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The Health Sciences Authority (HSA), a statutory board under the Ministry of Health (MOH) in Singapore, said in a statement on March 15 that one of its vendors, Secur Solutions Group Pte Ltd (SSG), had failed to properly secure a HSA database against access over the Internet. The database contained registration-related information of 808,201 blood donors which includes name, NRIC number, number of blood donations, dates of the last three blood donations and in some instances, blood type, height and weight. According to the HSA, the database did not contain any other sensitive, medical or contact information. A cybersecurity expert discovered the vulnerability on March 12 and alerted the Personal Data Protection Commission (PDPC) on the next day - HSA worked with SSG immediately to disable assess to the database. A police report has also been made by HSA and is in contact with the expert on deleting the information. Investigations are pending and preliminary findings indicate that other than the cybersecurity expert who raised the alert, there were no other unauthorised access to the database. The information provided to SSG was placed on an unsecured database in an internet-facing server on January 4 this year and the vendor did not put in place adequate safeguards to prevent unauthorised access. “We sincerely apologise to our blood donors for this lapse by our vendor. We would like to assure donors that HSA's centralised blood bank system is not affected. HSA will also step up checks and monitoring of our vendors to ensure the safe and proper use of blood donor information,” said Dr Mimi Choong, CEO of HSA in a statement. Including this latest case as reported by HSA, the Minstry had experienced four IT-related incidents since the SingHealth cyberattack which happened from June to July 2018. The other two incidents occured in January 2019 in which the confidential information of 14,200 HIV-positive individuals were leaked and last month, MOH said that a computer error had resulted in 7700 people receiving inaccurate CHAS healthcare subsidies.

The aging population is not only poised to swell but Baby Boomers are bringing tech chops and consumerism-era demands that health systems will be smart to embrace.

Last month, Indonesia’s Ministry of Health (MOH) announced the launch of their Sehatpedia app to facilitate the public’s access to health information. The app (currently only available on Android platforms) has an interactive consultation (live chat) feature and provides access to health articles, medical journals and health policies. Users can also register for outpatient appointments through the app but this is only limited to hospitals under the MOH. With the live chat feature, the public can consult doctors on health information needs such as disease complaints, health tips, and other medical consultations. “Sehatpedia can be accessed by all Indonesian people. Physicians from 32 vertical hospitals of the MOH will respond to the consultation queries,” said Secretary of the Directorate General of Health Services, Dr. Agus Hadian Rahim, Sp.OT (K), M.Epid, MH. Kes. In terms of the content for health articles, Sehatpedia is assisted by three communities: Health for Junior Indonesia (Kejora), which produces health articles relevant for young children, GARASI KITA community, and the FKG UI Teaching Staff Association. According to the MOH, about 8000 people have downloaded the app as of mid-February 2019.

The Belt and Road Initiative (BRI), also known as One Belt, One Road, is the Chinese government’s development strategy that was introduced in 2013 to build ties along the overland Silk Road Economic Belt and the naval trading route known as the 21st Century Maritime Silk Road. Although health is not at the core of the initiative, Ruwei Hu and his colleagues at the Sun Yat-sen University in Guangzhou and from the University of Utah in Salt Lake City, US, state that the BRI provides a common platform for regional public health emergencies through epidemic information sharing, exchange of preventive and interventional methods, and training health professionals. In China, there are both start-ups and big companies (including jianke.com, a Chinese B2C internet drug company, see featured image) looking to expand their knowledge and expertise in healthcare through internationalisation and collaboration with foreign companies, making the country a potential global innovator in healthcare, which is the theme of the latest HIMSS Insights eBook. The full article on China’s digital health Silk Road project can be found here.

The healthcare industry has, for many years, been highly dependent on technology. But with the introduction and use of new technologies such as machine learning and AI in healthcare, the issue of ethics has come into question. According to a Commonwealth Department of Health and Aged Care report, ethics is necessary where:  • healthcare services are research oriented, in that clinicians conduct or directly research using data; • healthcare services that have a wide spread of disciplines facilitate the development of cross-discipline linkages and collaborations; • high technology research and development activities are located close to major healthcare facilities, such as major teaching hospitals; • networks exist or have been encouraged to develop between healthcare services, research centres and industry partners; • opportunities for financial rewards are available for innovators in the public sector; and • venture capital and intellectual property services are readily available, and tax and other public expenditures encourage innovation. As such, even though these technologies bring huge potential and opportunities, they still need to be closely monitored. The University of New South Wales Research Ethics and Compliance Support Director Dr Ted Rohr told HITNA that issues around ethics arise when healthcare access data from medical records for research, for example. “Ethics is all about deciding whether the use of technology is appropriate and is used for public good. For example, AI has its positives, but it can be misused. So, having an ethical framework allows the proper use of medical databases for research and experiments with patients using devices,” he said. “Technology doesn’t take the ethics out of healthcare, it brings more ethics into healthcare. It enables devices to be presented safely to patients or data from apps from being misused, for example.” According to Rohr, a key part of new-age ethics is privacy legislation across both Federal and State Government legislation. “We need national guidelines and code of conduct for medical bodies to create their own codes. They’re very important in establishing a culture that whenever technology is used, that the user has understood the need to safeguard patients first.” But with healthcare being an industry that requires a human’s touch, Rohr said that it is unlikely that emotional decision making will fall into the hands of AI or robots. “There was a recent study that matched where humans see themselves against AI. The prediction was that jobs for humans are to oversee decisions made by these smart systems, because the ethical judgements made by humans is still necessary,” he said. RMIT University Associate Professor Adrian Dyer said “huge risks” around new technologies like AI and machine learning will exist if a code of ethics is not factored in during their development. “It comes down to how the technology is implemented. Protocols need to be set up when developing such technology but balances and checks need to come from people,” he said. “There are guidelines available but as soon as a system is collecting, managing or manipulating personal information, there’s national and state privacy laws that need to be obeyed. But exactly how that’s managed, needs to be looked into.” THE NEED FOR A DIGITAL CODE OF ETHICS In the move towards this future, the Royal Australian and New Zealand College of Radiologists (RANZCR) has released a draft report for the ethical use of AI and machine learning in medicine. This draft report, created by its AI Working Group, outlines eight ethical principles to guide the development of professional and practice standards with regards to AI and machine learning. These eight principles consist of considerations around safety, avoidance of bias, transparency and explainability, privacy and protection of data, decision making on diagnosis and treatment, the liability for decisions made, application of human values and governance of machine learning and AI. RANZCR President Dr Lance Lawler said these principles aim to ensure the protection of patient data, balanced with the application of humanitarian values. “New technologies such as AI are having a huge impact on healthcare, with enormous implications for both health professionals and patients. They have the ability to help doctors work in a more time-efficient and effective manner and – ultimately – provide even greater treatment for patients,” he said. Lawler said these guiding principles are necessary as the way radiology adapts to AI has a flow-on effect for patients and other healthcare professionals. “The agreed principles will, when established, complement existing medicinal ethical frameworks, but will also provide doctors and healthcare organisations with guidelines regarding the research and deployment of machine learning systems and AI tools in medicine,” he said. "There is a lot of hype and misinformation around AI; it is important to look beyond that and concentrate on… how we can best use it for the maximum benefit of patients.” Royal Brisbane and Women’s Hospital Metro North Hospital and Health Service Radiation Oncologist Professor Liz Kenny said the ethical principles outlined around AI algorithms and machine learning will help guide industry in decision making. “We’ve never been at greater risk of having machine learning and AI algorithms take us down the wrong path if we don’t get the ethics of them right. Today, because software such as AI and machine learning are not considered medical devices, there’s no regulation or ethical requirements around them,” she said. “So, we’ve got an opportunity to do this right – to do this solidly thinking through from patient safety, security of teams caring for them, the overall healthcare system, etc. “But today, we’ve got no handle on it and if we continue this way, we’re going to lose trust and the technological potential in front of us.” ETHICS AND THE STAKEHOLDERS' INVOLVEMENT And for a standardised set of regulations around these technologies, governance and stakeholder involvement is necessary, according to Dyer. “There are many stakeholders involved in new technologies. Before providing recommendations, researchers need to think about input from a variety of stakeholders. This shifts the burden of ethics across a number of stakeholders,” he said. “For example, shareholders in a healthcare company may be interested in maximising profit. Their perception of ethics may be more relaxed as they’re intending on using that data to make a profit. Someone interested in privacy legislation may be interested in protecting patient information. “So, there’s the general public – knowing what they expect, the wants of the healthcare industry and the way our governments manage that when determining the correct balance of ethics.” The University of Auckland Health Systems Lecturer Dr Monique Jonas previously said ethics plays an important role in emerging health technologies as it is “crucial in determining which health technologies should be funded, for which patients, upon what terms”. “The reason is that at least some emerging technologies promise to improve life and to extend life in a way that existing technologies are unable to do. So they carry potential benefits for patients,” she said. “Decisions about health technologies are inevitably ethical – they involve people’s interests, societal values and distributive justice. The acute importance of the end-point – the decision about whether to fund a given technology – means that the whole lead-in process that informs that end-point must be defensible in ethical terms. But it is not always clear what decisions are most defensible in ethical terms.” Kenny said governments need to address the ethical concerns arising from technologies like machine learning and AI algorithms by learning from the efforts of other countries. “There’s currently no principles around the use of AI algorithms and machine learning in Australia. If this flows in a completely unmanaged environment, it will be detrimental. The opportunity is not tomorrow, it’s right now,” she said. “It needs to start with something as simple as an agreement of terminology. For example, the UK has been very clear, through the House of Lords Select Committee, around a set of descriptors of these technologies. We don’t even have that remotely right here, which is resulting in ethical issues.” Kenny added that policy must lead the ethical discussion and said the draft report for the ethical use of AI and machine learning calls on “government of the highest level” to help industry get it right. “There needs to be a set of guiding principles for industry, vendors, researchers, care providers, and government themselves to set us on the right path,” she said. “With the Human Rights Commission and TGA having set out consultations, there’s serious work that needs to be done. This is an opportunity for government and regulators to come together and see it through.” GOING INTO THE FUTURE Rohr said that ethics in technology will continue to be an ongoing discussion given the rate of technological advancements. “There will need to be constantly evolving regulations in place to consistently ensure that there is no abuse of technology,” he added. Dyer suggested that conversations around what industry expects out of AI and machine learning should be brought up with the general public as a starting point, which can then be used by governments to make decisions and set up a legal framework. “It’s both a bottom-up and top-down approach. Research and industry have to advise government on what fits best, and government needs to act. Which one comes first, is interesting to see and will determine how we navigate this path going forward.” However, Dyer said there needs to be a greater understanding of the capabilities of AI and machine learning before a set of standards are set out and that ultimately, technology should only be an enabler of change. “The technologies are too new at the moment. I would advocate that for now, any time an important decision is made regarding human health, that it is always done by a perfectly-trained healthcare practitioner,” he said. “Technology can guide decisions but you need a human who is ethically trained to make that decision.”

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Samitivej Hospital Group, a private hospital brand in Thailand with a network of eight hospitals and owned by Bangkok Dusit Medical Services (BDMS), recently announced the launch of its one-stop Virtual Hospital app, offering three key services: Teleconsultation – a remote telemedicine consultation service that provides round-the-clock medical advice via a video call with Samitivej’s doctors and nurses. Test@Home – patients can have their blood samples taken in the comfort of their home and blood samples will be sent to the laboratory immediately. Medicine Delivery – medication will be delivered to patients with absolute data security as Samitivej adheres to the data protection standards mandated by the Health Insurance Portability and Accountability Act (HIPAA). Samitivej Virtual Hospital will be available on April 1, 2019, with services 24 hours a day, seven days a week. The consultation fee is 500 baht (approx. US$15.78) per 15 minutes, and patients using the service will receive a 20% discount on medications. In addition, the services of the Samitivej Virtual Hospital do not require appointments to be made in advance. Samitivej Hospital Group teamed up with six leading companies to launch the virtual hospital services: Advanced Info Service, Line Thailand, Muang Thai Life Assurance, Siam Commercial Bank, Sansiri and SCG Cement-Building. There is also a Samitivej Virtual Hospital control room (see featured image) located at Samitivej Srinakarin Hospital that has been designed with the specific purpose of enhancing the Samitivej Virtual Hospital experience. “A significant challenge in today’s healthcare industry is to move beyond digital disruption and service providers need to keep up with trends, innovate and develop new service models to continuously meet the needs of consumers in all sectors,” said Chairat Panthuraamphorn, Managing Director and Chief Executive of Samitivej Hospitals and BNH Hospital, in a statement. There are also plans to expand the Virtual Hospital service to BNH Hospital in the future, he added. Last month, BC Platforms announced that it will be providing its genomics platform to Bumrungrad International Hospital, a private multiple-specialty medical centre founded 1980 in Bangkok. In January this year, the Thai government added medicine, medical supplies and medical services to its price control lists. While there has been outcry from the private hospital industry that the price controls would adversely affect Thailand’s reputation as a medical tourism hub, the effects of the price controls remain to be seen.

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Eastern Health has rolled out a new trial across its Box Hill Hospital in Melbourne, Victoria, to help patients better manage their medication after they leave the hospital. DC MedsRec, the community pharmacy-based service for patients discharged from Box Hill Hospital with four or more medicines, aims to reduce the risk of harm from dangerous drug interactions. The trial, conducted in collaboration with the Australian Digital Health Agency (ADHA) and Monash University, will enable eligible patients to meet with trained community pharmacists, who will look at their hospital discharge summary via My Health Record (MHR), along with a range of other medication information on their electronic medical records (EMRs). The pharmacist will then check the patient’s understanding of the drugs they are taking, resolve any potential medicine safety problems and ensure any medication-related recommendations from the hospital are followed up. The pharmacist will also offer to dispose of any discontinued medications and prescriptions for the patient, with the patient's consent. The move follows Eastern Health’s successful EMR implementation at Box Hill Hospital In October 2017, in partnership with Cerner, as part of its Great Digital Information Strategy 2015-2020. ADHA CEO Tim Kelsey said the service was part of a $8.5 million program that trials innovative and new approaches to post-hospital support, palliative care and the management of chronic health conditions using digital technology. “Pharmacists involved in the Box Hill project will be able to access their patients’ hospital discharge summaries quickly and easily using My Health Record,” he said. “The ultimate aim is to ensure patients with complicated medication regimens don’t end up back in the hospital after taking a bad combination of medicines.” Monash University Project Lead Greg Duncan said the trial was initiated as a result of poor medication management during or immediately after a hospital stay, which becomes a risk factor in 28 percent of potentially avoidable hospital readmissions within 30 days. “We know medication errors often occur when patients leave the hospital and can mean patients end up being readmitted – so we will assess the impact of this new service on 30-day unplanned readmission rates to the hospital,” he said. Eastern Health Chief Executive Adjunct Professor David Plunkett said the trial positions the organisation to “provide both excellent clinical care and research,” with real-world benefits. “Community pharmacies from the Eastern Health area will take part in the pilot, with up to 5,000 patients potentially involved,” he said. The success of the service will be evaluated after 12 months, with Kelsey adding that the results could potentially shape future projects, helping patients throughout Australia better manage their medicines. This article first appeared on Healthcare IT News Australia.