Healthcare Asia (September - February 2019) by Charlton Media Group

The magazine for healthcare administrators and policy makers

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Display to 28 February 2019

HOSPITALS UNDER ATTACK SINGAPORE’S MASSIVE DATA BREACH SHOWS THAT HOSPITALS NEED TO STEP UP THEIR GAME IN ORDER TO WARD OFF POTENTIAL ATTACKERS AZHAR HARUN CEO, UMSCp14

CHINA’S INTERNET HOSPITAL BOOM OVERCROWDING IN SINGAPORE’S PUBLIC HOSPITALS WILL RISING COST STUNT THAILAND’S UHC GOALS? INDIA’S AMBITIOUS MODICARE PROGRAMME

FROM THE EDITOR Welcome to the awards issue of Healthcare Asia magazine! It has been a fruitful year for all of us as we concluded our first ever Healthcare Asia Awards. This year, we received 45 nominations from outstanding hospitals across the region, and 34 have been lauded for their outstanding commitment to innovation and stellar patientcare. Flip the pages and check out the big winners!

Publisher & EDITOR-IN-CHIEF Tim Charlton production editors Genelie Sta.Ana-De Leon Elisha Yamzon GRAPHIC ARTIST Elizabeth Indoy

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Meanwhile, in India, the government is attempting to provide a massive universal healthcare programme for half a billion people, but concerns are raised about financial and political sustainability. Stakeholders fear that the programme’s extremely low package rates will deter private hospitals from participating, whilst analysts warn that some of the programme’s key aspects may be prohibitively expensive. In Singapore, high-profile hackers are targetting healthcare institutions. How can hospitals protect their valuable data? Healthcare Asia also caught up with Azhar Harun, CEO of University Malaya Specialist Centre (UMSC) as he talks about how the hospital is eyeing to be an ecosystem with the most extensive spectrum of specialties and innovative medical equipment, and their plans to build a new wing with purpose-built private wards and clinics for a ‘pleasant patient journey.’ This issue also bears the event coverage of the the Healthcare Asia Forum held in Bangkok, Thailand. Read on and catch up on what has transpired. As always, we wish you the very best of health.

Tim Charlton

Healthcare Asia is also the media sponsor for the following events:

Editorial Enquiries If you have a story idea or just a press release please Email: ha@charltonmedia.com and our news editor will read it. For a personal message to the editor, put the word “Tim” in the subject line. Media Partnerships Please Email: ha@charltonmedia.com and put “partnership” on the subject line and it will forward to the right person. Subscriptions Email: subscriptions@charltonmedia.com Healthcare Asia is published by Charlton Media Group. All editorial is copyright and may not be reproduced without consent. Contributions are invited but copies of all work should be kept as Healthcare Asia can accept no responsibility for loss. We will however take the gains.

Distributed to all CxO, board levels, doctors, and healthcare professionals of major private/public hospitals and health ministries in ASEAN and Hong Kong.

2019

Healthcare Asia Forum

CONTENTS

EVENT COVERAGE

Rapidly growing costs stunt Thailand’s healthcare goals

eVENT COVERAGE

ceo INTERVIEW

UMSC’s CEO Azhar Harun reveals their

12 vision to be the ‘hospital of hospitals’

24 HEALTHCARE INSIGHT

FIRST 06 Are Singapore’s public hospitals

12 Health data is wealth: Why hackers

overcrowded?

Healthcare Asia lauded the best hospitals in APAC at the Healthcare Asia Awards 2018

ANALYSIS 22 Smart Healthcare’s evolution

targetted Singapore

07 China’s internet hospital boom

COUNTRY REPORT

08 Singapore’s healthtech startup boom 10 India’s ambitious Modicare

16 The doctors are out: Labour shortage

programme raises sustainability fears

Published Tri-annually Bi-monthly on on the the Second Second week week of of the the Month Month by by Charlton Media Group 101 Cecil St. #17-09 Tong Eng Building 2 HEALTHCARE ASIA Singapore 069533

cripples Hong Kong’s public hospitals

To access the stories online, visit the website

www.healthcareasiamagazine.com

DELIVERING THE BEST IN PERSONALIZED CARE MATTERS.

United Family Healthcare, a healthcare pioneer in China, uses our electronic medical record software to make better care decisions and improve the patient experience. Learn more at InterSystems.com/UFH

CASE STUDY

TrakCare: Transforming healthcare through technology, one hospital at a time

Three leading healthcare providers discuss how an electronic medical record system has improved clinical outcomes and boosted patient care.

hen Thailand’s Bumrungrad International Hospital rolled out the InterSystems TrakCare® electronic medical record (EMR) system in 2018, it experienced a rapid increase in patient satisfaction and operational efficiency. “Paper usage across the entire hospital has fallen dramatically with TrakCare’s deployment, and the increased use of electronic communications has also helped to reduce journey times for patients,” says Kenny Lim, Chief Information Technology Officer, Bumrungrad International Hospital. “By implementing TrakCare throughout the hospital, we achieved the highest patient satisfaction rating of over 95% over the past few months in several departments.” InterSystems TrakCare is a leading EMR system trusted by top healthcare providers in more than 25 countries worldwide. It helps hospitals provide a seamless patient journey by offering a unified record for each patient, which leads to faster and better decisionmaking. “When every doctor or nurse who is authorised to has rapid access to all of a patient’s data – including their allergies, clinical history, and previous and current diagnoses – it can lead to dramatically better decisions and patient outcomes,” explains Kerry Stratton, Managing Director Asia Pacific for InterSystems. Improved patient safety TrakCare enables streamlined and shared workflows across care settings to ensure that patients spend less time waiting. They avoid unnecessary testing and experience smoother care transitions. And more importantly, patients can be active, informed participants in their care. “Patients don’t get asked questions multiple times, speeding up the process and reducing delays,” Stratton says. At Bumrungrad, for instance, clinicians now use TrakCare to manage all patient interactions and facilitate their workflows. “This has improved communication between care teams and departments and reduced dependency on paper. Doctors and nurses are able to quickly and easily view a comprehensive, unified record for each

HEALTHCARE ASIA

Bumrungrad International Hospital has reduced patient journey times

“TrakCare’s clinical decision support capabilities provide safety alerts for a range of risks including drug interactions, therapeutic duplications, and duplicate orders.” patient,” Lim notes. He adds that TrakCare’s clinical decision support system also provides safety alerts for a range of risks including drug interactions, therapeutic duplications, and duplicate orders. “The most important contribution of the EMR solution to the organisation and its success has been to provide a single patient record that is clear and can be read without mistake. Over the next few years, hospitals will see almost all medical tools become digital. The challenge will be to get them all integrated with the EMR and managed in a single holistic solution,” Lim says. For Indonesia’s Rumah Sakit Pondok Indah (RSPI) Group, TrakCare is a crucial driver of research and growth. “If I look back, some of the processes and the projects we do for continuous improvement would not have been possible before implementing TrakCare,” says Dr. Yanwar Hadiyanto, CEO, RSPI Group. “Sometimes in the past we didn’t do a project because it was almost impossible to get a reliable indicator. It was too much work to get the data, and when you did it was very difficult and you didn’t know if it was reliable or not because it was done manually. With

the EMR, the information is much more accessible.” RSPI operates three premium hospitals in Jakarta. All three hospitals have deployed the InterSystems TrakCare unified healthcare information system. Its first hospital started using TrakCare in 2014, closely followed by the second in June 2015. The group’s newest hospital, RSPI Bintaro Jaya, opened in May 2017 and has utilised TrakCare from day one. Additional value for patients TrakCare also allows RSPI to analyse direct financial outcomes and make better use of its manpower. “Consider the direct impact for the main hospital where we have almost 2 million active patients with 2000 visiting outpatients a day. You can imagine how many people were needed in the medical report department to find the information on paper when each patient arrived. When we introduced the EMR we could reduce that manpower substantially and assign people to do things that were more productive. I am not saying finding medical records was not important. But with the EMR, some of those people can create additional value for our

Case STudy

Dr. Yanwar Hadiyanto, CEO, RSPI Group

patients,” Hadiyanto notes. Still, Hadiyanto credits TrakCare for dramatically cutting waiting times and improving RSPI’s operational efficiency. “Over time, we have managed to cut waiting times, some by half, some by even more. In the past, I remember people putting orders in on paper and then it was put in the system and sent to the lab where it was printed and people keyed in the order again into the machine. I counted maybe 15-20 steps to go from orders to get the results. The EMR significantly cuts down that process and the time from order to results,” he says. “TrakCare’s contribution is tremendous. I would like to put it in perspective. If we hadn’t implemented TrakCare when we did four years ago, maybe my options now would be very very limited.” A long and trusted partnership For over a decade, InterSystems has been a reliable partner for United Family Healthcare Group, China’s largest foreigninvested healthcare provider. “We have been using InterSystems TrakCare for 10 years. All the entities which are wholly owned and operated by UFH in China use the TrakCare EMR system,” says Dr. Jenny Shao, Health Information Systems Director, United Family Healthcare. “I think the EMR is an essential tool for modern

medical practice. We consider it to be the representation of clinical practice in a digital version.” In terms of patient safety, Shao says the EMR is crucial in providing medication management. With TrakCare, United Family Healthcare has been able to implement a closed loop medication management system in each of its hospitals. “We recently purchased medication dispensing machines for use on the wards – you need to have an identifier for the patient to obtain any medication. TrakCare is a modern EMR, it has inventory management, for example. It is important to have one system to manage everything.” TrakCare has also made a difference in ensuring a seamless referral system. “Every time we need to arrange a referral within our organisation from one healthcare provider to another we use the system to book it. The system then makes sure that every request is followed and there are no missing requests,” Shao explains. “With TrakCare we have been able to standardise workflows across the organisation in a professional way. There are differences between the specialties, but they are all using the same workflows. So every time we expand, we not only open a new hospital, all the entities follow the standards, and this brings efficiencies as well.”

is at the heart of modern healthcare. “Innovation can mean a lot of different things in a hospital setting. The starting point is having access to high quality patient clinical data. By moving clinical data and business processes into a unified EMR like TrakCare, you open up opportunities to learn from the data, and use those learnings to innovate,” says Dimitri Fane, InterSystems Director of Product Management – TrakCare. InterSystems TrakCare offers dashboards which show data that can be used to fine-tune clinical usage of the EMR. This allows organisational efficiency to be easily evaluated and improvements measured accurately. It makes a wealth of metrics available, which can be used to help achieve improvements in the clinical process. “It is important to remember that while innovation can be high tech and complex, it can also be as simple as adjustments to the way you handle patients upon arrival, or steps you take to reduce patient waiting times. Effective use of the EMR can really drive significant ongoing improvements,” Fane adds. “It is always a challenge and always a big task for the leadership to make everyone in the organisation adopt the system, it is very critical for success,” says RSPI’s Hadiyanto. “For those who have not yet implemented one, I think an EMR is no longer optional.”

The future of healthcare The experience of Bumrungrad, Rumah Sakit Pondok Indah Group and United Family Healthcare show that a reliable EMR system

For more information, including a video overview of United Family Healthcare, please visit http://bit.ly/2PhRkTK

“InterSystems TrakCare is a leading EMR system trusted by top healthcare providers in more than 25 countries worldwide.”

United Family Healthcare Group has used InterSystems TrakCare for 10 years

HEALTHCARE ASIA

FIRST HEALTHCARE EXPENDITURE 2012-2017

Average waiting time in public hospitals falls at around 2.5 hours

Are Singapore’s public hospitals overcrowded? SINGAPORE

Source: World Health Organization, Bmi Report, Ministries Of Health Of The Respective Countries, Asian Development Bank, Solidiance Analysis

HEALTHCARE ASIA

lthough globally hailed as one of the world’s most efficient healthcare systems, Singapore’s public hospitals are not exempt from high congestion levels especially at peak hours where occupancy rates could hit as high as 93%. The amount of waiting time to be admitted to a ward from the emergency department falls at around 2.5 hours, according to research firm Value Penguin, citing health ministry data. This metric is used for hospital overcapacity as this suggests that there is not enough personnel to handle patient requirements. Hospitals have the longest wait times during middle of the week with the average wait time of 3.2 hours in Tuesdays and Thursdays compared to an average wait time of 1.6 hours on weekends and 2.3 hours on Mondays and Fridays, added ValuePenguin. If this is the case, why is Singapore’s healthcare spending moving away from the establishment of hospital infrastructure that can absorb booming medical demand?

The average occupancy rates of Singapore public hospitals are around 85% but usually peak to as much as 93% during weekdays.

After a steady increase from 2012 to 2016, Singapore’s total healthcare expenditure actually fell from $10.48b in 2016 to $9.82b in 2017. However, if the data is to be analysed into operating and development expenses, operating expenditure actually increased by 10% YoY to $9.02b in 2017 whilst developmental expenditure fell 10% to $1.46b over the same period which indicates a shift in funding priorities. “The increased operational expenditure reflects an increase in elderly population and a consequent increase in usage of healthcare services of public healthcare institutions and longterm care facilities. The decrease in developmental expenditure can be attributed to the completion of several infrastructure projects aimed at increasing the number of hospitals,” according to Vikas Bedi, APAC Healthcare Research at data and analytics firm GlobalData Singapore has already taken proactive steps in responding to critical medical infrastructure gaps with six new hospitals scheduled for completion in 2022 and around 14 new polyclinics by 2030. This enables it to shift away from hospital building and set its sights towards the delivery of quality care especially as the ageing population is expected to double to 900,000 by 2030. “One also needs to look at how the Government of Singapore has been developing and facilitating the healthcare coverage and delivery over the years. The proactive steps taken by the government over the years as well as the advance planning and provisions outlined in the budget of 2018 bodes well for the healthcare system of Singapore,” added Bedi.

Average xxx Per capitadaily totalbed expenditure occupancyon rate health for 6 public hospitals (7/15/2018-7/21/2018)

Source: ValuePenguin World Health Organization

FIRST diagnostic services for some common and chronic diseases in patients’ follow-up visits to their doctors. Further, the top two levels of hospitals within the country’s three-tier system will be encouraged to provide online services, including consultations, reservations, and test result inquiries.

In April 2018, the State Council has given the green light to internet hospitals

China’s internet hospital boom

W China

hen China’s first officially approved internet hospital was launched in Guangdong in 2014, the outpatient service consisted of just four clinics operated by doctors from the Second People’s Hospital of Guangdong Province. Little did doctors know the service would quickly catch on: in just several months, the network of internet medical consulting facilities has expanded to over 1,000 sites, covering 21 municipalities in the province.

“Internet hospitals provide convenient outpatient service delivery. However, many of the internet hospitals are not yet mature and are faced with various issues such as online doctor scarcity and the unavailability of health insurance coverage,” said Xiaoxu Xie of National Research Institute for Health and Family Planning. In April 2018, the State Council has given the green light to internet hospitals. Medical institutions will now be allowed to provide online

The network of internet medical consulting facilities has expanded to over 1,000 sites, covering 21 municipalities.

Tech firms cash in on the boom Recently, internet giant Alibaba revealed that it will team up with Xi’an International Medical Investment to offer internet-powered medical services. Meanwhile, Alibaba’s rival Tencent has invested in Hangzhou-based WeDoctor, an online healthcare service that allows patients to video chat with doctors and make prescription requests online. “China’s enthusiastic adoption of innovative eHealth systems could encourage the rest of the world to make the internet an integral part of their medical care. The innovations and experiences of China’s internet hospital will be helpful and influential for any developing country whose medical resources are clustered in their big cities,” said Xie. “Medical institutions will partner with internet companies to offer online diagnostic services and followup consultations to meet the rapidly rising demand for healthcare and alleviate the problem of inaccessible and expensive public health services exacerbated by ageing demographics,” noted BMI Research.

The Chartist: Pharmaceutical firms flock to Asia for clinical trials Multinational drugmakers are flocking to Asian countries as it becomes an attractive destination for clinical trial research for new medicines. According to a report by BMI Research, the attractiveness of these nontraditional destinations for clinical research is predominantly driven by lower research costs. Greater competition for the same patient pool is a key driver of this trend, in addition to an increasingly burdensome regulatory environment for drug sponsors. Asia also boasts a number of specialised clinical trial centres, situated largely in China, South Korea, and Taiwan. Meanwhile, Japan recently gained conditional marketing approval for regenerative medicines, as well as Taiwan’s National University Hospital specialising in clinical trials for novel cancer drugs.

Room for clinical research in Asia per capita government spending by selct countries (2015)

Sources: World health organization, BMI

Attractive clinical research base China: clinical trials by phase and year

Source: ClinicalTrials.gov, BMI

HEALTHCARE ASIA

FIRST record-breaking vc deals in digihealth china

Singapore’s healthtech startup boom Singapore

MHealth startup Codoon

Digital health startups raked in a record amount of venture capital funding in the first half of 2018, a report by Mercom Capital Group revealed. Globally, venture capital funding jumped 22% on a yearon-year basis with a record $4.9b raised in 383 deals. The APAC region received $450m from 63 venture funding deals in the first half of the year, driven by large placements in Chinese health startups. Amongst the region’s biggest winners are health information management startup Infervision which raised $47m in Series B funding. Meanwhile, mobile health startup Codoon raked in $20m in Series C funding. “Apart from China, we see India as having great potential for digital health both in terms of venture funding received by Indian digital health companies and due to the proliferation of mobile phones among the population. Even though policy support for digital health is almost non-existent in both China and India, consumer-centric digital health technologies have taken hold,” said Raj Prabhu, CEO and cofounder of Mercom Capital Group. Other notable deals include SoftBank’s $400m private placement in Ping An Good Doctor, as well as Adamas Finance’s $5.45m investment in Singapore’s DocDoc. “Digital health companies attract enormous amounts of funding every year around the world. Companies need to be very focused on solving a pain point that is tailored to their communities. They need to have a differentiated product with hopefully some intellectual property behind it. Traction is very important and startups need to partner and show some successful trials and demos with healthcare organizations. The ability to overcome regulatory hurdles in specific countries is also very important,” Prabhu said. 8

HEALTHCARE ASIA

t’s boom time for Singapore’s healthtech firms as they raked in $16m worth of deals in H1 2018, healthtech ecosystem-builder Galen Growth Asia revealed. The biggest investment in a healthtech startup in Singapore was the $8.2m financing secured by artificial intelligencepowered startup UCare.ai. Founded in 2016, the firm utilises algorithms for prediction of healthcare patterns in patients. Meanwhile, Docdoc, which provides online search service and scheduling platform for medical appointments, secured $7.43m in March 2018. ObvioHealth, which offers a mobile clinical study platform for site-less clinical trials, raised $4.09m. “There is a level of acceptance and optimism amongst both institutional and individual investors based in Singapore that digital health and technological innovations are the way into the future,” said Deloitte Southeast Asia healthcare sector leader Dr. Loke Wai Chiong. However, Galen Growth Asia CEO Julien Salaberry believes that Singapore can further leverage its healthtech landscape if it puts as much focus on it

Singapore’s DocDoc platform

The biggest investment in a healthtech startup in Singapore was the $8.2m financing secured by artificial intelligencepowered startup UCare. ai.

as it already does for the fintech sector through initiatives from the Monetary Authority of Singapore (MAS). “They need to make a good balance between large organisations and startup ecosystems as to how they address the market, how they invest in the market, and how they support the market.” Meanwhile, EY Asean health transactions leader Abhay Bangi believes that the country’s healthtech sector can attract more investors through its commercialisation speed and its ability for reference to launch in other markets. Bangi was referring to the Health Sciences Authority’s (HSA) simplified regulatory framework, which enabled immediate market access for Class B and C standalone mobile medical applications starting June. “The changes seek to cater to different operational and emerging business models in the medical device industry and facilitate access and innovations, whilst safeguarding consumer health and safety,” Bangi noted.

Startup watch

The CareVoice launches voice-based AI health assistant china

Shanghai-based health startup The CareVoice has launched the first AI voice-based Virtual Health Assistant for insurers and employers in Greater China. This artificial intelligence-based symptom triage feature is integrated into the CareVoice platform, allowing insurance members to check their symptoms, access self-care content, and be guided towards relevant medical practitioners. This helps avoid unnecessary consultations by directing members to more relevant and costeffective medical providers. This feature has been launched in collaboration with Sensely, a US-based company.“We have already partnered with two insurers, AXATianPing and Ping An Health, to launch this consumer-centric innovation to the Chinese market,” said Sebastien Gaudin, CEO and cofounder of The CareVoice. The firm has also started expanding its operations to Hong Kong.

The team behind CareVoice

FIRST

India’s ambitious Modicare programme raises sustainability fears India

ndia’s attempt at providing universal healthcare has raised concerns about financial and political sustainability. Stakeholders fear that the programme’s extremely low package rates will deter private hospitals from participating, whilst analysts warn that some of the programme’s key aspects may be prohibitively expensive. The programme—known officially as Ayushman Bharat, or the National Health Protection Scheme (NHPS), but also dubbed as “Modicare”—will cover a staggering 500 million people, including the nation’s poorest residents. The scheme will provide an annual coverage of $7,000 per family for secondary and tertiary care hospitalisation. It will include over 1,000 treatment packages. Uncomfortably cheap Many insurance companies are closely monitoring the development around final premium in order to ensure viability, but some have opted to wait and see first before jumping into the new programme. However, private hospitals have already voiced their concerns over low package rates for treatment proposed under the scheme. “For example, the package rate for caesarean delivery procedure under NHPS is

$125, whilst the package rate is around $250 under existing schemes such as CGHS and RSBY. On the other hand, private hospitals charge anywhere between $278-$1300 for the procedure,” noted a report by CRISIL, a S&P Global company. The NHPS has a proposed target rate of $15 per family for a medical coverage of up to $7000, which translates into a premium of $3 per capita. “[This rate] looks very low, especially considering the involvement of private insurance companies having profit motive. In our base case scenario, the national average premium (with an average claim of $278 per family) comes to $24.55 per family, which is 63% higher than the NHPS-recommended premium rate,” the firm warned. Under close scrutiny Another aspect which bears close scrutiny is fraud monitoring. Under existing schemes, there have been several instances reported of private hospitals ordering unnecessary procedures and tests to cash in on the programme. Meanwhile, figures from the State Bank of India’s economic research department show that the initial cost of Modicare is estimated to be less than the

Modicare aims to cover 500 million people

market estimate of $1.7b, on the idea that the number of claims in the first few years will be low as it generally takes time for citizens to sign up for the programme. Meanwhile, the Insurance Regulatory and Development Authority (IRDAI) expects that health insurance coverage in India will rise from 34% to 50% thanks to the programme. “The mechanism and vehicle for raising the resources required will be a key monitorable. The National Health Mission has seen cumulative expenditure of $7.4b in the last two fiscal years and the government has already allocated budgetary support of $4.2b for fiscal 2019. With the implementation of NHPS, the central government will need at least Rs 6,500 crore per year on premium payment,” CRISIL noted.

HEALTHCARE OFFICE WATCHWATCH

Singapore’s Doctor xxxx Anywhere clinches $5.6m

Doctor Anywhere, Singapore-based Another player joins athe fray of coworking spaces telehealth raised at the heartstartup, of gardenhas citysuccessfully with the opening of $5.6m in athe Series A financing round. The WeWork, world’s largest coworking space round was anchored by Kamet provider. Located at beach centre,Capital the space Partners other boasts of aalongside perfect blend of investors. art, utility, and “We connect to healthcare productivity – all care-seekers in close proximity to Singapore’s providers through video youthful downtown district.call on the mobile phone, on-demand. platform The space features Our 690 digital desks and open-air gives you quickwith access tonatural healthlight, and splashed meeting places ample wellness solutions,walls wherever you are.AWe with pastel-colored and furniture. stay currently three services—General at WeWorkhave Beach Centre will be reminiscent Practitioner, Lactation, and Medical with of traditional Singaporean shophouses, Aesthetics consultations, ” said Lim Wai old storefronts, arched window frames, multiMun, founder ofand Doctor Anywhere. colored shutters, concrete breeze blocks The funds channeled placed aroundwill thebe office. But thetowards centerpiece growing thebuilding team base, exploring of the glass is its yellow mainnew staircase, businessWeWork verticalsBeach and developing more spanning Centre’s three floors. In healthcare fromdesign. this year here, classic solutions meets modern Its WeWork’s onwards. “At theSoutheast heart of Asia, our business, first venture into where we wish to integrated careWeWork’s to our residents arebring expected to increase users’ doorstep, and willfound be developing our 200,000-strong members amongst 212 businessinin20 that direction. ” he said. locations countries around the world. 10

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Singapore’s Doctor Anywhere team

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Healthcare insight: cybersecurity

Healthcare data has outgrown the value of credit card or social security numbers

Health data is wealth: Why hackers targetted Singapore Singapore’s high-profile data breach shows that hospitals need to step up their game in order to ward off potential attackers.

hen database administrators detected unusual activity on SingHealth’s IT systems in early July, little did they know that the episode would spiral into the most serious breach of personal data in Singapore’s history. Soon enough, the country watched in growing horror as reports revealed that the records of 1.5 million SingHealth patients had been compromised, including those of Prime Minister Lee Hsien Loong and other government officials. Forensic investigations later revealed that the hack had started eight days before the cyberattack was even reported. The data taken included the names, NRIC numbers, addresses, gender, race, and dates of birth of the patients. Information on the outpatient dispensed medicines of about 160,000 of these patients was also illegally accessed. The 12

HEALTHCARE ASIA

Medical information is expensive—it had a street value of around $50 as of 2015, compared to a measly $1 for credit cards and social security numbers.

Cyber Security Agency of Singapore (CSA) and the Integrated Health Information System (IHiS) later confirmed that the breach was a deliberate, targeted, and well-planned cyberattack and was not the work of casual hackers or criminal gangs. Profitable healthcare data For Singapore, one of the world’s most connected and technologically sophisticated nations, the breach was a painful reminder that healthcare data has grown its value that hackers are now willing to go the extra mile to obtain it. “Healthcare data has outgrown the value of credit card or social security numbers,” said Olli Jarva, managing consultant of software integrity group Synopsys. Data from the World Privacy Forum revealed that cases of medical identity theft has ballooned globally in recent years. This is because

medical information is expensive—it had a street value of around $50 as of 2015, compared to a measly $1 for credit cards and social security numbers. The average profit per medical record is a staggering $20,000, compared to just $2,000 for regular identity theft. Sid Deshpande, research director at Gartner, warned that the most immediate threats which victims will face are that of identity fraud, financial fraud, and tax fraud. “Data contained in healthcare records is more permanent than credit card information, for example, so citizens need to be alert to scams resulting from social engineering efforts,” he said. “This type of information likely fetches higher payouts on the dark web. It could also be sponsored by nation states that have interests inimical to Singapore’s,” he added. He noted that the breach likely started when a front-end workstation was compromised, followed by privileged access credentials being used to access a database. “Attackers are usually after administrator credentials because these often enable direct access to sensitive data,” Desphande noted.

Healthcare insight: cybersecurity Kenny Liew, telecommunications analyst at Fitch Solutions, further warned that the relatively lower number of servers could heighten cybersecurity risks. “We believe that Singapore could look at increasing secure server capacity to cope with the growing amount of data being collected and stored. This is especially as the volume of data in Singapore only grows by the day as the city state steps up the implementation of the government’s digital economy blueprint and is seeking to establish itself as a leading fintech hub,” Liew said. Liew added that healthcare is not the only sector at risk from cyber attacks. Insurance companies, financial services, ride-hailing, and bike-sharing easily come to mind, but almost every single industry which collects data are suspect. “The state-built digital repository platform MyInfo, which allows Singaporeans to automatically key in information for e-forms also remains a key prey for malicious cyber identities,” he added. Are hospitals ready? Over in the Farrer Park General Hospital, technology is such a crucial part of patient experience that even the meals that patients can order is linked to their digital medical records, so that any restrictions can be immediately applied. These services utilise a large volume of data, and the hospital uses artificial intelligence to protect this valuable information. “We have been able to identify users surfing the dark web, as well as misuse of internet bandwidth. Our AI tools have a 90% detection rate of any malware or abnormal behaviour within its systems,” said James Woo, chief information officer of Farrer Park Company. “Based on my experience, there have been increasing zeroday attacks over the years, and I am not comfortable with that. Hackers change their attacking pattern nowadays, and detection and behaviour learning are more important to prevent an attack even before it happens,” he noted. Woo warned that attacks of the future will become more dynamic

and is not going to be as structured as they are at present. “I believe that using artificial intelligence and machine learning allows us to tackle the dynamics of these changing trends. I also believe that attackers will eventually use AI to attack an organisation as well, so why not use AI to fight back and stay ahead of the curve?” he asked. Singapore’s cybersecurity frameworks are amongst the world’s strongest, but healthcare organisations face a unique challenge when it comes to warding off cyberattacks. Jarva noted that from a security standpoint, the healthcare industry shares the same shortcomings as other enterprises, but with some added obstacles. Aside from the lack of resources, the industry also has to deal with an “extremely heterogeneous environment.” “Whilst healthcare organisations may standardise on laptops and IT servers, providers also manage multiple devices that are attached to the network. These can include drug infusion pumps, imaging devices like MRI and CT scanners, and treatment software, such as those used to manage implantable pacemakers,” Woo said. For instance, large computer systems are typically part of a bigger project developed and delivered by third-party system integrators, where the supply chains can get complicated. This compounds the challenge to manage security, as different parts of the system may have different third-party software components and inherent vulnerabilities, and often, may not be properly identified and patched early enough. “This isn’t a challenge that is unique to healthcare, it is a challenge that every large organisation goes through,” Jarva added. Moving forward Although the government was lauded quickly for its swift action to contain the fallout after temporarily imposing internet surfing separation in SingHealth’s IT systems and resetting user and system accounts, damaging security concerns have already started to weigh in on business sectors

Olli Jarva

Sid Deshpande

Kenny Liew

Tan Shong Ye

that handle a wealth of customer information on a daily basis. To address other vulnerabilities, the government could also look into separating parts of the IT infrastructure that are not heavily reliant on the internet to operate so that sensitive information could benefit from another layer of protection against attacks, noted Joanne Wong, senior regional director for Asia Pacific & Japan at LogRhythm. “Whilst this is not a be-all and end-all solution, it makes remote access into the network much harder for external parties and thus creates a defensive shield for these systems,” she noted. Deploying secured information gateways that scrutinise voluminous data passing through networks could also prevent restricted information from leaking out, whilst at the same time block unwanted data from passing through. “Banks in Singapore and around the region frequently use secured information gateways as one of many deterrence measures,” Wong added. “This is generally a good practice and add an additional layer of security without compromising on the benefits of the internet.” PwC Singapore digital trust leader Tan Shong Ye noted how an organisation’s future investments can focus on strategy, process, technology, people, and culture. “With the increase in emphasis on digital and information comes the need for cyber risk assessments to keep personal data, client data, and intellectual property safe,” he said.

Security apparatus most robust in Singapore

Sources BMI Research

HEALTHCARE ASIA

Given the number of sub-specialists within any given speciality, it is possible to form a specialised hospital for each major specialty. Hence, today we are fundamentally a congregation of diverse specialised hospitals.

Predee Daochai President Azhar Harun Kasikornbank CEO UMSC 14 HEALTHCARE ASIA

INTERVIEW

UMSC’s CEO Azhar Harun reveals their vision to be the ‘hospital of hospitals’ With a depth of expertise consisting of over 240 super-specialised experts, University Malaya Specialist Centre takes its congregation of wide-ranged specialties to the forefront of healthcare in Malaysia.

ealthcare Asia recently caught up with Azhar Harun, CEO of University Malaya Specialist Centre (UMSC) as he talks about how the hospital is eyeing to be an ecosystem with the most extensive spectrum of specialties and innovative medical equipment, and their plans to build a new wing with purpose-built private wards and clinics for a ‘pleasant patient journey.’ Please tell us about UMSC’s operations in Malaysia. UMSC has been in existence since 1999. It was initially established as an initiative by University of Malaya and the Faculty of Medicine of the university to halt the brain drain of medical experts from the public sector to the private. Academic clinicians were allowed to carry out private practice on a sessional basis within the umbrella of the university. Today UMSC consists of over 240 experts across all specialities. Our specialists are not just specialised, but most of them are super- or sub-specialised. Therefore, a speciality like orthopaedics surgery will include hand surgeons, joint specialist, spine surgeons, orthopaedic oncology surgeons, paediatric orthopaedic surgeons, and even foot and ankle specialists. Neurosurgery today in UMSC comprise subspecialities of paediatrics, oncology, radiosurgery, epilepsy, functional (movement disorders like Parkinson’s disease), vascular and cranial base surgery. What are some of UMSC’s recent initiatives, innovations, and strategies? Given the depth and width of our existing expertise, our endeavour is to position UMSC as a ‘Hospital of Hospitals.’ This concept actually works in two prongs; the first point and the most obvious is given the number of sub-specialities within any given speciality; it is possible to form a specialised hospital for each major speciality. Hence, today we are fundamentally a congregation of diverse specialised hospitals. The second and perhaps a less obvious take is that the public wing of the university is the oldest teaching hospital in the country having recently celebrated its 50th anniversary. Since inception, UMMC (the public wing) has provided the final port of call to patients with complex problems that may not have a solution elsewhere. This is possible because the ecosystem provides the widest range of specialities with cutting-edge medical equipment to match. UMSC today exists in the very same environment, with the exception of providing private services utilising the same medical expertise and equipment. How much is UMMC’s involvement in UMSC? The relationship between UMMC with UMSC is symbiotic in nature. UMSC works closely with UMMC, especially

in the use of its facilities like imaging suites, theatres, and lab services. Excess capacity within the system is utilised by UMSC to provide its services. In return, UMSC pays UMMC various fees for rental of space and utilisation of services. This money is used to supplement government allocations to upgrade and maintain services within UMMC, ensuring that all patients (both public and private) continue to enjoy the high-end facilities that are provided. Correspondingly, there are also sound benefits for UMMC staff, as UMSC provides the avenue for them to earn extra by providing locum services after their obligatory working hours, instead of seeking to work elsewhere, if they choose to. The close collaboration between UMSC and UMMC equally allows a variety of complex cases to be discussed at length with a larger body of experts to prudently decide a suitable management plan formulated for individual patients. These experts come from a cross section of specialities to form multi-disciplinary management teams (MDT), ensuring that patients get the best plan based on science for their problem. What are your future plans for UMSC? We are hoping to have a new wing soon specifically for UMSC comprising purpose-built private wards and clinics. This is to ensure that patients receive the “private patient experience” that most private patients would anticipate in terms of a ‘pleasant patient journey’. We, however, will continue to link this facility to UMMC to ensure the high end services remain accessible and benefit both the private and public patients. Is there anything else that readers of Healthcare Asia should know about UMSC? UMSC is a private wing of a public university. It was set up initially as an avenue to retain expertise within the public tertiary education system to ensure training standards of under and post graduates are maintained. Today, UMSC takes pride in supporting a significant revenue stream directly and indirectly to the university to supplement the government allocations. Today UMSC Apart from the payment of services and rental, UMSC consists of over also returns its profits to the university which is restored 240 experts largely to the faculty of medicine and public hospital across all (UMMC) to support its activities. In addition to this, a specialities. percentage of earnings from our specialists is also refunded Our specialists to their various departments and the faculty of medicine to are not just specialised, but assist in activities such as research, education, and medical staff training and also to the UMMC Patient Fund to assist most of them the underprivileged who may have difficulties funding are super- or sub-specialised. their care. HEALTHCARE ASIA

Country report: hong kong

Hong Kong hospitals are suffering from chronic understaffing. Can it be cured?

The doctors are out: Labour shortage cripples Hong Kong’s public hospitals Insufficient doctors and medical professionals, inevitably long waiting times, and empty unused wards are only the tip of the iceberg for Hong Kong’s struggling public healthcare system.

hen construction of the Hong Kong Children’s Hospital (HKCH) first started over five years ago, the medical centre was expected to be fully operational starting the last quarter of 2018. Now, with just a few months before the deadline, it is apparent that the hospital’s ambitious targets will have to be scaled down due to Hong Kong’s persistent medical manpower crunch. The hospital has a planned capacity of 468 inpatient and day beds, but only 268 beds will be made available in its first year of operation. The hospital will also limit its services to only four out of 12 planned specialties, namely cardiology and cardiac surgery, nephrology, oncology, and paediatric surgery. The HKCH’s fate is a stark illustration of Hong Kong’s shortage of health professionals. Hong Kong 16

HEALTHCARE ASIA

lags far behind other developed countries when it comes to the number of medical professionals. For instance, government statistics show that there were 52,389 nurses in Hong Kong in 2016, representing a ratio of 7.1 nurses per 1,000 people. This is a far cry from the Organisation for Economic Co-operation and Development’s (OECD) standard of 9 nurses per 1,000 people, and means that Hong Kong needs 13,000 more nurses. The doctor shortage is even worse: Hong Kong has a ratio of 1.9 doctors per 1,000 people, compared with 5.1 in Austria, 2.8 in the UK, and 2.3 in Singapore. Part-time doctors and empty wards The HKCH is not the only government hospital to suffer from chronic understaffing. In 2017, a government audit revealed that almost a fifth of the North Lantau

The hospital has a planned capacity of 468 inpatient and day beds, but only 268 beds will be made available in its first year of operation.

Hospital’s floor space remained unused despite the fact that it has been open for over three years. Ward areas were either empty or used for storage, whilst the hospital’s canteen was left vacant since potential concessionaires believed that it was not a viable business. Medical equipment was also underutilised and the hospital was still not operating at full capacity. Seven out of 10 major medical equipment had a utilisation rate of less than 60%, whilst some electric beds, wheelchairs, and blood pressure monitors had not been used since procurement. The hospital had less than 400 staff members at the time of the audit report, representing a mere 61% of the headcount needed for full operations. “There is always a capacity shortfall in the city’s public hospitals, especially in terms of manpower.

Country report: hong kong Public hospitals account for 90% of the city’s patients, whilst employing only 40% of the doctors; whereas the private sector accounts for only 10% of patients whilst employing 60% of doctors, leaving the public healthcare system vulnerable to spikes in demand,” BMI Research said. In order to ease the strain, Hong Kong officials had come up with parttime contracts which allow doctors to practise in both private and public hospitals. However, such contracts have had unintended consequences, including the controversial case of a surgeon who left his patient midoperation to go to a private hospital in order to conduct another surgery. The patient, who was undergoing a liver transplant, was left for three hours on the operating table with her abdomen already cut open, and the surgery only resumed when the doctor returned over three hours later. “Hong Kong’s public hospitals face human resource constraints to meet the greater demands from its ageing population. This, along with the chronic underfunding within Hong Kong’s public healthcare system, will continue to undermine access to care,” BMI Research warned. The government has also tried to ease the burden of the public health sector by encouraging a higher takeup rate of private health insurance. “The Voluntary Health Insurance Scheme (VHIS) encourages more people to use private healthcare services through hospital insurance, thereby relieving the pressure on the public healthcare system in the long run,” said a spokesperson for the Food and Health Bureau. “The VHIS will provide a number of standardised product features that can enhance consumer confidence in purchasing hospital insurance for using private healthcare services when in need,” he added. The doctors are out In a previous interview, UK-trained doctor Daniel Poon revealed why doctors with overseas training rarely return to work in Hong Kong. “Like me, many overseas doctors do not believe returning to the city is a viable career move. To understand this reluctance, one must consider

the two main pathways to gain a medical licence in Hong Kong and the opportunity costs associated with each,” he said. The first method is through the highly competitive three-part medical council licentiate examinations, which is so notoriously difficult that some full-fledged doctors pass only after several tries. Doctors also have to complete an entire year of “retraining” in order to practise locally. This requires fully-trained doctors to be on call for up to 36 hours straight, doing routine work such as drawing blood and inserting IV lines. “An overseas doctor must first go through the infamous licentiate process before being allowed to practise in Hong Kong. The Medical Council of Hong Kong is very careful about who they allow to work in our community and they have made their requirements clear,” noted Charles Brantly, a UK-trained GP who completed the Hong Kong licentiate process in 2015. “If you decide to study abroad and wish return to Hong Kong in the future as a doctor, you should be confident and competent enough to face whatever the Medical Council throws at you,” he noted. The second route is through a limited registration with the Hospital Authority, which involves a one-to-three-year contract after qualifying as a specialist overseas. The situation is no better for foreign-trained nurses. Nurses trained overseas also need to pass extremely difficult professional examinations to register locally. The passing rate has sharply declined in recent years, and was only 4.95% in 2016. A candidate who fails the exam thrice must also undertake a 200hour course before being allowed to retake the test. As a result, it has been very difficult to recruit new nurses to fill the gap. Singapore, in contrast, has a far more liberal policy. Singapore’s Ministry of Health requires that specialists undergo a one-year “inclinic” duty, in which a physician of a similar specialty supervises the doctor’s work. For non-specialists, the requirement is two years. As a result, over 30% of doctors in Singapore are

Public hospitals account for 90% of the city’s patients, whilst employing only 40% of the doctors.

foreign-trained. As Hong Kong’s labour crunch looks unlikely to end anytime soon, BMI Research expects that the growth driver of Hong Kong’s healthcare sector will continue to be its private sector. “The Hong Kong government will continue to shift healthcare provision towards the private sector due to the growing financial strain and an overburdened public healthcare system,” BMI Research’s noted. In order to address the understaffing crisis in public hospitals, the government aimed to increase the number of medical graduates from 250 before 2014 to 420 by 2017. In 2016, the government also announced that public hospitals will get an additional 5,000 beds and 90 operating theatres in the next 10 years as part of a HK$200b ($25.4b) bundle of development projects to cope with a rapidly ageing population. However, the government has also emphasised that whilst it is providing sufficient resources to improve public services, it will also facilitate further development of private hospitals. “Private healthcare providers in Hong Kong will be well positioned for growth. Supporting this trajectory is the underdeveloped state of the public health sector and the growing importance of private investment towards improving healthcare delivery,” the report noted. “The private sector is a majority share of the Hong Kong healthcare market at present (accounting for 52.2% of total spending) and we expect the growth momentum to continue and, as such, private healthcare spending will increase as a share of total health expenditure to 54% by 2027,” the report added.

Hong Kong Healthcare Market Forecast

Sources: BMI Research

HEALTHCARE ASIA

healtHcare asia forum: Bangkok

Panelists discuss fragmented healthcare industry

Will rapidly growing costs stunt Thailand’s universal healthcare goals? Epidemiological changes, healthcare spending, and lack of integration persist in the country.

ith almost half of its electorate above 50 years old by 2025, Thailand is fast becoming one of the countries with the oldest populations in the region, one of the significant points discussed at the Healthcare Asia Forum in Bangkok. Next only to Singapore in terms of its ageing electorate, the country is also a highly attractive retirement spot for foreigners who prioritise affordable and quality healthcare and like the tropical weather. Mikael Feige, partner, Solidiance, said that healthcare demand is expected to accelerate given Thailand’s demographic transition. According to him, growth rates of seniors in Thailand are predicted to be much higher than OECD and will surpass the growth rates of the working population aged 16-24. The government has been fast at work trying to address this on top of other healthcare concerns, resulting in the growth in health spending per person which has outpaced growth of GDP per capita in Thailand since 2014. However, Feige said that Thailand’s spending for healthcare remains flat and not proportional to the rising healthcare demand. He showed that before 2017, Thailand’s share of healthcare spending over the total government expenditure remained flat. Whilst there was a 1% increase in 2017, it might not be enough to prepare for 18

HEALTHCARE ASIA

Thailand’s spending for healthcare remains flat and not proportional to the rising healthcare demand.

the rising demand for and costs of healthcare. “The rise of healthcare needs in Tier 2 and Tier 3 cities not only in Thailand, but in other countries in Southeast Asia, has led us to ask, how do we set up hospitals? Because Tier 1 cities are already mature, Bangkok already is, and the wealth of populations in Tier 2 cities is rising overtime, and more and more private care is becoming available,” Feige said. Amongst ASEAN 6 (Malaysia, Singapore, the Philippines, Indonesia, Thailand, and Vietnam), Thailand ranks second in terms of public healthcare expenditure. The country currently allocates 3.2% of its entire budget to health, compared to 2.3% for Malaysia, 2.1% for Singapore, 1.6% for the Philippines, 1.1% for Indonesia, and 3.8% for Vietnam. This may seem like a welcome development, but it falls short when juxtaposed with the average public healthcare expenditure all over the world at 5.9% and the average public healthcare expenditure of OECD countries at 7.69%. Pain points Thongtana Permbotasi, deputy director, Division of National Strategy and Reform, Ministry of Public Health, said that Thailand’s healthcare challenges can be summarised into three categories: epidemiological

Healthcare asia forum: Bangkok has established comprehensive co-payment schemes, trying to offer healthcare for all citizens, often through a general social health coverage, instead of savings and co-payments. “Improving the taxation of unhealthy goods could improve revenues and set better incentives for consumers. Government could channel resources obtained from excise tax on unhealthy consumption to. providing healthcare services. Harmonisation across countries is needed to avoid parallel imports,” Feige said.

Thailand’s healthcare challenges can be summarised into three categories: epidemiological changes, high healthcare spending, and the lack of highly-integrated care.

changes, high healthcare spending, and the lack of highly-integrated care. Changes in Thailand’s epidemiological landscape include aged patients with unexpected treatment outcomes, the increasing need to address migrants’ health, and the emergence of infectious diseases such as tuberculosis. On top of these changes, Thailand needs to find solutions to high healthcare spending characterised by increased BOR and LOS, unnecessary re-admissions, high cost of interventions, inappropriate drug use, and low quality management. The country is also challenged by primary healthcare inefficiency and poor networking and community engagement. Healthcare costs in Thailand are also exacerbated by other factors from both the demand and supply sides. Visit Vamvanij, director, Siriraj Hospital, said that rising healthcare costs are caused by behavioural changes in the population such as high expectations of patients and greater health concerns. On the supply side, Vamvanij noted the costs of ineffectiveness and inefficiency as well as the lack of data and insight into cost and saving opportunities. According to Feige, Thailand has indeed an opportunity to become a leader in cost efficiency and could achieve better outcomes with higher spending as compared to high-income nations. He cautioned that outcomes delivered from healthcare systems are certainly not directly proportional to the health expenditure spent, and Thailand might face the challenge of diminishing returns due to increase in health spending. “Gradual improvement in Thailand health is comparable to neighboring countries like Malaysia and Singapore. Despite the rising challenges, Thailand could take early actions to strive the right balance for health spending. Thailand could take early actions in ensuring the resources spent on healthcare are optimised and move towards or maintain on the efficient frontier by focusing on the 3 key actions recommended: generate new source of healthcare funding; streamline processes and budget to reduce overhead cost; and invest more in prevention at early stages of treatment,” Feige added. In terms of improving access to healthcare across the country, Feige said that Thailand could introduce streamlined public co-payment schemes instead of loosely covering free health services. At present, Thailand

Despite the rising challenges, Thailand could take early actions to strive the right balance for health spending.

Regional healthcare hub Amidst challenges that the government faces when it comes to providing affordable and quality healthcare, Thailand continues to thrive as a medical tourism hub in Southeast Asia. The competition is heating up, as neighbouring countries begin to strategise and offer less costly healthcare to foreigners. For instance, the Philippines is planning to build a large hospital with a specific focus on medical tourism, on the back of a rising expat population. “We’ve seen 3 million people come to Thailand for medical treatment over the past year. That’s much more than Malaysia and Singapore. We’ll keep growing but to what extent, I am not sure. I think the Chinese are still the ones that can grow the market when they come to Thailand. Hospitals here have the experience and knowledge for these kinds of patients, and the prospect for three to four years remains good,” Feige said. In 2017, it was estimated that Thailand will receive almost THB50b in income from international patients, a 3%-4% growth from the previous year. The International Healthcare Research Centre (IHRC) reported that medical tourism in the country will likely grow by 14% annually alongside the 12% growth of international tourist arrivals in the country. The Thai government has identified 19 countries as potential sources of medical tourists, and has approved a visa extension scheme for tourists from Cambodia, Myanmar, Laos, Vietnam, and China. For the other 14 countries, the government is also extending 10-year visas, a move to encourage more medical tourists and further grow Thailand as a healthcare centre. Olarik Musigavong, assistant hospital director, Chaophya Abhaibhubejhr Hospital, said that compared to Singapore, India, Malaysia, and South Korea, Thailand has a clear competitive advantage when it comes to the aspects of service and hospitality, the level of technological innovation, the quality of human resource management, the strength of partnerships, accessibility to the market, and the affordability of healthcare. One of the recent medical tourism milestones in Thailand is a partnership between popular mobile application BookDoc and Bumrungrad Hospital, one of the largest private hospitals in Southeast Asia. BookDoc allows users to connect to the best medical professionals in the region, and the network of the application continues to expand across top medical destinations. Musigavong said that going forward, the medical tourism in Thailand should continue to work on a HEALTHCARE ASIA

healtcare asia forum: Bangkok national policy, streamline organisational inefficiencies, embark on public-private partnerships, strengthen its wellness tourism strategy, improve human resource development, and work towards more hospital accreditations. At present, Thailand has 56 Joint Commission International (JCI) accreditations, more than double that of Singapore and thrice as much as Malaysia’s. Thailand’s healthcare sector must take into account the various components of the Global Wellness Economy, and focus on the rapidly growing components that it can deliver on, such as beauty and ageing; wellness tourism; healthy eating, nutrition, and weight loss; fitness of mind and body; and preventive and personalised medicine and public health, amongst others. According to Musigavong, healthcare leaders can also take their cue from medical tourism countries across the world. In Asia, India, Malaysia, Singapore, and South Korea remain tough competitors as well as good examples of medical tourism. Latin America has Brazil, Costa Rica, Mexico, and Cuba. Meanwhile, the Middle East has the United Arab Emirates (UAE) and Europe has Hungary, Poland, and Turkey. Meanwhile, Budi Raharjo Legowo, managing director of finance and accounting at PT Siloam International Hospitals based in Indonesia, said that medical tourism remains a goal for Indonesia. The country’s healthcare sector at present mainly caters only medical support for tourists who wish to take some tests or who need to go through very basic procedures while on vacation. In search of a cure In its drive to improve healthcare, Thailand has four reform aspects: effective governance and administration, policy integration and decentralisation, human resource transformation, and IT and digitalisation. Permbotasi said that in terms of strengthening service delivery, the government has also prioritised the enhancement of primary care and value-added to Thai traditional medicine, and disease prevention and health promotion, amongst others. Additionally, Feige said that although painful, the government may want to consider streamlining personnel costs to improve cost efficiency. Across, ASEAN 6 share of emolument costs of the total budget varies depending on each country’s practices. For countries with a higher spending on emolument, they should strive to minimise wastage and reduce redundancy by streamlining administrative processes. “On top of increasing funding, the local governments could also improve its efficiency in utilising the resources allocated to healthcare to minimise wastage and reduce redundancy. For example, as suggested by OECD, one of the wastage faced by its members is on administrative processes that add no value and money lost to fraud and corruption. This should also be an area for the local government of Thailand to further enhance its practices,” Feige said. Chin Tuck Piew, administrator, Gleneagles Kuala Lumpur, said that the region’s hospitals must be able to quantify their turnover costs. Specifically, administrators 20

HEALTHCARE ASIA

Local push for digitalisation has been difficult

The region’s hospitals must be able to quantify their turnover costs.

have to consider two types of costs: direct and indirect. According to Chin, direct costs include job ads, recruiting fees, signing bonuses, and salary increases. Indirect costs may be loss of productivity and loss in training when an employee who resigns takes away the skills and knowledge acquired at the expense of the hospital. These factors affect other employees who are also likely to resign. Furthermore, Chin said that there are internal and external challenges, and that administrators should continually ask themselves certain questions: who is going to do the work? What knowledge are we about to lose? What skills will we lose? What traditions will change? Hospital leadership must understand that the marketplace for good talent is competitive and that good people will be able to pick and choose their working environment. They must also consistently ask themselves how to create an organisation where people want to stick around. “Many times when a staff does not come to work or take plenty of sick leaves, a lot of managers send them to the HR. You do not even actually find out the issues, and you think that HR is the department that can solve your problems, which today is impossible. You know your people better, you should be accountable for them,” Chin said. If the region’s hospitals wish to capture the better part of the talent pool, Chin proposed a transition from the old way of hiring people to newer, more effective strategies. He noted the old way concentrates all people management responsibility to the HR, highlights good pay and benefits, likens recruitment to purchasing, assigns development to training programs, and treats everyone the same way. New strategies on attrition and retention management place the accountability of strengthening talent pools to all managers; shapes workplace, jobs, and strategy to appeal to talented people; likens recruitment to marketing; fuels development through stretch jobs, mentoring, and coaching; and affirms its people, but invests differently in A, B, and C players. “The traditional way of hiring people, going to the website portal, is not good enough. Recruitment should be strategic and we should determine how we are going to get people outside to add value to the organisation. We do a lot of recruitment through networking and not so much going to the network portal. We network with a lot of the talent of other hospitals because they know their talent, they know well what they can and cannot do,” Chin added.

CMY

2019

Healthcare Asia Forum MNL | JKT | KL | BKK

Healthcare Asia Magazine is proud event to welcome you to the for the healthcare arena. The Healthcare Asia Forum is happening from February to May 2019. The trailblazing event will gather over 200 healthcare leaders across Southeast Asia to discuss pertinent issues and whatâ&#x20AC;&#x2122;s hot in the healthcare scene. Presented by:

For speaking opportunities: If you are interested in participating as a speaker, panelist, or delegate, do contact our event organiser Andrea at andrea@charltonmediamail.com +65 3158 1386 ext 212

For sponsorship opportunities: If you are a vendor or partner to the healthcare industry and wish to sponsor/speak, please contact Rochelle at rochelle@charltonmediamail.com +65 3158 1386 ext 220

ANALYSIS: Smart healthcare

Blockchain representation

Smart Healthcare’s evolution Hospitals can better engage with consumers and elevate the patient experience by providing omni-channel patient access.

any entrepreneurs and health care consumers are asking fundamental questions about why the patient experience isn’t more personalised and why the system isn’t more convenient. Why do patients have to go to a centralised location to see a doctor? Why can’t the health plan, the hospital, and the doctors all agree to prices and a payment model before the patient gets involved? These are questions that established health care stakeholders should consider addressing if they hope to preserve and grow their existing customer relationships. Meanwhile, agile competitors not hindered by established processes and systems may be able to detect and capitalise on technology-driven disruptors more quickly than incumbents. According to the Deloitte 2017 Survey of US Health Care Consumers, personalised care from their providers—including clear communication and sensitivity— is respondents’ top health care priority. Hospitals can provide more personalised care, better engage with consumers, and elevate the patient experience by using digital solutions to aid omni-channel patient access, including customer apps, patient portals, personalised digital

HEALTHCARE ASIA

Telehealth provides a more convenient way for consumers to access care.

information kits, and self-check-in kiosks. Other digital channels and tools to enhance provider-consumer interactions include leveraging social media to improve patient experience. Social media offers health care organisations a potentially rich source of data to efficiently track consumer experiences and population health trends in real time, much more efficiently than current approaches. Meanwhile, Telehealth provides a more convenient way for consumers to access care whilst potentially reducing office visits and travel time. This convenient care model has the potential to increase selfcare and prevent complications and ER visits. Lastly, Virtual reality/augmented

reality (VR/AR) can engage patients in low-risk, artificially generated sensory experiences that could accelerate behavior change in a way that is safer. In the future, digital technology may improve the patient experience by providing real-time access to medical knowledge and assistance. Imagine a voiceactivated system for an impatient patient—an AI-powered, bedside virtual care assistant that can answer or direct queries to the most appropriate person at the hospital. This virtual assistant will be able to answer the patient’s routine questions about diagnoses, expected recovery experiences and times, and daily medication schedules. It also will be able to direct specific questions to specialists. In addition, the virtual assistant can act as a data repository for the patient’s medical history, test results, consultation times, appointment schedules, and even stories about other patients who had a similar diagnosis. Such accessible AI technologies will help empower patients. Enhancing the patient experience is regarded as a potential driver of hospital performance, since it can strengthen customer loyalty, build reputation and brand, and boost utilisation of hospital services through increased referrals to family and friends. Furthermore, research has shown that better patient experience correlates with lower medical malpractice risk for physicians and lower staff turnover ratios. From Deloitte’s 2018 Global Health Care Outlook

Preferences for care personalisation by age group

Source: Deloitte 2017 Survey of U.S. Health Care Consumers

event coverage

Healthcare Asia lauded the best hospitals in APAC at the Healthcare Asia Awards 2018

enior executives and prime industry figures from the Asia’s prestigious hospitals and healthcare firms gathered at the Conrad Centennial Singapore on 23 May 2018 for the first ever Healthcare Asia Awards night. The gala night featured 34 awards. The awards were expertly judged by Abhay Bangi, partner, Life Sciences & Healthcare lead, Ernst & Young; Mohit Grover, Life Sciences & Healthcare leader, Deloitte, and; Sabrina Tay, partner and deputy industry lead, Healthcare, RSM Singapore. Healthcare Asia publisher Tim Charlton deeply congratulated the awardees, saying “We are honoured to have gathered everyone under one roof tonight for the inaugural Healthcare Asia Awards. We applaud all of your efforts in pushing the industry forward, and we thank you for the tireless work on making healthcare better for businesses and patients.” Congratulations to all the winners!

HEALTHCARE ASIA AWARDS 2018 WINNERS

Muscat Private Hospital Patient Safety Initiative of the Year- Oman ICT Initiative of the Year- Oman Parkway Cancer Centre Corporate Social Responsibility of the Year- Singapore Marketing Initiative of the Year- Singapore The Ibn Sina Trust Diagnostics Provider of the Year- Bangladesh Philippine Heart Center Patient Care Initiative of the Year- Philippines St. Luke’s Medical Center - Global City Management Innovation of the Year- Philippines Service Innovation of the Year- Philippines Employee Engagement of the Year- Philippines Surya Husadha Hospital Marketing Initiative of the Year- Indonesia The Medical City Marketing Initiative of the Year- Philippines TROPICANA MEDICAL CENTRE Service Delivery Innovation Initiative of the Year- Malaysia Union Hospital Facilities Improvement Initiative of the Year- China ICT Initiative of the Year- China Vitallife Wellness Center Patient Care Initiative of the Year- Thailand

Amina Hospital Corporate Social Responsibility of the Year - United Arab Emirates

United Family Healthcare Hospital of the Year- China Health Promotion Initiative of the Year- China

Bumrungrad International Hospital Hospital of the Year- Thailand

Roberta Lipson of United Family Healthcare Ceo of the Year

Femto Research Group Co.,Ltd Service Innovation of the Year- Thailand Fullerton Healthcare Group Primary Care Provider of the Year- Singapore Patient Care Initiative of the Year- Singapore Facilities Improvement Initiative of the Year- Singapore INDRAPRASTHA APOLLO HOSPITALS Corporate Social Responsibility of the Year- India Patient Care Initiative of the Year- India Patient Safety Initiative of the Year- India Kovai Medical Center and Hospital Hospital of the Year- India

Rafael Solis of St. Luke’s Medical Center - Global City

Lablink (M) Sdn Bhd Diagnostics Provider of the Year- Malaysia Makati Medical Center Patient Safety Initiative of the Year- Philppines Customer Service Initiative of the Year- Philippines Mater Hospital Sydney – A facility of St Vincent’s Health Australia Facilities Improvement Initiative of the Year- Australia Service Delivery Innovation Initiative of the Year- Australia MHC Medical Network Pte Ltd Health Promotion Initiative of the Year- Singapore 24

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Philippine Heart Center Team

Phoebe Woo & Susan Cheow of TROPICANA MEDICAL CENTRE

Rafael Solis of St. Lukeâ&#x20AC;&#x2122;s Medical Center - Global City

Klaiupsorn Pongrapeeporn & & Sittichai Boonrawd of Femto Research Group Co.,Ltd

Representatives of Union Hospital

Esther Zhang & Emilie Lu of United Family Healthcare

Marilen Forsuelo & Anne Ruth de la Cruz of The Medical City

Oraphan Buamuang of Bumrungrad International Hospital

Pattaravadee Wangviriyaphan & Athip Nilkaeo of Vitallife Wellness Center

Representatives of Mater Hospital Sydney

Representatives of Philippine Heart Center HEALTHCARE ASIA

event coverage

Mater Hospital S ydney Team

Subbarao Rajavarapu & Aries Vitan Wong of Muscat Private Hospital

Susan Cheow of TROPICANA MEDICAL CENTRE

Alvin Choo of Fullerton Healthcare Group 26

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Nadeem Khan, Subbarao Rajavarapu & Aries Vitan Wong of Muscat Private Hospital

Union Hospital Team

Representatives from Bumrungrad International Hospital & Vitallife Wellness Center

Representatives of Fullerton Healthcare Group

Mater Hospital wins two international awards Sydney’s Mater Hospital excelled against some of Asia Pacific’s leading hospitals to win two major recognitions at the inaugural Healthcare Asia Awards 2018.

ater Hospital brought home the Facilities Improvement Initiative of the Year- Australia and Service Delivery Innovation Initiative of the YearAustralia at the Healthcare Asia Awards 2018 for its “Room Service - Improving the patient meal-time experience” initiative. Mater introduced Room Service in 2017,

making it the first hospital in New South Wales to do so. The service saw the hospital shift from a conventional set meal-time delivery system to a fresh-to-order system delivered within 45 minutes of ordering. Patients are now able to order what they want to eat, at a time that suits them most, and when they are actually hungry.

Alex Joyner (Director of Nursing), Jeffrey Tor (Sous Chef), Tamsyn Gardner (Manager, Food & Environmental Services), Janine Loader, (CEO, Mater Hospital), Toby Hall (Group CEO, St Vincent’s Health Australia)

The hospital has witnessed a remarkable reduction in wastage. Its general food wastage has declined 80% whilst plate wastage is down 20%. Importantly, patient satisfaction has radically increased. The hospital already enjoyed a highly regarded food service but with the introduction of Room Service. Press Ganey patient satisfaction has increased to 89%. Janine Loader, Mater CEO was on hand to receive the awards “It’s always terrific to win prestigious awards, what is particularly gratifying is being recognised for a service that is making such a huge difference to our patients, staff, and indeed the environment.”

“Its general food wastage has declined 80% whilst plate wastage is down 20%.Importantly, patient satisfaction has radically increased. ”

A phone call from the heart

Through two structured calls, clients are advised about their medication intake, exercise,treatments, and outpatient follow-up.

or most patients, arriving home from the hospital triggers anxiety and even stress. The act of managing one’s wellbeing after hospitalisation has never been popular among people who are recuperating from illness. This could be due to the lack of knowledge, skill or confidence to do so. We can’t blame them; illness has robbed men and women from having a sense of control with their own lives. Regardless, the worry has to stop. The Philippine Heart Center, a healthcare institution specializing in the management of cardiovascular diseases, has introduced PHC TeleCARE- a service that will bring the sense of control back to the lives of patients simply through two phone calls. “Your effort to call me made me feel guided and secured, this is very reassuring!” commended by one of PHC’s patients who received a call from the TeleCARE

service after being discharged. It is through telephone follow-up service that they acquire the confidence to manage their own recovery and wellness at home. But how will a simple phone call bring about meaningful changes? The answer is through health education. Through two structured calls, clients receive reinforcement health education about their medication intake, exercise, treatments, hygiene, outpatient follow-up visit schedule, dietary recommendations, and spirituality upon arriving home. It is imperative to do so because these clients, despite receiving health education through their discharge instructions prior to leaving the hospital, could have been distracted due to things happening simultaneously at this time: processing necessary documents, paying bills and transportation coordination are just some examples. This could make

“ It is through telephone follow-up service that they acquire the confidence to manage their own recovery.” 28 HEALTHCARE ASIA

the health education rendered at this phase unclear. The follow-up calls support this transition at home, which is where application of these teachings should happen. They are also given the chance to talk about their health concerns and ask relevant questions about their recovery. These are all part of the general objective to uphold the promotive and rehabilitative health practices, especially among clients diagnosed with cardiovascular diseases. The PHC TeleCARE now services all charity discharged patients of the Philippine Heart Center. With the evolving nature of this program, discharged patients may not only receive health teachings in the future but possibly more!

Co-published corporate profile

Union Hospital - Hong Kong bags two awards at the Healthcare Asia Awards 2018 The hospital won the Facilities Improvement Initiative of the Year and the ICT Initiative of the Year.

enovation works in Union Hospital (UH) - Hong Kong have increased dramatically in recent years. Implementation of a safety system is crucial to maintain a reliable and healthy hospital environment, to achieve zero tolerance of wound infections caused by dust contamination in Operating Theatre (OPT), and to have a comprehensive prevention of Pneumoconiosis. Usually, preventive measures during renovation included sealing up of the work sites with hoarding and use of exhaust fan. In 2014, UH strengthened its measures and implemented a 5-step renovation process to further enhance the safety of patients, workers, and staff. This renovation process comprised of risk assessment meeting among stakeholders prior to the renovation work, issuance of working permit, comprehensive training provided to workers, implementation of Renovation Monitoring System, and evaluation and continuous quality improvement during the entire renovation process. Award-winning service Air change per hour (ACH), an outstanding feature of the project, was calculated to ensure ventilation provided was in compliance with the ANSI/ASHRAE/ASHE Standard 170-2008 (>12 ACH). Both digital and mechanical manometers were utilised as a counter check mechanism to ensure accurate measure of negative pressure value in the sealed work site with an alarm set up to notify users if pressure below -10 Pa. Meanwhile, the end of the extended flexible exhaust hose was held by an adjustable drip stand. The hose could be adjusted to the working site with the highest dust concentration. The other end was connected to the inlet of a powerful exhaust fan which maximised the exhaust effect. The exhaust fan was assembled with recycled materials from discarded HVAC system and was very cost effective. An air flow test tube was applied at the entrance area to confirm that the air was sucked in by negative pressure. Union Hospital was also the regional pioneer to deploy mobile point of care solution. Given that “Patient Safety” is

HEALTHCARE ASIA

always on the top of UH’s evolution agenda, the hospital has sought to enhance its Mobile Clinical Solution (MCS) with new elements by aligning the innovative health information technologies to the day-today functions. From nursing care to doctor consultation, electronic prescription to examination request, hospital-centric to patient-centric, MCS was equipped with universal features to support the clinical workflow and to facilitate an accurate and evidence-based decision making in all domains. Together with the Bring Your Own Device and cloud technology, MCS not only covers the patient journey from admission onward, but also the treatment after discharge. In addition, MCS involves everyone at different levels and of different interest in the patient journey, including nurses, doctors, allied health professionals and even patients. All of them are able to access up-to-date clinical information at the fingertips via their own devices, be it an iOS or Android. With MCS, most of the traditional workflow can be streamlined and optimised by digitising the manual tasks. Along with the just-in time information and wireless access capability, the communication across the multidisciplinary medical team and the patient can be greatly enhanced, whilst staff

can free up their time to act as efficiently and effectively as practicable, patients are able to take more control and responsibility on their own care, and ultimately result in better healthcare outcomes by increasing the medication adherence. All in all, patient confidence in UH’s service as well as staff satisfaction have both been greatly enhanced, and a strong hospital-patient relationship is formed. Doctors, nurses, allied health professionals and patients are all benefit from it. Because of these projects, Union Hospital won the Facilities Improvement Initiative of the Year and the ICT Initiative of the Year at the Healthcare Asia Awards 2018. The Healthcare Asia Awards 2018 was held on 23 May 2018 at the Conrad Centennial Singapore.

CONTACT Company name: Union Hospital - Hong Kong Address: 18 Fu Kin Street, Tai Wai, Shatin, N.T. Phone number: (852) 2608 3388 Email: union@union.org Website: https://www.union.org/

“Union Hospital was also the regional pioneer to deploy mobile point of care solution.”

Dr Anthony K Y Lee, Chief Hospital Manager & Medical Director (CHM&MD), Union Hospital, Hong Kong

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Caught in red hands: Human-Cancer Genome Femto Research Group won the Service Innovation of the Year Award at the HCA Awards 2018.

hen it comes to health, humans have never been in a comfort zone. In the early 1900s, infectious diseases were the leading cause of death. Since 1900, the global average life expectancy has more than doubled and is now approaching 70 years1. Entering the 21st century, we live healthier and longer. Recently, a re-analysis of the public human sequence data has revealed the bacterial DNA insertion/integration in the human genome. Such integrations, relevant to our concern, are detected more frequently in (1) tumors than normal samples, and (2) RNA than DNA samples2. As many as 20% of total cancers worldwide are reported as caused by a microbial agent3. Viral, Bacterial, Parasitic and Fungal oncogenesis/carcinogenesis have been proposed, proved, and published. Our Healthcare Asia 2018 awarded service innovation, the “Plasma p53Microbiome©” can detect microbial genomes integrated in humans’ cancer genome in both non-sick and sick individuals. From our R&D and service during 2014-present, the number

of microbial genomes integration can be obviously seen in some asymptomatic individuals. Such integrations are markedly increased in patients especially those with late stage cancers. Targetted treatment from tech advantage Our test works in the similar way as FBI looks for a criminal DNA fingerprint in the CODIS database. Our microbe identification is based on the Human Microbiome Project (HMP) database, instead of the CODIS. Every year, approximately 2 million new cancer cases and 1.5 million deaths worldwide are caused by infections4. Cancers from infections generally have a higher mortality rate than other cancers. Now technology is on our side, infectious microbiomes on human genome can easily get caught in red hands, using the innovative “Plasma p53Microbiome©” service. The potential benefits of this service are obviously not far beyond imagination, prevention and treatment with precision. Direct and nonrandom treatment targeting at the known microbiomes

FEMTO’sefficiently team at The Healthcare Asia Awards should fight against those cancers caused by infections. Large, prospective studies of the microbiome substantially promise translational opportunities to reduce cancer morbidity and mortality by improving screening, prevention, and treatment5. Medicines, vaccines, natural products, and supplementations against infections have long been available as effective treatments. Tackling infections should be an effective way to reduce the cancer deaths than just mainly focusing on the cancers6,7. With the “Plasma p53Microbiome©” as a tool (to identify the microbiome targets), we should have chance to win the war against those infection-related cancers.