Healthcare Asia (July - October 2016)

ISSUE NO. 7

The magazine for healthcare administrators and policy makers

| www.healthcareasiamagazine.com

Display to 31 October 2016

Dr Watson vs

Dr Google Healthcare Asia

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Find out how healthcare professionals are dealing with information asymmetry

Dr. Luk Che-chung CEO, Queen Mary Hospital p16

Tae You Kim, Dr. Minerva Calimag, Chairman, SNU Cancer President, Philippine Hospital p5 Medical Association p18

Philippine Medical Association spearheads healthcare data optimisation p18 Singapore’s private hospitals clamour for greater support p22 Case Study: Gat Andres Bonifacio Memorial Medical Centre’s free dialysis centre p24 Malaysian hospitals find trouble integrating new technologyp10

FROM THE EDITOR Welcome to the seventh issue of Healthcare Asia!

As Southeast Asia’s patients, as with the rest of the world, become more dependent on Google when they feel sick, healthcare professionals are worrying how this could foster misinformation.

New technologies such as IBM’s Watson, however, struggle due to costs and presumed novelty.

Publisher & EDITOR-IN-CHIEF Tim Charlton PRODUCTION Editor Ephraim Bie GRAPHIC ARTIST Elizabeth Indoy

ADVERTISING CONTACT Rochelle Romero rochelle@charltonmediamail.com Trishia Garduño trishia@charltonmediamail.com

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We have a comprehensive case study on the Philippines’ Gat Andres Bonifacio Memorial Medical Centre’s free dialysis centre, which runs on zero out-of-pocket spending on the patients’ side. The hospital’s director, Dr Luisa Aquino, shares how the model for the dialysis centre was formulated, how it’s currently serving hundreds of patients in the country’s centre yearly, and how the centre plans to expand.

We also interviewed Queen Mary Hospital’s chief executive Dr Luk Che-chung, where he discusses the numerous innovations of the hospital, including lung perfusion for patients with severe breathing problems, as well as a pilot program to cater to patients with urgent cardiac arrest through extracorporeal memberane oxygenation.

This issue also features another case study about Singapore Medical Group’s new cardioscan service, which aims to curb the rising incidence of cardiovascular fatality in the city-state. We also feature the Philippine Medical Association and its initiatives for healthcare data optimisation in the country.

Asia is an exciting region for healthcare developments, innovations, trends, and breakthrough technologies, and we hope this issue gives you a glimpse of what’s happening and what’s yet to come.

As always, we wish you all the very best of health.

Enjoy!

Tim Charlton

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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.

A HIMSS AND MINISTRY OF PUBLIC HEALTH T

22 - 25 August 2016 Queen Sirikit National Convention Center, Bangkok, Thailand www.HIMSSAsiaPacConference.org (English Version) http://ehealth.moph.go.th/himss (Thai Version) Many healthcare systems are rapidly transforming to adopt a ASIA more patient-centered approach to care.HEALTHCARE Complimenting this 1 effort is the increased involvement from tech-savvy and betterinformed patients with their caregivers.

Brought to

In Collabo

CONTENTS

Study 24 Case GABMMC’s free dialysis centre model

INTERVIEW 16 CEO Queen Mary Hospital unveils

PROFILE 18 FEATURE Philippine Medical Association

lung perfusion for patients with severe breathing problems

spearheads healthcare data optimisation

FIRST

HEALTHCARE INSIGHT

06 PH medical staffing costs skyrocket

14 Watson vs Google: Asia fights information asymmetry

07 Hospitals mull joining UHC

COUNTRY REPORT

08 Malaysia eats the dust of peers in healthcare skills

OPINION 30 Information technology grabs spotlight at inaugural Healthcare Asia Forum 32 The digital healthcare leap

22 Private hospitals clamour for greater support as medical tourism stumbles

10 Hospitals find trouble integrating doctors with new technology

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

2 HEALTHCARE ASIA

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CO-PUBLISHED CORPORATE PROFILE

Seoul National University Cancer Hospital: At the forefront of cancer treatment in Asia The top-tier medical center for cancer is making its own mark in the region.

Seoul National University Cancer Hospital

I

f Koreans are alarmed by the country’s research program, experienced and excellent HCPs, and innovative systems to rising incidence of cancer – the improve treatment outcome, according to number of Korean cancer patients doubled in the decade after 2003 – then Prof. Tae You Kim, a medical oncologist they can breathe a sigh of relief knowing specialized in colorectal cancer and chairman of SNU Cancer Hospital. that a world-class treatment facility is As proof of its rising status, the hospital right in their backyard. is being benchmarked by China, Japan, The Seoul National University (SNU) Kazakhstan and other countries as a Cancer Hospital, which opened in model hub for cancer treatment in Asia March 2011, has spent the past five and around the world. years building one of the best medical SNU Hospital has been tireless in its services for cancer in Asia, attracting pursuit of cuttingtop healthcare As proof of its rising edge treatment providers (HCPs) status, the hospital is that delivers and treating patients that fly in being benchmarked by better outcomes from all over the other countries as a in the face of region. model hub for cancer increasing cancer in SNU Cancer treatment in Asia and prevalence Korea.

Hospital has around the world.

National data a prestigious reveals the number of cancer patients in pedigree as part of the highly acclaimed Korea almost doubled over the past 10 SNU Hospital, the latter of which has years from 125,707 in 2003 to 225,343 pioneered medical frontiers as Korea‘s in 2013. After 2010, more than 310 national central hospital. patients are newly diagnosed with cancer SNU Cancer Hospital is making its for every 100,000 population each year. own mark in the medical world as a The cancer risk stands at 36.6% for the dedicated cancer treatment facility average Korean whose life expectancy is with 28 centers and optimized medical 81 years, which means three out of 10 services. It sets itself apart from other Koreans will develop cancer in their life Asian cancer hospitals with a threepronged advantage: A world-class cancer time.

4 HEALTHCARE ASIA

In Korea, the cancer death rate is 150.9 per 100,000 population and lung cancer is the leading cause of cancer death.

“It is difficult to detect lung cancer earlier and it is prone to be metastatic to other organs or blood, making treatment very challenging. Lung cancer is followed by liver cancer, gastric cancer and colorectal cancer,” says Kim. In response to these alarming numbers, along with similar rises in cancer incidence in other countries in Asia and around the world, the SNU Cancer Hospital is transforming itself into a global research-based hospital with breakthrough research findings in developing novel drugs, including immunotherapy.

Immunotherapy may hold the key The SNU Cancer Hospital is active across all areas of clinical research covering basic and translational research and clinical research, including 260 studies of investigational drugs at the country’s first oncology clinical trial center.

“Our hospital is also conducting many studies of the latest drugs such as immunotherapy. We are also making efforts to help patients get faster access to new drugs by shortening the time to hospital of new drugs,” says Kim.

CO-PUBLISHED CORPORATE PROFILE reckons more will follow.

“Through these research programs, we will be making a difference with immunotherapy in the treatment of various cancer patients, including those with lung cancer, which has the highest mortality rate of any cancer.

Immunotherapy will help us accelerate the era of cancer conquest,” says Kim.

Tae You Kim Medical Oncologist SNU Cancer Hospital

Kim explains that SNU Cancer Hospital has keen interest in the development of new cancer treatment molecules.

Although a lot of cancer drugs are available and surgical methods have improved by leaps and bounds, cancer remains a challenging task, especially with regards to tackling resistance. But the area of immunotheraphy, which SNU Cancer Hospital is focusing on, seems to hold great promise in addressing resistance.“Recently, immunotherapy drugs are commercialized and these drugs give us hope that we will be able to overcome resistance as it uses the immune function of patients,” says Kim. SNU Hospital and its high-caliber team of HCPs are conducting clinical studies of immunotherapy among patients with head and neck cancer, breast cancer, gastric cancer and other types of cancer.

The clinical trials look to evaluate the efficacy and safety of immunotherapies in various patients, and the results should benefit patients, improving their treatment and care.

“We need to continue research to find whether there are available biomarkers to identify patients who are more suitable for immunotherapy, and to understand how immunotherapy can be used in combination with other cancer agents. SNU Cancer Hospital’s research team is actively participating in these studies,” says Kim. The hospital is conducting 32 immunotherapy clinical trials and Kim

Training programs for HCPs are also actively conducted in cooperation with various countries, including the United States, China and Japan.

The FIRST Cancer Hospital in Asia “Through the best knowledge and skills of our doctors, state-of-the-art medical systems, and world-class research & development capabilities, SNU Cancer Hospital will be your FIRST hospital Experienced and world-class HCPs in conquering The best-laid plans fall short “Through these research cancer,” says Kim. programs, we will be FIRST is if there are no brilliant minds making a difference with an acronym that stands to see them immunotherapy in the for acronym through, which treatment of various of Friendly, is why SNU cancer patients.”

Integrated, Cancer Hospital Research-based, hires an array of Smart and Trustworthy – all traits that experienced and world-class HCPs. exemplify the type of service SNU Cancer “Our HCPs who hold a wealth of Hospital strives to provide all patients. clinical experience and excellent research The FIRST principle led SNU Cancer skills,” says Kim, adding that the Hospital to place oncology nurses for hospital, with its association with the each center, who provide information or top-ranked Seoul National University, add necessary explanations to first visit manages to attract the best minds to its patients. The nurses then summarize the medical school. cancer history of first visit patients in HCPs also benefit from international advance and deliver it to oncologists. collaborations with other leading cancer The hospital strives to minimize treatment facilities. SNU Cancer Hospital unnecessary hospitalization to reduce the has signed agreements with the National wait time for admission.

Cancer Institute of the U.S. and City of And patients who are injected with Hope, a U.S. cancer hospital in areas of a cycle of less than 12 hours can get education, research and consultation. cancer treatment during the day without In addition, the SNU Cancer Hospital’s hospitalization. FIRST will serve as the Brain Tumor Center shares research guiding compass for the improvements findings with MGH, a Harvardthe hospital will be implementing in the affiliated hospital through regular video coming years. conferences.

The SNU Cancer Hospital is active across all areas of clinical research

HEALTHCARE ASIA 5

FIRST at Philippine General Hospital (PGH), agrees with Dr de la Pena, saying that the salary scale of other countries are simply incomparable with the scale in the Philippines.

“For the Philippines, you just have to make do with the current situation wherein you train your nurses and eventually they have to go. Like in the PGH, we have a thousand nurses, and every month, we have 5-10 people who leave us, and so you just train them,” Cubillan says.

Who owns EHR?

A rift is developing between consumers and doctors regarding whether or not the latter should have full access to their electronic health records. According to a survey by Accenture, the divide has widened in Singapore compared to two years ago, with patients now four times as likely as doctors to believe that patients should have full access to their records.

And it’s not just because the number of consumers who believe they should have full access have risen from 73% in 2014 to 82% today. The number of doctors who share the belief has also dropped from 30% to 17%. According to Penny O’Hara, managing director and APAC head of healthcare at Accenture, until now, the flow of clinical information has been to the doctor. “With digitisation driving a new level of information parity, doctors need to embrace – not resist – the notion of patients having complete access to their records,” she says.

Seeing unabridged data Additionally, the survey found out that 2/3 of consumers who believe they should have access want to see exactly what the doctor sees instead of a summary.

“This comes as the number of patients who know exactly what they can access in their EHRs increased 45% over two years, from 44% in 2014 to 64% today,” the survey says.

“However, significantly more consumers are likely to access their EHR to stay informed than to help with making medical decisions. The areas cited most often by consumers for using their EHRs to manage their health include having access to their physician’s notes about the visit (34%),” it adds.

6 HEALTHCARE ASIA

St Luke’s Medical Center Global City

PH medical staffing costs skyrocket

W

PHILIPPINES

hen Dr Arturo de la Peña, senior vice president and head for medical practice at St. Luke’s Medical Centre Global City in the Philippines faced rising staffing costs, instead of downsizing and cutting back on employees, he curiously doubled down on investing heavily on training their healthcare professionals. “By training them, we will be able to ensure high quality of care, and this will bring in volume to the hospital.

After you have brought volume, and have enough income, then you can now gradually increase the salary-scale of our nurses and our support staff,” de la Peña says.

De la Peña adds that the competition from foreign countries is hard to beat, offering more than six times the salary that hospitals in the Philippines offer. “The starting pay for nurses in Qatar is USD 2,500 a month, we’re paying about less than USD 425 a month.

You should be able to know your capacity to be able to know your staff. If you don’t then you’re paying them unnecessarily. With the present capacity, we invest heavily on their training,” he adds.

Leo Cubillan, chairman, department of pay patients hospital

Arturo de la Peña

Leo Cubillan

Government involvement Cubillan adds that this does not mean that the government and the healthcare institutions are not actively implementing measures to increase the competitiveness of the salaries of local healthcare professionals.

In fact, the Philippine government has mandated a higher salary scale for governmentemployed healthcare professionals, which will see nurses’ salaries go up by 10-20% by 2016.“The problem with the government though, is that it would not allow the addition of personnel. And in a way, it will limit your services. For the PGH, we keep on requesting for more nurses, because we want to maintain the ratio with the patient care and it’s been very difficult,” Cubillan adds.

Meanwhile, Dr de la Peña says that his hospital was also able to increase the salary scale of its healthcare personnel. “Higher now, or even equivalent to the government side. You have to earn enough, so when you have enough money, you can now begin to share it with your people,” he explains.

ASEAN readies for growth

Source: National Statistics Sources, BMI

FIRST

Zamzam Djaelani

Diah Saminarsih Zainoel Abidin Hospital

Private hospitals join UHC INDONESIA

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hen Zamzam Noerzen Djaelani, director of Awal Bros Hospital, heard of Indonesia’s universal healthcare plan, Jaminan Kesehatan Nasional (JKN), he was eager to join in. Zamzam says private hospitals make a key distinction between markets in metropolitan areas and peripheral areas, particularly outside Java. He adds that while most patients are usually backed by private insurance, a lot of citizens in the outskirts are largely dependent on JKN for their healthcare needs. “Because there is great demand for JKN in peripheral

areas, I think private hospitals are very keen to join the system. There is a very slim market; it’s either we go with the system or we do not have enough revenue,” Zamzam says.

But it’s not that easy for private hospitals to jump in. Zamzam also argues that the prices of services are usually too small for private hospitals to thrive on.

“Prices particularly for surgery and obstetrics are too small to provide sufficient care for the patient. Private hospitals are forced to use generic drugs and cheaper equipment, as well as pay lower

medical fees to practitioners. That is more of the problem we have in private hospitals. Maybe the government should consider some tariffs,” Zamzam explains.

Meanwhile, Diah Satyani Saminarsih, special advisor for Indonesia’s minister of health for Partnership and SDG says the health ministry isn’t closing the door on the possibility of using private insurance to complement JKN’s blind spots. “That is still under discussion; a key leader here is Bank Mandiri. I say we give two or three years more before we see any substantial improvements in this,” Saminarsih says.

Additionally, she also acknowledged that there lies a growing need to improve standard operating procedures in hospitals and clinics across the country. In particular, she cited the need to cut down on paperwork.

Universal Healthcare Advances

Source: Indonesia Investments *2016 are Indonesia Investment forecasts

The Chartist: Healthcare infrastructure in Singapore, HK, under immense strain Strained healthcare infrastructure is being more prevalent in Asian countries such as Singapore and Hong Kong, prompting the necessity of telecare to ease the domestic demand for medical services. According to BMI Research, strained hospitals are particularly acute in Hong Kong, noting that the large proportion of its public hospitals had a bed occupancy rate exceeding 100%.

“We expect the pressure on both healthcare systems to grow as chronic conditions such as diabetes and cancer become more prevalent,” BMI Research notes. Meanwhile, BMI adds that Hong Kong and Singapore will ultimately need a transformation in the delivery of healthcare as land constrains limit their ability to increase the supply of hospital beds.

Asia: Bed occupancy rate at public hositals for Hong Kong (%,LHS)

Asia: Bed occupancy rate at public hositals for Singapore (%RHS)

Source: Hospital Authority

Source: Singapore Ministry of Health

HEALTHCARE ASIA 7

FIRST

Malaysia lags peers in healthcare skills

Health system bureaucracy

W MALAYSIA

hat Mahenthiran Thanapal, director of business operations at Prince Court Medical Center thought about modernising hospitals was polarising.

He says making a hospital modern does not necessarily mean equipping hospitals with fantastic facades and the most expensive healthcare equipment.

“Hospitals in the near future would move away from investing in totally integrated IT infrastructures towards more of using mobile applications and the cloud,” Thanapal says.

However, Thanapal adds that not only the systems of the hospitals must be modernised, but also the skills of its healthcare professionals.

Healthcare professionalism “The government [should] put a moratory on some of the private colleges to ensure the quality and sufficiency of the amount of training of healthcare professionalism,” he says.

Thanapal adds that there should be more regulation in terms of the education that medical professionals receive.

“There are a lot of colleges allowed to operate, and the plurality is confusing for medical professionals. Patients

National Heart Institute, Malaysia

come to be served expecting the best in terms of skills and class because they are paying for it. They do not accept any room for error,” he adds.

Michael Wong, chief executive officer of IMU Healthcare, concurs that Malaysia still has a lot of catching up to do in terms of healthcare skills, adding that the country’s skills are far from adequate. “As far as skills are concerned, Malaysia still hasn’t caught up. But still, we have to do more with the little that we have,” said Wong.

“Malaysia is quite lacking especially in terms of IT skills. Hospitals in the country are not used to the big budgets required to bring the skills and facilities to the next level.”

As far as skills are concerned, Malaysia still hasn’t caught up.

Bright future ahead for Thailand’s healthcare firms Thailand’s private healthcare providers are well positioned for growth as the country’s status rises as a medical tourism hub, piggybacking local demand for medical services. According to a report by BMI Research, private hospitals also have the opportunity to expand into frontier markets such as Indo-China, which will, in turn, shape the sales channels for pharmaceutical firms with high-value pharmaceuticals and serve as a growing alternative to the public medical system.

BMI Research notes that political instability remains the significant roadblock to this goal, deterring medical tourists from entering the country. “For the year 2015, leading firms such as Bumrungrad International Hospital saw revenues rise by a strong 13% yoy to amount to THB17.6 bn, while Bangkok Dusit Medical Services increased its income,” BMI notes.

8 HEALTHCARE ASIA

Rajvitee Hospital

Bumrungrad International Hospital

Coordinating healthcare in a country-wide basis is a tough task, compounded by both systemic flaws and logistic difficulties. But surprisingly, over half (54%) of healthcare professionals and 43% of patients across the Asian region indicate that health system bureaucracy is a major barrier to coordinating healthcare in their countries, according to a survey

by Philips.

According to the survey, while 45% of healthcare professionals particularly in Singapore rate bureaucracy as a top barrier, 28% of patients say the same. “However, it is important to note that 70% of healthcare professionals think the financial structure of Singapore’s health system would have a positive impact on the integration of health data,” the survey noted.

Perception gaps Meanwhile, perception gaps also exist on the onus for preventing poor health, notes Philips. “Across the 13 countries surveyed, as patients age, they are more likely to believe they are the guardians of their own health – 79% of those 55 years or older in the 13-country total agree the individual is fully responsible for preventing poor health compared to younger patients (66% of those aged 18-34 across 13 countries),” the survey said.

Additionally, Philips says while Singaporean patients across all age groups agree that it is the responsibility of the individual to prevent poor health, 84% of those aged between 55 and 64 believe the individual is fully responsible for their own health.

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FIRST

Malaysian hospitals find trouble integrating new technology MALAYSIA

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hen KPJ Healthcare Berhad president and managing director Dato Amiruddin Abdul Satar noticed that doctors and nurses in the international healthcare firm have been spending more time looking at a monitor or using advanced healthcare devices, he observed that this lead to a reduction in medical errors. Amiruddin also went so far as to say that most of the errors that KPJ is facing right now is based mainly on their manual systems.

“We need to revise all of our softwares and programs to make sure that it can be used over the internet. It has to allow the system and the interface to interact with other devices,” Amiruddin says.

Amiruddin adds that the biggest challenge in this initiative to reduce medical errors through technology is how hospitals ask for budgets and manage costs.

“What applications and what systems we need to buy and how much they cost is a primary concern,” he says. “We need to go back to the shareholders, and we need to present the benefits that have been brought about by the budget.”

Persistent cost dilemmas Amiruddin adds that even in a large, international healthcare company such as

Sustainability woes threaten Asia’s UHCs

Universal healthcare may mean well, but it certainly does burn a hole in a nation’s pocket. And according to analysts, universal healthcare schemes are feeling the heat.

According to BMI Research, the financial sustainability of universal healthcare schemes will be an enduring challenge.

“This will apply to all markets in Asia Pacific: from Indonesia with the JKN accumulating a deficit of IDR4trn (USD302mn) in 2015,” BMI Research notes.

Additionally, some measures are expected to come from states, including cut medicine prices rather than to shift the burden onto consumers as a means of maintaining the sustainability of the respective universal healthcare schemes.

“Navigating this will require pharmaceutical firms to shift the focus away from price, and towards the value gained for the system,” BMI Research notes.

10 HEALTHCARE ASIA

KPJ, cost dilemmas could still persist. “The minute the users, the doctors, and the nurses double up and start using the system, then we start to see that the system is becoming slower.

This results in the company having to spend more. KPJ has been using these technologies for the last 6-7 years. We only have 40-50% in incorporating our doctors in the technology that we have.” He adds that there is a certain cultural friction occurring when a hospital or healthcare firm transitions to a more advanced system.

“These healthcare innovations are part of the gradual steps in addressing inefficiencies,” says Ahmad Shahizam Mohd Shariff, chief executive officer of Pantai Holdings Berhad.

“Many of the people who are used to the level of efficiency that you can see in airlines, banking, and financial services get really shocked when they go to healthcare services,” he adds.

Lacking unified standards Ahmad says that in reality, healthcare technology and systems usually lack a unified code of standards.

“The challenge remains that much of this is in the periphery of the process. I think we need to find a better way to move into the substantive areas. What’s common in all these areas of technological adoption is what

Amiruddin Abdul Satar

Ahmad Shahizam Shariff

Kuala Lumpur Hospital

I call common standards of platforms. It’s a lot more easier to implement, because all the vendors’ hardware and software have a common approach and language that we use,” he adds.

“This is where the industry must agree on a single process, like telcos and electronics manufacturers.”

Journey to universal healthcare a marathon rather than a sprint

Source: International Labour Organization, Health Systems Knowledge Network, World Health Organization, BMI

Low oil prices hit hard

Source: ADB, BMI

AD: Ring MD

HEALTHCARE ASIA 11

CO-PUBLISHED CORPORATE PROFILE

So, you’re thinking about designing your own eHealth strategy The aging of the world’s population combined with the growth of chronic medical conditions is putting relentless pressure on health systems globally.

Young children and older people as a percentage of global population

A

s nations around the world seek to address the challenge of the world’s aging population, they are exploring the ways in which information technology can help them drive healthcare improvements and innovation.

We spoke with Asia Pacific, Regional Managing Director for InterSystems, Kerry Stratton, to understand how a premier IT company with a specialty in healthcare IT helps its clients create and implement effective eHealth strategies.

The InterSystems frame of reference is more than 37 years of global health information technology experience, with systems installed in approximately 100 countries. In addition InterSystems’ electronic medical records (EMR) system, TrakCare®, was recently honoured as the “2015/2016 Best in KLAS for Global (non-U.S.) Acute EMR.” Following is what we discussed.

While there is wide variance in political and economic environments, countries face remarkably similar healthcare challenges around the world.

A well-designed eHealth strategy is a critical element of the effort to design sustainable healthcare models for the future.

Such a strategy must include a shift from hospital-centric healthcare for individuals to coordinated, distributed

12 HEALTHCARE ASIA

health and social care for populations.

A Viable eHealth Model There are four critical elements to an eHealth program.

First, the right foundation: the shared virtual care record. In an ideal world, all health and social care providers would work within a unified information system with real-time access to all of the information needed to make sound patient care decisions.

Coordinated care requires an inclusive and comprehensive person-centric record spanning the entire distributed care team, including community healthcare centres, specialists, hospitals, home help, and social care.

Similarly, it should reflect the breadth of data types, such as images, medications, notes, test results, and wearable device data.

While many individual healthcare organisations are moving toward a unified EMR, spurred on by patient safety and efficiency drivers, this kind of monolithic environment is not possible across a care continuum involving a

growing array of disparate organisations.

The community-wide model has different stakeholders, regulatory context, processes, IT systems, and often funding.

Consider, for example, the need to incorporate social services such as child protection into a community care process; these providers do not and will not use an EMR, yet they need to be able to connect all the dots for a given patient.

A comprehensive virtual care record aggregates information from all sources and participants, including the patientnormalises that record-and makes it available in a relevant format to each member of the care team in the appropriate workflow.

Second, the right tool for the job: agility at the point of service.

Optimal population health management requires safe, high-quality care for every individual, so every member of the virtual care team needs the best technology for his or her role. For healthcare professionals, this is a comprehensive EMR. For social care providers, it may be a registry or case management system.

But it must provide everyone with access to the shared virtual care record.

Assuming the foundational, shared virtual record is in place, clinical providers can choose an acquisition approach most suited to local priorities, relationships, and funding.

Regardless of the approach, all clinical team members must ultimately have the information they need to deliver care efficiently, adopt best practices, and communicate effectively.

Third, do the right thing: the shared care plan. We all want to do the right thing for the health of our communities. But given the distributed nature of the care team, the need for close communication, and the rapid introduction of new diagnostics and therapies, it is nearly impossible to keep

“A well-designed eHealth strategy is a critical element to design sustainable healthcare models for the future. Such a strategy must include a shift from hospital-centric healthcare.”

CO-PUBLISHED CORPORATE PROFILE

everyone adequately informed without technological assistance. Responsibility for this coordination can be unclear and technology to enable it lacking.

Within the hospital walls, integrated treatment pathways drive order sets within an EMR for a physical care team.

Complementing these, clinical decision support and alerting functionality reduce medication errors, assist with selecting optimal therapies, and warn of possible gaps in care.` Out in the community, the distributed care team needs a shared care plan, built on the shared virtual care record.

Fourth, the right focus: actionable analytics. The accounting truism that “what gets measured gets managed” applies to healthcare and is the reason why quality and performance measures have become widespread in healthcare systems around the world. The term “analytics” is used to describe a diverse mix of approaches, ranging from simple management reports to complex predictors of the risk of death from a specific condition.

The shared virtual record should include embedded analytics capabilities that support reporting, metrics, and dashboards at a minimum, as well as monitor and document improvements in both outcomes and utilisation.

It may also support risk stratification and predictive models, or be used as a near real-time data source for specialised analytics applications.

If you are ready to design or enhance your own eHealth strategy, consider developing a plan that includes these

steps: Step 1: Document the starting point.

Identify and begin gathering baseline metrics related to the goals of your eHealth initiative. You may have only limited data available at this stage, but this baseline will enable you to measure and accelerate successes.

Step 2: Create the connected health record. Start by examining the EMR strategy within your organisation to identify risks and the gaps in seamless care provision. The EMR will continue to be the centre of the universe for patient data, but that universe is expanding.

Step 3: Foster patient and provider engagement. Create outreach programs and peer champions to encourage providers, patients, and families to adopt and embrace the shared virtual record

and care plan as an integral part of their own care management processes.

Step 4: Enhance the EMR. Whether you adopt a single community-wide EMR or multiple different systems, implementing next-generation EMR technology requires careful planning and change management.

The shared virtual record provides the necessary archival repository to ensure continuity, and it insulates caregivers from the impact of that change, as older data sources are swapped out and replaced.

Step 5: Measure-Monitor-ImproveRepeat. At each step along the path to a mature eHealth program, there will be opportunities to enhance and improve care processes, drive efficiencies, enhance patient satisfaction, and learn from experience. The essence of a learning health system is continuous measurement and improvement.

Mr Stratton concluded, “Nations everywhere are facing the realities of a new healthcare environment — one in which healthcare is a team activity, patients are equal partners in the care continuum, and new approaches are needed to ensure sustainable funding for increased demands.

An eHealth model designed for this new environment spans the entire community, engages patients, reduces costs, and improves outcomes.”

If you have any questions regarding the content of this article, or would like to learn more, please contact Kerry Stratton via www.

InterSystems.com/HealthCareAsia

“Nations everywhere are facing the realities of a new healthcare environment — one in which healthcare is a team activity.”

An eHealth model spans ` entire communities

HEALTHCARE ASIA 13

healthcare INSIGHT: dr watson vs dr google

IBM’s Watson

Watson vs Google: Asia fights information asymmetry With information about symptoms at everyone’s fingertips, healthcare professionals grow more concerned about misinformation.

W

hen Parkway Pantai worked with IBM to integrate its decision support tools, they witnessed that their clinicians and nurses got healthcare data in the right context, faster, and more personalised to the patient’s needs. Kelvin Loh, chief executive officer of Parkway Pantai’s Singapore operations division, says the systems like cognitive computing can read, monitor, and quickly make sense of vast amounts of data for a short period of time.

Following the lead of one of the largest healthcare firms across Asia, other hospitals have also adopted breakthrough technology in their hospitals such as IBM’s Watson in order to improve and speed-up symptom analysis and determine the best treatment.

Just this June, IBM opened The Watson Centre at Singapore’s Marina 14 HEALTHCARE ASIA

According to Google, roughly 1% of overall searches, 35 million queries per day, in the search engine are symptomrelated.

Bay, an incubator designed to bring together healthcare organisations to help create solutions to leverage the technology’s capabilities.

“IBM’s new Asia Pacific headquarters is based in the same location, in the heart of Singapore’s financial district. Watson Centre at Marina Bay will act as a center of expertise for almost 5,000 IBM cognitive solutions professionals in the Asia Pacific region alone, including researchers, IBM Watson specialists, data scientists, software engineers, agile developers and analytics experts,” a release by IBM noted.

Additionally, IBM has also been working with hospitals and healthcare organisations across Asia-Pacific, including Bumrungrad International Hospital in Thailand.

Meanwhile, while healthcare technology companies have been

developing new, more efficient, and more reliable ways of healthcare diagnosis, there still remains a growing concern among healthcare professionals about patients consulting Google more than their physician.

According to Google, roughly 1% of overall searches, 35 million queries per day, in the search engine are symptom-related.

“But health content on the web can be difficult to navigate, and tends to lead people from mild symptoms to scary and unlikely conditions, which can cause unnecessary anxiety and stress,” says Veronica Pinchin, project manager of Google Health Search admits.

Google Health Search To address this, Google has been working on Google Health Search, which entails improving their search engine to optimise the search for symptoms.

“So starting in the coming days, when you ask Google about symptoms like “headache on one side,” we’ll show you a list of related conditions (‘headache,’ ‘migraine,’ ‘tension headache,’ ‘cluster headache,’

healthcare INSIGHT: Dr watson vs dr google ‘sinusitis,’ and ‘common cold’). For individual symptoms like ‘headache,’ we’ll also give you an overview description along with information on self-treatment options and what might warrant a doctor’s visit,” Pinchin says.

By doing this, Pinchin explains that the goal is to help patients navigate and explore health conditions related to the symptoms which were searched by the user.

This way, the engine can quickly get to the point where the user can do more in-depth research on the web, or link the user to a talk to a licensed healthcare professional.

“We create the list of symptoms by looking for health conditions mentioned in web results, and then checking them against high-quality medical information we’ve collected from doctors for our Knowledge Graph,” Pinchin says.

“We worked with a team of medical doctors to carefully review the individual symptom information, and experts at Harvard Medical School and Mayo Clinic evaluated related conditions for a representative sample of searches to help improve the lists we show,” she adds.

Intended for information Meanwhile, Pinchin says symptom search, like all medical information on Google, is intended only for informational purposes.

The tech giant advises that users should always consult a doctor for medical advice. “We rely on search results, and we reflect what’s on the web. Because of this, your feedback is especially important to us; we’ll use it to keep improving the results we show. You’ll notice in the weeks following launch that when we show symptom search we’ll automatically ask you if the results are helpful,” Pinchin says.

Pinchin adds that Google Health Search aims to cover more symptoms and to extend the search engine function to other languages and internationally. “The next time you’re worried about your ‘child with knee pain’ (even though it’s probably just growing pains), or have some symptoms you’re too embarrassed to run by your roommate, a Google

search will be a helpful place to start,” Pinchin adds.

Google Health Search, on the other hand, is not the first time the tech company improved their search engine to facilitate better health information searches.

Last 2015, Google unveiled Knowledge Graph, where the engine shows typical symptoms and treatments, as well as details on how common the condition is.

According to Prem Ramaswami, product manager for Google, all of the gathered facts for Knowledge Graph represent real-life clinical knowledge from doctors and highquality medical sources across the web, and the information has been checked by medical doctors at Google and the Mayo Clinic for accuracy.

But Google once again pointed toward professional medical advice over their search results.

Medical advice “That doesn’t mean these search results are intended as medical advice. We know that cases can vary in severity from person to person, and that there are bound to be exceptions. What we present is intended for informational purposes only—and you should always consult a healthcare professional if you have a medical concern,” says Ramaswami.

On the other hand, while IBM’s Watson seem to be the more credible choice for medical information, people have obviously been referring more to Google searches.

“I think the challenge is in the environment we are working in now,” says Amiruddin Abdul Satar, managing director and president of KPJ healthcare.

“Doctors are working in isolation in our environment at the moment, so it’s not easy for them to refer a patient now to another doctor to ask for a second opinion. That is the first challenge.”

Another challenge which Amiruddin refers to is the cost of innovative healthcare technology such as IBM’s Watson. “I’m sure that they’re not gonna give it for free. We are faced with the biggest challenge of containing our costs. At the end of the day, it’s about how much we can

Amiruddin Abdul Satar

Ahmad Shahizam Shariff

Veronica Pinchin

charge patients, and how much see value in this type of technology,” he says.

He adds that healthcare professionals cannot discredit the strong bond between the patient and the doctor.

“While the newer generation may refer to the internet most of the time, at the end of the day, they still have to go to the hospital.” Amiruddin adds that there may be other hurdles in using new technologies, such as government and ministry of health regulations.

Regulatory hurdles In Malaysia, Amiruddin says the biggest hurdle is the requirements set by the health ministry as to how much the doctors and hospitals can charge.

“This innovation helps take the weaknesses of the human expert and mitigate that, but this is not something that will be embraced by physicians with open arms,” says Ahmad Shahizam Mohd Shariff, chief executive officer of Pantai Holdings Berhad.

“There are a lot of experts and physicians involved, and it’s predicated on long years of training and experience,” he adds.

“Second opinion exists because human judgment comes into play,” he says. “Having a machine do this is going to be quite an interesting development.” Ahmad Shahizam Mohd Shariff however asserts that he would always prefer a Dr Watson to give me this information than Dr Google.

“One of the challenges for healthcare is the asymmetry of information,” he says.

Google Symptom Search

HEALTHCARE ASIA 15

Dr Mohd Azhari Yakub CEO Institut Jantung Negara 16 HEALTHCARE ASIA

Dr Luk Che-chung Chief Executive Queen Mary Hospital

CEO INTERVIEW

Queen Mary Hospital unveils lung perfusion for patients with severe breathing problems Dr Luk Che-Chung expects lung transplant cases to double in the coming years.

T

he 1,400-bed Queen Mary Hospital is the teaching hospital of the Li Ka Shing Faculty of Medicine of The University of Hong Kong.

Apart from serving regional residences, the hospital also provides tertiary and quaternary services across the territory for many complex and advanced services including organ transplants and coronary care.

Healthcare Asia interviewed QMH’s chief executive Dr. Luk Che-chung, to get a glimpse of what it’s like to lead one of Hong Kong’s largest hospitals.

University Pathology Building and the Houseman Quarters for the construction of a new block to accommodate key clinical services. Currently we are converting the Senior Staff Quarters into pathology laboratories and other facilities for decanting the existing facilities of these three buildings. The whole project is scheduled for completion in mid 2020’s.

What are some of the problems and challenges facing Queen Mary Hospital and how do you plan to address them?

The percentage of elderly population in the catchment area is comparatively higher than other districts in the territory. To better cater to the ageing population, we emphasize the orientation of services towards streamlined, integrated, multi-disciplinary clinical programmes which are patient-centred and holistic to ensure consistent and aligned delivery of high quality and safe services. We hope to achieve the right care, provided at the right time, by the right provider and at the right place so that the patients, especially the elderly, would find it accessible and convenient.

While the changing demography implies demand for increasing service capacity especially for chronic diseases, we address the challenge in our latest Annual Plan by locating more resources to enhance endoscopy and rheumatology services. Nursing support for on-call and emergency endoscopy cases has been strengthened over the years and we will provide additional 3000 Computerized Tomography (CT) examinations and 150 lung function laboratory tests per year in the coming future to meet the service demand.

What are the latest innovations, developments, and strategies to improve the quality of service of Queen Mary Hospital?

QMH began a pilot program in May last year to rescue patients with urgent cardiac arrest. The technique involves the use of extracorporeal membrane oxygenation (ECMO) with cardiopulmonary resuscitation (CPR) at the same time, which is the first in the city to make this innovation. Both machines acted as a patient’s artificial heart and lung respectively which could possibly save one whose heart had ceased beating for more than 30 minutes - a common cut-off time in a rescue attempt. One of the successful cases was a girl brought “back to life” when her heart stopped beating for 50 minutes. We are happy to see our new service saving more lives and bringing hope to the families.

QMH has been striving for excellence in our transplantation services. A new technique called ex-vivo lung perfusion (EVLP) was introduced last year to make lung transplantation more readily available for those whose lives are severely limited by their severe breathing problems. With EVLP, the incredibly delicate donor lungs are able to “recover from damage” so that a lot of those assessed to be unsuitable for transplant in the past could now be usable. Hopefully the number of lung transplant cases could be doubled in the coming future, where up to 20 patients per year could benefit from this invention.

Do you have plans for expansion?

The Hospital, having been operational since 1937, does struggle with space constraints and dispersed facilities in a number of aged buildings.

A redevelopment plan has therefore been kicked off since 2012 to turn QMH into a modern medical center adaptable to future service delivery models with adequate capacity to meet the community’s longterm needs.

The redevelopment project will be carried out in phases. Phase one redevelopment will cover the demolition of the Clinical Pathology Building, the

Hopefully the number of lung transplant cases could be doubled in the coming future, where up to 20 patients per year could benefit from this invention.

What are some of your future plans for Queen Mary Hospital for the next 2-3 years?

We are now actively looking into measures to deal with the demographic shift of our patients. We will keep on improving the management of chronic diseases and serious illnesses. The care and treatment for end-stage kidney diseases, cancer, stroke and blood diseases will be continuously reviewed and implemented in the coming years.

For kidney diseases, a collaborative model of close partnership between urology and nephrology will be developed to provide acute care which shares the resources and expertise of two departments.

Hospital networking will be coordinated to provide convalescent care, rehabilitation, palliative and end of life care. On the other hand, we hope to build up capacity for echocardiographic service and radiotherapy to meet the growing demands of the community.

HEALTHCARE ASIA 17

feature profile

PMA announces tough organisational changes

Philippine Medical Association spearheads healthcare data optimisation In a time of technological innovation, the premier medical association in the Philippines leads a breakthrough project involving the consolidation of healthcare data.

P

reviously known as the Manila Medical Society, an organization founded in the 1900s to “hasten delivery of medical assistance from the American Red Cross,” PMA has now grown to cover the entire Philippines, with various component, affiliate, and specialty societies nationwide, with membership strength of over 80,000. It is currently a member of the World Medical Association, and a co-founder of the Confederation of Medical Associations of Asia and Oceania and the Medical Associations of South East Asian Nations.

Eight strategic imperatives At present, the PMA aims to constantly engage in “dedicated selfless and humane service of the Medical Profession for a healthy Philippines and for the Glory of God,” armed with a vision of “a fellowship of physicians united in the common goal of acquiring the highest levels of medical knowledge and skills through continuing education and research, and to promote the healing ministrations of the physicians in the delivery of health care to patients.”

Under Maria Minerva Patawaran-Calimag, PMA President for 2014-2015, the PMA adopted the tagline 18 HEALTHCARE ASIA

PMA has now grown to cover the entire Philippines, with various component, affiliate, and specialty societies nationwide, with membership strength of over 80,000.

“PMA: Empowering the Filipino Physician for NationBuilding,” with the additional exhortation “Unite for Change, for the PMA and the Nation.” And as President, Patawaran-Calimag focused her leadership on eight strategic imperatives: Institutionalize the mission, vision, and values of the PMA; strengthen the PMA as an organization; enhance the relevance of the PMA among its members; build capacities and empower the physicians; promote quality medical education; improve physicians’ access to continuing professional development (CPD); play a pivotal role in crafting policies and laws for the country; and elevate the status of the PMA in the local and international scene.

With so many changes in the pipeline, the PMA sought to assert its identity as the country’s premiere medical organization by emphasizing the significance of unity among its members.

“The PMA as envisioned by our forefathers is an association of all physicians that would look after each other’s welfare. Our duties and responsibilities at the PMA should be to make sure all physicians, regardless of specialization and affiliation, are cared for, nurtured, and empowered,” Patawaran-Calimag, the PMA’s 93rd president declared. She cautioned: “We should thwart

feature feature profile profile The PMA has been active in representing its members in various fora and industry organizations, as well as in lobbying for relevant legislation involving the medical field.

Medical Center Manila

any attempt by any sector to disembowel the profession, to divide the physicians, and disintegrate the PMA in exchange for personal gains or political ambitions.”

A “One PMA,” according to Patawaran-Calimag, meant harnessing the power of organized medicine, and is founded in an inherent service and “love” for the organization and its members.

The PMA under Patawaran-Calimag’s term marked progress through initiatives that addressed members’ concerns and concerns of the organization as a whole, all in the aim of preserving the PMA’s status as the premier advocate organization for the nation’s doctors.

Educational reforms On top of the PMA’s to-do list was to beef up its educational program, as working committees undertook several initiatives throughout the year. There was a seminar workshop on the Ebola virus, as well as several advocacy campaigns, notably on the graphic representation of the effects of tobacco smoking on cigarette packages. Other issues that the PMA pushed for were waste segregation and disposal, environmental sanitation, climate change, and mangrove rehabilitation.

These activities saw the engagement of the PMA members and the organization’s close collaboration with several stakeholders in the medical field.

The PMA’s CPD program—or the education of physicians following the completion of formal training, or the acquisition of knowledge, experience, and skill as well as the development of personal qualities—was also further strengthened.

“Among physicians, CPD consists of any educational activity which helps maintain, develop, or increase knowledge, problem-solving, technical skills, or professional performance standards. Keeping up-to-date enables them (physicians) to work legally and effectively, all with the goal that they can provide better healthcare redounding to patient safety,” Patawaran-Calimag noted.

The PMA first initiated during Patawaran-Calimag’s term its OWL@PMA (Online Webbed Learning @

Partnerships for Medical Advancement) Program for CPD of Physicians, a MOOC (massive open online course) site using open-source learning management system Moodle Analytics, which enabled physicians to recommend educational and professional development tracks according to context.

“The OWL@PMA is anchored on the philosophy of heutagogy,” explains Patawaran-Calimag, referring to the study of self-determined learning. “It recognizes that physicians are not only lifelong learner but that they are engaged in learning for life. Our goal is to create an alternative virtual platform that will elevate the educational experience of physicians by measuring their learning and engaging them at their own pace and convenience,” she adds.

Benefits improved The PMA has also been responsive to its members’ non-educational needs as the organization initiated the improvement of facilities at the Doctors’ Inn and explored avenues to extend living benefits afforded by the existing PMA Power Card.

In terms of infrastructure, the PMA also did its part in ensuring that the organization remained an environmentally-friendly one with the PMA headquarters now sporting LED (light-emitting diode) lights. This move slashed the PMA’s electric consumption by over a third, or by 35%. In the pipeline are plans to conserve other finite resources such as water and paper, and to streamline office clutter, whether physical clutter or process bottlenecks.

On the external front, the PMA has been active in representing its members in various fora and industry organizations, as well as in lobbying for relevant legislation involving the medical field. These initiatives have placed PMA at the forefront of pressing issues and gave the group’s members a unified voice in addressing these.

At the forefront of legal hurdles The PMA was present during the hearings of the Senate Committee on Health on the Physicians’ Act,

Lung Center of the Philippines

HEALTHCARE ASIA 19

feature profile dignity, respect for peers, dedication to every physician’s constituent rights, and patient’s safety.

“The practice of Medicine has had recent major changes that impact on the Standards of Conduct, Performance and Ethics of the Medical Profession. In the spirit of interprofessional collaborative practice, the practice of the medical profession, invariably requires a safe and ethical physician engaged in a systematic environment made conducive to such safe practice together with other healthcare professionals,” the declaration noted.

In her capacity as leader of the PMA, PatawaranCalimag recognized the organization’s unique position as it surpassed its 111th year. Should the PMA embrace this position, or simply ignore it?

“The ground is definitely shifting beneath our feet and change is upon us. Dear colleagues, change can be scary.

But we must never forget: change can also be good. Today, we stand at a crossroads in the history of health care in this great nation,” remarked Patawaran-Calimag.

San Lazaro Hospital

where the PMA pushed for recognition as the country’s integrated professional organization in medicine given the group’s pioneering status and its accreditation with the Professional Regulation Commission. In exchange for this, the PMA pledged to work on a harmonized bill to protect the welfare of Filipino physicians.

In addition to this, the PMA was also present during several other important committee hearings during the year: Ebola virus crisis, transparency and accountability in the disbursement of Sin Tax proceeds, drug safety and fake drugs, among others. A notable piece of legislation that the PMA opposed, however, was the Marijuana Bill, as the group believed “there are other options for obtaining marijuana for compassionate use through the FDA (Food and Drug Administration) and DDB (Dangerous Drugs Board).

On the international scene, Patawaran-Calimag ably represented the PMA at the APEC (Asia-Pacific Economic Cooperation) Business Ethics for SMEs in Nanjing, China as one of 200 participants from 20 APEC economies who gathered to promote ethical environments in the biopharmaceutical and medical device sectors.

The PMA also hosted the 29th General Assembly and 50th Council Meeting of the Confederation of Medical Associations in Asia and Oceania, with the theme “eHealth Database in an Information Technology Era where Patawaran-Calimag promoted the Philippines’ initiative in Health Information Exchange.

A declaration of commitment As a fitting cap to a busy year, it was also in 2015 that the PMA’s members signed the Declaration of Commitment to the Ethos of the PMA. This commitment was a pledge by the PMA’s members to work for positive change, specifically toward serving the needs of their constituents, underscoring the PMA’s mission and values of integrity, 20 HEALTHCARE ASIA

PMA was also present during several other important committee hearings during the year: Ebola virus crisis, transparency and accountability in the disbursement of Sin Tax proceeds, drug safety and fake drugs, among others.

The PMA at a historic crossroads She noted the organization faced “two paths”: the path of inaction and divisiveness, and the path of collaboration and innovation, one that would lead toward productive change. A crossroads that is certainly historic in nature.

Patawaran-Calimag then challenged the PMA’s members to embrace the organization’s changes in a confident manner, keeping in mind the PMA’s mission and values, and the recognition of the crossroads that the organization faces.

“The great thing about living through history is we don’t have to just witness it. We can shape it,” she declared.

At the end of the day, the PMA’s strongest and most significant assets remained to be its members, the Filipino physicians. Patawaran-Calimag called for a more united PMA—an organization working as one toward a common vision of progress for the country.

Philippine Medical Association building

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Tel : +(603) 6140 6666 Fax: +(603) 6140 8833 HEALTHCARE ASIA 21

cOUNTRY report: singapore

The tourists are not coming back, experts say

Private hospitals clamour for greater support as medical tourism stumbles

Neighbouring ASEAN hospitals are rapidly modernising, and private healthcare providers in Singapore are struggling for growth as international patients vanish.

P

rivate healthcare providers need booster shots from the government in order to help them cope with the dwindling number of hospital owners.

Experts and industry players note that Singapore’s hospitals are up against stiff competition from their counterparts in ASEAN. As more southeast Asian hospitals modernise, the city-state is slowly losing its appeal as a medical tourism hub.

For instance, Indonesian healthcare providers have invested heavily in securing new facilities and equipment, says Beng Teck Liang, executive director & chief executive officer, Singapore International Medical Centre. This trend is among the culprits behind the sharp drop in Indonesian medical tourist arrivals, and has exacerbated the impact of the weak Indonesian rupiah.

“It’s a given. In markets like Indonesia and Vietnam, we’re going to see a progressive improvement in the healthcare sector, which will result in fewer patients heading to Singapore,” Beng says.

Beng notes that the hospital has seen declining numbers of medical tourists in the past couple of years, particularly those from Indonesia. While demand from Vietnamese patients remains strong, Beng believes that the trend of declining arrivals is not likely to be resolved in the near 22 HEALTHCARE ASIA

Private hospitals need to cope with a massive shift in the profile of international patients.

future.

“Indonesian healthcare providers are aggressively investing in new facilities and equipment. I think they are successful in encouraging patients to stay local, particularly now with the use of universal healthcare,” he says.

Cutthroat competition Beng notes that the private hospitals need to cope with a massive shift in the profile of international patients. He highlights that in the early 1990s, Indonesian patients went to Singapore for even the most basic medical procedures; now, they only head to Singapore for extremely complex cases. As a result, earnings from medical tourism has dropped by as much as 40% in some cases. Beng stressed that private hospitals need more government support in order to stay ahead of their aggressive regional competitors.

“We’ve actually had many conversations with people like the Singapore Tourism Board (STB) as to how they can help us, but I think their hands are tied as well. We want to have a dialogue with the Ministry of Health, but so far this has proven to be more challenging to have those conversations,” he says.

cOUNTRY report: singapore Beng notes that the Singapore Tourism Board has done its level best to help private healthcare players, but the regulator cannot do much about the competition that private providers face from public hospitals. Overseas patients are also crucial to the earnings of public hospitals, and Beng reckons that it is unlikely that governmentowned players will stop accepting foreign patients in order to give way to private providers.

“There comes the dilemma. We do want to kick-start something; STB has encouraged the private sector to band together to grow medical tourism ourselves with some of their support. But our view is, what’s the point?

We’re going to grow private sector medical tourism, but who’s going to benefit? So we really want to have that conversation with the government to understand exactly what’s going on from their viewpoint,” he says.

Another problem is the huge capacity from the public sector which is about to enter the market. Public hospitals have expanded aggressively and hired plenty of foreign doctors, which will further put a strain on private operators.

“With this extra capacity, at some point in time, I think the government is going to realise that the only way to sustain some of these hospitals is again to open up medical tourism. So again our question is: Why are we investing to build?” Beng laments.

“We think in the next three or five years, the government is going to come back and say, let’s all get together and promote Singapore medicine together,” he adds.

Lawrence Patrick, chief executive officer of Johns Hopkins Singapore International Medical Centre, concurred with this sentiment. “I think the dilemma here is that for a number of years the government told the private sector: If you build it, they will come and we will partner. But now, in a couple of years, they’re not going to need that capacity in the private sector and we’re going to see consolidations again,” he says.

Beng Teck Liang

Lawrence Patrick

Chris Norton

Internalisation is key Patrick notes that internalisation is a key growth pillar for private healthcare providers in this era of declining medical tourism arrivals. Consolidation will also be a key theme for players as this revenue source dries up.

“While we can’t bring the patients here, we can go abroad and get those patients into the system. And then International visitor arrivals, top 15 markets, January-December 2015

Source: Disembarkation/Embarkation Cards

It is unlikely that governmentowned players will stop accepting foreign patients in order to give way to private providers.

there’s this notion that we all get better together so I think as a result of weakening medical tourism, we are going to see more consolidations here, such as more public-private partnerships,” he says.

Christopher Norton, Director of Healthcare at PwC South East Asia Consulting, concurs that partnerships are the way forward for healthcare players in Singapore.

Consolidation will not only hone the city-state’s edge in medical tourism, but it will also help public institutions provide better services to resident patients.

“Singapore is always known for its quality and safety and expertise. But other hospitals, such as in Malaysia and Thailand, are also working to get international accreditation. This will be challenge for providers here,” he says.

Beng, meanwhile, shares that Singapore Medical Group has established the most advanced eye facility in Jakarta in partnership with Ciputra Group, known as the Ciputra SMG Eye Clinic. It opened in October last year.

Although expanding to overseas market is key to growth, Patrick cautioned that the continued internalisation of private players might have a negative effect on the local medical tourism sector. “We can continue to go to these overseas markets in order to compete, but what will that do to our operations here in the long-term?” he asked. He adds that Johns Hopkins no longer expects medical tourist arrivals to return to previous levels, and the group is rolling out a contingency plan to keep earnings robust.

“As a group, we have taken the forward-looking approach. While we will still be able to cultivate overseas medical tourism visits to Singapore, the new way for organisations is to really reach out to these emerging countries,” he says, adding that the group is also looking to expand into Vietnam.

“The private sector will always find ways to survive, and we are surviving. We’ll always find ways and means of getting to the market,” Beng stresses.

While the threat from emerging Asian economies is very real, Beng says that Singapore still has an edge in terms of more advanced software and staff.

“The positive note is that there is rising demand from countries like Vietnam, which is doing really well from an economic standpoint. The facilities there are still fairly rudimentary, and because wealth levels are increasing, they’re seeking better health care,” he notes.

Patrick, however, is a lot less sanguine on Singapore’s prospects. “I don’t see the sector bouncing back. Currency fluctuation is one reason, but I think low oil prices is a bigger drag,” he says, adding that the decline in commodity prices has impacted demand from wealthy Middle Eastern patients. “Until they start to rebound, the patients won’t be coming back,” he says.

Singapore’s medical tourism prospects were among the topics discussed at the recently-concluded Healthcare Asia Forum, which was held in Singapore on May 12. The event gathered about 40 top practitioners and was supported by Ortho Clinical Diagnostics and Avigilon. PwC served as the event’s thought leader.

HEALTHCARE ASIA 23

Case Study: gabmmc dialysis centre

GABMMC Dialysis Center Phase 1

GABMMC’s free dialysis centre model

See how the Philippines’ Gat Andres Bonifacio Memorial Medical Center is tackling the problem of unaffordable dialysis treatments head on despite underfunding and overcapacity.

W

hen the former Philippine president Joseph Ejercito Estrada ran his then-presidential home of Malacanang several years ago, there was a 10-unit dialysis centre in the building providing free treatments that many of those present desperately needed but could not afford without financial assistance.

The fact that poor patients were trooping all the way to the presidential palace to avail of free dialysis treatments seemed to have stirred Estrada’s heart, and this led to an initiative prompting the city of Manila to establish additional free dialysis centres and expand access to the life-saving treatments.

“The cost for each treatment was P2,000 to P2,500 ($45 to $55), which was hard to shoulder for poor patients, which end up dying without treatment,” says Dr Luisa Aquino, chairman of Gat Andres Bonifacio Memorial Medical Center (GABMMC), a hospital that has emerged as one of the pillars of free dialysis treatment not only in the city of Manila but in the entire country.

Aquino remembers how at the time when Estrada first learned of the huge servicing gap in dialysis treament, the government-owned health insurance corporation PhilHealth was only sponsoring 52 treatments a year, or less than a third of the 168 treatments a patient would need per year.

But after interventions and increased funding priority, that number has spiked to 90 sponsored treatments per 24 HEALTHCARE ASIA

“The cost for each treatment was P2,000 to P2,500 ($45 to $55), which was hard to shoulder for poor patients, which end up dying without treatment.”

year. The city of Manila was also one of the first cities to take action and fill the huge gap in treatments, but it was through circumstance that GABMMC began its ambitious dialysis centre.

Dialysis centre is born “Originally, the government was planning to house the dialysis centre in the Hospital ng Maynila but the building was still in construction, so it was offered to GABMMC,” recalls Aquino of how the project statred.

“Because of the space, we computed that we could afford the space to accommodate 60 machines. A 60-unit facility would be the biggest in the country, larger than the 40-unit facility in the National Kidney and Transplant Institute in Davao.”

Being a public hospital, there was a question on how GABMMC would fund this groundbreaking dialysis centre and keep it operational, especially with a goal of providing free dialysis treatments to Filipinos in need.

One of the first steps for the hospital was to secure the support of the city council. A feasibility study was also drafted and passed, which helped ensure that the project would be sustainable based on the available city budget.

It also needed to find a partner that would be able to pour in the multi-million-peso investments for the dialysis machines, which the hospital found in the form of a joint venture agreement with B. Braun, the largest

Case StudY: gabmmc dialysis centre dialysis servicing company in the country, plus assistance from the likes of the Philippine Amusement and Gaming Corporation.

“Legally, the advise is, the city council had to establish a resolution to permit a joint venture. Before that, the city council established a joint venture resolution authorising the city government, which is the legal basis for the dialysis centre,” says Aquino.

Aquino recalls how when the dialysis centre project was first floated, there was a feeling of momentum rolling in as more partners came on board and pitched in different ways, especially financially.

“It all came flowing with the additional sources of funds.

It’s a big thing,” says Aquino.

It certainly helped GABMMC that it had a strong reputation for public service and more than a decade of experience in running a dialysis unit, which made it easy for partners to rally behind its dialysis centre and free treatment initiative.

GABMMC Eye Centre

with the dialysis treatment lines in Malacanang and subsequent initiative to build a large a dialysis centre in GABMMC that put the hospital in the national health map.

The GABMMC dialysis centre – also known as the Manila Dialysis Center (MDC) – has gained steam because of its making as a priority project under the City Health Care Program, which is a subsidy for the indigent patients under the Orange Card Health Care System. This meant local government support and financing assistance would flow easier to the constructing the dialysis centre and sustaining its operations.

And so it was with these partnerships and extensive planning that the GABMMC dialysis center was established in December 2014 through a joint venture agreement forming a public-private partnership with B. Braun.

MDC was envisioned to become the largest dialysis center in the country with 100 machines that provide quality hemodialysis treatment at no cost to all Manila residents, and Aquino says the pieces all came together even though the project at once seemed impossible to pull off because of the high costs and manpower required.

Additional services GABMMC was established through the vision of the beloved mayor Alfredo S. Lim, which served the city as its two-time mayor from 1992 to 1998, and again from 2007 to 2013. The former mayor wanted GABMMC to be a hospital that would provide for the least fortunate residents of Manila, and with the enactment of City Ordinance No. 7947, a 6-storey building was erected at 8001 Delpan Street to serve as the hospital’s initial facility.

GABMMC became fully operational in 1999 was the fourth hospital built in the city. Its location in Tondo, Manila in District 1 made it especially accessible to a large concentration of the city’s most depressed and populated areas. The hospital would help provide affordable medical services to these residents – it began with an out patient department then quickly added emergency room and wards – spanning a vast catchment area of 137 barangays inclusive of Parola, Smokey Mountain, Recto, Divisioria, Balut, Velasquez and Vitas.

Adding more services since opening in 1999, GABMMC debuted its dialysis unit in 2004 with four machines, then adding a few more machines in the years following. While the hospital has constantly improved its number of beds as well as expanded its services to even include pediatric intensive care units and an operating room complex, it is arguably Estrada’s fateful encounter

The dialysis centre is completely staffed xxx

“The machines work in conjunction to offer free treatments 3 times a week for patients.”

Three-phase implementation While the dream target of 100 machines is far from a reality, GABMMC has a plan to at least come close to that number. Phase 1, which is ongoing, has put 26 machines operational in MDC since December 2014.

The machines work in conjunction to offer free treatments 3 times a week for patients, which is a service that is superior to charity treatments in other hospitals, which only offer treatments 2 times a week.

“Because our funding is sustained, we are able to sustain the number of treatments weekly, in addition to the free medicine and supplies,” says Aquino.

MDC serves 26 patients daily multiplied to three shifts, equating to 78 sessions. The centre is also kept open six days a week from Monday to Saturday to ensure that the treatments are conveniently available to the patients.

Patients that want to avail of the dialysis treatmemts are HEALTHCARE ASIA 25

Case Study: GABMMC dialysis centre required the bare minimum of what is required to deliver the service: An identification card, a prescription from the doctor, a laboratory test and clinical abstract.

While other free dialysis treatment centers might get clogged up with clients, MDC has devised a system to lower waiting times for patients. Emergency cases are handled immediately, and there is “almost always little to none” waiting time for patients.

“In rare cases when there would be no vacancy, we transfer the patient to other centres for B. Braun. The patient would then wait for a vacancy in the main centre, which would take no more than a week. But usually, treatment starts immediately once the patient goes to the station,” says Aquino.

Part of what makes MDC quick in servicing clients is that there are two nephrologists who are in charge of the dialysis centres.

The strong backing and financial support for MDC has also enabled the hospital to offer intra-dialytic nutrition for the first time in the Philippines, assisting patients with kidney disease to battle malnutrition. It is being piloted with 10 patients.

Aquino says the extra effort to bring in cuttingedge treatment options to dialysis patients stems from GABMMC’s quality statement of “maintaining high standards of specialty health care by keeping abreast of the latest knowledge and skills in the treatment of illness and medical practices.”

Aquino says that as a public hospital and local government unit, there is the usual challenge of meeting patient demands, but she assures that the centre “has been largely problem-free.” She adds that while there has been an initial adjustment period, most of the kinks have been ironed out which has led to the current smooh and efficient treatment process.

No out of pocket expenses In order to widen access to dialysis treatments to less affluent Filipino patients who badly needed them to survive, GABMMC was determined that the center would spare poor patients of all out of pocket expenses.

The eye centre eventually had to charge its patients

26 HEALTHCARE ASIA

The eye centre has specialists, but lack equipment

“Three partners would foot the dialysis treatment bills: Philhealth shoulders 48%, the city of Manila shoulders 45%.”

This required GABMMC to find partners and create terms of agreement that would distribute the treatment costs in a sustainable way.

Three partners would foot the dialysis treatment bills: Philhealth shoulders 48%, the city of Manila shoulders 45%; and the Philippine Charity Sweepstakes Office, a sweepstakes agency that raises funds in part to promote public health, would shoulder 7%.

GABMMC would pay for the facility and also staff the program with doctors, B. Braun would staff nurses and invest in the machines for the dialysis centre, an outlay that initially amounted to around P36 million.

“This project is a step towards the country achieving universal healthcare. It’s definitely one of our goals,” says Aquino on why the hospital has been striving to provide free dialysis treatments in the past few years.

“To contribute as a local government unit, we participated not only by enrolling our poor patients to PhilHealth, but also by improving our facilities. Our role is to provide equipment, furnish facilities, and provide all the medicines to get rid of out-of-pocket spending,” she adds.

In fact, the GABMMC has stated in its vision statement that it will “provide affordable quality specialized health care comparable to that given in private hospitals, most specially to the less privileged residents of Manila.”

Furthermore, in conjunction of affordability, it stresses that it must deliver a high standard of health care to all patients through medical services from competent specialists that are not only very professional, but also compassionate.

Aquino reckons there is a need to amend the existing joint venture agreement so that any profit from the dialysis centre can be put into a trust fund, proceeds from which can be given back to the centre instead of just asking from the city.

But so far, the free dialysis treatments have been a boon in saving and improving the lives of patients.

Nearing overcapacity “The patients have been very thankful to both the city and hospital for the free treatments. It helps ease the burden for our poor patients who earn hardly enough.

Our poor patients now get a lifetime of free and adequate

Case Study: gabmmc dialysis centre treatments,” says Aquino.

“However, we are nearing overcapacity. Nowadays, the centre is almost always full and going overboard with the capacity, so we’re rushing the phase 2 right now. We’re confident that phase 2 will be opened sooner.”

Phase 2 would add 34 machines to the dialysis centre, and is currently undergoing the process for licensure with a target completion date in December 2016.

“We just waited for the Phase 1 machines to be used entirely, before we begin work on Phase 2. The location, actually, for phase 2 is ready. We just have to wait for the machines, which will be provided by B. Braun. We want the facility to be ready not just in terms of quantity, but also in terms of quality,” says Aquino.

There are even blueprints already for a phase 3. There is still space for the addition of 30 more dialysis machines, which will then push the total in the centre to around 90, almost close to the envisioned plan of 100 machines.

“The original plan was actually 100 machines, but logistically it is still not possible,” says Aquino, acknowledging some of the constraints of the hospital’s available floor area. “We might extend the area to increase the machines.”

Through its partnerships, sustainable financing plan, and high quality service delivery, the GABMMC dialysis centre has become one of the gold standards for dialysis treatment in the country, which has led questions on whether the model will be replicated in other parts of the city and the greater Metro Manila area.

Aquino says the hospital has no plans for expansion now, but she reckons it would be ideal to put up a similar dialysis centre in the 300-bed Ospital ng Maynila, which is a non-profit tertiary facility where many poor patients consult and will benefit from free treatments. She reckons that if a plan to put up a dialysis centre pushes through in Ospital ng Maynila, two of the biggest hurdles in implementation would be to find the space to fit the machines and allotting the manpower to run the facility.

Inadequate funding Along with overcapacity in its dialysis centre, GABMMC as a whole still faces funding hurdles especially for its other services, although Aquino and its administrators are hard at work to alleviate these concerns.

The Manila city budget in 2015 was P12.29 billion and around 20% or P2.44 billion was alloted for health. GABMMC received 15% of the total budget allocation for district hospitals, which until recently has been insufficient in funding hospital initiatives, from equipment upgrades to infrastructure improvements.

“There is very minimal funds for improvements for the hospital and for the equipment. So it was difficult for us to get by after years of wear-and-tear in the hospital.

It’s also been hard to request for repair, maintenance and repainting for the hospital,” says Aquino.

“These recent years, however, the government prioritised the hospital more, leading to complete renovations for the hospital. Before, the hospital looked like a traditional, beaten down government hospital. Now, we renovated almost every patient room, including the

The dialysis centre runs from Mondays to Saturdays

patient wards. We’re also buying equipment little by little, including specialised equipments,” she adds.

Aquino reveals that what makes the MDC special is its financial sustainability, a critical feature that is hard to replicate in other projects. She gave as an example an eye center the hospital had established. Using the modernisation fund, the hospital procured equipment for eye treatments and cataract surgery, which can be quite expensive and are also desperately needed by Manila residents.

“The eye center was originally was not funded by the government and no capitalisation at all. The only thing we had for the centre was the doctors. Due to the strains of the eye center, the facility was forced to charge patients for treatment eventually,” laments Aquino, contrasting to the free service that it offers to dialysis patients via the MDC. “What was happening was, doctors were not able to provide the adequate services as there was not enough funding. That went on for 10 years, from 1998 to 2008.

From 2008 until now, the equipment is both minimal and low quality. This was typical of a government-run centre,” she adds.

“The Manila city budget in 2015 was P12.29 billion and around 20% or P2.44 billion was alloted for health.”

Different models Aquino reckons that the free model of the dialysis centre cannot be applied to the eye center due mainly to a lack of partnership like the one forged with B. Braun for MDC. Still, the eye center is not without funding support.

PhilHealth continues to be one of the biggest sources for assistance for the eye center, and the funds that flow from the program are spent on equipment, room renovations and supplies. “It’s a huge help, considering that the bulk of our budget is mainly for personnel services,” says Aquino, but she adds that more can be done to provide eye treatments for Manila residents.

“Our current problem is that PhilHealth is restricting the number of cataract surgeries per doctor, due to a problem in monitoring the reimbursement. There was a time when they overpaid for the cataract surgeries, and they had to curb their expenses. Each doctor can now do only 50 cataract surgeries per month, be it private or charity. We’re hoping to appeal, but we’re working with the restriction now,” says Aquino.

HEALTHCARE ASIA 27

post-event coverage: medtronic & NNI the most advanced technology, supported by education, to deliver better therapy access and improved patient outcomes,” she says.

Professor Ng Wai Hoe, medical director of the NNI also concurs that deep brain stimulation is a proven technique in alleviating disabling symptoms of the harrowing disease, and that the partnership of NNI with a world leader in medical technology will push the centre of excellence into the forefront of brain modulation.

Seow Wan Tew, deputy medical director, NNI; Ng Wai Hoe, Medical Director, NNI; Zenobia Walji, VP SEA, Medtronic, and Jacob Paul, VP, restorative therapies group, Asia Pacific, Medtronic

NNI and Medtronic establish centre of excellence

The partnership will push the boundaries of Parkinson’s disease treatment.

W

hen Medtronic conceived its plan to enhance its treatments with innovative deep brain simulation (DBS) devices, it was aiming to address the rising number of Parkinson’s disease patients across the globe. Because of this, and just in time for World Parkinson’s day, Medtronic International signed a memorandum of understanding with the National Neuroscience Institute (NNI) to push the boundaries of Parkinson’s disease treatment.

By combining the NNI’s enchanced specialist care with Medtronic’s technological prowess, the partnership aims to introduce the feasibility of highly programmable and MRI-safe DBS devices to patients who may not be receptive to prescribed drugs to suppress the symptoms. “It is an opportune time for this partnership to be recognised on World Parkinson’s Day, to create a greater awareness of this devastating neurodegenerative disease and highlight the commitment and efforts of NNI to advance in treatments,” a press release from the 28 HEALTHCARE ASIA

The Centre will enhance patient care, safety and quality outcomes.

It will also play an important educational role to help to establish similar centres in the region.

NNI notes.

From the partnership, both Medtronic and NNI aim to establish a centre of excellence for DBS focused on achieving the best outcomes for patients, enhance patient access to DBS therapy through continuous patient education programmes, develop fellowship training for clinicians from South East Asia and worldwide who wish to learn about DBS therapy, play a leading role in the adoption of new technologies that enhance patient care, and identify areas to cooperate in clinical research activities pertaining to the field of Brain Modulation.

Technology and education According to Zenobia Walji, vice president of Southeast Asia at Medtronic International, the partnership illustrates that Medtronic is a company which cares deeply about alleviating pain, restoring health, as well as extending life. “This partnership with NNI allows us to bring this mission to life, by bringing

Enhancing outcomes “The Centre will enhance patient care, safety and quality outcomes.

It will also play an important educational role to help to establish similar centres in the region and enhance accessibility of high quality DBS therapy in the region,” Ng Wai Hoe adds.

Nicolas Kon, co-director of the NNI centre of excellence for DBS, and also a consultant of the department of neurosurgery at NNI says the centre carefully selects patients and counsels them as part of a multidisciplinary team before they go under the procedure. “After the device, which is like a pacemaker, is carefully implanted and turned on, our patients experience an immediate improvement in their movement.

This leads to a significant benefit in their overall function and quality of life,” Kon says.

Meanwhile not unlike any other therapy, DBS carries a small risk. “NNI has a dedicated team (comprising neurologists, neurosurgeons, Advanced Nurse Practitioners (APNs), psychologists and therapists), which carefully screens patients prior to the procedure and supports at all stages of the treatment. This helps minimise risks and improve outcomes. We have also put in place processes to ensure that all our patients are cared for in a holistic manner tailored to their individual needs,” Kon says.

The National Neuroscience Institute (NNI) is the national and regional centre of excellence for treatment, offers over 20 clinical subspecialties and treat a broad range of conditions affecting the brain, spine, nerves and muscles.

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HEALTHCARE ASIA 29

event coverage: healthcare asia forum 2016

Healthcare Asia Forum 2016 in Singapore

Information technology grabs spotlight at inaugural Healthcare Asia Forum The four-city circuit covered Manila, Kuala Lumpur, Jakarta, and Singapore.

T

he problem with healthcare data in the Philippines, as well as in the other parts of the Southeast Asian region, is that information is often scattered all over the place in different formats, making it difficult for a myriad of organisations and companies to interpret and utilise them properly.

Data optimisation was only one of the pressing industry topics discussed in the Manila leg of the first-ever Healthcare Asia Forum 2016.

“There is a need for data harmonisation in the Philippines, which is currently addressed by the Philippine Health Data Information Exchange. [The problem is that] different formats of data do not match, and the recorded data is very difficult to assess online,” said Maria Minerva P. Calimag, MD, president of the Philippine Medical Association.

Healthcare IT in the Philippines was also a main anchor in a talk by Allen Bacallan, Vice President and 30 HEALTHCARE ASIA

There is a need for data harmonisation in the Philippines, which is currently addressed by the Philippine Health Data Information Exchange.

Chief Information Officer at Cardinal Santos Medical Center (CSMC), where he discussed home healthcare in Asia. Allen Bacallan used his own home healthcare experience in the CSMC as a launch pad in the discussion.

Meanwhile, another hot topic discussed in the forum was the investment side of healthcare, with financing being a weighty topic in the industry. According to Larry Tenorio, FVP Financial Director and Head of the Finance Directorate at Manila Doctors Hospital, a lot of incentives are being done to sweeten deals for healthcare investors, such as fresh capital, income tax holidays, and tax incentives on the importation of medical equipment as well as infrastructures. He was also joined in a panel discussion by Elizabeth Dantes, Vice President and Chief Financial Officer of the Management Committee at Cardinal Santos Medical Center.

Dantes added that if the Philippines wants to compete with other ASEAN countries in terms of healthcare, then it must first improve its infrastructure.

To complement the financing in Asian Healthcare, the final panel discussion centered on the topic of the cost conundrum in Asian Healthcare, which featured a diversified panel consisting of Ma. Luisa Aquino, MD, Director of Gat Andres Bonifacio Memorial Medical Center, Arturo de la Peña, MD, SVP and Head for Medical Practice at St. Luke’s Medical Center Global City, Leo Cubillan, MD. Chairman, Department of Pay Patients Hospital at Philippine General Hospital, and Teri-Louise Hitosis, Country Marketing Manager at Ortho Clinical Diagnostics.

Modernising skills and facilities While Malaysia is a top-tier destination for medical tourism in the Southeast Asian region, it has recently

event coverage: healthcare asia forum 2016 55% of patients trust the internet more than the doctor. This is resulting in the emergence of new business models.

Healthcare Asia Forum 2016 in Kuala Lumpur

been losing out to its neighbors, who often offer more innovative devices and treatments, as well as bettertrained staff. Bridging the gap in modernisation was only one of the pressing healthcare issues discussed in the Kuala Lumpur leg.

“As far as skills are concerned, Malaysia still hasn’t caught up. But still, we have to do more with the little that we have,” said Michael Wong, Chief Executive Officer of IMU Healthcare. “Malaysia is quite lacking especially in terms of IT skills.

Hospitals in the country are not used to the big budgets required to bring the skills and facilities to the next level,” he said.

Wong was joined in a panel discussion by Mahenthiran Thanapal, Director of Business Operations at Prince Court Medical Center and Mohd Azhari Yakub, Chief Executive Officer of Institut Jantung Negara.

“Modernising hospitals does not necessarily mean equipping hospitals with fantastic facades,” Prince Court’s Thanapal said. “Hospitals in the near future would move away from investing in totally integrated IT infrastructures towards more of using mobile applications and the cloud.”

Thanapal added that this shift would be revolutionary for hospitals in terms of costs and easing the operational burden of healthcare institutions by passing it to the customers. Using mobile applications and leveraging healthcare services using cloud technology was also a focal point for a talk by Christopher Norton, director in the Southeast Asia Consulting practice of PwC as he

spoke about healthcare trends and the future of the industry.

“55% [of patients] trust the internet more than the doctor. This is resulting in the emerging of new business models. People who were not involved previously in the healthcare market are trying to disrupt the landscape,” Norton said.

Norton was also a member of a panel discussion discussing healthcare IT and how the survival of Asia’s hospitals hinge upon it.

Joining him on the panel were Dato Amiruddin Abdul Satar, President and Managing Director of KPJ Healthcare Berhad, and Ahmad Shahizam Mohd Shariff, Chief Executive Officer of Pantai Holdings Berhad.

“The culture of healthcare is expecting doctors and nurses to spend more time looking at a monitor,” said KPJ Healthcare Berhad’s Amiruddin. “With this change in culture, what we can see is the reduction of medical errors.

Most of the errors that KPJ is facing now are based mainly on the manual systems.” To close the forum, Suresh Ponnudurai, CEO of World of Wellness and malaysiahealthcare discussed Aged Care in Malaysia. As a nation faced with a looming silver tsunami, Ponnudurai said that the time is ripe to invest in improving aged care in the country.

Search for the missing middle Indonesians working in the informal economy are giving local regulators a headache as the deadline for the country’s ambitious universal healthcare coverage (UHC) plan

draws closer.

The so-called “missing middle” covers a wide range of individuals, from the homeless on the streets to sophisticated freelancers and self-employed workers, said Diah Satyani Saminarsih, M.Sc, Special Advisor for The Minister of Health for Partnership and SDG. Diah shared that the UHC program now covers around 150 million out of Indonesia’s population of 250 million.

Out of this number, 100 million are covered by the government, while 50 million are paid independently.

“If you dig into the data, right now 80% of the population has been hospitalized at one point or another, mainly due to catastrophic illnesses.

This puts a huge economic burden on the UHC. Indonesia needs many more healthy patients to cover for the expenses of unhealthy people,” Diah added.

Although the current number of sick Indonesians is already staggering, data from International SOS show that there isn’t much cause to be optimistic in coming years. Noncommunicable diseases (NCDs) are estimated to account for 71% of all deaths in Indonesia from 2012 to 2030 and will cost the country US$4.47 trillion or US$17,783 per capita, said Richard Jones, M.D., Technical Adviser, International SOS. “Indonesia will experience a tsunami of NCD-associated medical expenditures in the next decade. We have a lot of data on healthcare, and what we could be doing with data is the future of healthcare. If we are able to identify people who might be at risk early on, we can look at a population-based approach rather than a reactionary approach,” Jones said. In order to address the expected spike in healthcare spending, Diah stressed that it is imperative that private hospitals get onboard with the UHC system at the soonest possible time.

“Care is not enough if it is only given by public hospitals. Private hospitals and clinics need to be part of the whole system. As long as everyone is still bickering about whether to be in or out of the system, I don’t think the universal health coverage will be much more effective than it is already now,” she said.

HEALTHCARE ASIA 31

OPINION

David McKeering

The digital healthcare leap

David McKeering Singapore Healthcare Leader, PwC South East Asia Consulting

W

hether we like it or not, technology has become part of our lives. It has arguably helped us as individuals become more informed and more connected. The use of technology is embedded in industries such as banking, automotive, insurance and retail. Today the healthcare sector faces a daunting new digital challenge: how to unleash the power of technology to fundamentally reinvent how care is delivered. On top of their existing technology needs and priorities, today’s healthcare providers need to address the digital requirements as demanded by healthcare policy or by consumers and other stakeholders in order to both meet the changing needs of consumers and stay ahead of the curve.

The success of Digital Health initiatives rely heavily on having the right information in the right place at the right time for use by the right clinician. To really use technology effectively in healthcare, we need systems to interact with one another to leverage the right data to make informed decisions about the delivery of care. “Digital” is not about the technologies, it’s about coming up with new ways of solving problems, creating unique experiences and accelerating business growth. Digital as an enabler is focused on disruption, engagement, digitisation, and trust.

To us at PwC, this means: Disruption - transforming businesses through innovative models that don’t exist in the market today; Engagement – Enabling digital interactions between clients and customers in a more engaging, seamless way; Digitisation – Digitising the processes to improve employee productivity, supplier interaction, and customer satisfaction; and Trust – Ensuring secure information in a digital age to inspire trust in the providers by the customers.

Yet these challenging financial times discourage all but the most prudent, high-return investments. Advanced, enterprise-wide digital healthcare solutions should head many healthcare providers’ list of “must have” capabilities. Our experience is that Digital healthcare can dramatically improve an organisation’s productivity and in turn provide benefits in both patient outcomes and the bottom line. Over the longer term, digital healthcare will help system wide operations and organisations to deliver more powerful healthcare.

Integration and connectivity Healthcare companies should look to how they will integrate and connect their existing systems with new digital technologies and merge the data locked or siloed inside them to generate meaningful, actionable insights for caregivers. In the new digital health era, digitally enabled care is no longer going to be a nice to-have, but rather a fundamental business imperative. Industry leaders across providers, insurers, medical technology and the pharmaceuticals all see major shifts in how care is being delivered. Digital technology has the potential to bridge time, distance and the expectation gap between consumers and clinicians.

32 HEALTHCARE ASIA

Consumers are no longer passive patients

After decades of slow progress, it’s time for healthcare to take the leap into the new digitally enabled healthcare era. Healthcare providers and administrators need to set strategies that harness technology for mutual interests and mutual gain as they build care delivery models with patients—not patient encounters—at their center. The companies that will emerge as winners in this new marketplace will be those that can articulate how technology can add value, align incentives, strategically share and analyse data, and redeploy, extend and expand their workforce to embrace digital enablers.

Choosing the right digital health strategy Understanding which digital health technologies healthcare providers and consumer’s value should shape digital strategies; Generating meaningful, actionable insights through analytics will focus investments and yield better, faster results; Understanding what motivates both caregivers and consumers to adopt and continue to use digital technology will be critical for sustainability; and rethinking the workforce and informing workflows will fuel the digital health return on investment.

Innovative companies are empowering healthcare customers with new solutions and forcing the entire industry to rethink the way it does business. With the patient/customer becoming more discerning, customer experience has become a key motivator for providers. Consumers are no longer passive patients, but rather engaged and more discerning. The near future will be marked by how well the industry responds to this consumer shift. Hospitals and healthcare providers that fail to adapt will risk declining revenues as consumers turn elsewhere to have their healthcare needs met.

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Activated T Cell Inactivated T Cell

PD-L1

PD-1 Receptor PD-L2

PD-1 Receptor PD-L1

Discover PD-1:

An immune checkpoint pathway1

OBC:

Artist’s interpretation based on scanning electron microscopy.

Some tumor cells can evade the body’s immune response, which may result in disease progression2,3 • One function of the body’s immune response is to detect and destroy tumor cells through activated T cells and other mechanisms; tumor cells express multiple antigens that are not expressed in normal tissue.1–3 • However, some tumor cells may evade the body’s immune response by exploiting the PD-1 checkpoint pathway through expression of the dual PD-1 ligands PD-L1 and PD-L2.1,2,4–7 • PD-L1 and PD-L2 engage the PD-1 receptor on T cells in order to inactivate T cells, which may allow tumor cells to evade the immune response.1,2,8

MSD is committed to furthering the understanding of immunology in cancer, including the role of the PD-1 pathway.

PD-1=programmed cell death protein 1; PD-L1=programmed cell death ligand 1; PD-L2=programmed cell death ligand 2.

References: 1. Pardoll DM. The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer. 2012;12(4):252–264. 2. Keir ME, Butte MJ, Freeman GJ, et al. PD-1 and its ligands in tolerance and immunity. Annu Rev Immunol. 2008;26:677–704. 3. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646–674. 4. Quezada SA, Peggs KS. Exploiting CTLA-4, PD-1 and PD-L1 to reactivate the host immune response against cancer. Br J Cancer. 2013;108(8):1560–1565. 5. Zou W, Chen L. Inhibitory B7-family molecules in the tumour microenvironment. Nat Rev Immunol. 2008;8(6):467–477. 6. Rosenwald A, Wright G, Leroy K, et al.

Molecular diagnosis of primary mediastinal B cell lymphoma identifies a clinically favorable subgroup of diffuse large B cell lymphoma related to Hodgkin lymphoma. J Exp Med. 2003;198(6):851–862. 7. Nomi T, Sho M, Akahori T, et al. Clinical significance and therapeutic potential of the programmed death-1 ligand/ programmed death-1 pathway in human pancreatic cancer. Clin Cancer Res. 2007;13(7):2151–2157. 8. Latchman Y, Wood CR, Chernova T, et al. PD-L2 is a second ligand for PD-1 and inhibits T cell activation. Nat Immunol. 2001;2(3):261–268.

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