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home CARE knocks on asians’ doors Governments are riding on telemedicine and home care to provide services especially for rural Asians
Display to 28 February 2016
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Dr Ashok Philip Malaysian Medical Association
The Philippines’
hazy healthcare Asian hospitals must be
tech-aggressive
Case Study:
NCCS’ RAPIDE Plus:
Interviewwith Farrer Park Hospital’s CEO
first Singapore boosts efforts to spur R&D
opinion Southeast Asia health’s new entrants
FIRST Southeast Asia plagued with ‘affluence diseases’
himss 2015 coverage Healthcare IT takes the limelight in Asia
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PAge 32
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FROM THE EDITOR As the year comes to a close, Healthcare Asia is both wrapping up 2015 and welcoming 2016 with a feature on Farrer Park Hospital’s new CEO and his firm goals of hitting the young hospital’s breakeven status in 5 years and making it the go-to place not only for patients but also for medical professionals.
Publisher & EDITOR-IN-CHIEF Tim Charlton PRODUCTION Editor Roxanne Primo Uy art director Bryan Barrameda Editorial Assistant Ephraim Bie
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The Healthcare Asia team also flew to Singapore to be at the HIMSS AsiaPac 2015 and be right at the center of issues plaguing and gracing the healthcare industry in the region. You will see our features leaning on healthcare IT and futuristic approach on providing healthcare to Asians as these are the biting points discussed by vendors, players, and professionals at HIMSS. We also profiled The Malaysian Medical Association and its presence amidst the rapidly increasing number of doctors in the country. The president himself discussed how they feel the pressure to transform Malaysia’s healthcare industry and push it towards the path of transparency for the benefit of both stakeholders and industry players. Lastly, check out how healthcare will come knocking at your door in the future as home healthcare evolves towards making privacy a prime importance. How will investors in emerging countries like the Philippines ride this tide? Start finding out for yourself and get the pages flipping. Enjoy!
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HEALTHCARE ASIA 1
CONTENTS
coverage: himss 22 post-event Healthcare IT takes the limelight in Asia
Dr Timothy Low CEO Farrer Park Hospital
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profile Malaysian Medical Association tackles 16 feature lack of healthcare transparency
FIRST 04 Singapore boosts
efforts to spur R&D
05 Will policies thwart innovation? 06 SEA plagued with ‘affluence diseases’
HEALTHCARE INSIGHT 10 Telehealth and home care knock on Asians’ doors
OPINION 30 The future of healthcare 32 Southeast Asia health’s
COUNTRY REPORT
new entrants
24 Spotting opportunities in the
08 Asian hospitals predicted to be
cEO INTERVIEW FPH’s new CEO sharpens the hospital’s competitive edge
Philippines’ hazy healthcare
tech-aggressive to survive
14 HEALTHCARE ASIA
Healthcare_Nov-Feb2016.indd 14
Published Tri-annually on the Second week of the Month by Charlton Media Group 101 Cecil St. #17-09 Tong Eng Building Singapore 069533
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To access the stories online, visit the website
www.healthcareasiamagazine.com
11/17/2015 4:07
co-published Corporate profile
Krixi Care: Building bridges across gaps in healthcare through telemedicine
Krixi Care’s revolutionary telemedicine platform aids medical professionals perform procedures from afar.
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he lack of qualified medical professionals in specialized fields is a problem that is persistent in both developed and emerging markets. Even in more developed healthcare system to amply cover ailments, which require the expertise of specialized professionals. For example, many hospitals do not have doctors who are aptly qualified to diagnose and treat stroke victims that are available around-the-clock especially in smaller and peripheral hospitals. This lack of neurologists means that emergency departments in these facilities are unable to immediately treat acute stroke victims on-site, for whom immediate care is of the utmost importance. Krixi Care is a remote telemedicine platform which allows medical professionals to diagnose and assess patients without being physically present at a facility, according to CEO Sandeep Agate. This also allows patients better access to highly specialized services regardless of location. Not just a standard platform Telemedicine is a key innovation in healthcare which has helped to overcome challenges such as the lack of on-site specialists at numerous facilities. Dr Rajinder Singh, Senior Consultant, Department of Neurology, National Neuroscience Institute, explained in a recent interview that using Krixi Care’s telemedicine platform has allowed patients in facilities that do not have on-site neurologists to access the proper FDA-approved treatments for acute stroke. Singh notes that
this platform has facilitated rapid diagnosis of stroke patients and assessment & approval of their eligibility to receive specialized treatments. Krixi is not just a standard telemedicine platform, but also includes comprehensive and scalable features that allow medical professionals to produce real time consult reports, collect data and produce on-demand support documents. The Krixi Care product suite includes add-on consultation tools, such as DICOM image review and multi-party audio/video conferencing and data analytics. Decision support tools are on hand to facilitate complete diagnosis remotely. This allows medical professionals to seamlessly integrate the usage of Krixi Care into their normal workflows with minimal disruption. The platform is 100% browser based and requires no installation of new software or hardware. Facilities can easily roll out this cloud-hosted platform, which is also mobileready, allowing physicians to utilize it no matter where they are. Hub-and-spoke model This platform works on a hub-and-spoke model, with a “hub hospital” or larger healthcare institution serving as the base from which a consulting physician will operate. A consulting physician, who is most often directly affiliated with the hub hospital provides coverage for remote consultation
Sandeep Agate, CEO, Krixi Care
to peripheral “spoke hospitals” which do not have the necessary specialists in their emergency rooms. For hub hospitals, there is absolutely no hardware or software required for integration into their IT system, as the platform is completely browser based. A hub hospital looking to roll out the system simply needs to train its doctors to use the very user-friendly interface. Spoke hospitals only need a DICOM 3.0 compatible CT scanner and a mobile, wireless cart configured with a laptop and high-resolution remotely controlled network camera in order to work on the platform. Krixi provides 24/7 technical support for institutions using the platform, which allows for smooth operations round-the-clock. Singh says that the system was very easy to use with most doctors being able to use it within 30 minutes after the training, which means that transition into the system is very smooth. Dr. Singh notes that there has been a significant increase in the number of patients being treated with IV rTPA, the FDA-approved treatment for stroke, since the implementation of this new telemedicine service. Singh notes that there are huge opportunities for telemedicine even outside stroke care given the demographics of the current population. Krixi helps to overcome issues given its ability to extend the coverage ability of facilities and medical professionals.
“Telemedicine is a key innovation in healthcare which has helped to overcome challenges.” HEALTHCARE ASIA 3
FIRST possessing 15-30 years of research experience; as such, most biotechnology firms rely on foreign talent from the US (United States) and/or Europe for their executive positions to allow these companies to grow,” Roeder says.
WIN-WIN-WIN IS THE NEW TREND
Like an intricate machine, the healthcare industry functions with numerous cogs, with each rotating to make the whole thing work. However, this complexity makes it often easy to forget that healthcare is essentially leaning on skilled staff and medical professionals who collectively drive the whole patient experience from start to end. According to a recent Deloitte report entitled ‘Healthcare 3.0 – Healthcare for the new normal’, career mobility and equality for healthcare staff are emerging as two of the most pressing concerns in the healthcare industry, as professionals demand more mobility and markets become more integrated. “The healthcare ecosystem will be facing stiffer competition for healthcare professionals. As it is, countries like Singapore and Malaysia are transit countries for foreign nurses seeking further migration to end destination countries and this has created staffing gaps in the respective health systems,” the report says. A tripartite system The report says a long-term goal is to work towards a tripartite system leveraged on a triple-dividend relationship, or a win-win-win relationship between the healthcare industry, the healthcare worker, and the consumer. “This will go a long way to ensure the health and vitality of the entire healthcare ecosystem, and ensuring a continued evolution of the quality of the overall healthcare experience,” the report adds. “Hence, there is an increasing importance for any healthcare system of the future to have its priorities set on equal and fair access,” the report says.
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Singapore races to lead the region in R&D
Singapore boosts efforts to spur R&D
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hen Singapore bared its bid to be a regional leader in the field of biotechnology research and development (R&D), few imagined the rapid pace of progress in this sector. Today, Singapore faces challenges as significant demand for healthcare puts a strain on resources, particularly on local labour. “Governments face growing pressure to manage costs without impacting quality or access to care. Singapore is faced with a similar challenge,” notes David McKeering, Singapore healthcare leader at PwC South East Asia Consulting. According to Lynn Roeder, managing director of Hays Singapore, Singapore’s problems lay among skilled employees as she points to this year’s Hays Global Skills Index, where Singapore’s score of “6.0” suggests “a significant talent gap due to growing technical skill shortages.” Roeder also observes that “government initiatives that endorse local Singaporean hires for middle income jobs have further exacerbated the shortage of talented locals.” “As Singapore is a relatively young economy, there is a lag with established scientific professional
Lynne Roeder
David Mckeering
Doubling down on education Lately, however, the Singaporean government has been ramping up its education efforts in the hopes of producing an educated workforce. “Singapore has been encouraging R&D growth in biomedical sciences, and technology in various industries. Scholarships, external hiring of talent from top universities and research institutions has been done to spur innovation and R&D. The educational institutions have been beefed up at both the undergraduate and postgraduate levels to increase the number of scientists in the biomedical sciences,” says Chong Yoke Sin, chief executive officer of Integrated Health Information Systems, citing the recent completion of the Lee Kong Chian School of Medicine as an additional venue to train more doctors. Aside from the government’s own efforts, collaborations with the private sector have also been sought to deal with the labour shortage. “New business models are emerging that have governments collaborating with the private sector to address the situation with transparency and favourable outcomes. Public-private partnerships are one option that offer the benefits of long-term cost savings,” McKeering suggests.
Healthcare expenditure % of GDP 2011, 2016
Source: EIU, Frost and Sullivan analysis
FIRST
David Mckeering
Natasha Gulati
The ageing population puts pressure on healthcare spending
Will policies thwart innovation?
H
ealthcare in Southeast Asia is facing a major challenge. With a compound annual growth rate of 1.2%, changes in population demographics and disease profiles, the pressure to deliver has never been more apparent. “The total population in Southeast Asia is estimated to grow from 612 million in 2013 to 657 million in 2019. This is expected to drive the demand for healthcare services and put enormous pressure on healthcare spending in the region,” explains Natasha Gulati of Frost & Sullivan Asia Pacific. Gulati says that with the elderly
being at a higher risk of suffering from chronic diseases and disability, an ageing population is expected to cause a surge in medical costs and healthcare services in the region. She adds that the total value of healthcare expenditure in Southeast Asia could reach US$150 billion by 2016 with both a rise in private spending from the growing middle class as well as public government initiatives to improve access to healthcare services in the region. “With support from respective governments, emerging policies are not at all aimed to be a chokehold to innovation; rather the goal is
to set world-class standards that encourage R&D investment, innovation and development of quality products that meet regional and local needs,” she says. One such innovation is mobile healthcare. “Mobile healthcare solutions are being deployed more rapidly in emerging markets than in developed economies. In the emerging markets, patient awareness and expectations of mHealth are, on average, far higher than in developed countries,” says David McKeering, healthcare leader at PwC South East Asia Gulati says the use of mHealth in the region is less from a diagnosis and day-to-day management, but more from a patient monitoring perspective, so most of the programs are telehealth and remote monitoring based. “Developing countries are expected to grow at rate even faster than that of the developed countries,” she says.
Opportunities in ASEAN healthcare sectors
Source: Frost and Sullivan
The Chartist: High app penetration is a golden opportunity for mobile health With the adoption of mobile healthcare apps skyrocketing even in emerging markets such as Indonesia, the time for mobile health is now. According to Analysys Mason, slightly less than 50% of respondents used a health/fitness app in the Asia-Pacific countries surveyed. Among these apps, fitness and nutrition were the most popular. “Almost 60% of respondents in the region pay for medical insurance, and therefore have a strong financial incentive to monitor their health in order to keep their insurance premiums low,” says Sherrie Huang, head of APAC research at Analysys Mason. However, it’s not that easy for mobile operators to barge into the healthcare industry, as healthcare services require professional knowledge and experience.
mHealth app category share
Source: research2guidance, 808 apps form Apple App Store, Google Play, BlackBerry App World and Windows Phone Store (March 2014)
Percentage of respondents
Source: Analysys Mason
HEALTHCARE ASIA 5
FIRST
SEA plagued with ‘affluence diseases’
Pothole in Asian palliative care
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outheast Asia’s healthcare industry is going full speed towards an era of unprecedented transformation. As it deals with economic and population growth and increasing affluence, analysts ponder the next step for the region as clamor for better private healthcare and widespread public healthcare reform become louder by the day. “Despite health expenditure increasing two and half-times between 1998 and 2010, reaching over $68 billion nonetheless, healthcare quality and provision varies widely across SE Asia,” says Paul Barach, clinical professor at Wayne State University. Barach argues that while rapid population growth remains a pressing concern, it overshadows another important trend—Asia is on track to become oldest region in the world by 2050. “Asia’s elderly population is projected to hit 922.7 million by the middle of this century,” Barach says. Barach adds that Southeast Asians are also being crippled by noncommunicable diseases or “diseases of affluence” brought about by modern lifestyle habits. “Over 191 million people are now living with diabetes in the AsiaPacific according to the International Diabetes Federation (IDF). The relative
Racing towards change
death rate from NCDs has burgeoned in several countries in the region, including Indonesia (up 8%), Malaysia (up 6%), the Philippines, and Cambodia (up 5% each),” Barach says. This spike in healthcare consumption has put public healthcare systems under political, financial and social strain. “As many countries offer universal healthcare where public healthcare facilities offer free or largely subsidised healthcare, increased government spending will happen in the near future,” says Chong Yoke Sin, CEO of Integrated Health Information Systems. “Private healthcare costs will go up in developing countries, but deliver better healthcare outcomes,” Chong adds.
Despite health expenditure increasing, healthcare quality and provision varies widely across SE Asia.
Why simplicity is healthy for struggling healthcare firms It has always been “innovate or perish” in the healthcare industry. Healthcare firms are always scrambling to invest in new products, new targets customers, new technologies and new countries. It’s paradoxical how some healthcare firms who invest much in these aspects fail to see profitable growth for their company. According to a report by Bain & Company, the solution doesn’t lie in complex investments, but in simplification. “The call to simplify may sound obvious, but it runs counter to the growth strategies of most pharmaceuticals and medical technology companies,” says Preston Henske from Bain & Company. “Many have pursued revenue growth through expansion and investment in more countries, additional product variations and new customer segments. As a result, their businesses have become rife with complexity, which has raised costs,” Henske added.
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Singapore may be doing stellarly in its palliative care, ranking 12th in the global “Quality of Death” index by the Economist Intelligence Unit, but a glaring hole remains in its hospice palliative care services: a sustainable model of financing. According to the World Health Organisation, palliative care involves improving the quality of life of patients and their families associated with life-threatening illness. Despite beefing up its healthcare spending, Singapore’s hospice palliative care services still face a serious problem as it is still largely driven by charities. “So while Singapore ranks sixth for affordability of palliative care, charity operators still play a key role in keeping home hospice services free. These providers have to constantly fundraise a significant portion of their operations from donations,” the EIU said. Sustainable financing Meanwhile, the projection of demand for palliative care doubling by 2020 aggravates the need of Singapore to formulate a sustainable financing model. Currently, EIU says palliative services in the city-state are being funded by a mix of government grants, Medisave, and Medifund, but financing structures tend to lean towards acute care. On the other hand, EIU also says Singapore also needs a proactive initiative to equip its doctors with better knowledge, as a Lien Foundation survey found out that only 44% of doctors in Singapore said they were familiar with palliative care.
co-published Corporate profile
InterSystems: Enabling Connected Health
A healthcare informatics platform is an essential piece of a connected health strategy.
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Kerry Stratton Regional Managing Director InterSystems
“We look forward to engaging with more of Asia’s healthcare providers to improve quality of care by sharing information and connecting communities.”
ith advances in technology shaping nearly every aspect of human life, the demand for information, especially in the healthcare sector, has now reached unprecedented levels. Information, however, can only be rendered useful in the medical field if appropriately captured, processed, and accessed. Information, whether from doctors or patients, must make sense to whoever uses it. “Over the past several years in Asia, there has been great progress made in collecting patient information in hospitals,” says Kerry Stratton, Managing Director, Asia Pacific for data management software firm InterSystems. “But that’s not enough now. Patients also have valuable information from their primary care doctors, from clinics they visited, from allied healthcare providers, or even social care. We need to bring that data together to make smarter decisions for the individual patient and to improve the health of populations .” The value of data InterSystems, the company behind the health information systems of most of the United States’ top hospitals, understands the value of medical data. Founded in 1978, it has developed a health informatics platform that provides reliable, highperformance, and scalable technology for three key capabilities: data management; connectivity to applications, data sources, and devices; and creating insights from the data. As a testament to its success, the company reported $489 million in revenues as of yearend 2014. “What sets InterSystems apart is our unified health informatics platform,” Stratton
shares. Upon it, InterSystems has built its TrakCare healthcare information system, which is used by some of Asia’s leading private hospital groups including United Family Healthcare in China, Rumah Sakit Pondok Indah in Indonesia, and Bangkok Dusit Medical Services. Upon this platform, InterSystems has also built its HealthShare family of products that help customers capture, share, understand, and act upon data. “Our solutions are designed to capture information, share it in a meaningful way, aid understanding of this information, and, ultimately, drive transformative action across organizations and communities,” says Stratton. HealthShare enables many innovative solutions. In London, it is being used to capture patients’ “end-of-life” wishes and support home care. “It’s a really good concept that provides information about patients to many healthcare organizations to enable collaboration: ambulance, primary care, community, emergency—all have a single view of that information although the data resides in different locations.” Headquartered in Cambridge, Massachusetts, many of InterSystems’ initial activities centered on the US and Europe. More recently, the company has ramped up its presence in South America, Asia and the Middle East. It now has regional offices servicing healthcare customers in Australia, China, Japan, and Thailand. “We’ve got global experience implementing a shared electronic medical record within hospitals and enabling connected care across the greater community: not just primary healthcare, but also allied healthcare and social
care,” Stratton explains. “For example, we’ve worked with the state of Victoria [Australia], Brazil, Chile and the National Health Service in Scotland to create connected care environments that improve care quality and reduce costs. In Indonesia, we’ve helped Rumah Sakit Pondok Indah create a paperless hospital environment, which recently saw them recognised by the prestigious SWA magazine as a Top 3 e-Corporation in Indonesia.” Patient engagement Asked if there is a role for health IT solutions to directly address consumers in Asia, Stratton replied with an unhesitating, “Yes.” “We have developed a patient engagement solution called HealthShare Personal Community, and I see this coming to Asia. We have introduced this to some of our existing customers, and it’s evolving very quickly.” This kind of system, Stratton explains, benefits patients by empowering them to make informed decisions. “It helps them take more responsibility for their own healthcare, which is important to achieving good outcomes, especially those with chronic disorders.” There are patients afflicted with diabetes now able to monitor their blood sugar levels thanks to solutions developed by InterSystems. “Patients are capturing their own blood sugar information on a daily basis, and the treatment they’re taking. I think this will be very valuable,” Stratton says. Armed with its vast international experience, InterSystems is now investing in growing its business in Asia further. “InterSystems provides worldleading software for connected care,” says Stratton. HEALTHCARE ASIA 7
FIRST
Asian hospitals predicted to be tech-aggressive to survive
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hen information technology began finding its way into Asian healthcare in recent years, analysts began noticing how the paradigm for hospitals and clinics across Asia has begun to shift to keep up with the enormous advances in the digital age, in ways that are seen to benefit both patients and the healthcare industry as a whole. “Technology is the foundation for better care delivery and preventative healthcare across the globe, from a booming metropolis to a rural village,” says Andy David, SAP Healthcare Director for Asia Pacific. “Investment in technology such as the digitization of patient healthcare records and hospital data allows healthcare workers real-time access to data, which in turn allows them to make more informed and better decisions,” David adds. Natasha Gulati, Industry Manager for Transformational Health at Frost & Sullivan Asia Pacific, agrees, noting that Asian hospitals are now in fact becoming more responsive to patient needs. “The role of IT in the Asia-Pacific healthcare industry has evolved over the past few years. While IT previously merely enabled automation, it now affects integration across the entire healthcare delivery value chain in the region. This emphasizes the fact that healthcare is no
longer about treating the sick, it’s about providing better health and wellness for everyone, and that’s the big change in business model that we are seeing across providers,” Gulati notes. Increasing patient benefits Aside from improvements to hospitals’ business models, patients themselves are also directly benefiting from advances in Asian hospitals’ digital capabilities. “There will be greater transparency by hospitals, clinics and healthcare systems with the public. As a result, the patient will become more demanding and the healthcare profession will in itself move up the notches,” says Chong Yoke Sin, chief executive officer (CEO) of Integrated Health Information Systems. According to Gulati, “the industry is fast moving towards empowering consumers to take more ownership of their own health by providing the requisite data and health & wellness tools.” Moving forward, Asian hospitals are expected to aggressively utilize IT to deliver better results—with a greater bias toward overall patient healing and wellness. “Hospitals need to constantly innovate in terms of service delivery without compromising on quality of care and consider the best ways to utilise resources. The challenge for hospitals is to constantly remain
Andy David
competitive and provide what patients really need at fair value,” says Timothy Low, CEO of Farrer Park Hospital Ruder Finn. For instance, Chong predicts “hospitals will be better integrated and equipped with devices integrated to the electronic medical records. Next-generation hospitals will also use more robotics, smart apps and data analytics to fulfil their operational goals.” Low also foresees that “changes in technology will make some treatment processes obsolete.”
Hospital Watch
Ng Teng Fong General Hospital unveiled
The 700-bed Ng Teng Fong General Hospital (NTFGH) and the 400-bed Jurong Community Hospital (JCH) recently opened in the west of Singapore. Managed by Jurong Health Services, the hospitals are Singapore’s first to be designed and built together from ground up as an integrated development to enable treatment and rehabilitation to continue seamlessly between the hospitals for better care, greater efficiency and convenience. Some of the patient-centric designs include the unique fan-shaped wards that provide a window for every patient in the wards, including ICU and HD patients. A first in Singapore, the design improves ventilation, natural lighting as well as infection control to aid in patient recovery. At the Specialist Outpatient Clinics Tower, patients only need to register once at the start of their visit.
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Ng Teng Fong General Hospital and Jurong Community Hospital
Fan-shaped wards
Chong Yoke Sin
co-published Corporate profile
Truven Health Analytics raises healthcare quality with industry-leading resources The company’s solutions are increasing efficiency and saving lives.
effectively address their needs. “A more recent use of our solutions, especially on the analytics and surveillance side, has been in monitoring and tracking of pandemic outbreaks in the community. Versatile solutions Currently, Truven Health focuses on three And if you use our real-time surveillance tool in the emergency room, for example, key areas. First comes the Truven Health Micromedex 360 Care Insights Suite. With you can actually monitor 24/7 patients Sandeep Makhijani , Regional Director, Asia Pacific it, clients are provided tools and resources who are coming in showing symptoms of pandemic breakout,” Makhijani said. “So to conduct real-time clinical data there are different ways clients are using surveillance, manage patient risk, and ruven Health AnalyticsTM aims to enhance efficiency and effectiveness improve patient outcomes. This proactive our solutions and deriving benefits.” Truven Health is cognizant of the of healthcare at the government and supervision allows for immediate specificity of their clients’ needs. identification of at-risk patients and hospital level, and it has done just that for over 40 years. Healthcare providers in intervention opportunities, improvement Differences in healthcare systems and economic climates across the globe over 90 countries rely on Truven Health to of clinical outcomes due to reduction produce challenges unique to certain of adverse events, and management of empower their management teams and patient risk through infection prevention regions, so Truven Health is setting its clinicians in making confident decisions. sights on expanding its consulting and and antimicrobial stewardship. Truven Health combines healthcare advisory services. The second focus is clinical expertise with intelligent applications “We combined software and benchmarking. Truven Health and the industry’s leading benchmarking ® methodologies with intellectual and CareDiscovery enables healthcare methodologies and analytics to improve human assets to providers cost, quality and outcomes. “Healthcare providers in help our customers to identify Many of the company’s clients over 90 countries rely tackle issues that inefficiencies may know Truven Health best for its ® they cannot alone on Truven Health.” within the Micromedex Solutions, the brand under solve,” said Global process which Truven Health sells its evidenceSales Vice-President Per Holst-Hansen. of care, determine internally the best based clinical content solutions. “We have also been working with some practices to pinpoint drivers of variation The Micromedex clinical decision of our clients to build country- or regionin cost and quality, and use reliable support tools, evidence-based drug, specific clinical and financial databases and relevant data to prioritize the disease, and toxicology information and in order for them to compare themselves improvement of services. patient engagement tools, which are to the best performing hospitals on local, The third key area is operational available in 15 languages, help hospitals performance improvement. Truven Health regional, or multinational levels.” ensure patient safety. In addition, the The company is committed to making company offers solutions for operational, ActionOI® helps healthcare providers investments in key international markets define strategic direction and align financial and clinical performance such as Asia Pacific. It is also growing hospital resources to drive cost savings improvement. its distributor and value added reseller and operational excellence. What sets analytics from Truven Health “In terms of operational efficiencies and system, and partnering with more apart from any others in the industry is cost savings, we have clients like WellStar electronic medical record vendors and that Truven Health customers are able system integrators. Health System. Using our ActionOI to use proven methodologies bundled in For further information, contact solution, WellStar was able to identify tools and resources to track, define, and sandeep.makhijani@truvenhealth.com. benchmark their clinical, operational, and 90 million dollars in annualized financial improvements with 15 million dollars of financial outcomes. that in labor expense,” cited Regional Additionally, Truven Health provides Director, Asia Pacific, Sandeep Makhijani robust and reliable comparative datasets in a discussion at the 2015 Healthcare for benchmarking. Clinical benchmarks, Information and Management Systems for example, are based on the largest Society (HIMSS) Asia Pacific Conference. available in-patient administrative “That’s huge. These are amazing results database that comprises discharge data that our clients have achieved.” for 21 million patients representing Additionally, the adaptability of the 2,700 hospitals each year. Operational Per Holst-Hansen, Global Sales Vice President company’s solutions allows clients to and financial benchmarks are based on data from 750 hospitals and healthcare organizations, and 250 hospital departments.
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HEALTHCARE ASIA 9
healthcare INSIGHT: Home Healthcare
Quality care is always within reach
Telehealth and home care knock on Asians’ doors
Governments are riding on telemedicine and home care to provide services especially for rural Asians.
T
hanks to technological advances, Asia is hurtling towards a new model of healthcare delivery where consultation and care is increasingly delivered in the comfort of patients’ homes. When Asian patients want to check up their diabetes or undergo a hemodialysis session, they may soon do so without stepping out of the house. Home healthcare is fast gaining momentum in Asia, and is viewed as the logical evolution from the hospital-centric approach that has dominated the past decades. Smarter medical technology Analysts credit the recent wave of smarter medical technology and rising wealth in the region as the primary enablers of home healthcare, allowing physicians and other medical professionals to diagnose and 10 HEALTHCARE ASIA
Consumer based digital health technologies are making their way into our homes in the form of biosensors and other technologies such as smart watches.
manage chronic conditions remotely. “With the emerging new model of care where prevention is better than cure, and continuous monitoring is possible because of the advances and facility of improved telehealth devices bundled with the service, it is true that outpatient and home healthcare will feature more prominently going forward,” says Chong Yoke Sin, CEO at Integrated Health Information Systems. “For chronically ill patients, their outpatient visits should result in better control of their conditions, and less episodes in the hospitals. In the longer term, home care will feature even more, and one can envisage that hospital care will extend to the community hospital for stepped down care, and then the home for a longer period of rehabilitation,” Chong says. “Telehealth will facilitate this, together with nurse visits to the
home,” adds Chong. Patients are encouraged to visit hospitals where doctors and technology are located, but the proliferation of smart medical diagnostic devices, wearable monitoring tools and telemedicine care and management systems have made the home a viable node for certain healthcare services. Digitising health “Consumer based digital health technologies are making their way into our homes in the form of biosensors and other technologies such as smart watches,” says Yogesan Kanasingam, professor, School of Medicine at University of Notre Dame. “These innovative digital health technologies support self-care at home and collect massive data which could support evidence based care,” Kanasingam says. Kanasingam reckons handheld diagnostic tools on personal watches and smart phones are beginning to generate massive amount of data that rival, and even replace some invasive clinic based devices. These wireless technologies will enable real time collection of patient data and
healthcare INSIGHT: Home Healthcare provide better access and outcomes for patients, such as smart EpiPen casings that automatically alert medical professionals during an allergic reaction. In the same vein, smart wearable devices such as digital tattoos, implants and smart lenses are being equipped with traditional clinic based tools like ECG, heart rate monitoring, glucose monitoring, muscle activity tracking, breath monitoring, and UV light measurement. “As the adoption of wearables continues to grow, we will see more value placed on accessing digital health data by healthcare organizations to provide value-based models of care,” says Kanasingam. With the influx of patient from these smart gadgets and wearable technologies, hospitals and doctors can now deliver point of care and remote chronic disease management through telehealth processes. Home care advantages Healthcare providers are increasingly moving towards care delivery in the home to improve patient outcomes and convenience and reduce costs, says Tony Sherbon, partner, advisory – health at EY in Australia. “Patients appreciate the care provided in their familiar surroundings and the reduction in the burden of travel to appointments,” adds Sherbon. Hospitals, in turn, can cut down on costs and avoid unnecessary expansions if they can integrate sophisticated home monitoring and online consultation services. Hospital admissions and Emergency Department attendances can both be reduced and result in savings for hospitals, says Sherbon, but this requires careful implementation. “The workforce costs of homebased care may sometimes be greater than center-based care,” warns Sherbon. “In order to implement home-based care programs, clinical staff, carers and patients need to be engaged in the design process because substantial changes in workforce capabilities and work design are required for successful implementation.” Sherbon describes well-established home-based care programs as
those that continually monitor their performance and their patient needs through regular evaluations. Focus is given on patient outcome measures, patient satisfaction surveys and hospital admission rates of patients enrolled in the home-based care programs. The evolution to home care Analysts attribute the evolution to the home care model to the growing wealth among Asians, which is in turn shifting their healthcare habits and preferences. “The rise of the affluent Asian middle class means that individuals are more prepared to pay for healthcare at private clinics due to a perception of improved quality and convenience. This is particularly true in countries such as India and Vietnam where the middle class is thriving and the private healthcare sector is booming,” says Andy David, healthcare director for Asia Pacific Japan at SAP. “This affluence is also creating increased demand for private clinic in convenient locations such as shopping malls. This is not only unique to Asia. In the US, the supermarket chain Walmart, now provides clinics in many of its stores combining walk-in convenience with budget-friendly prices,” he adds. Increasing importance David says outpatient and home care services are becoming critically important in countries like Singapore where many patients prefer to visit the hospital as their first point of call, rather than their general practitioner (GP). “Demand on public healthcare institutions continues to grow at an unprecedented pace. With not enough beds to go around, public healthcare institutions are under pressure to guide less urgent cases from the crowded Accident & Emergency (A&E) departments to their GPs. “To help ease the burden on A&Es more countries are deploying medical call centers, that take patients who call in, through a triage process to determine if there is a need to rush to A&E, visit an out-patient clinic or simply rest and recover at home.
This process results in clear benefits to national healthcare systems but requires significant investment in education to change the behavior of the population,” he adds. Andy David
Chong Yoke Sin
Tony Sherbon
Yogesan Kanagasingam
David Mckeering
Integration challenge As home care becomes more prevalent in Asia, sustaining its growth will require hospitals to provide customers with a so-called “continuum of wellbeing” or a series of seamlessly integrated, customised health services alight to a patient’s health philosophy. “Consumers in this era will reward trusted service providers that can help achieve this,” says David McKeering, Singapore healthcare leader at PwC South East Asia Consulting. “In the new health era, the mere collection of data will be replaced with lightning-fast analysis delivered directly to a care team that anticipates problems before they arise. Individuals will be co-creators of their health decisions, spending more of their discretionary dollars on tools that help them live well,” says McKeering. He expects the shifting focus from inpatient to outpatient services will move care delivery closer to the home with the help of retail businesses, remote monitoring and mobile devices. There should be a significant consolidation in the health industry as this happens. “For incumbent health companies, the emergence of these popular technologies presents a central challenge: to partner or compete?” says McKeering. “Successful organisations will eliminate administrative waste, improve health and reduce errors,” McKeering adds.
Telehealth industry: region fastest adopter of telehealth, Global, 2013-2023
Source: Frost and Sullivan
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co-published corporate profile
Menarini Asia-Pacific goes full throttle to accelerate growth in the region
One of the fastest growing pharmaceutical companies in Asia strives for greater heights as it extends its regional capabilities and unveils a slew of brands.
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ith 130 years of pharmaceutical exceeding USD350 million, growing at business experience, Menarini nearly twice the average pharmaceutical Asia-Pacific is a trusted annual market growth rate of 10% in European brand with a dynamic the region over the past three years, international leadership team and according to IMS Health. over three thousand dedicated sales, Here at its regional headquarters in marketing and support professionals in Singapore, Menarini has consolidated thirteen key healthcare markets across its regional leadership position with the Asia-Pacific region. Formerly known over 110 multinational managers and as Invida Group, professionals in “Menarini strives to the Company was a contemporary become the choice renamed after being office acquired by the environment brand of patients Menarini Group in at Mapletree and consumers 2011, the world’s Business City and the preferred leading Italian to propel its biopharmaceutical pharmaceutical partner ambitious of physicians.” company growth plans. headquartered in “We have Florence, Italy. steadily advanced our commercialization Since then, Menarini has gone full excellence as we expand our reach in the throttle, bolstering its pipeline, extending markets. regional capabilities to drive business Menarini is here to stay and strives growth and introducing a slew of to become the choice brand of patients healthcare brands in key therapeutic and consumers and the preferred areas. Menarini Asia-Pacific is now one pharmaceutical partner of physicians and of the fastest growing pharmaceutical the trade. With a long-term view, despite companies, with annual revenue intermittent macroeconomic turbulence 12 HEALTHCARE ASIA
in some countries, we are not hesitant to invest in our growth using Singapore as the staging hub,” said John A. Graham, CEO of Menarini Asia-Pacific. Addressing unmet needs Menarini believes in the infinite spectrum of opportunities across the biopharmaceutical sector, in both RX and OTC, to meet unmet needs in the region. Though steeped in the RX sector with established proprietary and partnered brands in Cardiovascular, Allergy & Respiratory, Dermatology, Men’s Health and Oncology, Menarini took a leap of faith into the fast growing OTC market in 2009. Within a few short years, Menarini had developed a USD100 million Consumer Health business in the region. Among the many products it currently markets, its flagship anti-scar gel, has become the market leader in Asia and the number one brand in its product category in at least six countries. More recently, Menarini launched its easy to apply nail anti-fungal product, Kerasal, across the region as it saw a
co-published corporate profile largely unmet need for this medical for the faint hearted and partners must condition in many markets. have a long term view and steely resolve Through continuous portfolio to succeed with the right partner.” said rationalization, careful market Graham. segmentation Partners can “treading in the Asiaand unique take immediate Pacific markets is not Asian physician advantage of insights, the abundant for the faint hearted Menarini has and partners must have a opportunities been adept to the region long term view and steely in identify and and maximize resolve to succeed with the value of address the the right partner. ” unmet needs their portfolio, among patients or work with and consumers. Menarini to establish a sustainable With this motivation and belief that business in the markets more quickly Asian patients deserve to have more than they could alone. rapid access to innovative medicines, With robust capabilities across the Menarini’s regulatory and marketing value chain, strong sales footprint teams have been busy with implementing and extensive reach across physician an average of more than ten product networks, key opinion leaders, and trade launches every year since 2012. This partners, companies who partner with trend is set to continue unabated in Menarini can expect to build productive the foreseeable future if its ambition to and profitable alliances. Its current triple revenue within a few years is to be partners in selected countries include realized. Gilead Sciences, GE Healthcare, Baxter, Ipsen , Meda, Dr. Falk, Faes Farma, and Strong partnering tradition Moberg Pharma, to name a few. Menarini’s preoccupation with accelerating pharmaceutical innovation What’s next on the horizon in the region has accentuated its quest to Whilst most of Menarini’s R&D currently partner with like-minded companies from stems from Europe, the Singapore hub around the world who want to tap into is already coordinating ongoing and the Asia-Pacific growth story. However, new clinical research across a number entering the Asia-Pacific markets is not of markets today. Menarini has also without its challenges. established a little known subsidiary “The heterogeneous markets are here over a year ago, A. Menarini a considerable barrier to entry for Biomarkers Singapore Pte. Ltd. Together many. Given the different healthcare with selected partners, Menarini frameworks and regulatory requirements Biomarkers has embarked on multiple in each market, it can be mind boggling research collaborations globally to and Menarini functions as the gateway identify biomarkers that could be the for biopharmaceutical companies to next breakthrough in precision medicine unclutter the complexities of the market advancement. and reduce the risk of entry. However, Coupled with Menarini’s proprietary treading in the Asia-Pacific markets is not DEPArray™ system, the world’s first
John A. Graham CEO, Menarini Asia-Pacific
patented technology that could automatically isolate rare single tumour cells, Menarini Biomarkers offers an unprecedented capability for R&D teams to study rare cells and determine the biological significance of distinct subpopulations of cells within a sample. With this knowledge, customers are developing new diagnostic and therapeutic strategies to improve patient outcomes and address unmet medical needs. In conclusion, Graham reiterated: “We build our success based on accelerating the arrival of technology innovations to the region and the ability to recognise a product’s potential to benefit Asian patients and consumers. We develop good brands that address unmet needs and invigorate lives, which is our brand promise.”
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Dr Timothy Low CEO Farrer Park Hospital
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CEO INTERVIEW
Farrer Park Hospital’s new CEO resolute on sharpening the hospital’s competitive edge Dr Timothy Low reveals how he plans to balance profitability and value in Farrer Park Hospital.
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arrer Park Hospital is a tertiary healthcare institution in Singapore which boasts of a fresh approach to medical treatment. It has the design capacity to have 145 beds in four suites for inpatients, and is currently licensed by the Ministry of Health to operate 54 beds. Healthcare Asia interviewed Farrer Park’s CEO, Dr Timothy Low to give us a glimpse on what it’s like to develop his hospital’s organisational culture and his aim of reaching breakeven status within five years. What makes you excited about your new position? This is a new hospital that was built from the ground up and I am excited that I get to chart a new direction and develop it into a hospital that will be the talk of the town, one to be admired for its fairness and value in service. I am most excited about taking Farrer Park Hospital to break-even status within five years’ time, building an organisational culture where staff will embrace professionalism, objectivity, kindness and empathy as their work ethos, as well as developing leaders at every level.
“It is important to constantly innovate in terms of service offering and not just have the best medical devices.” What three goals are you focused on? The three goals I would like to focus on are leading the hospital to break-even status within five years’ time, making Farrer Park Hospital a choice facility for specialists to practise in by offering top class medical equipment and services, and to develop Farrer Park Hospital into an employer of choice in the healthcare industry. What would you do differently given this position? It is important to empower staff at every level and have the trust that everyone will do their best at their level. Given this trust, I am sure our staff will leverage on their own strengths and feel the responsibility and motivation to act in the best interest of patients and the organisation. We encourage our staff to be proactive problem solvers and as a servant-leader, I would help them succeed. What changes are you planning for Farrer Park Hospital? I must thank my predecessor for doing such a wonderful job of making the transition easier for me. We have opened 75% of our facilities, and by next year, we will
be fully open. In the coming years, it is about leading everyone on the team towards the same direction and focus to give the best patient experience and make a difference on the healthcare scene. With the healthcare industry moving towards advanced technology, human interactions have diminished significantly. There is a lack of the human touch, and ‘e-interaction’ is replacing face-to-face interaction. It is difficult to show passion and compassion without the human touch which is so important and compelling for therapeutic healing and emotional assurance in the healthcare industry. What are your key business philosophies? My business philosophy is to strike a balance between business profitability and providing value. It is important to constantly innovate in terms of service offering and not just have the best medical devices. All these help to develop our competitive edge and will enable Farrer Park Hospital to stay on top of the competition. To be able to truly say that Farrer Park Hospital is a hospital that offers real value to patients at the end of the day is gratifying. How have your previous positions/experiences prepared you for this one? My stint at Gleneagles Hospital has given me a good grounding of hospital administration while my stint with the Pharmaceutical and Medical Devices industries augmented my experience with a deeper understanding of regional healthcare and trends in medical advances and technology. I hope to leverage on this to make Farrer Park a hospital that is known for top-class services both locally and regionally. At Gleneagles, I had implemented the core tenets of servant leadership to effect a paradigm shift in hospital administration. When I first joined Gleneagles, the hospital was struggling with low staff morale, high staff turnover and high customer complaint rate. Customer Satisfaction Index from 74% to 79%, reduced attrition rates from 3.01% to 1.65% and won 14 awards for Gleneagles, including the inaugural Asian Hospital Management Award consecutively for four years. What challenges are you facing as you begin your term? It is challenging to recruit people with compassion and passion in the healthcare industry, especially for nursing personnel. This is a worldwide challenge and it is especially critical in Singapore to find the correct personality type and profile to provide the human touch in healthcare. In the new era and generation, what is lacking is the sense of respect, humanity and compassion that is critical to provide the much needed X-factor. HEALTHCARE ASIA 15
feature profile
The Malaysian Medical Association building
Malaysian Medical Association tackles lack of healthcare transparency
President Dr Ashok Philip talks about MMA’s vision of transforming Malaysia’s healthcare industry and promoting transparent relations.
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hen Malaya and Singapore gained their independence in the 1950s, a team of doctors, led by Dr. S.G. Rajahram, Dr. B.R. Sreenevasan and Prof. A.A. Sandosham, met at the Institute for Medical Research at Jalan Pahang, Kuala Lumpur with a clear ambition in mind. Fresh from gaining independence from British rule, the visionary doctors were enthusiastic about the development of Malaya and Singapore, in particular the future of medical doctors in the territories. “We had meetings either at the Institute of Medical Research or in our homes,” says Dr. Ronald McCoy, one of the original members of the committee. “It was a very informal kind of setup. We were only just learning to handle not just medical affairs, but also national affairs with independence.” From those meetings came the idea for the Malayan Medical Association, which, half a century later, is now the Malaysian Medical Association (MMA). The MMA currently has 21 committees, addressing concerns ranging from government policies on smoking to adaptation mechanisms in the face of the Trans Pacific Partnership Agreement (TPPA). The association continues to grow amidst a rapidly increasing number of doctors in the country and the pressure to transform Malaysia’s healthcare industry. 16 HEALTHCARE ASIA
The association continues to grow amidst a rapidly increasing number of doctors in the country and the pressure to transform Malaysia’s healthcare industry.
According to a book on the history of the MMA, during the British rule, Malaysian residents who aspired to become doctors had to attend the King Edward VII College of Medicine in Singapore, which was established by the British government in 1905. Graduating doctors were represented by the King Edward’s Alumni Association, considered that time as a powerful medico-political organisation both in Singapore and Peninsular Malaya. Starting out “The Malaysian Medical Association was initially the Malayan Branch of the British Medical Association. However, after independence, the Malayan Medical Association was set up in 1959. That has grown into the Malaysian Medical Association which has a branch in each state of the Federation and one in the Federal Territory of Kuala Lumpur,” says Dr. Ashok Philip, the president of MMA. In the 1950s, rapid political developments pressured medical associations in Malaya and Singapore to adapt to the changes. The Malayan Medical Association was established to take over the functions of the Malayan Branch of the British Medical Association following its dissolution in Malaya. It also took over the professional functions of the
feature feature profile profile The group’s objective was to bring doctors together to improve professional standards, both for individual doctors and the country’s entire healthcare system as a whole.
Dr Ashok Philip, President Malaysian Medical Association
Alumni Association of the King Edward VII College of Medicine and Faculty of Medicine, University of Malaya. The alumni association was relegated to a social and recreational role as an old boys’ club and continues to be active in organising annual reunions. Philip says the association was set up by pioneers including Dr. Mahathir bin Mohamad, who later went on to become Malaysia’s longest-serving prime minister. The group’s objective was to bring doctors together to improve professional standards, both for individual doctors and the country’s entire healthcare system as a whole. The MMA president says that in its early years, the medical profession in Malaysia was relatively small, and a large percentage of doctors were members of the association. “The association is a voluntary grouping of doctors, who choose to become and remain members – there is no statute or law compelling membership. We are also very open. Any doctor who is eligible to practice in Malaysia can become a member. In addition, all Malaysian medical students, wherever they are studying, can become student members,” Philip says. Over the years, however, while the number of members continued to grow, its proportion of the total number of doctors in the country has fallen. “To some extent, this is because doctors sometimes prefer to join smaller associations which focus on specialties or special interests,” Philip says. Despite this, MMA remains the largest single organisation representing doctors in Malaysia, and wields considerable influence on the Malaysian Ministry of Health and other government ministries and departments. “When they wish to gauge the responses of the profession to proposed policies or current situations, they usually consult the MMA,” Philip says. Early gains Despite not being able to function as a trade union, MMA was able to lobby for benefits to doctors in the country, among them the improvement of working conditions, better pay for doctors in the public sector, and compensation for extra work. “In the United Kingdom, the (British
Medical Association) is a trade union which represents and fights for the rights of its members as regards pay and working conditions. In Malaysia, the MMA does not function as a trade union, because the law forbids doctors in the public sector from forming a union (and doctors in the private sector are mostly self-employed),” Philip says. Another achievement of the association was the implementation of the “call allowance.” “When on call, doctors would work office hours as normal, then continue overnight work without a break, and do a normal day’s work the next day before getting off,” Philip explains. In the 1980’s, the shortage of doctors meant that most housemen and medical officers had to be on call once every two or three days. As for specialists, they were on call practically every day, but fortunately were not required to stay in the hospital. “The MMA worked long and hard to get a call allowance for doctors in government service,” Philip says. He said their initial requests for additional compensation were rejected because they were told they could not claim overtime. “The authorities declined to accept our contention that this was not overtime. We were not staying back to complete work, but to take on fresh work,” he says. Eventually, the association was able to persuade the Public Services Department to send some of their officers to follow some on-call doctors on duty. Currently, the MMA also plays a major role in keeping all doctors up-to-date with evolving medical knowledge through Continuing Professional Development (CPD) activities. Gaining recognition Until recently, Philip says these activities were encouraged but not mandatory. However, the newly amended Medical Act and its attendant regulations now require doctors to have a minimum number of CPD points which is mandatory for renewal of the Annual Practising Certificate (APC). “The body issuing the APC is the Malaysian Medical Council. After long discussions and many meetings, the MMC has tasked the MMA with collecting and
Confederation of medical associations in Asia and Oceania
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feature profile
Malaysian Medical Association’s office
collating CPD points for APC renewal for all doctors in the private sector. The Ministry of Health is responsible for CPD points for its own doctors,” Philip says. Oversupply of doctors In his inaugural speech this year, Philip took notice of the challenging landscape of medical practice in Malaysia. “The challenges facing the profession seem to be mounting daily. Some of these challenges are the inevitable result of the aging population and changes in lifestyle and diet. Some, however, seem to arise because there are attempts to regulate or tax medical practice without really understanding it. Finally, some challenges are the result of poorly coordinated policies, whose fruits we are now reaping,” he says. Starting in the 1990s, Philip says the number of private medical colleges in Malaysia grew at a rapid rate. As a result, the number of medical graduates increased, and at present 5,000 new doctors seek employment every year. Moreover, the number of public hospitals where these new doctors can undergo housemanship has not increased at the same pace as the number of doctors. As a result, fresh graduates are waiting longer and longer to be employed. “The MMA fears that during this long waiting period, some fresh graduates may lose interest in the field and wander off to greener pastures. After all, with so many young people becoming doctors, it is probable that for some of them, at least, medicine is not a passion or a vocation but a course they have been pushed into,” Philip says. Moreover, the MMA executive says six to eight months of hanging around waiting, can lead to medical graduates’ knowledge and skills deteriorating, making it more difficult for them to start their training. Philip says the oversupply of doctors is the result of what seems to have been poorly planned and inadequately monitored licens18 HEALTHCARE ASIA
The number of public hospitals where these new doctors can undergo housemanship has not increased at the same pace as the number of doctors.
ing of private medical colleges by the Ministry of Higher Education. “The MMA and individual doctors have been voices crying in the wilderness for many years, warning of the all too obvious consequences of this wanton expansion of medical programmes. Only now are our warnings starting to be taken seriously,” Philip says. He says that the Ministry of Health was not responsible for the influx of medical graduates into the country, but it should have spoken up more forcefully to prevent the problem since it is responsible for training the new doctors and maintaining standards of medical care in Malaysia. “Unless new training hospitals come online, whether new or upgraded, this is going to be an uphill struggle,” he says. Philip adds that with budgetary constraints, few new hospitals are going to be built, and few old ones are going to be upgraded. He says the recent drastic step of freezing government posts makes the problem more acute, because even with new hospitals, there is no assurance of getting new posts. “Don’t forget that once housemanship is done, you have to find room for the new medical officers. Are there enough posts for them? What avenues are there going to be for further training and specialisation? Will non-traditional routes of career advancement be further developed? Not everyone wants to be a specialist, but that doesn’t mean they want to stagnate. Will the government be hiring doctors on contracts? Will unemployed doctors be flooding the streets?” he says. Philip says the solution to the problem must be multipronged. “First of all, no new private medical colleges should be given licenses. If any college fails to fill its quota of students for one year, the limit for subsequent years must be reduced permanently,” Philip says. He adds that if a college gets into financial difficulties, it must be allowed to fold up, and its license should not be awarded to another body. “As for those young doctors
Managed care organisations meeting
feature feature profile profile waiting for jobs, the MMA is planning to have courses to help them understand, anticipate and deal with the rigours of housemanship,” Philip says. Transforming the Malaysian healthcare industry Philip says the transformation of the medical industry in the country has been lurking in the wings for a long time. He says he is aware that there are pressures on the healthcare budget, and the need to restructure the healthcare system of the country is becoming overwhelming. “Over 20 years ago, many businessmen were confident that a National Healthcare System similar to that in Australia or Taiwan was imminent. As of now, nothing has come about,” he says. A few years ago, there was much talk about the 1Care system in the country, a national health service that aimed to provide Malaysians equal access to public and private medical care. “Consultants have come and consultants have gone. Their expensive reports pile up but nothing seems to be happening,” he says. The proposal was shelved amid a flurry of opposition, sending everything back to the drawing board. “Even now there are consultants studying our healthcare system with a view to making predictions about its transformation,” Philip says. “The MMA feels that such a momentous change to a system that functions so well should not be undertaken lightly.” Philip says the reason behind transforming the country’s healthcare system must be transparent, and there must be an open discussion with stakeholders on the best way to enact change. He says the association has reached out to the Ministry of Health, indicating their wish to be involved from the earliest stages of the restructuring process. “To be fair, the restructuring of a healthcare system that works so well is going to be tough to sell. If it isn’t broken, why fix it? If the Ministry of Health wants to convince
Malaysian Medical Association with the Malaysian Prime Minister
The reason behind transforming the country’s healthcare system must be transparent, and there must be an open discussion with stakeholders on the best way to enact change.
people that change is necessary, it will have to be very open about why the present system cannot continue. If there is an impending budget blowout, tell us. Without full and frank consultations, people are going to be paranoid and rumours will spread,” he says. Philip says that it is a climate of incomplete information that allows people to believe that 10% of their salary is going to be taken for health insurance. “Incomplete information allows people to believe that they will not be allowed to choose their (general practitioner). Incomplete information makes the claim that everyone can only get four free doctor visits a year sound plausible. None of this may be true, but once people believe these things, they will resist any change,” he says. Looking into the future “In the coming year, we expect that the new Medical Act will come into force. Among other things, this will see the corporatisation of the MMC (Malaysian Medical Council), compulsory medical indemnity insurance and minimum CPD points for APC renewal,” he says. Philip says there are other matters that have to be discussed with the MMC, and they have written to them to continue the dialogue on such issues. Philip says MMA’s relationship with the MMC has been mutually beneficial, and he vows continuing to work to keep it so. “Of arguably greater importance is a looming problem on the near horizon. We are all aware of the National Health and Morbidity Surveys carried out by the Ministry of Health, which show a seemingly inexorable rise in non-communicable diseases among our populace. If this continues, huge losses in productivity will be the result. Since lifestyle changes such as a richer diet and less physical activity are the main culprits behind this problem, only lifestyle changes can reverse this trend,” Philip says. However, he admits that such changes are extremely difficult to initiate, and even more difficult to maintain. HEALTHCARE ASIA 19
CO-PUBLISHED CORPORATE PROFILE
How revolutionary data analytics is made breezy and more secure by EMC
EMC’s innovations take pride in making healthcare’s overwhelming information more friendly to public transform their operations and deliver information technology as a service. The products EMC has to offer can help companies handle data, from storage, cloud computation, big data, protection and security to content management and analytics. The company provides end-to-end enterprise solutions to clients looking to improve the way in which they aggregate and harness their data. EMC has been around since 1979. That’s 36 years of experience in dealing with information that started from dossiers, rolodexes and floppy disks to databases, big data and the cloud. In that time EMC has become the largest provider of storage systems in the world. EMC has around 70,000 employees all over the world and is represented by 400 sales offices globally.
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magine a company that would like to better engage its customers through various marketing channels and new product offerings. The first step would be to get to know their demographics and consumer preferences. This would entail collecting all sorts of information on their customers such as name, sex, birthdate, location, likes and dislikes, hobbies and interests. After that data is aggregated, the information must then be arranged in a way that it can be interpreted by a company’s marketing and product teams. This means a huge amount of data collection and organization, which will be essential for any organization that is looking to harness or analyze all this information. In the old days of storing information research meant digging through stacks upon stacks of files, documents, ledgers and maybe even floppy disks. Looking for a book in the library meant
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understanding the Dewey Decimal System and going through multiple cabinets of index cards. Radio stations had crates of records in vinyl, tapes and CDs. Doing away old methods In today’s age, organizations have to be ahead of the curve, which involves going digital, especially data storage and management. The modern organization needs to be able to collect, organize and analyze its data in real time given the speed at which the competitive environment moves. Enter EMC. EMC is a global leader in providing information storage and tools to businesses and service providers to
Emphasizing innovation The company places a premium in being innovative. It has thousands of technical research and development employees around the world. It has R&D facilities in Brazil, China, France, India, Ireland, Israel, the Netherlands, Russia, Singapore and the United States. Its manufacturing facilities are in Ireland and the US. These facilities are ISO certified and held in the highest quality standards. EMC is a multi-awarded company in terms of products, financial achievements and work environment. In 2014 it was number 18 on the World’s Best Multinational Workplaces list. It has multiple awards for disability employment matters, and veteran employment. EMC is 128th in the Fortune 500. It’s a component of the S&P 500 Index and has been in the Dow Jones Sustainability Index for North America for four consecutive years. For all its recognitions and achievements EMC is simply a community of innovators and problem solvers.
“In today’s age, organizations have to be ahead of the curve. The modern organization needs to be able to collect, organize and analyze its data in the speed at which the environment moves.”
CO-PUBLISHED CORPORATE PROFILE
Think local, act global EMC has worked with three medical institutions, the Sydney Adventist Hospital, Tokoshima University, and Harvard Medical School, to set-up a picture archive system which can also sync images across devices. EMC is providing tools for healthcare providers and agencies to integrate their data and to ease their inter-operability. Now, imagine a company bent on providing the best quality service it can provide its clients and customers. That’s EMC. It thinks local and acts global. It innovates as quickly as the world moves, adapting to the times and offering the best data storage, management, and protection service the world can see.
“EMC innovates as quickly as the world moves, adapting to the times and offering the best data storage, management, and protection service.” NEXT GENERATION STORAGE FOR HEALTHCARE WORKFLOWS PACS/VNA
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Solving the data puzzle EMC can solve both the data management and aggregation conundrum, which allows marketers to effectively mine and analyze customer data. Imagine a company with over hundreds of thousands of customers all over the globe. That is a lot of customer information. EMC is capable of hosting big data. Imagine a company that wants all its data at the fingertips of its officers and employees. EMC has a cloud for that. Imagine a hospital with multiple patient records, which translate to large healthcare information databases to manage and analyze. EMC also has information solutions for that. EMC had a booth at the 2015 Healthcare Information and Management Systems Society Asia Pacific Conference in Singapore. Sanjay Joshi, Isilon CTO, talked about how EMC can help manage the biggest data of all, population-scale genome information. Joshi explained that putting the data
hardware and that EMC has products for backing up and protecting data, encompassing identity verification and encryption. Its RSA brand is at the forefront of cyber defense to identify threats, confirm and manage identities, prevent breaches, IP theft, fraud and cybercrime. EMC is also preparing for the explosion of telemedicine, which is a fast-growing sector globally. Joshi predicted that there will be around 50 billion devices in the world by 2020, connecting medical professionals to patients even in areas that they could not normally cover. EMC is up to the challenge of finding a way to integrate the data and images that can be captured by those devices.
Breezing through analytics In line with that, data analytics can be done in a breeze. It can dig up and consolidate patient information and research data to identify trends and patterns. Sanjay mentioned that in the US, where he lives, more than 50% of medical records have been breached in the past two years. What’s more troubling is that from 2013 to 2014 record breaches increased by 100%. He talked about how data can be protected through policy, software and
FTP
Imagine a company wants to provide targeted advertising for its clients. Without data analytics, this entails manually combing through customer info or consumer touchpoints in order to locate where most of the consumers of their clients are. In addition to being inefficient, this may also yield results that are not necessarily accurate.
INTEG RIT Y
Sanjay Joshi, Isilon CTO
from all the cells in a single person’s DNA from end to end would amount to 10,000 crossings of the solar system. Doing that for the entire population of the planet would be 100 crossings of the Milky Way galaxy, which is 100,000 light years across. That is a lot of information, the biggest data known to man, and EMC is working with genome machine companies to work on containing and understanding that. Understanding population-scale genome information is what Joshi refers to as the ‘holy grail.’ Their innovations also provide population-scale understanding of disease trends and how it can be fought. It is also has a solution for organizing data and even archiving it. Records of inactive patients can be archived and retrieved as easily as those of current and active patients. Tracing medical history doesn’t have to be hard work.
Social Content
ANALYTICS Population Health
Environmental Data Financial
Fraud Detection Quality/Cost Management Compliance
THE HEALTHCARE DATA LAKE
HEALTHCARE ASIA 21
post-Event coverage: himss 2015
Healthcare IT takes the limelight in Asia
In today’s digitised world, keeping up isn’t enough for firms to remain relevant.
Asian healthcare leaders debate over issues at HIMSS AsiaPac 2015
H
ealthcare players are pressured to be highly innovative and competent, and must constantly outdo each other in catering to a rapidly growing demand for healthcare—most especially in the case of Asia Pacific’s healthcare sector where a big chunk of the market is just slowly starting to fully embrace technologies. Singapore is among the Asian countries who are at the forefront of healthcare innovation as its ambition of building the world’s first SMART Nation is currently underway. What would be the challenges in making this a reality? Will other developed countries like Japan, South Korea, and India follow suit soon after, and when will developing countries make their markets penetrable to this technology? This and more were fleshed out at the HIMSS AsiaPac15 Digital Healthcare Week held from 6 to 10 September at the Marina Bay Sands. Currently in its fourth consecutive year in Singapore, HIMSS kicked off the conference under the theme “Smart Healthcare - Transforming how we manage Health.” Exhibition space at HIMSS was sold out and this year’s conference saw the number of exhibitors and sponsors reach 92, while the number of healthcare leaders and professionals from 38
22 HEALTHCARE ASIA
countries numbered 1,767. In his opening speech, Mr Gan Kim Yong, Singapore’s Minister for Health, says that Singapore is dead set on making healthcare more proactive for both its people and healthcare providers. “In Singapore, we are aspiring to become a Smart Nation and Smart Health is an important element of our agenda. We seek to identify opportunities for effective use of information technology to deliver beneficial citizen centric healthcare services. Our focus is on ideas and solutions which will address the needs for both our people and our care providers,” he adds. Healthcare IT is king It was revealed at HIMSS that 78% of healthcare execs will be using analytics to assess population health by 2018 and 62% of health IT leaders are increasing cloud budgets to provide more coordinated, cost-effective care. This is what’s been brewing in Singapore’s healthcare sector, and of course, it is not alone in its healthcare IT initiative as speakers and exhibitors from peer countries shared their journeys in pushing for a healthcare sector that’s accessible to all. For instance, Dr. Richard Royle, executive director at UnitingCare Health, talks about their launch of a new 96-
bed fully integrated digital hospital in Australia. Through a Health and Hospitals Fund (HHF) grant in 2011, the Australian Federal Government provided $47 million in funding for the $96 million project, including $21 million for the eHealth component. Dr. Royle also tapped on population health management in Australia and the lessons other countries can obtain. “Information technology is a catalyst as this turns data into action. Healthcare firms can use predictive analytics to identify and build the right programs and actions. It consequently reduces costs and improve community healthcare.” He forewarned firms though that they should engage patients in a personalized way so that patients will not feel uncomfortable to give firms access to their health information and effectively engage in their health. This way, patients will also feel the need to connect with the firms’ care teams. Dr. James S. Miser, chief medical information officer at Bumrungrad International Hospital, also shares how having a robust, cognitive computing decision support system that organizes patient data to deliver the highest quality treatment in the molecular age. For Japan, Sakiko Ota, project researcher at The University of Tokyo, discusses her team’s project that developed a digital-enabled infrastructure of community care for enhancing inter-professional work. The authors interviewed healthcare providers and official caregivers about the usability of the system and inter-professional work. Telehealth buzz Telehealth was also a key buzzword in HIMSS AsiaPac 2015 as Dipl. Ing Christoph Westerteicher, business director, Philips Hospital to Home International, Philips Healthcare Global shares that telehealth has been proven effective by numerous pilot studies.
“We at HIMSS hope that we provide the opportunities for you to see what the solutions are and find ways to implement them.”
What are the challenges healthcare providers, patients and payers have experienced? And what are the key lessons learnt for telehealth to deliver on its promises? These are few of the questions he tackled in his talk. The overall discussion on healthcare IT will of course be incomplete without touching on the topic of big data. Lim Cher Wee, deputy director, Corporate Planning, Tan Tock Seng Hospital, discusses the hospital’s Healthcare Intelligence (HI) an enterprise level business intelligence system that translates data from clinical and administration-related databases into meaningful information. Zooming in on SMART Healthcare Healthcare is one of the fastest-growing areas of the digital universe, growing at a whopping 48% every year according to Sanjay Joshi, Isilon CTO, EMC, which provides more reason for countries to go SMART. Asia is struggling and striving to become an amazing hub of SMART nations and cities. This goal is reflected by these 6 countries ‘efforts in pushing the movement forward. Songdo in South Korea is the world’s first SMART city and is due for completion by 2015. Iskandar, Malaysia in Johor has also been chosen as the pilot region for a smart city model for Malaysia. Japan is already conductin SMART City operational experiments in four strategic locations. Indonesia has chosen Kutai to become its model smart city. Singapore is on its way to becoming the world’’s first SMART nation. Lastly, India is already finalizing plans and its framework to develop 100 smart cities.
skills to successfully deliver SMART care.” Gupta adds. Major investments will have to be made, he says, and there will be a big need for a model ROI that is good enough to meet the opex. Apart from design challenges, Joshi of EMC also raised the apparent digital challenges. “As data goes into electronic systems, the number of cyberattacks have shot through the roof and doubled,” he adds. And as if a cyberattack isn’t a big hurdle by itself, data explosion amplifies the existing challenges. Hooi Ka Mei, Director, Applications-EMR, Integrated Health Information Systems, says that 665 terabytes of data are being managed on average by healthcare applications and healthcare firms. This makes the gap that is lack of integration bigger. “Up to 75% of these data are not available for view from the EHR. Healthcare firms
must also brace themselves as connected devices will eat up a hefty chunk of 16% of digital universe by 2020 generating an increasing amount of data,”Hooi says. It has been a whirlwind week of healthcare IT at HIMSS, and Stephen Lieber, president & CEO, HIMSS says at the event’s closing, “We at HIMSS hope that we provide the opportunities for you to see what the solutions are and find ways to implement them.” HIMSS Asia Pacific 2016 will be held in Bangkok, Thailand in August.
“Healthcare is one of the fastest-growing areas of the digital universe, growing at a whopping 48% every year.”
Lurking hurdles “Everyone is part of the SMART Health solution,” Tan Kok Yam, Head of Smart Nation Programme Office said in one of the keynotes. Rajendra Pratap Gupta, member of National Board of Advisors at Maharashtra Unviersity of Health Sciences, agrees saying that “Behaviour change is vital for SMART Nations to succeed.” But he warns that design challenges must be expected to bombard the countries. For a starting SMART City design, a high degree of innovation for affecting behavioural changes among users is required. “We must also be aware of SMART retrofitting. There should be understanding of concepts of redevelopment, greenfield development and these must be matched with HR
HEALTHCARE ASIA 23
cOUNTRY report: Philippines
St. Luke’s Medical Center - Global City
Spotting opportunities in the Philippines’ hazy healthcare Despite numerous headwinds battering the country, firms continue to get bullish on the sector as potential starts arising
I
n recent years, we’ve seen a notable amount of investment activity in the Philippine Healthcare sector. On the infrastructure side, conglomerates such as Ayala Corporation (AC) and Metro Pacific Investment Corporation (MPIC) have been making acquisitions in medical facilities while United Laboratories (Unilab) has expanded beyond pharmaceuticals production and followed suit through subsidiary Mount Grace Hospitals, Inc. Together, the three companies own 2,877 beds which represents roughly 5% of the country’s total private hospital beds. The two conglomerates AC and MPIC have also announced interest in acquiring more hospitals and possibly building them through various PPP’s. In particular, MPIC is looking to get aggressive in the 24 HEALTHCARE ASIA
Prescription drugs continue to dominate the market and make up almost 46% of households’ out-of-pocket expenditures.
hospital acquisition space with 15 planned acquisitions over the next few years. Companies such as Robinsons Land have also made indications that they may want to enter the space, possibly through Joint Ventures. The pharmaceuticals and healthcare retailing space has also garnered attention from large firms. According to Che Javier of PwC, this segment is worth about $3.3B, and is forecast to grow at a CAGR of 5.1% over the next five years. Reason for optimism Given the optimistic outlook for the sector, Javier notes that many of these firms have been taking advantage of opportunities to expand through acquisitions. Robinsons Retail Holdings, Inc. purchased a small and a mid-sized chain last year, acquiring Chavez Pharmacy. The company has expressed its view
that despite the number of drug stores branches, there are still many underpenetrated areas. Further, there is still a large portion of pharmaceutical retailing being done through traditional drug stores, indicating the potential for modern retail to gradually replace this channel. The company also was looking to acquire Rose Pharmacy, a Cebu-based chain with more than 230 outlets and a strong provincial presence. This company was acquired by Dairy Farms Ltd, a subsidiary of Hong-Kong conglomerate Jardine Matheson. Prescription drugs continue to dominate the market and make up almost 46% of households’ out-of-pocket expenditures, according to the Philippine Institute of Development Studies (PIDS), and shows that a large share-of-wallet can be gained by those entering this space. Another fast-growing space is the Generic Drugs market, estimated by PwC to grow at a CAGR of 6.8%, which is faster than the industry as a whole. Ayala Corporation recently purchased Generika, a chain of generic drug retail stores with 441 locations, in line with its bullish view on the healthcare sector. The
cOUNTRY report: Philippines company noted in a recent briefing with investors that this “pocket-sized” investment should be thought of as a healthcare play rather than an entry into retailing. The company has also invested in QualiMed, a small-format medical clinic predominantly located in the company’s malls. AC maintains the view that “Social Infrastructure” such as education and healthcare will be essential components of the country’s continued development, and will benefit from the increasing per capita income and rising demand for these services that follows both population and income growth. Spending continues to dip Despite the rising need for healthcare, healthcare spending as a percentage of GDP is persistently low in ASEAN at 4.6% versus the 5% recommended by the World Health Organization (WHO), and analysts expect it to fall to 4.5% by 2018. Investment in the sector has not been sufficient in the Philippines, despite recent activity and both access and infrastructure to healthcare services must improve. Rhenu Bhuller, a partner at Frost & Sullivan’s healthcare practice, notes that the sector needs a mix of both public and private spending to be sustainable. Access to basic services, for example, continues to be low in the Philippines given the lack of investment. Karen Rogacion, a CorpFin manager at PwC Manila, notes that only about a third of the population has access to basic pharmaceuticals and only 82% of the population is covered by the Philippine Health Insurance Corp. Spending on infrastructure has not moved up in tandem with increasing demand as evidenced by the inadequate ratio of hospital beds to population, and poor coverage. According to PwC, the Philippines has one of the lowest bed-to-population ratios at 10 beds per 10,000 people and the country would need at least 100 new hospitals or 10,000 additional beds at the bare minimum. Fortunately, the country’s government and private sector are both making steps in the right direction in terms of investment in this sector.
The state’s Department of Health (DOH) will get a record increase in budget. From a 2015 budget of P87.7 billion, the DOH will have P132.7 billion at its disposal next year.
Greg Navarro
Greg Navarro, managing partner of Navarro, Amper & Co. (Deloitte Philippines) notes that the Philippine government has allocated significant funds to improve coverage and infrastructure, particularly in rural areas which need the most investment. “The government announced that the state’s Department of Health (DOH) will get a record increase in budget. So from a 2015 budget of P87.7 billion, the DOH will have P132.7 billion at its disposal next year,” Navarro said. He notes that most facilities are concentrated in Metro Manila and in Region III, but this large additional investment will help make headway into bringing healthcare access to poorer, less accessible areas. Navarro also explains that the private sector is beginning to take a greater interest in building the insurance business, which should allow for greater healthcare coverage as more and more Filipinos avail themselves of it. Penetration of insurance is still quite low in the Philippines at 2% versus more than 25% in ASEAN neighbors such as Malaysia and Thailand, and has plenty of room to move up as a percentage of GDP. Growth-driving medical tourism Given the Philippines’ push to grow its tourism sector, and the abundance of medical professionals in the country, there has recently been great interest in developing Medical Tourism. According to Navarro, there are a number of hurdles the country needs to address before it can develop this segment of the healthcare sector.
The talent pool and more serviceoriented nature of the staff are not enough given the infrastructure deficit of the country, which has hampered the growth of the broad tourism sector as a whole. The country needs to upgrade its international airports because medical tourists from abroad will be averse to flying to countries where flights are often delayed, cancelled or unable to land, given the sometimes time-sensitive nature of their trips. Interconnectivity between the country’s islands also remains a challenge, with big improvements needed across land, air and water transport. He also notes that it will become important for the country to find its niche for medical tourism. “India is well-known for high-end surgeries, while Thailand is famous for cosmetic procedures. A few years ago, the Philippines’ Department of Tourism (DoT) was looking at dental services as a market focus,” says Navarro. The Philippines has to find the specific practices in which it has a competitive advantage (whether cost or technical) and capitalise on it. Both public and private sector investment are coming on-stream to contribute to development of this sector, even from traditionally unrelated industries. Greg Navarro notes that numerous companies are looking at more innovative ways to improve coverage and access to services through their own industries. “One telecommunications company, for example, has established a 24/7 health hotline manned by licensed Filipino doctors,” says Navarro.
Out-of-pocket health expenditure (% expenditure on health)
Karen Rogacion
Rhenu Bhuller
Source: indexmundi.com
HEALTHCARE ASIA 25
Co-published corporate profile
Medtronic meets foundational healthcare system needs with a focus on partnerships
Product innovations delivered through services & solutions drive better outcomes. value-based healthcare models that can deliver better patient outcomes — while maintaining or reducing costs. Incorporating an understanding of economic value has been fundamental to Medtronic’s approach to providing products and services. Over 85,000 Medtronic employees have been trained on the fundamentals of economic value and the Medtronic Integrated Health Solutions business moves beyond devices to focus on system-level services and solutions. Today, Integrated Health Solutions is helping hospitals and health systems align value across the care continuum by delivering more efficient and improved care to patients.
F
or over six decades, Medtronic’s Mission has remained the same - to alleviate pain, restore health, and extend life for people around the world. More than 62 million people benefit from Medtronic technologies each year, equating to two people every second. Medtronic continues to look ahead to the future and has been examining innovative ways in which, together with industry stakeholders, foundational or universal healthcare needs can be addressed. Improving clinical outcomes, expanding access, and optimizing cost and efficiency all need to be achieved if healthcare systems are going to be able to cope effectively with an aging global population, an increasing burden of chronic disease, legacy payment and delivery systems with misaligned incentives, and government policies and regulatory systems. Medtronic believes that their expertise, technologies, and the data and insights these technologies generate can be utilized to help establish aligned,
Reduced cost, better outcomes Medtronic’s ability to achieve better outcomes for patients at a reduced cost is demonstrated by the innovative, high quality therapies that they are developing. The company has invested heavily in medical research and development, particularly in diabetes, a condition that affects millions of people globally. One of the major projects the company is currently working on is the development of an artificial pancreas, known as a Closed Loop system, designed to help people with diabetes achieve better glucose control through advanced protection from hypoglycaemia. Heart failure is another area of focus for Medtronic, with hospitalizations for heart failure patients costing billions in indirect and direct costs. The cardiac resynchronization therapy (CRT) device was developed to adapt to the individual rhythms of each patient’s heart, which have significant potential in helping heart failure patients avoid being hospitalized again, which greatly reduces costs. Improving global access to quality healthcare In addition to cost considerations, global
“Medtronic believes that partnerships with like-minded players across the industry are necessary to develop a new framework for driving healthcare transformation.” 26 HEALTHCARE ASIA
access to quality healthcare is another area of focus for Medtronic — millions of people across the world still do not have adequate access, particularly in developing countries. An example of a Medtronic initiative to expand access is the Shruti program in India, which is helping patients with hearing impairments. An estimated 63 million people in India suffer from hearing disabilities caused by ear infections that went undiagnosed because of limited access to healthcare. Medtronic and its partners developed a program which offered free community screenings, and set up referrals for patients in need of treatment. Nearly 115,000 people have been screened by the program thus far, and 43,000 cases of infections and hearing loss have been successfully diagnosed. At the same time, Medtronic’s “Healthy Heart For All” program, which brings greater access to heart rhythm and vascular treatment to patients, is being run at more than 120 facilities in over 22 cities in India. Today, more than 1,200 physicians have received training, 147,000 patients have been screened, and more than 14,000 of these patients have been treated. Strengthening partnerships Medtronic believes that partnerships with like-minded players across the industry are necessary to develop a new framework for driving healthcare transformation. The medical technology company has taken many steps to move in this direction: with the acquisition of Covidien, their increased portfolio of innovative products, greater clinical and economic expertise, and larger global footprint have positioned Medtronic as a strong partner for physicians, hospital systems, patients, payers, and governments around the world. For Medtronic, developing new partnerships with those who are committed to achieving the benefits of value-based healthcare is as important as innovations at the therapy, procedural, and system levels. Medtronic is ready to change the future of healthcare.
Co-published corporate profile
Medtronic APAC President Bob White talks about transforming healthcare
The company is a thought leader in value-based healthcare.
F
or Medtronic, opportunities to transform healthcare in the AsiaPacific region are boundless. Recognising the vast possibilities in the region, Medtronic continues to strive to develop solutions to the acute problems of aging populations and increasing noncommunicable diseases. Bob White, Medtronic’s president for Asia-Pacific, says Medtronic is aware of the uniqueness of the APAC region, where highly developed markets coexist with emerging ones in a modern retelling of the ‘Tale of Two Cities.’ “While Medtronic remains focused on developing technologies and services that can drive more value into existing health systems, we are also actively leading and participating in efforts around the globe to create programs that improve disease diagnosis, patient referral and treatment outcomes,” White says. Value-based partnerships Keeping its eyes on ensuring that the power of technology is harnessed extensively and leveraged within healthcare systems, Medtronic leads the industry in delivering better patientcentered outcomes. “We seek to be an engaged and collaborative industry leader committed to seeing that value-based healthcare efforts are successful for patients and caregivers,” White explains. Partnerships are important to Medtronic, which looks to incorporate value-based principles in its collaborations. “We stand willing to partner with public and private payers, governments, and hospital systems interested in working together to shape and deploy value-based business models,” he says. Medtronic firmly believes its growth strategies – therapy innovations, global access, and economic value – will usher in the shift to value-based healthcare. White says Medtronic is up to the task of weathering intense clinical and economic challenges which have plagued global healthcare systems. “Medtronic is responding by committing ourselves to new approaches
and new forms of innovation that will support better clinical outcomes, greater access, and optimized cost and efficiency,” White explains. “The product or service we deliver must provide an economic benefit, such as making care delivery more efficient, minimizing system waste, or expanding patient access to therapies.” Landmark acquisition The acquisition of medical technology firm Covidien opened a new chapter in Medtronic’s exciting history. The integration of two of the largest standalone medical technology companies in the world paved the way for new ideas and new solutions, utilising each player’s strengths and facilitated long-term stability. “We now have a bigger portfolio of innovative products, which extends into the services and solutions we can provide to our customers. We are also creating new business models that improve access to our products and services around the world in both emerging and developing markets,” White says. Going forward, Medtronic is committed to forging new types of partnerships to achieve the ultimate goal of bringing integrated, quality care to its patients. In its six decades of service, Medtronic has always taken a proactive stance by continuously launching new products, services and solutions, forging new partnerships, and developing new approaches to healthcare transformation. White cites Medtronic’s “Healthy Heart For All” program in India, which delivered better heart disease awareness, access to healthcare, and affordability to the locals. “We are working with local hospitals and physicians to remove barriers to patient access to heart rhythm and vascular treatments,” White says. Looking into the future, Medtronic strives to align value to more integrated and efficient care.
Bob White, President, Medtronic Asia Pacific
Spearheading advancements “Medtronic is committed to partnerships with all stakeholders to better leverage existing technologies and services, as well as develop new solutions that better integrate health systems, in order to reach an era of value-based healthcare across the globe,” White says. While Medtronic says the role of technology in healthcare is just beginning to take shape, the company hopes to be at the forefront of improving clinical outcomes and maximizing efficiencies across the care continuum. At the end of the day, White highlights the importance of its 5,000 employees in APAC, who are part of an almost 90,000-strong global workforce. “They live our Mission every day – to alleviate pain, restore health and extend life. We believe that as a team, and in partnership with healthcare professionals, hospitals, governments, and other stakeholders, that we can take healthcare further, together,” White says.
“The product or service we deliver must provide an economic benefit, such as making care delivery more efficient, minimizing system waste, or expanding patient access to therapies.” HEALTHCARE ASIA 27
Case Study: nccs
The National Cancer Centre Singapore
NCCS’ RAPIDE redefines system efficiency The National Cancer Centre Singapore makes use of breakthrough RFID technology to maximise time, cut back on inefficient absenteeism, and deliver better healthcare to its patients.
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hen the National Cancer Centre Singapore (NCCS) noticed hospital resources were being wasted when patients failed to show up or came in late for their appointments, it employed a smart system powered by radio-frequency identification (RFID). NCCS deployed the Real Time Ambulatory Patient Information Deployment Enabler (RAPIDE) which is an RFID-enabled system for medical resources management and patient tracking. Since its launch, the system has enabled the centre to treat more chemotherapy patients and reduce their waiting times at the Ambulatory Treatment Unit (ATU), which is responsible for providing chemotherapy treatment and related procedures to roughly 35,000 patients annually. Absenteeism spawns inefficiency “Patient absenteeism – either no shows or late arrivals for scheduled appointments – is one of the challenges faced by ATU at NCCS. Failure to attend an appointment on time results in inefficiency because the 28 HEALTHCARE ASIA
The system reduce their waiting times at the ATU, which is responsible for providing chemotherapy treatment and related procedures to roughly 35,000 patients annually.
vacant appointment interval is often not used by another patient, resulting in underutilization of resources,” says Mag Tan Wooi Lin, senior nurse manager at National Cancer Centre Singapore. NCCS explains that at the National Cancer Centre Singapore, the ATU is physically separated into two suites, an architectural factor that makes it almost impossible for the scheduler to tell which bed or chair is vacant. Logistical challenges Furthermore, manual planning of medical resources and patient tracking become a headache. In addition to no-shows and late arrivals, there are times when patients might develop drug reactions and complications requiring extended treatment time. “If the procedure takes longer than expected, subsequent patients were forced to wait longer, resources became unavailable, and patients’ schedules were altered. Doctors and nurses also wasted precious time searching for resources for the treatment,” Lin says.
In response to these logistical challenges, NCCS worked with Hong Kong Communications Co., Ltd to implement the RAPIDE system with a strategy of assigning patients with an active RFID tag and increasing the centre’s flexibility when deploying nurses, doctors and other resources throughout the day. RAPIDE was integrated with the admission process. Each patient that arrives at the hospital would be assigned an active RFID tag and the system would match them with their respectively assigned nurses. Nurses, doctors and the centre’s 46 chairs and eight beds were also tagged. RFID readers installed on the ceiling would then detect all tags, decipher the data transmitted to them and allow administrators to make more efficient allocation of medical resources. RAPIDE System’s Five-Step Process 1.) Front counter staff uses RAPIDE system to register a patient and issues her a RFID tag. 2.) Patient wears tag and receives an SMS 30 mins before her appointment. 3.) RFID read-
Case Study: nccs ers on the walls and ceilings detect signals from the tags, and together with sensor mats on the recliners or beds, transmit data to the system to pinpoint the patients’ and nurses’ locations. 4.) Rapide shows a recliner is occupied on the computer screen, when sensor mats and RFID readers transmit signals from the patient’s and nurse’s RFID tags 5.) Patient drops the tag into the dissociation box once she completes treatment. Rapide then releases the resource for another patient. “Due to the tagging of the nurses to the patients, the RAPIDE system could be used to identify the staff overseeing the patients, allowing easy location and responsibility over them. The system would also allow visibility of the treatments’ live duration to facilitate more flexible resources deployment, allowing the staff to take in ad hoc treatment cases,” says Lin. “The patient will be notified by SMS reminder 30 minutes before the treatment. Treatment duration can be extended for 30 minutes or an hour by the nurse pressing a designed button, which allows the scheduler to re-schedule the resources for other patients,” Lin adds. Better resource planning NCCS says that since implementing the RAPIDE system, the centre’ has significantly raised visibility of realtime processes between the treatment unit and the waiting area. “This has resulted in a better resource planning and scheduling
Patient sits on the allocated chair with the nurse
Due to the tagging of the nurses to the patients, the RAPIDE system could be used to identify the staff overseeing the patients, allowing easy location and responsibility over them. Active RFID is given at registration
system, based on real- time feedback from the data captured,” says Lin. The numbers have been impressive: NCCS saw an 8% reduction in waiting time for treatment. Correspondingly, treatment capacity of ATU has been increased 22%, or around 4,000 more patients catered annually. The centre’s utilization of clinical resources, such as beds and recliners, has also increased by 20%. Overall resource efficiency now consistently reaches 90%, as opposed to 70% to 80% before the RAPIDE system was implemented. In addition, 100% traceability of patients and nurses is also achieved. “Our nurses no longer need to manually search for empty recliners, or make calls to check if drugs are ready. Instead, they save about 69 hours a month or 825 hours a year, which they now use to treat more patients,” says Lin. These improvements are critical as NCCS strives to attract more patients in Asia and around the world, and establish itself as the best-performing national and regional centre that provides clinical services to cancer patients. NCCS also finds the service improvements critical in saving the lives of cancer patients in Singapore, where cancer posts the highest lethality among diseases. “Treatment interventions, including chemotherapy and optimal delivery of care, are paramount in influencing patient’s chances of survival. Improving resource allocation and service turnaround time would also enable timely treatment and increase in treatment capacity,” says Lin. The RAPIDE system also allows the centre’s pharmacy
staff to electronically update the status of a patient’s drugs, so staff can see on their screens if a patient’s drugs are ready for him to begin his chemotherapy treatment. RFID innovations The RAPIDE system builds on the growing reputation of NCCS in developing award-winning RFID technology. In, the NCCS in cooperation with Changi General Hospital (CGH) and the Health Ministry’s Information Technology arm, IHiS, pioneered a dashboard system which reduces waiting times for more serious A&E patients. NCCS and IHiS won two HIMSS Elsevier Awards for outstanding achievement in healthcare IT for the RFID-enabled system, which shortens patient waiting times at the CGH chemotherapy unit. The CGH’s Emergency Department Dashboard extracts real-time data from various sources to provide A&E doctors and staff with key information at a glance, such as patient volumes and waiting times, so they can provide timely medical care for more serious cases. The system’s automatic drill-down and trend analysis capabilities enable staff to drive further improvements in quality and operational efficiency. CGH managers can also view dashboard information from their computers, tablets or mobile phones securely, and make timely decisions. The system has also improved coordination across departments to facilitate patient flow. A mass casualty module built into the dashboard enables staff to better handle substantial surges in patient volumes and workloads. HEALTHCARE ASIA 29
OPINION
Dr Yong Chern Chet
The future of healthcare
Dr Yong Chern Chet Healthcare Sector Leader Deloitte Southeast Asia
O
ver the last 100 years, the healthcare industry has progressed within a relatively stable operating (business) environment even with the adoption of significant technological advancement in that course of time. And rightly so, as it is a practical industry grounded by the rigour of scientific knowledge and logic while being in harmony with the fine art of healing - a reference to the special relationship/trust between patient and medical personnel. With this said, unlike the convention of the past, the future of healthcare comes as much from external drivers as from within the industry itself. The new normal This statement comes from both a very basic point about how rapidly we are changing the way we are interacting with our technology and environment, to major systemic shifts changes in business models including the rapid rise of ecosystems and platforms for service and product consumption. As the adage goes, “change has changed” and in the New Normal, relentless disruption gives rise to increasingly complex systems and cross-industry convergence. Even in traditionally protected fields like healthcare, mainstay players cannot let their guard down against competition which can come from not only traditional rivals but also from the giants of seemingly unrelated industries e.g. technology houses, data analytics firms, artificial intelligence companies, consumer goods organisations, telcos, insurers, financial institutions, nimble and innovative start-ups or the government, to name a few. Convergence of technologies Under Deloitte’s Future Healthcare Centre of Excellence initiative, a dedicated foresight/futures studies research titled “Healthcare in 2065” was carried out to envision a future whereby healthcare is indeed personalised and designed around the individual. In this narrative, sensors, smart devices, wearables and sophisticated technologies will begin to replace the traditional health check-up; tracking everything from vital signs, caloric intake/consumption to sleep patterns. The convergence of technologies will form the basis of the medicalised, quantified self hence the business model of healthcare will shift from one of episodic illness events to a subscribed and evolved continuous wellness approach. The main features summarised from the research are: •Patient centred healthcare: Everything from diagnosis and drugs to devices will be custom designed
30 HEALTHCARE ASIA
Rise of the machines
to seamlessly integrate into a patient’s (or consumer is this sense) daily life. •Wearables at the forefront: Always on and constantly collecting data, these peripherals are the basis of the medicalised quantified self. •Digitised and decentralised doctors: Improved connectivity and miniaturised diagnostic technology means accessibility and convenience for future medical consultations. •Rise of the machines: Medical robots and artificial intelligence create more efficient healthcare platforms that are powered by insights of data analytics. •Evolved healthcare provision: Services will now be consumed continuously lending itself to a subscription based business model that focuses on high productivity and asset light strategies. Logical value innovation response The creation of such a future healthcare model is not solely a technology play but also a logical value innovation response to the issue of ever rising healthcare cost and tight manpower constraints arising from the pursuit of a traditional acute care model. As the saying goes, “the best way to predict the future is to create the future”. Hopefully, organisations currently within the industry pay heed to the development of megatrends and sense the directional change of winds to be always one step ahead in the game or better still, transit smoothly from the “old” set of rules to be “new” rules during the changeover.
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OPINION
David McKeering
Southeast Asia health’s new entrants
David McKeering Singapore Healthcare Leader, PwC South East Asia Consulting
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ew entrants from outside the traditional business of healthcare are redefining the US$9.59 trillion global healthcare market for consumers, providers, payers, and investors in both developed and developing nations. A new entrant is a disruptive, recent arrival to a market or industry. These may include companies whose core businesses reside entirely outside of the new industry, or businesses expanding into new roles. These “new entrants” are pioneering pathways into virtual healthcare, more affordable and convenient care options, wellness and fitness, and more. Healthcare challenges such as affordability, quality and access persist across the world. South east Asian markets face ageing populations and increasing incidence of chronic diseases coupled with the lack of infrastructure and difficulties with access. This is in the context of struggling economies and limited investment in healthcare infrastructure. Relief is coming in the form of new players on the healthcare field that can cut through inefficiencies and offer a higher standard of care by leveraging consumer, business and technology. PwC’s 18th Annual Global CEO survey found that technology and healthcare are the top two industries targeted by companies from other sectors. When CEOs were asked which industries their organisations had entered within the past three years, healthcare emerged at the top of the list. A leapfrog opportunity For Southeast Asia these new entrants represent a significant leapfrog opportunity. Innovation can spring more rapidly from emerging economies than from developed countries. Where urgent needs prevail in a less regulated environment, health solutions offered by new disruptive forces can root more quickly. For example, the collaboration between Sony and Samitivej Hospital Group offers innovative services and brings the future of healthcare solutions to life, enabling the hospital to serve more people in remote areas where healthcare is out of reach. Under the agreement Sony will lease pilot medical systems to Samitivej for evaluation, such as its content management system (CMS) and Telehealth camera system in the medical field. To enhance the efficiency of Samitivej’s hospital operations, Sony will supply equipment from its range of professional audio and video solutions, video-conferencing systems and surveillance devices. These markets are also attractive for new entrants since they may find a more receptive audience, where governments are actively working to reform their health systems. There, governments may be more amenable to innovation and can act as a catalyst for new market opportunities. For example, as Indonesia undergoes health reforms, they plan to become a single-payer health insurance system that will provide universal healthcare for its citizens by 2019. Information technology 32 HEALTHCARE ASIA
will be part of the solution to keep costs down and expand care. The reform also eases foreign investment in many sectors, including pharmaceuticals, to speed up the flagging economy and provide opportunities for outside companies to own and start their own operations. Non-traditional players and governments Governments are also seeing the benefits of engaging nontraditional players in their healthcare agendas. For example, the Singapore government is aiming to advance health promotion initiatives upstream. They are encouraging the people of Singapore to eat healthy by using novel tools adopted by market research companies, and engaging local food manufacturers and hawkers to develop and sell healthier foods though the board’s ‘Ask For’ program. New entrants from outside the traditional business of healthcare are enabling new solutions to old healthcare challenges for south east Asian markets. They are pioneering pathways into virtual care, enabling integrated care models to deliver more affordable and convenient care options as well as contributing to wellness and health prevention programmes. They are filling gaps between a citizen’s healthcare needs and the current medical infrastructure. This provides an opportunity for south east Asian governments to improve healthcare delivery and for new players to move forward into healthcare with fresh ideas and skills. In south east Asia, the opportunity for collaboration between new entrants, incumbents and governments to build trust among citizens, ensure continuity in the delivery of services and build on existing knowledge to offer more efficient care, is significant.
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