Malaysian single-specialty hospital purchases cutting-edge medical equipment

INTERVIEW Malaysian single-specialty hospital purchases cutting-edge medical equipment

ALTY invested millions to provide the most advanced equipment for orthopaedic care.

MALAYSIA

Malaysia’s newest orthopaedic hospital faced a challenge when starting up – how their patients could get the best services without breaking the bank. With this in mind, the team at ALTY, or “Adding Life to Years” Hospital in Malaysia, purchased some multi-million cutting-edge technology focusing on orthopaedic care.

Unlike big hospitals, ALTY did not invest in technology that is unrelated to orthopaedic treatment. After consultations with its partners and surgeons, ALTY spent US$3.4m (RM15m) to acquire advanced medical equipment such as imaging systems for accurate diagnosis of orthopaedic diseases to help doctors evaluate their patients more accurately.

These medical devices were not only used to deliver advanced care to patients but also to help other orthopaedic surgeons in Malaysia.

From its soft opening in January 2022 to its official launch in July 2022, the hospital has so far performed 295 orthopaedic surgeries.

Healthcare Asia spoke to Anwar Anis, Executive Director for ALTY Orthopaedic Hospital, to share how one of the single-specialty hospitals in Malaysia will operate to offer “better quality” of orthopaedic treatment to patients.

What is “Adding Life to Years” and what can Malaysians expect from the hospital?

ALTY is one of the first single specialty orthopaedic hospitals in Malaysia. We certainly feel that whilst we’re not the first, we’re the most complete, having a full set of surgeons.

This is a hospital that is a partnership between surgeons, and also, a private healthcare investment platform, TE Asia, which has been developing single specialty hospitals around the region for the last five to six years. ALTY, as the name stands for, is adding life to years. We believe with our approach to orthopaedics, we can certainly help people live better, not so much about extending their life, but simply having a good quality of life from an orthopaedic perspective.

We also had surgeons transitioning from their previous place of employment to ALTY and this took place all the way until 2022. As of July 7, we are a full-fledged single-specialty orthopaedic hospital with eight resident surgeons and close to 150 staff to provide the best care for patients.

What did the launch of the ALTY Hospital mean for orthopaedics in Malaysia?

The launch of the hospital was almost symbolic to a certain extent but it was also about being ready to now serve the community, both in Kuala Lumpur, Malaysia and around the region as well. We now have an orthopaedic hospital that is geared towards providing the best standard of care for general orthopaedics but also a place where the general public and even other doctors can bring their patients to do complex orthopaedic procedures.

In ALTY, we have very experienced surgeons who have partnered with TE Asia. But because they are here together as partners, this is a place where a surgeon doesn’t do things alone, especially for complex procedures with significant benefits to the patient. We are the first in Malaysia to install an advanced imaging system called EOS that is very much catered to orthopaedics, especially for scoliosis, but also the first in Malaysia to install a weight-bearing magnetic resonance imaging (MRI).

We have these technologies that are good for orthopaedics and as such, we will be providing these services not just to the surgeons in ALTY but we’ve already expanded them and made them available to other orthopaedic surgeons in Kuala Lumpur. We certainly are going to make orthopaedic care more accessible to the general community, not just to the team of surgeons that we have.

What is unique about ALTY’s services?

Diagnostics, which are specific to orthopaedics. We are the first to install a couple of technologies and that enhances the procedure. We can obtain a clearer image, a better report. An innovative way of doing the diagnostics itself will certainly

We are going to make orthopaedic care more accessible to the general community (Photo: Anwar Anis, Executive Director,, ALTY Orthopaedic Hospital)

The launch of the hospital was symbolic; it was about being ready to now serve the community

give the surgeons a different angle.

On weight bearing, for example, the fact that you do an MRI in a standing position gives the surgeons a better view of how their spine is compressed, or how their joints react when they are standing rather than lying down.

We are also offering robotics that’s growing in Malaysia. We hope to make it more mainstream, so that patients can benefit from what robotic surgery can do for joints at the moment.

We also have a 3D C-arm that allows our surgeons to do an almost CT (computed tomography) like scan in the operating theatre that allows them to know whether their implants are in the right place before a patient is closed up; rather than doing the procedure and then the patient is sent back to the ward and a day or two later doing a CT scan and then determine if there was some misalignment or some corrections that need to be made.

Since this involves a lot of cutting-edge technology, would this come at a premium cost for the general public?

Quite contrary, one of the advantages of a single specialty is that we’re able to use economies of scale and bring the costs down. We have eight surgeons who have gotten together and agreed that there is one partner vendor for joint implants and a partner vendor for spine implants. This is quite rare, although we may think otherwise, whether it’s a public or private hospital.

To be able to consolidate and negotiate the best implants at the best price, we offer this back to the patient. Despite being a single specialty hospital for orthopaedics, having some very established experienced surgeons and using some good implants, ALTY is very competitive in the market and offers it at a very cost-effective rate to the patients. Additionally, even for diagnostics, we keep it very competitive. I think the proof is in the fact that we have doctors from other hospitals sending patients to us for their scan. Now, we even have the Ministry of Health sending patients over to us and we’re just about to finish discussions about having a university hospital send their patients over to us for the advanced imaging system as well. I think we certainly are making the technology accessible by keeping the pricing very affordable.

How did ALTY hospital convince its management to buy these cutting-edge technologies?

I would split it into different aspects. One is we are a partnership between the doctors and TE. As a partnership, what we do is unlike multi-specialty hospitals and large hospitals, there is a robust discussion between the surgeons and TE even though we’re setting up the hospital to look at what makes sense from an orthopaedic perspective. We don’t have to then invest in technology that is quite general that needs to cater to non-orthopaedic needs.

You can imagine in a large multicenter hospital, whatever technology you buy, needs to be as generally applicable as possible because there are so many specialties that are competing for those resources.

However, in ALTY, we know that these technologies are being put to use predominantly for orthopaedics. Thus, it wasn’t much of an issue in deciding to invest in these multimillion-dollar technologies because we know that the focus is on a particular specialty.

COUNTRY REPORT: INDONESIA Indonesia struggles with electronic medical record implementation

Only 13% of hospitals have optimally implemented electronic medical records, according to a survey by PERSI.

Data information from electronic medical records can facilitate policy-making and public access to health services

Most of the 3,000 hospitals in Indonesia still use traditional and manual record-keeping of their patient’s medical histories. This causes bottlenecks in healthcare procedures. To push healthcare institutions to digitise records and digitalise processes, the Health Ministry released a new regulation that gives them until the last day of 2023 to transition to an electronic system.

The Regulation of the Minister of Health Number 24 of 2022 was released in August. This supports the implementation of the sixth pillar of Health Transformation, which is the health technology transformation. The other five pillars of Health Transformation include primary service, hospital referral services, health resilience system, health financing system, and health human resources.

“This is done to provide convenience because the public can obtain traceable diagnosis results, and data information from electronic medical records can facilitate policy-making and public access to health services,” said Chief of Digital Transformation Office of Health Ministry, Setiaji in a press conference.

The regulation requires electronic medical records and processes starting from patient registration, distribution of patient medical records that can be carried out between internal units of healthcare facilities, recording of patient clinical data by medical personnel, coding and reporting of medical records in internal healthcare facilities, as well as the transfer of medical record contents in order referral to other healthcare facilities.

The process of filling out and distributing medical records will be based on the patient’s consent, and this medical record data is regulated by the Health Ministry for its storage and security standards.

Later, patients can access their electronic medical records through PeduliLindungi, an application that is commonly used by Indonesians during the COVID-19 pandemic to access certificates and information about vaccines and to check in at public places. Healthcare facilities must be connected to an integrated platform that combines various applications from various health industry players that have been provided by the government, namely SATUSEHAT.

Hospital concern

The Indonesian Private Hospitals Association (ARSSI) supports the implementation of electronic medical records in hospital services.

“The unique geographical condition of Indonesia as an archipelagic country requires good and equitable quality health services. In addition, the online health service system can reduce bottlenecks that still exist in hospitals today, such as the problem of long queues because patients are queuing back and forth,” said Secretary General of ARSSI, Ichsan Hanafi to Healthcare Asia.

However, Hanafi highlighted the obligation to organise medical records by different hospitals’ capabilities. “There are more than 3,000 hospitals in Indonesia, of which 65% are private hospitals with varying hardware, human resources, and financial conditions so that they have different adaptability,” he said.

Hanafi noted that only a few private hospital groups are listed on the stock exchange and have strong financial health, whilst the majority of private hospitals are sole owners. He suggested that the Health Ministry make a module.

The results of a quick survey by the Indonesian Hospital Association (PERSI) in March 2022 regarding electronic medical records and hospital digitisation, with 646 hospitals as respondents, showed that only 13% of respondents had implemented electronic medical

Indonesia as an archipelagic country requires good and equitable quality health services

We will intensively conduct socialisation for the application of this electronic medical record. Because this is a cultural change

Socialisation will guide medical personnel to understand more about IT, because they will be the ones to input patient data

records optimally. It also shows 32% of respondents stated that they will only implement electronic medical records and as many as 17% have no plans to implement electronic medical records. In this quick survey, the questions asked to respondents include what kind of Hospital Information Management System module is used, what types of electronic data are available in the electronic medical record application, how hospitals develop digital transformation, where hospitals put the location for electronic data storage and hospitals’ outlook about digitalisation maturity.

“If you look at the results [of the survey] this needs attention because the situation is not the same [amongst hospitals,” said PERSI’s Head of Data and Information Compartment, Anis Fuad at a press conference.

Digital Maturity Index

To overcome the various hospital conditions in the implementation of electronic medical records, the Health Ministry will map all health facilities with the Digital Maturity Index.

“From the index, it will be known which health facilities are ready or not. There will be a level, and then from there we will use it to implement this policy,” said Setiaji.

The Digital Maturity Index is an instrument for measuring hospital digitisation. The assessment through this index includes hospital governance, organisation, and human resources such as how the hospital’s IT strategic plan is, how many human resources will focus on networking or become programmers, and how much the hospital has budgeted for IT. Another assessment is a matter of information system architecture about how the front office and back office are as well as the application of electronic medical records. Hospital data and interoperability standards such as variable and metadata standards and data coding standards are included in this index. Likewise, the capabilities of IT system infrastructures, such as data centres and internet connections as well as reporting and analysing hospital data, for example, how to use dashboards and analytics in the hospital.

Setiaji explained that, the Health Ministry will cooperate with the Communication and Information Technology Ministry in ensuring that the use of electronic medical records is not problematic in terms of the internet. “There are healthcare facilities which are located in remote and marginal areas where it is difficult to get an internet signal, for that we can not directly implement data synchronisation but can be done gradually, for example, synchronisation is done once a day,” the Health Ministry chief said.

The Health Ministry is also working with the National Cyber and Encryption Agency (BSSN) to strengthen the security of medical record data. Setiaji said the Health Ministry has prepared guidelines on how to secure data and prepare electronic medical records with security that meets government standards. “We will also intensively conduct socialisation for the application of this electronic medical record. Because this is a cultural change. Socialisation will also guide medical personnel to understand more about IT, because they will be the ones to input patient data. It is hoped that this can be accelerated where by the end of 2023 everything has been connected and digitised,” he said.

In the Health Digital Transformation Roadmap launched by the government, 2022 is the year to develop architectural designs— one of them is an integrated health service system platform, which was built in the previous year. In 2023, implementation will begin and in 2024 it will be an expansion of the coverage of an integrated health facility information system.

Ichsan Hanafi

Setiaji

Anis Fuad

Patients can access their electronic medical records through PeduliLindungi, an app commonly used during the height of the pandemic