medicine purchases outside the hospital, will face up to 5 years imprisonment, up to 100,000 baht fine, or both. The Department of Internal Trade will be inviting representatives from hospitals to explain the measure, and will consider further measures to control medicine and medical service pricing in the future.

New Zealand’s Ministry of Health will provide access to two core national systems - the National Health Index (NHI) and Health Practitioner Index (HPI) – using FHIR interfaces. Group manager digital strategy and investment Darren Douglass said that by improving access to these core data sets as FHIR resources, the Ministry expects to make it easier for healthcare organisations and vendors to use them within their health applications. The staged release of NHI and HPI production FHIR APIs (Application Programming Interfaces) is planned from mid-2020.     “New Zealand has adopted the HL7 FHIR (Health Level 7, Fast Healthcare Interoperability Resources) standard for exchanging healthcare information electronically as a core component of our interoperability architecture and standards, along with SNOMED CT and other health terminology services,” said Douglass. The NHI is a unique identifier assigned to every person in New Zealand and the HPI identifies health professionals. “These two foundational data sets are already widely used across the NZ health sector so it made sense to provide access to these first,” he said.   HL7NZ chair emeritus David Hay is working with the Ministry on the project and says there are big gains to be had by opening up health data to multiple players. Existing players like GP and hospital system suppliers generally already have access, but the interfaces are not that standardised or widely used, he explained. “My vision is that we have an eco-system where smaller specialist systems can be created that nevertheless utilise these core national systems,” said Hay. “This is a critical first step on the road to allowing that and I’m really delighted the Ministry is making this step and putting funding behind getting this working.” Hay is assisting with the design and community engagement as a large part of FHIR is the community of people who can assist with both the design of the interfaces and implementation of them. Initial work has been on the NHI interface with a draft design due to be completed before a HL7 FHIR and SNOMED CT Implementation Workshop in Auckland on June 19, where it will be tested by the community. Hay said by involving the FHIR community in the process, it ensures changes to the design are made early on in the process rather than needing expensive re-working at a later date. Once the necessary security and privacy protections are in place, Hay hopes to see other data sets exposed in the same way, such as prescribing data. “FHIR is emerging internationally as the next generation of interoperability standards,” he said. “New Zealand has the potential of becoming leaders in some of this space because we are relatively small, we have national systems already in place and we’re willing to give things a try.” Douglass said the changes are part of the wider Digital Health Strategic Framework objective of accessible trusted information. Some read-only APIs are planned for earlier release to add and update functionality and guides for testing and implementation will be released in advance of each production release. This article first appeared on eHealthNews.nz.

Located in the central region of Singapore, Tan Tock Seng Hospital (TTSH), which is the largest hospital under the National Healthcare Group (NHG), announced that it will be launching a Command, Control and Communications (C3) system to manage resources efficiently, support operational decisions, optimise patient flow and respond effectively to ground situations. What’s it about Currently, the C3 system is at pre-production stage at the newly-opened TTSH Operations Command Centre located at the Centre of Health Innovation (CHI), housed at the newly opened Ng Teng Fong Centre for Healthcare Innovation. The first phase will start with streaming data from various operational systems to give a comprehensive overview of a hospital’s operations in real-time, providing operational visibility.  It will progressively use advanced analytics to generate actionable insights to provide situational sensing so that the hospital can better pre-empt and act in advance of situations before they occur. The C3 System is set to go live progressively from third quarter 2019 to support daily operations, making TTSH the first Smart Hospital enabled by C3. It will be built on a base infrastructure and will be progressively scaled to the other public hospitals over the next few years.  Additionally, the C3 System will also be integrated within the Regional Health System to allow a more seamless care experience as patients move across care settings such as from the pre-hospital phase to the acute hospital to the community hospital. Prior developments to the C3 Before 2008, bed allocation was a very manual process, which relied largely on coordination via pen, paper and phone. Since then, bed allocation in TTSH has evolved, first with the implementation of RFID tagging in TTSH, which allowed the hospital to automate admission and discharge workflows, as well as identify the location of patients in real time. In 2012, TTSH implemented an algorithm-based decision support bed allocation system, incorporating more than 350 clinical and optimisation rules to ensure that critically ill patients are admitted first, and that the right bed is allocated to the right patient the first time. This helped to reduce overflows, transfers and rework. On the record “Much like an airport control tower, the C3 Smart Hospital System is the nerve centre for the hospital. It is a real-time integrator of systems, enabling TTSH to better optimise resources and manage patient flow,” said Mr Gan Kim Yong, Minister for Health, in a statement. 

Three representatives from their respective fields of AI – clinical practice, research and healthcare apps came together for a panel discussion around the current and future developments of AI in healthcare on the second day of the HIMSS Singapore eHealth & Health 2.0 Summit on April 24. The panel consisted of Dr Ali Parsa, Founder and CEO, Babylon Health, Dr Ngiam Kee Yuan, Group Chief Technology Officer, National University Health System, Singapore and Dr Hwang Hee, Chief Information Officer & Associate Professor, Department of Pediatrics, Seoul National University Bundang Hospital, South Korea. The hype cycle of AI in general and in healthcare Mr Neil Patel, President, Healthbox, Executive Vice President, HIMSS, USA, who was the panel moderator, began the discussion asking the panelists on their thoughts on the current hype cycle of AI broadly and in healthcare. “I think at the general level, we’re seeing a much greater update of machine learning and deep learning because of the availability of two things: one is the data that becomes available and secondly, relatively cheaper or cheap computing power that one can get today. That spurred a new revolution and allowed us to use information in ways we never thought possible. But it’s also created real challenges – one of the key things I tell every software developer is to ensure that the data is ‘clean’, that’s paramount. And I think from that point of view, we always have to think about AI with reference to the data we select,” said Dr Ngiam. He explained that the best way to describe ‘clean’ data is to reflect reality. In healthcare data, something is usually missing or there’s too much noise or extra data points that do not necessarily contribute to the desired outcome. Another way to look at it is that the data has to be appropriately selected for the specific purpose. For example, if the purpose is to predict the length of stay at a hospital, then the length of stay data has to be absolutely spot on and all the determinants of length of stay has to be within that dataset.  Citing from his experience in the varied use of AI in the Babylon Health app, Dr Parsa said: “I think we use the word AI for a whole set of different techniques. And each of those techniques are useful for different applications. For instance, for diagnosis, you cannot use what is currently called deep learning because the likelihood of misdiagnosis is very high and the technique to be used is probabilistic graphical modelling, which is very close to probability analysis – it just happens to be that machines are better at probability analysis that the human brain can be.” For Dr Parsa, the hype of AI is high and in the short-term, it will continue to do what it has done in the last few years but in the long-term it will surpass all the current imaginations. The observation by Dr Ngiam is that the healthcare vertical is lagging behind in the AI hype cycle compared to industries like finance and logistics. In healthcare, the use of AI is directly affecting patients so it has to bear the same standards as other medical devices that are currently in medical practice. AI technologies in healthcare are slightly overhyped but in terms of real adoption, there needs to be factors like a really mature EHR system, good data streams, finding ways to deploy these AI technologies and training doctors to ‘buy in’ into using these technologies. Augmenting, not replacing doctors There are reports or articles that get a lot of press, for instance, of AI algorithms being tested against real doctors and ‘beating’ the human doctors repeatedly. The debate of whether doctors are going to be ‘replaced’ by AI algorithms is also a polarising one. However, Dr Ngiam pointed out that one of the key principles that all can agree to is that AI tools are meant to augment, not replace doctors. “What we found which consistently (in studies) was that when the doctors took the machines’ suggestions, they were better than either the doctor or machine alone. I think that’s what we really want, that is, a combination of AI and a doctor is better than either of them.” Adding to Dr Ngiam’s statement, Dr Parsa said, “The augmentation (of AI) to existing services is unbelievably valuable and we should not underestimate the contribution technology makes today. The contribution it makes today makes those who use it significantly better than those who don’t, that in future, makes those who don’t use it, irrelevant.” Using AI to increase empathy From Dr Hwang’s personal experience as a clinician in South Korea, he feels that AI can help him concentrate more on his patients compared to the conventional way of practice. For example, he takes 30 minutes to an hour to do an electroencephalogram (EEG) interpretation compared to the AI software which just takes five minutes to do the same – that frees up more time for him to communicate with his patients.  One of the biggest complaints mentioned by Dr Ngiam is that doctors spend way too much time staring at screens and they may not be looking at patients sufficiently. He explained that AI can help doctors transact a consult with the empathy that is required or that patients want from a doctor – AI can help with the hard work of summarising of key points, so that doctors are better prepared to meet with the patient, rather than for them to read off a screen.  During one of the Babylon app tests, Dr Parsa found out that it was possible to reduce the time of consultation from 10 minutes to about five minutes, which would increase the satisfaction of patients. However, his 16-year old son who also did some of the tests – found that it was not very good as he had to repeat answering the doctor’s questions after he had answered the same questions via the app.  Dr Parsa’s point was to think about the changing perceptions of humans: “For the first time in history, an 18-year old in Singapore, Korea, Iran, India, the US and the UK are closer to each other in their mentality and culture than they are compared to the past – that had never happened before. You now have a generation of human beings that behave globally in a very similar manner.  That generation does not want to spend two hours or wait for a few days to see a doctor or get a surgery, and being asked the same questions over and over again, that’s just not the way they were brought up. And we need to be very careful not to forget that shifting human culture, which is very significant.”

Pinnacle Ventures has launched a pharmacogenomics programme to enable genetic testing to drive personalised prescribing decisions. The innovation arm of Pinnacle Midlands Health Network, a not-for-profit primary health care management company in New Zealand, is also working on embedding biomarker information into electronic health records and linking it to a clinical-decision support prescribing tool that can help prescribers by providing direct access to international pathways and guidelines. Pharmacogenetics involves prescriptions being tailored to a person’s genetic make-up, as people metabolise drugs in different ways, which can have a significant impact on a drug’s effectiveness. Ventures plans to do about 5,000 pharmacogenetic tests over the next 12 months, says chief executive John Macaskill-Smith. Some will be self-funded because individuals are struggling with their medications and others will be fully funded by Ventures, targeting specific groups within the Midlands population. Macaskill-Smith says it is a simple test that covers 65–70 per cent of medications frequently prescribed in New Zealand. “The New Zealand health system is under strain but using testing like this you could reduce the trial and error of prescribing and prevent adverse reactions to medications,” he said. Ethnicity plays a big part in how a person metabolises drugs, but the clinical trials that prescribing information are based on very rarely involve Māori or Pasifika test subjects. Macaskill-Smith said Ventures is partnering with key kiwi groups, Auckland University and Otago University medical schools and Callaghan Innovation to support research and develop a better understanding of how unique New Zealand populations respond to different medications. People who have a pharmacogenetic test can choose to consent to contributing their non-identifiable demographic information to researchers. Embedding the biomarker information into EHRs ensures a patient’s results are used for both current and future prescribing decisions, he said. Macaskill-Smith says a lot of direct-to-consumer online genetic-testing tools involve people essentially “giving away their DNA” as there are no protections or consent processes for how the testing company might use it. “You can lose ownership and visibility of where your DNA has gone. We are saying your DNA is yours and you should have control over it, so we are trying to promote safe and informed use of your genetic information by embedding it back into your own EHR,” he said. “Seeing an individual’s health record shift away from being largely about providers recording notes around their activity to actually becoming a blueprint for an individual’s health and wellness information is incredibly exciting. “This is the real health revolution that is about to occur, and including and using your DNA is core to this.” A virtual training package to help primary care providers respond to this genetic information is also being offered. The US Food and Drug Administration requires pharmaceutical companies to publish biomarker information in relation to how people with different genetic make-ups might respond to specific medications. Many health providers in the US use pharmacogenomics as a key tool in treating their patients, and other places, such as Canada and the European Union, are heading in this direction. The New Zealand government does not require this information to be published, but international curators have emerged and can be used to access individual drug information and treatment pathways to inform how doses should be altered according to people’s genetic make-up. This article first appeared on eHealthNews.nz.