ASIA News

Hutt Valley District Health Board (DHB) is using robots to process the 24,000 e-referrals it receives every year. Hutt Valley DHB is based in Lower Hutt, and covers an area including Upper Hutt, Wainuiomata and Eastbourne, located in the Wellington region of New Zealand. The DHB, along with Wairarapa and Capital and Coast DHBs, has recently embarked on a project to automate the Mental Health Intake Assessment process. Former chief information officer at Hutt Valley Shayne Hunter spoke at the HiNZ 2018 conference in Wellington last November about the e-referrals automation project. He said this was previously an end to end process of manually registering and processing all e-referrals, estimated to require more than 4600 hours annually or the equivalent of 2-2.5 full time clinical administrators. “We embarked on a project to try and make that robotic,” he explained. During a 3-month pilot period, the robotic process automation attempted 681 e-referral registrations had an 83 percent success rate, saving an estimated 71 hours in staff time. For e-referral processing there were 900 attempts and a 75 percent success rate, saving 56 hours. He said there were problems with the data coming in, such as missing data, which means human interpretation is still sometimes needed. “It doesn’t have to be start to finish robotically, it can co-exist with humans in the process,” said Hunter. “We took the person from referrals and they’ve now become a virtual workforce manager to help automate other processes.” A plan to use robots to speed up basic clinical coding, so coders can spend more time on difficult coding scenarios, has been paused due to the high level of complexity. However, the Mental Health Intake Assessment project is moving ahead and the DHBs are hoping to be able to automate 100 percent of the process. Hunter added that the DHB is also looking at embedding AI to interpret the content where there is missing data. This article first appeared on eHealthNews.nz.

Royal Darwin Hospital (RDH) and Siemens Healthineers have partnered in a venture to expand oncology services available in the Northern Territory, providing the hospital with an advanced PET CT scanner that offers patients the capability to scan faster using lower doses of radiation and personalises scans to a patient’s specific medical condition. RDH is the largest hospital in the Northern Territory region of Australia. Siemens Healthineers A/NZ Molecular Imaging Business Manager Tim Lagana said that the Biograph mCT Flow Edge scanner features advanced capabilities such as improved lesion detectability and reduces unnecessary exposure to radiation with two features.  The first is FlowMotion, which eliminates the need for bed-based imaging used by traditional PET scanning forms.  “As a result, examination parameters such as speed, image resolution and motion management can be easily adjusted to the precise dimensions of organs and routinely incorporated into a single scan for every patient,” Lagana said. The second feature he identified is the Definition Edge CT scanner. “Due to the full electronic integration of Siemens’ Stellar detector, electronic components like microchips, conductors, etc. are integrated directly at the photodiode. This reduces electronic noise coming from the detector elements and thus, improves the signal-to-noise ratio (SNR) for optimised image quality.” According to the RDH, the new service will be the “first of its kind” available in the territory and is one of only four in Australia. NT Health Senior PET Technologist Jack Anderson said that following installation, patients who had to previously travel up to 3400km interstate for access to diagnosis and treatment monitoring equipment can access these services much closer to home. “Previously, Northern Territory patients would have to travel interstate to have a PET scan in order to diagnose or help manage their medical condition,” he added. “The new RDH PET service can make a huge impact for these patients by reducing delays to diagnosis and treatment due to the need for interstate travel; better access to specialist diagnostic services for patients with geographic, physical mobility, language or income barriers; and reducing the costs to patients, carers, families and friends incurred during interstate travel for diagnostic services and treatment.” Anderson said this installation also puts the Northern Territory on the map with one of Australia’s most advanced medical imaging systems on the market, providing treatment options and pathways for the region’s most complex diagnostic and disease requirements. “RDH now has equivalent medical imaging services to the major hospitals in other capital cities, with enhancement to its provided services,” he said. “The new equipment has the potential to position the territory as a hub for PET research in Northern Australia and the Asia Pacific region, and furthers medical specialty in the territory, increasing the capability and integration of the local cancer services.” Although currently geared towards oncologic applications, Anderson said the system also has the capability to image neurological disorders such as alzheimer's, dementia and epilepsy, and assist in the diagnosis and provision of care for patients with other medical conditions like infections and inflammatory disorders. This article first appeared on Healthcare IT News Australia.

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

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

Southern District Health Board (DHB) in New Zealand has kicked off its Digital Health Maturity Models project with the Ministry of Health. Southern and Mid Central DHBs were chosen by the Ministry last year to pilot three HIMSS Analytics maturity assessments: the electronic medical record adoption model (EMRAM), outpatient EMRAM (O-EMRAM) and the continuity-of-care maturity model (CCMM). Southern DHB business solutions manager Jack Devereux says the CCMM assessment project started in late February and involves filling out questionnaires based on five care settings: acute, secondary, primary, home support and residential care. For each of these settings there are three stakeholder groups – governance, clinical and information technology. Each of these has 250 questions to answer and around three weeks to respond. The HIMSS website says CCMM focuses on the capabilities needed in order to “seamlessly coordinate patient care across a continuum of care sites and providers”. On March 27, a training workshop with HIMSS, the Ministry, Mid-Central staff and DHB representatives from each region will introduce the assessments nationally. The following training days are an opportunity for the CCMM surveys to be reviewed and discussed with the Southern DHB stakeholder groups. Preliminary findings from all three assessments will be presented back on day four of the workshop. “That’s just a starting point, as the idea around the training is to identify people who can assess progress on an ongoing basis as we look to implement some of the actions identified,” Devereux says. HIMSS EMRAM scores hospitals internationally on their adoption and use of electronic medical records on a scale from 0–7, and O-EMRAM is used to evaluate services provided outside of a hospital or acute care environment. Devereux says the EMRAM and O-EMRAM surveys will be completed predominantly by the information services team, with pharmacy and clinical directors potentially being involved. He says the DHB is focused on implementing electronic health records as part of its digital transformation strategy. “We want to use this opportunity to inform our actions over the next few years as we head towards a new digital hospital being built here,” says Devereux. Mid-Central DHB will be next to assess its digital maturity. Ministry of Health group manager digital strategy and investment Darren Douglass said last year that the success of the pilot programmes will inform whether the assessments are rolled out nationally. This article first appeared on eHealthNews.nz.

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

Speaking during a panel session at the recent AFR Healthcare Summit, Royal Australian College of General Practitioners (RACGP) President Dr Harry Nespolon said the way remote healthcare and telehealth is offered has changed little since the 1960s.   “Doctors still need to see patients in front of them to dispense care. It hasn’t changed much over the last 50 years. I used to work for the AMA [Australian Medical Association] and my boss once said, ‘fish and chips shops today have more technology than most GPs’. There is still some truth in that,” he said. NSW Health Secretary Elizabeth Koff addressed the need for industry, governments and patients to grasp the concept of new-age telehealth and remote care as virtual care delivery models see traditional provider-patient interactions evolve. “Not everyone universally understands what we’re trying to achieve with telehealth. It’s not just about providing face-to-face communication in an effectively and timely manner in rural and remote Australia,” she said. “It’s also about data and information exchange that we can do in a systematic way to enhance patient care.” According to Silver Chain CEO Dale Fisher, consumers are ready and asking for changes to how remote care is offered, but there are some setbacks. “Consumers are directing the future of care and are asking for changes to how remote care is offered. The policies exist, but there needs to be funding flow from governments to support those policies,” she said. “The funding needs to flow into innovative programs that consumers are asking for. Digital disruption and innovation has already happened. What we haven’t done as a health system is adapt and take advantage of the digital revolution.”    Nespolon agreed, adding that general practice needs to be freed from its current regulatory and financial constraints and that’s something that needs to be worked towards. “Medicare and Medibank were set up as face-to-face systems and they still are face-to-face systems. Over the years, successive governments have credibly tried to resist the idea of breaking that nexus. That is about to change and both the potential governments are interested in delivering on what consumers want, which is the ability to access their healthcare in a variety of ways depending on their needs.” Royal Flying Doctor Service of Australia (RFDS) CEO Dr Martin Laverty said telehealth is part of the organisation’s DNA, but part of the challenge it faces is that the latest technologies don’t work without proper broadband coverage.   “If the pipe doesn’t deliver broadband into remote areas, the devices aren’t going to work. The promise of recent times, for high-speed broadband into the bush is not yet clinically-grade reliable. And until this happens, we’re going to be held back in our next investment.” Securing the nuts and bolts in healthcare Koff said having an agile system in place would enable interoperability, allowing care at a local district level or hospital level be fully integrated with primary care and other services. “The issue around digital enablement and being agile is something health is not known for. And that’s something we struggle with at a system manager level. Whilst we’re keen to have the architecture right, we need interoperability so it can be integrated,” she said.     According to Laverty, some of the challenges of telehealth will be eradicated with the next layers of development in broadband delivery. “The problem has not been solved with the existing satellite and mobile reach of broadband connectivity. That's the difference between consumer and clinical grade. We haven't achieved clinical grade, even if we've got patchy consumer-grade broadband access across remote areas today.” Fisher said in the lead-up to a working virtual hospital system, industry needs to be designing innovative programs in partnership with other organisations. “Rather than worrying about where the money comes from, we need to invest in our organisations to bring siloed parts of our operations together to demonstrate that there is a new way of doing things to deliver good care,” she said.    Nespolon concluded the session by saying that a barrier isn’t necessarily technology, but rather, people. “You can’t force technology on to people. It’s whether people want to use it and how they use it. For example, electronic health records have the potential to do great things, but hasn’t taken people all the way through. A more gentle approach is necessary in getting this message across,” he said. Carelink Managing Director Craig Porte, who spoke at a separate session during the summit, said there is still a heavy reliance in traditional delivery models of care in rural areas of Australia, resulting in an unequal distribution of benefits. “Interoperability, unreliable internet, a lack of offline solutions and investments are only some of the problems in remote Australia. There are plenty of amazing technologies that work out there, but for true remote care, they all need to be connected,” he said. “Face-to-face care is still necessary in rural and remote Australia. Interoperability – offline and online systems working together seamlessly – is key. AI will play a role going forward too; simple things like driverless cars will be essential in delivering remote care. Mobile solutions delivering care to the home will also need to become more mainstream. “But we have to keep in mind that technology is only an enabler in keeping people in their communities. Our challenge, as an industry, is to take the next leap in delivering true remote care.”  This article first appeared on Healthcare IT News Australia.

The Palmerston North-based Health Hub Project in New Zealand is aiming to reduce health inequities and increase access to care with the help of artificial intelligence, machine learning and blockchain. Project co-founder David Hill is a GP at the Health Hub Project in Palmerston North, which runs four general practices with around 9000 patients. Hill says clinically trained people are a diminishing resource in healthcare and the system cannot rely on that to ensure its sustainability in the future, therefore technology needs to be used to “balance that inequity of supply and demand”. “The whole point of what we are doing is trying to make sure that we use IT in a way that allows or permits greater equity of access to patients and starts to reduce the reliance on the ever-dwindling resource of healthcare workers,” he says. “Also, to advance the value proposition that we give to patients.” The first stage of the Health Hub Project is developing a New Zealand-focused model of risk stratification to identify those patients who are most at risk and in need of services. “We want to look at a much more integrated model of risk stratification, so it’s not just clinical but psychosocial factors like housing and education as well,” explains Hill. He says these factors are drivers of poor health, which impact Māori and Pasifika people disproportionally, and the model could help differentiate other drivers. He is also working with researchers at Massey University to develop a social exclusion measurement for New Zealand, which will be incorporated into the risk stratification. The project’s aim is to create a database of patient information and to use AI and machine learning to develop the risk stratification score and enable researchers to look at the impact of health interventions. Hill says the database will start with the 9000 patients at the Health Hub Project practice. Patients will have access via an app to their own data, and be able to input it, as well as choose how it is shared with researchers. The organisation is working with a small team of New Zealand-based software architects to design, develop and implement into practice a secure application, using blockchain technology. “The nice thing about blockchain is it allows you to identify each block of data and anonymise it,” he says. The data will be housed in a data warehouse and the primary use will be for the direct care of that patient. “So, when a patient phones for an appointment, we know their risk stratification score and that allows us to allocate appropriate resource for the patient when they come in,” he says. The current thinking is that if patients want an expanded analysis that includes comparing their diagnosis with larger populations, they would have to opt in to sharing their information anonymously for research purposes. Hill says they are talking to a number of potential investors locally and internationally about the data analysis tool and app to progress the development of the software. This article first appeared on eHealthNews.nz.

The machine learning algorithm can also help with screening for diabetic macular edema, a boon for patients in a country where physicians are in short supply.

Last Wednesday (February 20), President Rodrigo R. Duterte of the Philippines officially signed the Universal Health Care (UHC) Act into law, which guarantees equitable access to quality and affordable healthcare services for all Filipinos. It will also automatically enroll Filipino citizens into the National Health Insurance Program and expand PhilHealth coverage to include free medical consultations and laboratory tests. Aside from the automatic enrollment of all Filipinos to PhilHealth, other significant reforms that will be implemented over time include: designating PhilHealth as the national purchaser for health goods and services for individuals, such as medicines; improvement of health facilities especially in underserved areas; responding to the gap in health workers throughout the country; strategic engagement of the private sector; and creating and expanding new functions in the Department of Health (DOH) to improve the delivery of health services, according to an official statement by the DOH. Presidential Spokesperson Salvador Panelo said the UHC program may be implemented “gradually” since Congress has yet to draft a final bill raising tobacco taxes. Last month, the House Committee on Health in the Philippines House of Representatives chaired by Rep. Angelina Tan approved a substitute bill seeking to establish the National eHealth Systems and Services that shall deliver health services through cost-effective and secure information and communications technology (ICT). The bill seeks to utilise ICT to deliver health services which has the potential to be profitable, improve quality, change the conditions of practice, and improve access to healthcare, especially in rural and other medically underserved areas. With the approval of the National eHealth System and Services Act and UHC being signed into law, the Philippines has a monumental task of delivering accessible, quality healthcare services to all its 105 million citizens. Some have criticised the UHC as a political gimmick but the true challenge for its successful delivery cannot rely on the sole commitment of state authorities: it must also seek the cooperation and collaboration from private healthcare players and even tap on the capabilities on the burgeoning health tech industry.