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hitting health targets
how the christchurch earthquake shifted the nz health minister’s approach to disaster response
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FIVE BUZZWORDS
IN HEALTHCARE
CASE STUDY:
tRIGGER TOOLS AHF PRESIDENT
RUBEN C. FLORES ON ASEAN HEALTHCARE
Chai Chuah Acting Director-General New Zealand Ministry of Health
ARE HOSPITALSTHE ONLY ANSWER FOR SOUTHEASTASIA?
HEALTHCARE INSIGHT Finding the right mix of public and private funding
COUNTRY REPORT Healthcare for everyone: Indonesia’s next big goal
ANALYSIS How top telecoms are answering the healthcare call
first How AIMS accelerates patient care
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PAge 28
PAge 18
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2 HEALTHCARE ASIA
FROM THE EDITOR Welcome to the second issue of Healthcare Asia magazine! As Southeast Asia gears up for the ASEAN Integration and countries evaluate achievements and setbacks in terms of the Millennium Development Goals, we at Healthcare Asia continue to keep tabs on how these two major events are affecting the region’s burgeoning healthcare sector.
Publisher & EDITOR-IN-CHIEF Tim Charlton ASSOCIATE PUBLISHER Laarni Salazar-Navida PRODUCTION Editor Roxanne Primo Uy Editorial Assistant Joana Rizza Bagano Editorial Assistant Alex Wong ADVERTISING CONTACT Hannah Ruby Rafael hannah@charltonmediamail.com
In this issue, we discuss Indonesia’s new government and where it is on the roadmap to its own universal healthcare program, otherwise known as Jaminan Kesehatan Nasional (JKN). ADMINISTRATION Lovelyn Labrador accounts@charltonmediamail.com Advertising advertising@charltonmediamail.com Editorial editorial@charltonmediamail.com
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We also highlight the importance of looking at healthcare in retrospect to improve the quality of healthcare systems. The chief executive of New Zealand’s Ministry of Health shares with us how loopholes in disaster response had changed his philosophy on approaching healthcare targets. Meanwhile, hospitals in the Philippines and Singapore have developed and implemented trigger tool programs to reduce the number of adverse events among their patients. Also, the region’s healthcare institutions are challenged to go beyond accreditation and continuously improve the quality of their services amid the huge increase in the number of JCI accredited hospitals. You will also find a quick rundown of this year’s awardwinning medtech products, the latest in equipment innovation, and expert opinion on hospital management and IT. Again, we wish you all the very best of health.
Tim Charlton Healthcare Asia is available at the airport lounges or onboard the following airlines:
Editorial Enquiries If you have a story idea or just a press release please Email: ha@charltonmedia.com and our news editor will read it. For a personal message to the editor put the word “Tim” in the subject line. Media Partnerships Please Email: ha@charltonmedia.com and put “partnership” on the subject line and it will forward to the right person. CNH: Will Qianhai jeopardize Hong Kong’s position? 6 Sep 2013
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CNH: Will Qianhai jeopardize Hong Kong’s position? DBS Group Research
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6 Sep 2013
In mid-2012, the China’s State Council approved the development of the Qianhai Shenzhen-Hong Kong Modern Service Industry Cooperation Zone. Four industries were focussed upon: finance, logistics, information services and science & technology services. Particular emphasis was placed on finance, for which the government designated Qianhai to be built into an experimental zone for financial innovation and further opening-up to the outside world. Back then, market watchers found it difficult to associate the mudflat with such bold plans. We, however, have been optimistic about the project. Specifically, we stated in earlier report that the zone’s development would be kicked off by the launch of a cross-border RMB lending scheme (see “CNH: RMB lending set to cross border in pilot plan”, 16 April 2012). In Jan13, only nine months after the approval has been granted, fifteen Hong Kong banks were authorized to offer a combined RMB2 bn of loans for Qianhai companies. More impressively, the first Qianhai land auction was held in July and construction is planned to start by October. It signals that the zone has already entered into an expansion period.
An analogy of Shenzhen SEZ in 1980s While many were previously skeptical about Qianhai’s future, they have now turned to the other extreme of worrying that its rise might jeopardize Hong Kong. Such fears are overblown. In our view, the Qianhai project is similar to the establishment of the Shenzhen Special Economic Zone (SEZ) in the 1980s, which has, in fact, bolstered Hong Kong’s competiveness.
Three decades ago, Hong Kong’s manufacturing industry was seriously hit by soaring costs
Three decades ago, Hong Kong’s manufacturing industry was hit by soaring costs. Factory rents and manufacturing labor wages ballooned 140% and 170% respectively during 1980-90. The city’s international competiveness was being challenged by several lower-cost developing countries in the region. For instance, the manufacturing labor costs in IndoneChart 1: Transformation of HK economic activities sia at the time was only during 1980-2000 one-fourth that of Hong Kong. 30% 90% Shenzhen became an expansion outlet for Hong Kong manufacturers and the timing could not have been better. The availability of abundant inexpensive land and labor in Shenzhen made it possible for Hong Kong manufacturers to move labor-intensive processes across the river. Meanwhile, more skill-inten-
Manufacturing 25%
Service (rhs)
85%
20% 80% 15% 75% 10% 70%
5% 0%
65% 1980
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Nathan Chow • (852) 3668-5693 • nathanchow@dbs.com 1
*If you’re reading the small print you may be missing the big picture
HEALTHCARE ASIA 1
CONTENTS
ACCREDITATION’S NOT JUST 04 FIRST FOR SHOW ANYMORE
16 ANALYSIS HOW TOP telecoms are answering the
profile 18 Feature entering the five emerging arenas for aSEAN healthcare
FIRST 04 Indonesia zones in on in-vitro
FIRST
06 Where are the Indonesians? 06 When privilege trumps privacy 06 Check out this nurse-friendly, 3G-capable smartphone
14 New Zealand Ministry of Health’s
patient care
healthcare sector
05 A bite of the China pie
PROFILE
08 How AIMS accelerates
05 Southeast Asia’s burgeoning
healthcare call
chief upgrades system by learning from shortfalls
REGULAR 12 Role of governments in healthcare 22 This year’s top-of-the-line
30 Big data in healthcare 31 Are hospitals the only answer for
medtech products
26 Healthcare for everyone:
Indonesia’s next big goal
28 Global trigger tool programs
OPINION
Southeast Asia? 32 The top five buzzwords in private healthcare
Published Bi-annually on the Second week of the Month by Charlton Media Group #06-09 E, Maxwell House 20 Maxwell Road
2 HEALTHCARE ASIA
To access the stories online, visit the website
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FIRST framework. Once a hospital gets certification, the real journey begins,” says Dr. Girdhar J Gyani, director general, Association of Healthcare Providers in India. The issue of complacency after accreditation has come to the forefront as Southeast Asia sees a spurt in accredited organisations. Currently 120 of the 683 organisations accredited by the Joint Commission are now located in the region.
indonesia zones in on in-vitro
When the Indonesian government decided to boost spending on invitro diagnostics (IVD) technology to combat the rising incidence of infectious diseases such as tuberculosis and dengue, IVD companies opened their arms in anticipation of large revenue windfalls. But what should be an earnings downpour could end up as a disappointing trickle if the market fails to address the shortage in skilled healthcare workers and laboratory facilities. The current skill and technology gap “hampers the accurate identification, diagnosis and reporting of infectious diseases in the country,” says Frost & Sullivan, and is one of the key challenges for companies seeking to cash in on the burgeoning market. The study estimates that market earned revenues for infectious disease IVD will expand by more than half over the next four years, rising from $38.6 million in 2013 to $59.9 million in 2017 at a compound annual growth rate of 11.4%. The infectious disease market is now one of the largest IVD segments in Indonesia, constituting approximately 62% of volume. Both multinational companies and domestic firms will need to focus on staff training and adopt new technologies to improve turnaround times of infectious disease tests. “The domestic participants in the low-end market will have an edge due to their competitive pricing and faster turnaround time,” says Sanjeev Kumar, healthcare research analyst at Frost & Sullivan. “Meanwhile, multinational companies (MNCs) in the high-end market can meet various end-user demands by offering improved localized service.”
4 HEALTHCARE ASIA
Beyond getting good marks
Accreditation’s not just for show anymore
W
hen Apollo Hospitals Group devised its strategy to deliver worldclass patient care, it knew for certain that securing the right accreditation was only the first step. “Accreditation is a starting point for an organization,” says Dr Anupam Sibal, group medical director at Apollo Hospitals Group. “It aids collaborative leadership that strives for excellence in quality and patient safety. It helps build a culture of quality improvement and streamlining of systems and processes.” This reflects a shift, as accreditation is no longer seen as a marketing badge that helps increase revenues, but a springboard for better clinical outcomes and patient safety.
A starting point Hospital groups that do not rest on their accreditation laurels will find that they are in a solid position to enhance their service reliability and efficiency, and further lift their standards past their complacent peers. Sibal says accredited organizations can begin to focus on measuring, benchmarking and improving their clinical outcomes – a metric that matters most to patients. “The accreditation is basically
Currently 120 of the 683 organisations accredited by the Joint Commission are now located in the region.
Culture of improvement Accredited organizations will need to work on creating a culture of continuous quality improvement, says Gyani. “Employees need to be empowered to take ownership of their respective processes. There needs to be a process of internal system audits, clinical audits, monitoring of indicators, and finally management reviews.” A culture that promotes excellence as a habit, with the right incentives and accountability, goes a long way in achieving the best clinical outcomes with service excellence and cost efficiency, adds Sibal. Accredited organizations should support their continuous improvement processes with initiatives like Kaizen and Six Sigma. Adopting technological innovations will also separate organizations from the rest of the accredited pack. “Technology, no doubt, is changing the global healthcare delivery landscape and its right adoption at the right time makes a remarkable difference,” says Sibal.
JCI accredited hospitals in APAC continue to grow
Source: Frost and Sullivan
FIRST In the developed world there is one dentist per 1100 people, but in Singapore, that ratio is one dentist for every 3,000.
Visited the dentist yet this year?
A bite of the China pie
M
ost people think the opportunities in healthcare are around ever growing private hospital groups. But one Singaporean company is showing there is more than one way to take a bite out of the healthcare apple. Q&M runs 60 dental practices across Singapore, with more clinics in Malaysia and China — making it one of the fastest growing dental chains in Asia. Statistically speaking With 180 dentists in Singapore the group employs one in seven
dentists in the city state, and has 600,000 patients say “ah” each year. The group is led by Dr Ng Chin Sau, himself a dentist who was previously with Singapore’s Ministry of Health. Dentistry is one area of healthcare set to explode in Asia, with figures showing that a surprising 54% of Singaporeans do not visit a dentist even once a year. The numbers for the rest of ASEAN and much of Asia would be worse than that. In the developed world there is one dentist per 1100 people, but in Singapore, one of the best healthcare centres in Asia, that ratio is one dentist for every 3,000 people
— and in China it’s one per 10,000. One benefit of being such a large firm is being able to work as a group and a multi-disciplinary team, rather than as individual dentists. Patients seem to like this because they can easily be referred to one of a number of specialists. Check-ups in China But it is in China where the group hopes to take a bigger bite of the pie. Only 8% of Chinese visit the dentist once a year, leaving 92% with poorer than could be hoped for oral hygiene. Q&M is investing heavily in setting up in China’s second tier cities and has a healthy $200 million war chest to do it. They also, rather unusually for dental practice, have started buying dental supplies companies in China as well. It is an interesting vertically integrated approach, but one that could lead to a pearly-white future for the group.
Number of dental specialists, Q&M
Source: CIMB Research
The Chartist: southeast asia’s burgeoning healthcare sector With the integration coming into full swing in the next few years, Southeast Asia’s healthcare market is projected to expand at a CAGR of 6.8% over 2010–20 to USD134.2 billion by 2020. According to a report by Almasah Capital, the private sector is expected to account for 53% of the overall pie, as the public and private healthcare markets are expected to expand at CAGRs of 7.2% and 6.4%, respectively, over 2010–20. The healthcare sector in SEA is likely to be largely driven by growth in the healthcare sectors of emerging countries. Growth — in government funding, private participation, population, and income levels — is expected to provide an impetus to the healthcare sector in these countries.
Total market size and share of ASEAN countries, 2020
Source: Almasah Capital
Healthcare sector growth, 2010-2020
Source: Almasah Capital
HEALTHCARE ASIA 5
FIRST
Where are the Indonesians?
When privilege trumps privacy
onventional wisdom states that when you build a new hospital in Singapore, foreign patients will inevitably come. But what if they stop coming? Singapore is finding out that it may just be at the point where its best-in-class hospitals are too pricey for many of the wealthy foreigners they were relying on to fill up their beds. IHH Healthcare, the bellwether listed healthcare firm that runs the Mount Elizabeth hospitals, among others, recently noticed that its Indonesian patient numbers were down. Indonesians have long been the dominant force in medical tourism to Singapore and the fact that they are no longer coming to the same extent should be of some concern. Part of the reason is the weakness in the Indonesian currency, which has dropped almost 20% against the Singapore dollar over the year. Add to that wage inflation, which has been running red hot in Singapore, and it’s a recipe for more expensive healthcare. IHH was forced to raise wages by 13%, and wages account for a third of their revenues. The group did see an increase in local patients and foreign patients from nontraditional markets such as the Middle East and Myanmar which made up for the drop in Indonesians. IHH reckons that emerging markets will see strong
Singapore’s chronic health patients may highly value their privacy, but many can live with the idea of strangers seeing their medical records if it means they can view their charts over the Internet. Slightly more than half, or 51 percent, of Singapore’s consumers with chronic health conditions believe that accessing their medical records online outweighs the privacy risks, according to a new Accenture survey. It was also found that more than three-quarters or 76 percent, believe patients should have the right to access their healthcare information. But despite their eagerness to access their medical records online, roughly 69 percent said the top barrier to accessing their records was not knowing how to do so.
C
Is shishkebab replacing nasi goreng on the menu?
demand for quality private healthcare, in the face of changing demographics in its home markets, rising affluence and an increasing number of medical travellers from non-traditional markets. That is a good thing for IHH, but it does beg the questions: where have all the Indonesians gone and just how much medical inflation can Singapore bear and remain competitive? The group is also diversifying; most recently buying Radlink-Asia, outpatient diagnostic and molecular imaging services firm, from Fortis Healthcare Singapore for S$137m. The days of relying on Indonesian patients to fill ever more private hospital beds in Singapore has ended.
IHH was forced to raise wages by 13%, and wages account for a third of their revenues.
Check out this nurse-friendly, 3G capable smartphone A smartphone with unique features specifically designed for the healthcare environment, Ascom Myco is designed for nurse communications and efficient management of clinical workflows. According to Ascom, their new smart device is purpose-built for the healthcare industry to provide patient-centric user experience, and has been pre-tested with numerous key users. Ascom says that the mission is to bring “the right information to the right person at the right point in time.” Multi-radio access allows Ascom Myco to used 3G networks and therefore allows communication outside the healthcare facility. Combined with Ascom UNITE middleware, nurse call systems and third party apps, Ascom Myco is the driver to improve the quality of mission-critical communication and to make workflows more efficient.
6 HEALTHCARE ASIA
Clients take proactive role These research findings suggest the emergence of a new generation that is taking a more proactive role in managing health. Health providers must adapt by providing transparency and tools so patients have larger control of their online medical data, says Corissa Leung, who leads Accenture’s health business in ASEAN. “As consumers continue to demand more access to their personal data online, we expect that patients will gain more power to manage some aspects of their own care. This will not only make healthcare more effective but also more sustainable, as consumers doing more for themselves will free up the system to be more productive.”
FIRST
Anesthesia Information Management System accelerates patient care
W
hen patients step into one of the more cutting-edge clinics or hospitals in Singapore or Malaysia, many may notice a marked improvement in care delivery — procedures are completed more quickly and smoothly, and operating staff give more attention to the patient, rather than focusing on paperwork. Ask the operating staff, and they will likely credit the enhanced service to advanced technology such as their newly adopted anesthesia information management system (AIMS). One example of such a system is GE’s newly launched Centricity Perioperative in Singapore and Malaysia. Better care, big savings With an AIMS assisting them, anesthesia providers can automate whole parts of the data monitoring and documentation during the perioperative process. “We need all the data from the blood, from the IV, from the ventilator, from the monitor, and it’s all automatically downloaded into the system. So rather than having to spend time jotting down details, the anesthesia provider can actually spend more time with the patient,” which results in better patient care and better patient outcomes,” says Mitch Silong, vice president and general manager of healthcare IT at GE.
Information is also readily delivered on screens and tracked digitally after the operation in the recovery area, which further cuts down on inefficiency and results in savings, while still upholding higher patient care standards. Silong says that by having a robust information system in place to assist in patient documentation, clinics and hospitals have seen “very big” financial payoffs. Savings are made from more cases starting on time, as anesthesia providers simply look at a monitor and find that all the information needed is already displayed without having to sift through physical records. “If you’re in an operating procedure and it’s the first case of the day, generally, what you’ll do here is ‘Does anyone see the consent?’ ‘Where is the patient’s record?’” says Silong, but a robust AIMS helps eliminate this paper chase. Cross-departmental collaboration, chronic care AIMS can be implemented in radiology, perinatal and even ambulatory EMR departments to also boost the efficiency of each of these departments. And when patient information has to be shared across departments and other distribution channels, the system also reliably sends data to and from departments. This results in the whole enterprise becoming a more collaborative
healthcare WATCH
Tacloban one year on
For the elderly, energy and cooperation are not a problem when it comes to disaster response. This is according to a report released by HelpAge International and the Coalition of Services of the Elderly, one year after Typhoon Haiyan wreaked havoc. According to the report, older people have been instrumental in helping 150,000 people recover from Typhoon Haiyan. Approximately 1.27 million people over the age of 60 were affected by the typhoon, or 8% of the reported 16 million people affected, many losing their homes, livelihoods and loved ones. Through the help of local older people organisations, HelpAge and the CSE set about ensuring that older people had regular incomes, shelter, healthcare and access to their rights and entitlements. These was achieved through shelter repair and training in carpentry and geriatric care, and piloting a mobile community health service, among other measures.
8 HEALTHCARE ASIA
Engaging the community in rehab efforts
Vicki Hamilton
Mitch Silong
The new healthcare assistant
and efficient environment as staff can access more information faster, obtain better visualisation, and provide better clinical diagnostics to physicians and healthcare practicioners. Silong claims AIMS allows hospitals to provide better chronic care. The big data and analytics captured by the system reduces the daunting task of tracking whether chronic care patients are taking their treatments and medicines, and can develop a more predictive and customised delivery of chronic care.
HEALTHCARE ASIA 9
Co-published corporate profile
A different take on health care innovation How CapsuleTech is reinventing our idea of medical solutions into their medical records,” he says. Almost two decades ago, there was very little competition for CapusleTech’s idea. When a major need for the innovation surfaced in 2004, the company received its first round of venture capital funding. Shortly thereafter, CapsuleTech started a division in the United States.
Gene Cattarina, CEO
W
hen on the subject of the medical technology industry, what often comes to mind is the idea of ‘invention’. Most people who wish to enter and thrive in the industry are always looking to invent the “machine of the future” – the next CT scan, the next X-ray, and so on. While it’s all about plain creation for most, CapsuleTech shows that innovation comes in different forms; that building on current technology is just as innovative and useful as creating a completely new invention. Building on history Founded in France in 1997, CapsuleTech began as a small consulting company. As it navigated its way through the clinical IT market, the company discovered a niche that it could fill. CEO Gene Cattarina recalls the hospital information system of the past and describes the complications that it suffered. “Many of the bedside medical devices had different protocols, many standards. It was a real problem for hospitals to take this data and move it
The Idea CapsuleTech’s core business is providing medical device information systems, which are designed to capture and manage data from a hospital’s various medical devices for timely delivery to electronic medical records, as well as clinical systems for analysis and decision support. The company is present in the US, as well as in Singapore, at over 1,700 hospitals in 37 countries, and is looking to expand further to the rest of Southeast Asia. CapsuleTech’s big idea was actually borne out of the clutter left behind by past ‘new ideas’. “There was a very important niche that needed to be filled in clinical IT and healthcare,” shares Cattarina, “that niche was to be able to get medical information from medical devices into the electronic medical record.” CapsuleTech was able to see that the plethora of unintegrated medical devices was making it difficult for hospitals to efficiently synthesise medical data for effective analysis. By simply focusing on the data communication shortfalls of the then-current medical devices instead of focusing on building something completely new, CapsuleTech was able to provide a solution to the medical field’s multiple medical device data integration problems which were often shrugged off. Problems such as the risk of human error, the risk of untimely responses, and plain inefficiency of what was then a primarily manual data entry process, were addressed by a simple yet game-changing innovation.
“By simply focusing on the data communication shortfalls of the then-current medical devices instead of focusing on building something completely new, CapsuleTech was able to provide a solution to the medical field’s multiple medical device data integration problems which were often shrugged off. Problems were addressed by a simple yet game-changing innovation.
10 HEALTHCARE ASIA
From the very beginning, location has been a key element for CapsuleTech in terms of business expansion and growth. “The growth opportunity today is to look at things globally,” Cattarina adds. This is one of the reasons why CapsuleTech is in Asia, particularly in Singapore. The company is currently looking at four very important markets: the US, Northern Europe, Southeast Asia, and Middle East. For CapsuleTech, Southeast Asia’s remarkable growth is the key factor driving the Company’s initiatives in the region. CapsuleTech already has one major tender in Singapore along with four major tenders going on in Australia. “Singapore is the gateway to Southeast Asia. The sophistication of healthcare IT in Singapore is rather good compared to other countries, and that makes what we do important.” Scaling up solutions CapsuleTech is also proactively taking steps to widen the reach of their solutions. For instance, CapsuleTech’s Medical Devices Information System could change the way doctors respond to critical cases. “We can take the data and send it to the hospital’s clinical decision support and alarm management systems, which can alert doctors to a patient’s deteriorating condition,” shares Cattarina. This is especially important for cases such as Sepsis, when the prospect for recovery virtually decreases by the hour. CapsuleTech is also developing dashboards to monitor biomedical devices. “We will know exactly what’s going on, which medical devices are being used, when they’re being used, and what room they’re being used in.”The company aims to extend its reach to other areas such as ambulatory, longterm care and skilled nursing facilities. CapsuleTech’s systems will not only allow hospitals to be more efficient in their operations, but the information collected through CapsuleTech’s systems could also help make Big Data more intelligible. Ultimately, CapsuleTech’s goal is to improve the quality of clinical outcomes, decrease the chances for medical errors, and improve the productivity of clinicians in their day-to-day work environment.
healthcare INSIGHT: government funding
Public-private partnerships are inevitable for Vietnam
Finding the right mix of public and private funding
Whether it’s public or private, or a mix of both, citizens still look to those at the helm of leadership to provide the best for their medical needs.
H
ealthcare is complicated business, from providing services to far-flung areas to ensuring everyone has adequate insurance cover. The government’s responsibilities extend far beyond financing, and these include teaming up with the private sector to provide the best standard of care for the public. Dr Lawrence Lai of the Hong Kong Hospital Authority has enumerated a number of concerns surrounding the healthcare industry and the government. These include the extent of healthcare government should directly provide, the issues surrounding public funding and whether or not the private enterprise is better at delivering healthcare than the government. Healthcare systems in different countries show the varying extents of government involvement in
12 HEALTHCARE ASIA
While governments fund the large majority of services, the private sector plays an important secondary role in healthcare financing.
healthcare, and how the state’s relationship with the private sector affects the quality of healthcare delivery in a country. The United States, for example, has two main public health insurance programmes: Medicare for the old and Medicaid for the poor. “As baby-boomers age, the numbers hitting their 65th birthday, and thus qualifying for Medicare, are rising inexorably. As for the poor, another part of the Obamacare reforms will entitle million of lowincome families to join Medicaid for the first time. Add in the effect of a rising population, and the combined enrolments of Medicare and Medicaid will grow by around 30% by 2022, when one-third of the population will be on one scheme or the other,” says Dr. Luong Ngoc Khue from the Department of Medical Service Administration of Vietnam’s
Ministry of Health. He adds that the steady privatisation of publicly funded health care in the United States could accelerate, if, for instance, Republicans succeeded in moving all of Medicare to a voucher system. Government-funded healthcare “However, for the insurer, having the government as their main customer is not without its perils. They are usually taking on all the risks of rising medical costs in return for fixed fees,” Khue says. UnitedHealth recently tried to exclude some doctors from its Medicare plans to save money, but a court ruled that it cannot. “The government may at any time decide unilaterally to cut the prices it is prepared to pay; the insurers’ shares have swung wildly in reaction to officials’ talk of doing just that. Looking after state-funded patients is guaranteed to be a big business in the years to come; big profits are far from guaranteed,” he says. The socialist nation of Vietnam, on the other hand, gives all decisionmaking powers to the government in terms of healthcare management. However, Khue says the government
healthcare INSIGHT: government funding does not have strong enough financial resources to improve the quality of care and treatment of illnesses including cardiovascular diseases, diabetes, muscuskeletal diseases and cancer, among others. “Since then, the state direction is to raise awareness, enhance the leadership of the Communist Party and authorities at all levels in the implementation of innovation in operational mechanism, financial mechanism in the health sector, continue to fulfil the operational mechanism of the public health services towards the fair development of public sector as well as private one, and improve accessibility to highquality health services for Vietnamese people, in which implementing (public-private partnerships) is an inevitable solution,” Khue says. Currently, in Vietnam, public healthcare is still the mainstream choice, with the state owning 90% of hospitals in the whole country. “The operating trend of the Vietnamese healthcare system is that the government continues to own the majority of hospitals, while encouraging the development of private health, both in quantity and quality,” he says. The government is focused on the development of preventative medicine and encourages the private sector to occupy the segment of average to high income patients. Working with the private sector In the case of Canada, the country has a mixed public-private system where the private sector delivers healthcare services and the public sector is responsible for financing them. Khue says, however, that the Canadian system is not completely consistent with this model. The Canadian government exercises considerable authority over the delivery of services by the private sector, and while governments fund the large majority of services, the private sector plays an important secondary role in health care financing. Under the Canadian healthcare system, individual citizens are provided with preventative care and medical treatments from primary care physicians, as well as access to hospitals, dental surgery and
additional medical services. With a few exceptions, all citizens qualify for health coverage regardless of medical history, personal income or standard of living. “Canada’s healthcare system is the subject of much political controversy and debate in the country. Some question the efficiencies of the current system to deliver treatments in a timely fashion, and advocate adopting a private system similar to the United States. Conversely, there are worries that privatization would lead to the inequalities in the health system, with only the wealthy being able to afford certain treatments,” Khue says. Regardless of this political debate, however, Canada boasts one of the highest life expectancies and lowest infant mortality rates among industrialized countries, which Khue says many attribute to the country’s healthcare system. In the Philippines, there seems to be a problem with how private health institutions operate within the regulations set by the government. “The problem is private hospitals are overregulated by government rules and regulations from the Department of Health, Department of Environment and Natural Resources, Bureau of Fire Protection, municipal tax, city rules and the Bureau of Internal Revenue. Hospitals are forced to lessen their expenses and charge higher to survive and continue giving good services to the poor patients,” says Dr. Rustico Jimenez, president of the Private Hospitals Association of the Philippines, Inc. Jimenez adds that Philhealth, which covers the majority of patients, pays hospitals by case rate. He says the rates, however, are lower and not properly studied. The government does not pay within 60 days, so hospitals suffer financial problems. “The Department of Health implemented a reclassification of hospitals in 2013 where most hospitals were downgraded to infirmary or clinic status. This also has an effect on the Philippine Health Insurance Corp. payments,” he says. Is private better than public? In Vietnam, the private sector operates the finances more efficiently
that the public sector, Khue says. “Operational mechanisms in public hospitals have a bias towards a subsidy regime which is not suitable for the socialist market economy. While investment in health is a long term one that is in need of huge capital, the current price of medical Lawrence Lai services is only counting the direct cost factors but not some other important factors such as staff cost and depreciation of fixed assets,” he says. Therefore, the revenue is not enough to reinvest in improving the quality of infrastructure and health workers. Luong Ngoc Khue “Meanwhile, private hospitals are very decent investments, but not operational due to a lack of effective medical personnel who are experienced and skilled in clinical activity; besides, those hospitals have brand name in the healthcare market, so they cannot obtain trust from Rustico Jimenez patients,” he says. Currently, he says there is no provision in Vietnam allowing public servants and officers of public medical establishments to work in private health facilities within office hours. “Therefore, to address this issue, the government is considering the research in order to enact the proper policy,” he says. The promise of PPP In overcoming certain challenges in costs and investments, Khue says governments can turn to the private sector and form public-private partnerships. “When appropriately structured and executed, (the private sector) can help address specific cost and investment challenges, deliver improvements in efficiency and enhance service quality,” he says. Total healthcare spend in the ASEAN, as % GDP
Source: World Bank, Edelman
HEALTHCARE ASIA 13
Dr. Chai Chuah Acting Director-General, Chief Executive New Zealand Ministry of Health 14 SINGAPORE BUSINESS REVIEW | JANUARY 2014
CEO INTERVIEW
New Zealand Ministry of Health’s chief upgrades system by learning from shortfalls Looking at previous mistakes and understanding the key elements are crucial in decision-making.
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hai Chuah is the Acting Director-General for Health and Chief Executive of the Ministry of Health in New Zealand. In this interview, he shares with Healthcare Asia lessons learned from the government’s response to the Christchurch earthquake, a new philosophy in approaching the healthcare targets in New Zealand, the biggest challenges facing his leadership and the innovative ways that the Ministry of Health is making healthcare better for New Zealanders. What lessons can be learned from natural disasters — drawing from your experience in the Christchurch earthquake? We were more focused on health events, like a pandemic, we thought that the generic process was setting up for a pandemic would easily fit in in a national disaster. It’s quite different around a natural disaster versus a pandemic. The pandemic is more about containment, public health, basically national disaster... initially it should be around trauma. Another thing we learned more is that the recovery planning process needs to start the same day as we start the rescue. Because we were so
“The question of ‘how did you achieve that?’ is much more interesting for us, because you can reach the target in multiple ways and some of the ways are actually not sustainable.” focused on the rescue, the recovery process didn’t start for a little while. How do you balance making changes in your leadership while being ‘respectful of the past’? Our biggest limiting factor is the capacity, capability and the culture of our leadership. They’re only doing what they know and that’s because of what they’ve learned from the past. And that’s actually suitable for looking after the New Zealand health system in the past, but it is insufficient to take us forward. Is there a direct link to your change in philosophy in the ministry and to how much you have improved in reaching your targets? We’ve changed from the early years from just focusing on same system, just focused on getting the number. Now we’re more interested to understand, so how did you achieve that? The question of ‘how did you achieve that?’ is much more interesting for us, because you can actually achieve the target in multiple ways and some of the ways are actually not sustainable. So now our conversation is much more. It’s great that you hit the target, so let’s talk
about how did you do that? What’s the biggest challenge, is it in the primary care, is it in the hospital care, is it managing the transition of patients through that, is it the technology behind that? There are multiple things that are actually putting pressure on the system, and there’s a push and pull on all of them. And different jurisdictions will have different nuance about that. So it’s about understanding. First of all you got to understand the key elements, all those things play a part in terms of actually putting a pressure on the system. So you’re actually going to start to look at and address those issues. What are the things that you are trying to change as you try to get through the system? The key thing that we’re trying to get change through is how do we actually get our New Zealanders to take more responsibility in terms of keeping themselves well, and secondly is how do we work with our provider organization and the professions to solve, work in partnership with the community. It’s a very difficult thing because it’s a paradigm shift into who holds power. So most traditional health systems, the power lies in the profession and the people who run health organization in hospitals. So patients come and receive service and they leave. In the 21st century patients are wanting much more to be having a say in what you do to them. Even when you go to a hospital, they want to say, ‘I want a second opinion, I just don’t want to take the first one you gave me, where else can I go, I’ve done my research on the Internet, what about this option?’ So the power shift is coming forward. In New Zealand we’re trying to say, let’s get these citizens much more engaged. Let’s get providers and profession to respond. To do that has implications on technology, has implications on our workforce training and development, has got implications around who do we develop in terms of who will lead this change. We’ve actually put in place electronic transactions; all of the transactions are electronic. GP referrals to hospitals are electronic, discharge of hospitals back to GPs is electronic, GPs’ prescriptions to pharmacies are electronic. We’ve just launched the patient portal. We got to the point where we’ve put enough content. We’ve got sufficient clinical leadership so that’s been launched with seven of our most senior GPs. We’ve also just launched the patient portal. We got to the point where we put enough content and sufficient clinical leadership from seven of our most senior GPs who we have also appointed as e-portal ambassadors. HEALTHCARE ASIA 15
ANALYSIS: telehealth
What’s the latest pharmaceutical plan?
How top telecoms are answering the healthcare call The pioneers who are fuelling the growth of telehealth and mobile healthcare services around the world.
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f you are looking for the unsung heroes of the digital healthcare revolution – the ones who are providing patients with revolutionary virtual consultation services, lifesaving remote caregiving technology and real-time medical data access online – look no further than these five telecommunications firms who are pushing the boundaries of what is possible in telehealth and mobile healthcare. AT&T In response to the growing number of elderly people in the United States and the rest of the world, including developed Asia, AT&T Digital Life is looking to provide an in-house monitoring service for caregivers called Digital Life Care. The service comes as more US adults than ever are becoming caregivers to their elderly loved ones who choose to live at home than stay 16 HEALTHCARE ASIA
Information flows faster as health ICT interacts intelligently with building management, facilities management and clinical information systems.
at expensive assisted living facilities. AT&T estimates that for the next two decades, 10,000 Americans will turn 65 each day and annual assisted living costs are projected to balloon to $50,000 by next year. The telecommunications company has designed the service to help elderly people stay at home safely, while providing peace of mind for their families. The service does this by giving caregivers a way to stay informed about their loved one’s health condition including their daily activities such as eating, taking medication and moving around the house. It uses a combination of state-of-the-art equipment, predictive analytics and ambient monitoring technology to give caregivers customized updates on the daily activities that matter most while allowing their loved ones to live independently, according to Kevin
Petersen, president at AT&T Digital Life. “The core of Digital Life is a smart, simple and customizable automation and home security service. We are taking this one step further with our new service to help our customers reduce the caregiving burden and help care recipients remain in their homes longer,” says Petersen. After finishing its employee trial stage, AT&T hopes to deploy the solution to customers in 2015. BT Harnessing its expertise in information systems, BT is powering eHospitals, mobile healthcare initiatives and cloud collaboration for multidisciplinary healthcare. BT is developing new and creative technology innovations in these areas as patients demand more localised, higher quality and affordable healthcare services, says Dr Karen Peachey, clinical director, Asia Pacific, Middle East and Africa at BT Global Services. BT enables eHospitals – a term used to describe the digitisation of data and care delivery processes of the modern hospital – to effectively integrate information and communications technology
ANALYSIS: telehealth (ICT). This allows information to flow faster as the health ICT interacts intelligently with building management, facilities management and clinical information systems, according to Peachey. BT supports the connectivity needed for telehealth and telecare services, where patients can connect virtually with practitioners and support the growing trend of homebased self-care. The company assists healthcare providers in areas such as encryption to safeguard online client information, project management and help desk support across devices and operating platforms. BT is also enabling reliable cloud collaboration that allows healthcare providers to streamline their processes and give patients the best quality of care speedily. BT Cloud Contact allows a multi-disciplinary healthcare team to work in harmony from different locations through multiple channels such as calls, voice, email and web interactions. In the next five years, BT will move towards enhancing interoperability, digital hospital design, mobility, analytics, telehealth and telecare, and ICT managed services, says Peachey.
Shane Solomon
Matthew Key
Kevin Petersen
Arun Kundu
Telefónica Telefónica is using strategic community collaborations to improve eHealth delivery through Telefónica Digital. Its digital innovation unit recently partnered to expand the reach of Saluspot, an interactive health community of registered doctors and users that pioneered free online consultation service in Spanish in 2012, to Latin America, leveraging Telehealth industry: Fastest adoption of telehealth by region, global, 2013-2023
Source: Frost and Sullivan
Telefónica’s strong brand presence in the region. Telefónica counts over two million eHealth service customers in Latin America in the business-toconsumer segment, and the Saluspot partnership will allow a faster roll-out of a wider range of eHealth services across the region, says Matthew Key, CEO at Telefónica Digital. “Consumers demand easy, agile and global access to health services,” says Gonzalo Castellano, CEO at Saluspot. “The technology is ready to guarantee that access, especially in some Latin American countries where it is still limited.” While not replacing face-to-face medical consultation, Telefónica and Saluspot provide accurate, qualified information from medical professionals as a superior alternative to patchy medical information obtained from unauthorized and unqualified sources. Telstra Telstra has also entered the telehealth arena with the recent launch of Telstra Health, its new business division that seeks to become Australia’s leading provider of integrated eHealth solutions. “We’ve seen what the digital revolution has meant for other industries and we believe that healthcare in Australia could benefit from eHealth to better serve all Australians,” says Shane Solomon, health managing director at Telstra. Composed of a specialised team that includes an assembly of innovative eHealth companies in Australia and around the world, Telstra Health hopes to provide integrated eHealth solutions. Telstra sees itself as a vital bridge among healthcare stakeholders, connecting patients to their doctors, doctors to other providers, and everyone to all the care and information they need on demand, says Solomon. Telstra is leveraging its status as a trusted brand and its experience in working with complex enterprises to build a connected system that supports eHealth services in Australia. The company has partnered with industry leaders to roll out groundbreaking products
such as Australia’s first full doctor consultation via video or telephone through its new company, ReadyCare. Solomon says Telstra will work closely with customers to understand what eHealth solutions they need instead of pursuing a top-down approach to product development. Verizon Verizon is harnessing virtual and mobile technology to expand medical care access for patients through its Verizon Virtual Visits service. Focusing on increased convenience and higher cost-efficiency in consultations, Verizon Virtual Visits allows clinicians to remotely see patients via video on a smartphone, tablet or computer. “With ready access to connectivity and applications, patients, providers, and payers can share biometric information to better manage patient-directed care plans for chronic diseases. And when patients can monitor their own long-term conditions, everyone benefits,” adds Arun Kundu, head of professional services & global strategy, Asia Pacific, Verizon Enterprise Solutions.” Patients log in through a secure app on their mobile device or Web portal, answer a set of healthrelated questions, and discuss with a clinician who then evaluates the patient’s condition and provides an appropriate care plan. Prescriptions are sent electronically to a conveniently located pharmacy chosen by the patient. Verizon addresses privacy and data security concerns by encrypting virtual visit data and keeping the data on its own cloud storage. Verizon also aims to lower the cost of care by shifting cost models using new, more efficient healthcaredelivery technologies. Cloud adoption, using an IaaS model, is making it easier for organizations to move to the cloud. “The healthcare solutions also require one crucial component: secure means to store and transport personal data. From the network to devices and everything in between, Verizon’s secure solutions make real-time information and applications available to help improve the quality of care,” adds Kundu. HEALTHCARE ASIA 17
feature profile
How do we make healthcare relevant for all?
Entering the five emerging arenas for ASEAN healthcare The president of Asian Hospital Federation gives us a near-term outlook.
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sian nations and their healthcare leaders need to overcome five daunting challenges, from borderless healthcare to ASEAN integration. The Asian healthcare sector may be riding high on rising medical tourist demand and the onset of ASEAN integration, but five critical issues could spoil its successful rapid growth over the next five years. If Asia fails to properly and effectively prepare for its ageing population especially in its developed countries, ASEAN integration, advanced information technology, and the booming demand for borderless healthcare and “people-centred” care, then it will stumble, says Dr Ruben C. Flores, president of the Philippine Hospital Association (PHA) and current president of the Asian Hospital Federation (AHF), an international non-governmental organization with representative hospital associations and hospitals
Asian hospitals will need to increasingly provide treatment for chronic illnesses and diseases afflicting middle-aged and elderly people.
from different countries in Asia. Ageing Asia Flores foresees the rapid ageing in developed Asia as one of the defining healthcare issues in the region. With countries now having a significant senior citizen population due to longer lifespans and low birth rates — Japan is around at 60% — Asian hospitals will need to increasingly provide treatment for chronic illnesses and diseases afflicting middle-aged and elderly people. The emergence of this massive elderly Asian cohort also presents an opportunity for countries such as the Philippines to develop their medical tourism. They can also set up retirement villages as attractive options for elderly Asians who want to “live with peace and normally” in their old age. The Philippines is especially suitable as a retirement destination because of the hospitality of its pop-
ulace. “Because Filipinos are known to be caring people, there are a lot of investors coming all the way to the Philippines to see the prospects of bringing their elderly people over to these retirement villages for home and long-term care.” Flores says demand for retiree villages will come from countries like Japan, Korea and China. The Philippines, if it chooses to develop this industry, can capture a large share of this market as its nursing professionals have already established a strong brand of care around the world which would be a strong selling point for retirees. “Anywhere you go in the world, there are always Filipino nurses working in hospitals. So the Filipino brand of nursing care is something that the country can capitalize on. Filipinos are well-known even in international forums, which recognize the good caring and compassionate way Filipino nurses deliver care to the patients.” “That’s a good brand and because of that Filipinos can market their retirement villages with the assurance of the Filipino brand of caring.” The Philippines has already set up a few sample retirement villages
feature profile in Laguna and Batangas provices, and Flores suggests investors may build more retirement villages in special economic zones assigned by the Philippine Economic Zone of Authority for medical tourism to receive incentives. ASEAN integration Another urgent challenge for Asian healthcare professionals is to prepare for the sweeping changes that will be brought about by the ASEAN integration, which begins in 2015. Flores says each country has formed its own task force and are preparing according to the agreements. “One of the challenges of the ASEAN integration is how to make healthcare services available to those member countries who are lacking in resources, and the same time making these services available to countries where the cost of care has prohibited access.” He offers as an example his home country, the Philippines, which needs to catch up to compete with hospitals in neighbouring countries. “I think the Philippines is lagging behind by 20 years.” But with the ASEAN integration looming, there is a push to increase the budget allocated to the Department of Health and upgrade the health facilities to be on par with the rest of the region and international standards. The increased funding will be used to procure more stateof-the-art equipment, among other improvement measures. The integration has also triggered in the Philippines a revision of staffing pattern to a more modern model. Flores says improved personnel will complement the upgraded health facilities and raise the quality of healthcare services. Flores says ASEAN integration might also eventually bring about one system of accreditation, licensing, and standards for the medical professionals that would include the doctors, the dentists, and even the pharmacists. “So what does it mean? It means that when you are a licensed doctor in Singapore, you can practise in the Philippines. That is mutual recognition agreement.” He expects that by 2015, member
countries will firm up such agreements, the implementing rules and regulations, and standards. But the question for countries like the Philippines that are lagging behind in personnel training and facilities is their preparedness for the massive changes: can their educational systems handle increased training demand? The rigours of ASEAN integration may be too hard to handle for unprepared nations. Less developed countries will also have to address the issue of how to make healthcare services available to the poor as well as medical tourism patients coming from various parts of the globe. “We don’t want to see a situation where a country’s poor patients that need treatment are competing with clientele coming from more affluent countries.” Here is where the government agencies must intervene, argues Flores. In the Philippines, he says the Department of Health has a very clear mandate to provide healthcare to the poor and will be counted on to bring that focus to government healthcare measures. They can then work hand in hand with the private sector, which will lead the charge in medical tourism, suggests Flores. Such a synergistic strategy of publicprivate partnerships is a global strategy developed to make services efficient, productive and more costeffective.
Bridging the access gap
ASEAN integration might also eventually bring about one system of accreditation, licensing, and standards for the medical professionals.
Speaking of standards, the ASEAN integration could pave the way for standards in practising traditional medicine, also known as alternative medicine, in Asia. “It is something that is being practised in most of the ASEAN countries so we would like to standardize the practice in order to ensure its safety and efficiency when being used by the consuming public.” Ideally, Flores says, the practice of alternative medicine in China, for example, will have to be proven safe and effective and not just with historical or anecdotal evidence. “We want to make sure that there is scientific basis for the application and practice of alternative medicine.” But there is a danger in seeing ASEAN integration as the panacea for all healthcare woes. In the Philippines, he says, there are glaring problems such as the overcrowded nursing population and the resultant depression of the profession’s wages. Doctor wages are also low, as least for those in the public hospitals. “The problem of the nursing profession is quite big because we really have an oversupply. We have interviewed possible applicants for nursing positions two years ago and when you call them after two years they are still jobless,” says Flores. “There are not enough job opportunities for them here and abroad, which means that we still have a big
feature profile
Dr. Ruben C. Flores President Asian Hospital Federation
problem. In fact, based on current information, many of them are working in call centres, and many of them are employed in the pharmacy outlets. They are nurses dispensing drugs and medicines.” Meanwhile, a doctor working in a government hospital, with a family of two children, would have to work extra to support and sustain the family. “You don’t have a full-time doctor working at the hospital because they have to have sidelines. That’s the reality. As for the nurses, most of them would like to work abroad.” Borderless healthcare and Ebola Asian hospitals will also need to upgrade their patient care to match the needs of a borderless world where health data and innovations flow freely between countries, and where patients can more easily travel abroad to avail themselves of treatment options outside their home country. This puts pressure on healthcare organisations to raise their service standards, to match their competitors and meet rising patient expectations. “We are expected to be able to deliver borderless healthcare,” says Flores. “E-health and information technology has made communication faster and easier, especially on the part of healthcare consumers, so they are now knowledgeable because they have access to all this information about a particular illness.”
“It means that the level of patient expectation has increased so they demand more, they expect more, and of course the demand for quality healthcare is always there as a challenge.” Aside from meeting ever-higher patient expectations, Asian hospitals will need to work together with governments to combat the increasing threat of chronic and infectious diseases like Ebola, AH1N1, and MersCov. The ease of global travel and emergence of borderless healthcare makes it imperative for healthcare organisations to be ready and prepared to handle these diseases when they cross borders at any given time. As an example, Flores says the alarming mortality of Ebola – it kills about half of the people infected – is putting pressure on Asia to fasttrack the training of scientists to find out how to combat its spread. The medical community must also conduct scientific research, clinical trials and developments to help find a cure for Ebola, which currently only has supportive treatments. Flores reveals that the AHF is trying to meet and come up with a plan of action for Ebola. This is on top of individual country efforts to raise their infection control. Speaking for the Philippines, he says that as early as January – even before the Ebola outbreak captured the world headlines – the country already launched a search for best practices in infection prevention and control. “When you talk of infection control, most of the principles of an infection control program can be applied in the prevention and control of Ebola. We were a step ahead of Ebola because we are now in the final phase of our search for innovations and best practices in infection prevention and control.” Flores says his organization has gathered around 47 entries for all parts of the country that would involve both government and private hospitals. The goal of the advocacy program is to raise the awareness of the hospital personnel about the importance of infection prevention and control practices, since this would protect confined patients
Asian hospitals need to evolve their patient care to match the needs of a borderless world where health data and innovations flow freely between countries.
from hospital-acquired infection. “It’s actually more for the protection of the patients using the facilities of the hospital. And, of course, we would also like to improve the level of quality of care.” PHA is also partnering with the Department of Health to finalize and strengthen the standards for a safe hospital, and to establish a program that would help keep Philippine hospitals safe from these incidents. In the battle against infectious diseases like Ebola, Flores says the government will play a critical role. He points out how the Philippine government hacted quickly to come up with a plan of action to control and prevent the spread of Ebola. Other stakeholders must then work together with the government to set up stricter infection control. He says the hospital sector, for example, would need to inform first and foremost hospital workers about what Ebola is and how it is transmitted. Information is the first line of defence as it provides people with knowledge of how to act when the situation arises. “If you are not knowledgeable about the disease, you panic, so really the first thing to do is to inform healthcare workers about Ebola.” Flores says the PHA helped out in this regard by trying to gather all the technical information about Ebola and put it on the organization’s website so that member hospitals can access all the technical information about Ebola. The reason for making such information available is to the encourage the hospitals to create an Ebola taskforce within the hospital. The taskforce would be in charge of informing all staff of the hospital about Ebola, who in turn would be responsible for educating the public
Per capita healthcare expenditure
Sources: WHO
feature profile about the Ebola – basically a trickledown information campaign. “Everybody has to be knowledgeable about it so that we don’t panic when a case arrives. Also, this task force should be in charge of doing surveillance work if a suspected case of Ebola arrives in the hospital.” Flores says this taskforce model is already being implemented in a few Philippine public hospitals, but PHA is trying to involve private facilities where many patients are also admitted. The public information campaign must include tips on how a relative of a patient suffering from Ebola must act, such as concealing the patient but instead bringing or referring that patient to the appropriate facility so that they can be diagnosed, treated, and quarantine, as the need arises. Such a referral system is critical if an Ebola infection control system is to succeed, says Flores. He describes a system where identified government hospitals would serve as the referral centre for Ebola as it would not be ideal for Ebola cases to be admitted to a large number of hospitals. There is a need to identify special hospitals where you put all the infected patients for easier management and containment of the disease. Part of making this work involves making information to hospitals available on where to refer infected patients, and all other logistical procedures. IT and research With the growing complexity of information technology and advances in medicine, Flores says that Asian hospitals can no longer ignore the role of data in medical care. This is why developed Asian countries such as Japan and Korea have set up national information technology, or IT, systems which have afforded them advantages in patient care. But each has its own set of flaws and there is “no perfect story.” “Maybe it is because of rapidly changing healthcare demands, so you need to reprogram your information technology. The IT systems have never been 100% successful but
they have helped improved access to healthcare through telemedicine and teleradiology. These are new modes for making healthcare more available to people across borders.” But not all countries in Asia would be able to set up a comprehensive IT system; mainly due to the large amount of capital investment required. In the case of the Philippines, the lack of funds has prevented the country from coming up with a unified IT system that would connect both the private sector and the government sector, as well as the various agencies related to health, says Flores. Flores also laments the lack of priority given to herbal medical research, especially with the proliferation of medicines which have not been trialled clinically and are currently being used based purely on anecdotal evidence. Other countries which have invested research dollars in clinical studies to determine the benefits of treatments, backed with scientific data, have the golden opportunity to market the resulting products. “People-centred” patient care Flores describes a shift from healthcare as a patient-centered, diseasespecific service to one that he calls “people-centred” which takes into consideration factors such as the patient’s family and social circumstances.
Crossing the digital divide
Japan and Korea have set up national IT systems which have afforded them advantages in patient care.
“We are increasingly recognizing the importance of people-centered healthcare where the patient is at the centre of the health scenario, with all these significant others playing major roles.” This means that when Asian doctors treat patients these days, they now have to consider the totality of that individual, including their mental, spiritual and psychosocial – as well as economic, social, political and religious – status. “You look at that patient as part of a community of people. Because what is really very important is the role of other significant people around a particular patient in facilitating the care and the cure of that patient. The support of significant people in the community is vital.” Flores cites as an example a patient who suffers from a mild stroke and is hemiplegic, which means the patient will not be able to support himself without the compassion and support of people around him or her. People-centred patient care takes into consideration not only the proper treatment for the stroke and rehabilitation, but also weaves into the overall care the psychosocial support that patient would need to recover. People-centred care shines especially for patients who are disabled, seniors and young – all of whom would benefit from psychosocial support on top of quality medical treatment.
top medtech products
Discover this year’s top-of-the-line medtech products From therapeutics to critical care and drug delivery, digital innovation and user-friendliness remain the key ingredients for success among this year’s notable companies.
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ealthcare Asia caught up with the MDEA Program to bring you this exhaustive list of the winning products of the 2014 Medical Design Excellence Awards, the medtech industry’s premier design competition. The MDEA Program recognizes the achievements of medical device manufacturers, their suppliers, and the many people behind the scenes — engineers, scientists, designers, and clinicians — who are responsible for the groundbreaking innovations that are saving lives; improving patient healthcare; and transforming medtech worldwide — one innovation at a time. MDEA entries are evaluated by an impartial panel of medtech experts jurors comprising a mix of practicing doctors, nurses, and technicians alongside industrial designers, engineers, manufacturers, and human factors experts. MDEA winning entries must excel in areas of design and engineering excellence; manufacturing and technological innovation; clinical efficacy; cost-effectiveness; as well as overall benefits to patients, endusers, and the healthcare industry. Check out the top devices from Healthcare Asia’s chosen categories and discover how their flair for innovation, efficiency and ergonomics allowed them to rise up the ranks.
2. ARKON anesthesia delivery system The ARKON allows anesthesiologists to keep their patients in full view while simultaneously controlling and monitoring gas delivery using their preferred workflow. Manufactured by Spacelabs Healthcare (Snoqualmie, WA). Supply and design credit to Design Concepts Inc. (Madison, WI). ARKON offers natural storage areas for equipment and paperwork, and an expandable work surface, among other features.
Critical-Care and Emergency Medicine Products
3. Isolibrium critical-care air support surface Isolibrium aims to provide tools for nurses to care for patients while its advanced pressure redistribution systems helps prevent pressure ulcers in patients. Manufactured by Stryker Medical (Portage, MI). Supply and design credit to Humphrey Products Company (Kalamazoo, MI), Grand Rapids Foam Technologies (Grand Rapids, MI), Les Produits Plastitel Inc. (Laval, Quebec, Canada), Twisthink (Holland, MI), and Derby (South Bend, IN). Isolibrium is a powered support surface designed to assist in the prevention and treatment of all pressure ulcers and isolates pressure redistribution through its exclusive air pod technology. It enhances the microclimate with its unique LAL system, while providing a clinically relevant pulmonary solution. Isolibrium support surface’s unique low-air-loss system enhances the microclimate through its air channelling technology.
1. Hemolung RAS extracorporeal carbon dioxide removal system The first fully-integrated Respiratory Dialysis® system, the Hemolung RAS combines advanced technology with usercentered design to provide simple, effective, and minimally invasive extracorporeal CO2 removal (ECCO2R). Removing carbon dioxide and delivering oxygen directly to the blood allows the patient’s lungs to rest and heal while avoiding intubation and facilitating protective ventilation. Hemolung RAS provides respiratory dialysis, a simple, minimally-invasive form of extracorporeal carbon dioxide removal (ECCO₂R) that acts as an alternative or supplement to mechanical ventilation in cases of acute respiratory failure.
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top medtech products General Hospital Devices and Therapeutic Products 1. LuViva Advanced Cervical Scan LuViva is a point-of-care, non-invasive test for early detection of disease that leads to cervical cancer. It does not require a tissue sample. The test provides an immediate and objective result at the point of care, reducing false-positive and falsenegative results. Manufactured by Guided Therapeutics Inc. (Norcross, GA). Supply and design credit to Big Bang (Decatur, GA), Seaway Plastics Engineering (Port Richie, FL), Gupta Permold Corp. (Pittsburgh, PA), and Herman Miller Inc. (Zeeland, MI).
2. MetaNeb system MetaNeb is indicated for mobilization of secretions, lung expansion therapy, and treatment and prevention of pulmonary atelectasis. It can also provide supplemental oxygen when used with compressed oxygen. Manufactured by Hill-Rom Services Pte. Ltd. (Singapore). The MetaTherapy® Treatment maximizes efficiency for patients and clinicians by combining lung expansion, secretion clearance and aerosol delivery into a single integrated therapy by the MetaNeb® System. In CPEP (Continuous Positive Expiratory Pressure) mode, the MetaNeb System provides medicated aerosol combined with continuous positive pressure to assist in holding open and expanding the airways. In CHFO (Continuous High Frequency Oscillation) mode is a pneumatic form of chest physiotherapy that delivers medicated aerosol while oscillating the airways with continuous pulses of positive pressure.
3. MuV patient transfer system The MuV system is lightweight and ergonomically designed to reduce patient stress and the physical toll on hospital workers during patient transfer, reducing workplace injuries and increasing efficiencies and reimbursement criteria. Manufactured by CEGA Innovations LLC (Sioux Falls, SD). Supply and design credit to Kablooe Design (Blaine, MN). The MuV Board’s smooth, low-profile engineering reduces demand on medical staff, promotes safer body mechanics, and eliminates unnecessary patient manipulation. The MuV Board pins materials on the first bed surface, greatly reducing the risk of contaminated bedding and debris coming into contact with the second, clean bed surface.
Drug-Delivery Devices and Combination Products 1. PROPEL and PROPEL mini mometasone furoate implants PROPEL and PROPEL mini dissolvable steroid-releasing implants reduce the need for additional surgical procedures and for oral steroids, which can have serious side effects, for patients suffering from chronic sinusitis. Manufactured by Intersect ENT (Menlo Park, CA). Propel uses sustained release technology to deliver mometasone furoate directly to the sinus mucosa. The device has what is described as a “spring-like design,” which conforms to a patient’s sinus anatomy and props open the sinus cavity. The use of Propel reduces the need for additional surgical procedures and steroid pills. Propel is also manufactured in a smaller version known as the Propel mini.
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top medtech products Radiological and Electromechanical Devices
2. DebioJect intradermal drug delivery device The DebioJect was conceived to overcome the problems encountered with classical intradermal delivery techniques. The innovative microneedle allows both pain-free and precise injection of up to 500 ÎźL in a few seconds. Manufactured by Debiotech SA (Lausanne, Switzerland). Supply and design credit to CEA-LETI (Grenoble, France), Mecaplast SA (Botterens, Switzerland), and the Royal Institute of Technology (KTH) (Stockholm, Sweden). DebioJect offers several advantages compared to the standard Mantoux technique: improved usability, reproducibility, reliability, accuracy of dose administration with barely any pain, as well as a reduction in risk of needle stick injuries for healthcare workers.
1. AIRO Mobile Computed Tomography (CT) System The AIRO Mobile CT integrates advanced imaging technologies into existing medical workflow and provides the clinician with procedural flexibility as well as real-time CT imaging information where and when it is needed. Manufactured by Mobius Imaging LLC (Ayer, MA). Supply and design credit to Varian Medical Systems (Salt Lake City, UT), Excelitas Technologies (Salem, MA), Hamamatsu Corp. (Bridgewater, NJ), Analog Devices Inc. (Norwood, MA), Rotek Inc. (Aurora, OH), Marlborough Foundry Inc. (Marlborough, MA), and Aved Electronics Inc. (North Billerica, MA).
3. Auvi-Q epinephrine auto-injector Auvi-Q is a single-use epinephrine autoinjector used to treat life-threatening allergic reactions (anaphylaxis). It is the size and shape of a credit card, the thickness of a cell phone, and includes a unique voice instruction system. Manufactured by Sanofi (Bridgewater, NJ). Supply and design credit to KalĂŠo Pharma (Richmond, VA), and Medivative Technologies (Indianapolis, IN). Auvi-Q is the first-and-only compact epinephrine autoinjector with audio and visual cues that guide patients and caregivers step-by-step through the injection process. Auvi-Q provides users with audible and visual cues, including a fivesecond injection countdown and an alert light to signal when the injection is complete. In addition to being an auto-injector, Auvi-Q features an automatic retractable needle mechanism to help prevent accidental needle sticks.
2. NvisionVLE Imaging System The NvisionVLE Imaging System is the first and only volumetric optical coherence tomography device cleared by FDA for endoscopic imaging and imaging of esophageal tissue microstructure. Manufactured by NinePoint Medical (Cambridge, MA). Supply and design credit to Farm Design Inc. (Hollis, NH). The NvisionVLE Imaging System, with Advanced OCT, uses an optical signal acquisition and processing method to create more complete cross-sectional images. Indicated for use as an imaging tool in the evaluation of human tissue microstructure, including esophageal tissue microstructure, it provides two-dimensional, cross-sectional, real-time depth visualization. The safety and effectiveness of this device for diagnostic analysis in any tissue microstructure or specific disease has not been evaluated.
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top medtech products 3. LumaGEM Molecular Breast Imaging (MBI) system LumaGEM is an effective adjunct to standard mammography. It is a patient-friendly and cost-effective tool for detecting earlystage cancers in dense breast tissue. Manufactured by Gamma Medica (Salem, NH). Supply and design credit to Farm Design Inc. (Hollis, NH), and Sunrise Labs (Auburn, NH). The technology measures and images the distribution of radionuclides by means of photon detection in order to aid in the evaluation of lesions in the breast tissue. In a proof-of-principle study involving 936 women with dense breast tissue, the combination of mammography and LumaGEM MBI was significantly more sensitive than mammography alone in detecting cancer (91% vs 27%).
2. INTUITION Instruments for DePuy ATTUNE Knee System INTUITION instruments combine the surgical process with the implant options to allow surgeons to balance the soft tissue as well as control the implant position and fit for each patient. Manufactured by DePuy Synthes, Joint Reconstruction (Leeds, UK). Supply and design credit to DePuy Synthes, Joint Reconstruction (Warsaw, IN). The INTUITION™ Instrumentation combines the surgical process with intuitive and efficient instruments that enables users to balance the soft tissue and precisely control the implant position and fit for each patient. Intuitive instrumentation combined with a comprehensive range of sizes gives precise control over the implant fit and position.
SURGICAL EQUIPMENT, INSTRUMENTS, AND SUPPLIES
3. ASSIST Silver antimicrobial graft cover dressing ASSIST Silver is a low-adherent antimicrobial graft cover dressing that combines Active Fluid Management technology with a low-adherent layer to provide optimal moisture balance, eliminate the need for additional low-adherent layers, and provide 7-day antimicrobial protection. Manufactured by Milliken Healthcare Products LLC (Spartanburg, SC). Supply and design credit to Haywood Vocational Opportunities Inc. (Waynesville, NC). ASSIST Silver dressings were designed specifically for the management of skin and skin substitute graft applications. A proprietary porous, non-adherent layer was added to the AFM layer to reduce the risk of dressing adherence at removal. The Active Fluid Management® technology pumps fluid in one direction through the AFM layer away from the patient, while providing antimicrobial protection and a moist environment.
1. Zip Surgical Skin Closure Zip is a noninvasive skin closure alternative to sutures and staples for surgery and lacerations, offering time-savings, better cosmesis, lower infection risk, and greater patient comfort. It is easy to apply and patients can remove it at home. Manufactured by ZipLine Medical Inc. (Campbell, CA). Supply and design credit to Innovative Drive LLC (Redwood City, CA). The Zip® 16 provides secure skin closure for longer incisions that are typical for total hip (THA), total knee (TKA) and total shoulder arthroplasty procedures. The device may also be used for procedures including spinal fusion (anterior and posterior approach), pacemaker/ICD implant, skin excision and laceration closure.
cOUNTRY report: Indonesia
Are Indonesia’s nursing and medical students ready?
Healthcare for everyone: Indonesia’s next big goal
The government of the world’s third-biggest democracy takes on the formidable task of providing healthcare for every Indonesian
H
ow do you solve a problem like covering healthcare for more than 250 million people? For a country as huge as Indonesia, the solution lies in an ambitious program that aims to introduce universal health care coverage by 2019. Fresh from electing President Joko Widodo in the recent national elections, Indonesia is now focusing on making healthcare a priority on the government’s development agenda. This task, however, comes with a number of challenges and opportunities that require a look at the archipelago’s changing market and political landscape. A public-private business The country’s system for healthcare is characterized by a blend of publicprivate provision of services, with the public sector taking the biggest role, especially in rural areas and
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One of the key supply challenges in Indonesia is the provision of health services in rural and remote areas in a dispersed archipelago of over 17,000 islands.
for secondary levels of care. Private provision, however, is increasing. Puti Marzoeki of the World Bank says health service utilisation rates are generally low nationally. About 14 percent of the population use outpatient care in a month, around 60 percent of outpatient visits occur at private facilities and the rest at public facilities, mostly at primary care level. The country’s National Socioeconomic Survey also show that the better-off use private facilities for ambulatory services: 69.5 percent compared with 51.6 percent among the bottom three deciles. Public facilities continue to dominate inpatient care, except for the top three deciles, a larger proportion of which use private facilities for inpatient care. The country’s basic primary health care is provided by the private sector via the puskesmas, with each serving a catchment area at the subdistrict level of about 25,000 to 30,000
people. The country has over 9,500 puskesmas, and each is required to have at least one medical doctor on staff. About a third of all puskesmas also provide inpatient services. Primary care is also provided by private doctors, including 70 percent of doctors at puskesmas who practise privately after hours. “In principle, puskesmas are meant to provide referrals to secondary and tertiary public hospitals, although in practice the gate-keeping and referral functions of puskesmas are not strong. There are no penalties for self-referring to higher facility levels: patients can go directly to secondary/ tertiary hospitals and obtain services without puskesmas referrals,” says Marzoeki. Marzoeki says one of the key supply challenges in Indonesia is the provision of health services in rural and remote areas in a dispersed archipelago of over 17,000 islands. The government is upgrading puskesmas with inpatient facilities, especially in secondary towns and rural locations. The government has allocated funds to expand inpatient facilities specifically for maternal emergency-ready facilities. The Ministry of Health contracts doctors
cOUNTRY report: Indonesia and midwives under the Pegawai Tidak Tetap policy for distribution throughout the country, which offers shorter contracts and higher remuneration for rural and remote postings. Challenges ahead For Amanda Simmonds and Krishna Hort of the University of Melbourne’s Nossal Institute for Global Health, challenges to Indonesia’s universal healthcare system include a fragmented health financing system, decentralisation, demographic transition, high outof-pocket spending and low levels of government spending on health. The country also does poorly in reaching Millennium Development Goal 5 — to reduce maternal health and mortality by three quarters. According to WHO, Indonesia’s total expenditure for healthcare amounts to 2.7 percent of GDP, among the lowest in the world compared with 3.9 percent in India, 4.1 percent in the Philippines and more than 8 percent in South Africa and Brazil. “The need for additional hospitals and health centres is particularly pressing outside of Java and the main urban centres, since many of the newly insured citizens reside in the less industrial regions,” says Muhamad Heikal, Southeast Asia consultant for APCO Worldwide. For Andrea Isabel Co of UOB Kay Hian, bed shortage stands out as a concern as demand continues to rise, along with the scarcity of medical staff. “Boston Consulting Group predicts Indonesia’s middleand upper-income consumers will grow from 74 million in 2013 to 141 million by 2020 (or a 9.6-percent compound annual growth rate), with rising income to fuel demand. However, Indonesia has only nine hospital beds available for every 10,000 people, compared with developed markets’ 29,” she says. Foreign doctors and nurses are also prohibited from employment in Indonesia hospitals. Indonesia has around 2,200 hospitals, approximately 62 percent of which are private. There are an estimated 270,000 hospital beds, implying about 1.1 beds per 1,000 population, much lower than
Krishna Hort
Muhamad Heikal
Puti Marzoeki
the global standard of 3. About 45 percent of beds are at private hospitals. The ownership of tertiary hospitals is mainly public, and the nation has about 376 tertiary hospitals, some of which are centres of excellence, Marzoeki adds. “With the rollout of the new health care system, important questions – including the scope of coverage of the first nationwide insurance scheme, otherwise known as Universal Health Care Coverage/Sistem Jaminan Sosial Nasional (SJSN), as well as the readiness of the infrastructure – remain unclear,” Heikal says. Launched in 2014 during the tenure of President Megawati Sukarnoputri, SJSN was born out of the social upheaval that followed the crippling Asian Financial Crisis of 1997-1999, says Heikal. The Indonesian government passed law No. 40/2004 to create a basic social security net to protect its citizens from economic risk due to illness, injury, old age and death. The law aims to give a sense of security to Indonesians who need no longer worry about their savings depleted and livelihood shattered by a sudden illness. The government also passed a law to establish the Social Security Agency in October 2011, and with that came the development of a roadmap to implement universal health care. Jamkesmas, the health insurance for the poor and the near poor, has also been expanded to reach 76.4 million people. Jamkesmas cardholders, can, in principle, use primary care services at all puskesmas and inpatient services at secondary
and tertiary public hospitals and empanelled private hospitals. Roadmap to universal healthcare Simmonds and Hort say the Road Map toward National Health Insurance – Universal Coverage 20122019 was developed under the aegis of the National Security Council, and represents agreed position of the various ministries involved, including Finance, Health, Labour, Social Welfare and Internal Affairs. The roadmap includes two foundational steps: to create an organising body responsible for the management and implementation of Universal Healthcare Badan Penyenlenggara Jaminan Sosial, to be operational by 1 January 2014; and the establishment of full population coverage with social health insurance by 2019, to be known as INA-Medicare (Jaminan Kesehatan Nasional). With the publication of the roadmap in place, there is an opportunity for a review of the proposed design and implementation, which may prove useful for policy makers and provide lessons for regional policy makers dealing with the same challenges, they add. “Implementation over the coming years will not be easy, and there are likely to be teething problems. However, opportunities for the private sector, increasingly willing and able to play its part, are considerable. With the right engagement and industry alignment, there is a window of opportunity to shape a health care system that is both affordable and competitive,” Heikal says.
Health insurance coverage in Indonesia, 2012
Source: Republic of Indonesia 2012. Road Map toward National Health Insurance, 2012-2019
HEALTHCARE ASIA 27
CASE STUDY: Trigger toolS
NUH accomplished lower unexpected mortality
Trigger finger: Hospitals reduce adverse events
National University Hospital and St. Luke’s Medical Centre set an example.
Y
ou trust you’re in good hands when you are in a hospital for treatment. But what happens when hospitals turn out to be dangerous places due to medical errors, resulting in what people in the medical community call “adverse events” (AEs)? The good news is that top hospitals around the world are taking steps to address the issue. Responding to this concern, the United Statesbased Institute for Healthcare Improvement (IHI) formulated a Global Trigger Tool for Measuring AEs, to effectively measure the overall harm level in any health care organization and improve health care worldwide. Improving health care This tool, which provides health care organizations with a methodology and training information to identify various possible AEs, can help
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The unexpected mortality rates decreased from 11.3% in 2012 to 9.3% the following year.
hospitals identify and reduce events that can cause harm to their patients. At present, the IHI Global Trigger Tool has been adopted and is in wide use by hospitals around the world to evaluate AE rates while taking measures to improve patient safety. Among the hospitals that have adopted Global Trigger Tool Programs— resulting in dramatic success — are the National University Hospital in Singapore (NUH) and St Luke’s Medical Centre-Global City in the Philippines. NUH: Increasing survival rates NUH reviewed delays in appropriate management of deteriorating patients in general wards. It noted a number of problems in treating its general ward patients, including the failure to detect and escalate medical conditions that result in AEs, rather than the lack of response once a crisis has been recognised. There were
delays and failures to treat patients based on hospital audits of cardiac arrest and severe sepsis, among others. Even the hospital’s nursing and junior medical staff said they did not feel their patients were safe, especially outside office hours. They also noted communication gaps between junior doctors and nurses when patients are experiencing various conditions leading to AEs and with no explicit monitoring plan. Because of these issues, key stakeholders in the hospital, comprising clinicians, nursing, allied health and administrative staff, conducted a rapid improvement event in January 2012. NUH adopted a Trigger Program, a simple communication and recognition tool to help first-responder care teams (junior doctor and nurse) identify, evaluate, escalate, and institute management in general ward patients who are potentially unstable. NUH conducted studies related to the project, redefined standard workflow and documentation, organized a training program for its junior nurses and doctors, and even redesigned the colour-coded vital signs chart and also created a clinical pathway for patients having abnormal vital signs. It conducted mass awareness campaigns for the staff and assigned nursing champions and clinicians to evaluate and strengthen the program. A successful pilot program was followed by a hospital wide roll-out to adult inpatient general wards in September 2012. Results later showed that AE rates were reduced from 9.4 per cent in 2012 to 8% in 2013. The unexpected mortality rates decreased from 11.3% in 2012 to 9.3% the following year. The survival rates of all resuscitated patients with pre-crisis triggers jumped from 40% in the fourth quarter of 2011 to 54% in the same period in 2013. There was a jump in trigger rates from an average of three to 16.6 per 1000 deaths and discharges. “The success of the program
CASE STUDY: Trigger toolS is attributed to support from senior management and the initial involvement of all key stakeholders,” says Dr Sandhya Mujumdar, NUH’s Deputy Director of Medical Affairs. “Well-defined roles and responsibilities among the nurses, junior, and senior doctors built rapport, respect for each other, and good teamwork.” “Results show that the program has been effective to a certain extent, and the key to its real success lies in continuously improving and allowing the culture of calling triggers to become pervasive,”she adds. St. Luke’s: Fewer admissions with adverse events St. Luke’s started its Global Trigger Tool program in July 2013 as the hospital’s proactive solution to address the growing challenge that AEs and harms inflict in their institution, with a focus on unreported AEs and harms. “The Global Trigger Tool is a demonstration of our commitment and dedication to learn more from previous adverse events identified and to use the information to prevent these from recurring,” says Dr Alejandro Dizon, St Luke’s Medical Centre chief quality officer. “The Global Trigger Tool presents both a retrospective and preventive method in improving patient safety, where the data gathered is used to initiate proactive and preventive improvement strategies.” St Luke’s created Global Trigger Tool teams composed of nurses, physicians, and pharmacists who were trained by the hospital’s Quality and Patient Safety Group to review and identify triggers to AEs based on patient records. NUH trigger rates per 1000 deaths and discharges
Source: CEIC, HSBC Source: NUH
There was an average of 53 AEs per 100 admissions in the first quarter of 2014, compared with the average of 56 the previous year.
Going retrospective on patient safety
These reviews were then adopted and implemented as part of the hospital’s overall patient care policy to establish preventive and proactive measures for future cases. GTT teams were created from a group of Patient Safety Officers (nurses, pharmacists and physicians) who were trained by the Quality and Patient Safety Group. “The implementation of the Global Trigger Tool was initiated in our hospital as a proactive solution using retrospective information gathered to address the growing challenge that adverse events and harms inflict in our institution, with a focus on unreported adverse events and harms,” Dizon says. A project progression model was created from the data gathered to monitor and analyse patient risk events and reduce medication errors and drug AEs, among others, with the hope that it would transfer to improved clinical outcomes and decrease in AE occurrence. Other activities as part of the program included developing performance improvement team projects related to patient care and medication errors, risk reduction management committee meetings, an internal and anonymous reporting system designed for the recognition and reporting of safety issues or incidents, and an internal competition for International Patient Safety Goals to promote stronger awareness among the staff. The program has resulted in improved clinical outcomes and
a decrease in AEs. In a program evaluation review conducted from Aug 2013 to March 2014, AEs decreased from an average of 140 in 2013 to 97 in the first quarter of 2014. There was an average of 53 AEs per 100 admissions in the first quarter of 2014, compared with the average of 56 the previous year. In 2013, there was an average of 31 per cent of admissions with AEs, whereas in the first quarter of 2014, the average was only 23 per cent. “The Global Trigger Tool ensures patients that their safety and the quality of care they receive are of utmost importance,” says Dizon. Contributing factors, according to St. Luke’s, may be attributed to initial improvements such as the development of performance improvement team projects related to patient care and medical errors; root cause analysis conducted for medical errors; Risk Reduction Management Committee meetings conducted about patient safety incidents, among others. “We want to assure our patients better safety through proactive measures that are developed in relation to the collected data,” he adds. Dizon says that the hospital is committed to putting in place a culture of safety for its patients, who can rest assured that safeguards and improvements are being developed. St Luke’s is the first and only hospital in the Philippines to implement and use the Global Trigger Tool, according to Dizon. HEALTHCARE ASIA 29
OPINION
Sash Mukherjee
Big data in healthcare: Unlocking the hidden potential
T
he recent Ebola scare has revived conversations about epidemic management and the role of Big Data in healthcare. In reality however, investments in Big Data/analytics in Asia/Pacific healthcare is primarily being driven by health economics, as the concept of accountability becomes mainstream, starting with the mature economies. As far as Big Data technology adoption is concerned, the countries in the Asia/Pacific region may be categorized as: • The leaders (Australia, Singapore, New Zealand, and Hong Kong) that have been incorporating business analytics for the longest time, and are now pushing the boundaries of what is possible with Big Data with supporting regulatory environments for handling personal and business data. • The midstream countries (Korea, Taiwan, China, and India) that have a more limited adoption and tend to focus more on the processing of customer and citizen data. • The starters (the remaining countries) where ongoing modernization and build-out of infrastructure is a major gateway to future Big Data/ analytics initiatives. The leaders in the region are focused on healthcare Big Data, with their national eHealth record systems as a good starting point.
“Living within our means” has become the mantra for many district health boards in New Zealand with the rapid growth of healthcare costs and the requirement to produce performance metrics. Concurrently, at the National Institute for Health Innovation symposium on Big Data in Healthcare held in October 2013, there was keen interest in accessing National Health Index (NHI) encrypted and anonymized data for proactive care delivery. Implications for healthcare providers would be to create a shared service model for “Big Data will eventually unlock hidden technology deployment with noninsights to improve clinical outcomes.” competing partners, as the cost of Big Data technologies can be prohibitive. • Consider an interactive and agile development Singapore aims to be an International Big Data approach to manage expectations of business and Analytics hub and to show instances of early users and avoid scope creep. adoption of the technologies. That the country • Take incremental steps when continuing to is serious about utilizing the data gathered by integrate data from multiple sources to move the National Electronic Health Record (NEHR) toward high levels of trust in the information. system, is evident by the health informatics Big Data technology projects will essentially courses offered at the National University of fall into two categories: doing more efficiently Singapore. tasks that have been done for years; and doing Australia’s Public Service Big Data Strategy completely new things that were never before aims to adopt Big Data technologies without possible. Beyond health economics, Big Data will compromising individual privacy. Activity eventually unlock hidden insights to improve based funding and public reporting sites like clinical outcomes, leveraging ever-increasing MyHospitals.com are seeing investments in data sources and optimizing current investments patient administration and clinical analytics. In in data management assets. Healthcare the future, the Department of Health envisages organizations should however be wary of the the design of the personally accessible health definitional confusion and hyperbolic marketing records, MyHR, to include capabilities for in the Big Data market today. detailed analytics of user behaviour. 30 HEALTHCARE ASIA
BY Sash Mukherjee Research Managaer IDC Health Insights, Asia/Pacific
How big are Asia’s big business analytics?
OPINION
David McKeering
Healthcare of the future: are hospitals the only answer for Southeast Asia?
S
outheast Asia is a region of vast social, environmental, economic and political diversity, which has contributed to the disparate health status of the people in the region. The spectrum ranges from established healthcare systems like Singapore, recently ranked by Bloomberg as the most efficient healthcare system in the world, to emerging countries like Laos and Cambodia, where communicable disease are still prominent. Irrespective of economic prosperity or health system maturity, there are two common factors Southeast Asian countries share: an increase in population ageing, and a shift in the disease burden from infectious to chronic diseases causing more people to be sick, more often, and for longer periods of time. This is leading to an increase in demand for hospital services beyond current capacity. Many hospitals are reporting bed occupancy rates of over 85% which international research has shown can have a negative impact on patient safety as it can result in higher rates of patient mortality, hospital acquired infections and post-discharge mortality. In a healthcare system, hospitals are primarily designed for treating acutely sick patients, providing access to a range of diagnostics, specialists and treatment options in a single location. Intended for urgent and acute cases, hospitals are instead treating an influx of nonacute patients that do not require urgent or emergency treatment. These non-acute patients typically require longer, more resource-intensive hospital admissions for conditions that could be managed in other healthcare settings. The traditional response of governments to this increase in demand for hospital services has been to build more hospitals. With minimal health infrastructure to deal with existing demand for acute patients, this may be part of the solution. However, since demand in many circumstances is being driven by non-acute patients, often with long term chronic conditions, continuing reliance on hospitals as the primary mechanism to service the health needs of the population is unsustainable, and in many emerging countries unaffordable. Many developed health systems around the world now recognise the need to shift the way healthcare is delivered to cope with the future health needs of the population. Just as other service industries, such as banking,
telecommunications and retail, have changed their operating models to better engage customers and provide more convenient services, this shift is beginning to happen in healthcare systems around the world. The future improvement and sustainability of health systems throughout Southeast Asia will require a systemic shift away from traditional models towards a more integrated health system tailored for a whole of person approach, considering the social, environmental and economic diversity of the country and at the local community level. Integrated healthcare is an approach that promotes moving more services out of hospitals, providing more home and community care options, developing models of care for the elderly and for patient cohorts with specific chronic conditions, and using more allied health professionals to support patients to stay out of hospital longer, and return home faster. As developed countries retrospectively redesign integration into their established healthcare systems, there is an opportunity for developing countries to design and develop an integrated healthcare network that spreads demand across the healthcare system. As investment in healthcare continues to rise, not only from government but also from the private sector, an integrated healthcare economy will make Southeast Asia an attractive market for providers and new market entrants to deliver accessible, high quality and safe healthcare.
BY David McKeering Healthcare Leader PwC South East Asia Consulting
Healthcare should be within arm’s reach
HEALTHCARE ASIA 31
OPINION
JOSHUA RICHHEIMER
The top five buzzwords in private healthcare
W
ith some of the finest doctors and nurses in the world, and top-class facilities and equipment, Singapore has now become a hub for medical tourism. Below are the five ‘must-know’ healthcare buzzwords to aid in the basic understanding and overview of private healthcare in the city. 1. Healthcare Inflation With private clinics pushing to out-do each other with equipment and skilled people, increases in annual costs are a fact of life in the private healthcare sector. For patients and businesses with private healthcare plans, these inflationary pressures need to be factored into future coverage and budgets. The Singapore Government announced an impressive 6.4% budget increase in public healthcare spending. The private sector, similarly, will be planning for the opportunities and challenges of supplying medical services to local private patients, and an increasing number of medical tourists. As Singapore’s medical tourism grows, so will the demand and, potentially, the price of care. 2. Enhanced Portable Insurance A small number of companies provide Portable Medical Insurance, which allows an employee the right to retain certain benefits when switching employers. This coverage is typically applied through a Portable Medical Benefit Scheme, a Transferable Medical Insurance scheme, or a Shield Plan. A key feature of Portable Insurance is that employees will not be excluded from coverage due to pre-existing conditions. 3. Medical Auditing Businesses need to trust that medical clinics are not overcharging, and that certain clinics are not seen as ‘soft touches’ for medical certificates. Medical auditing and investigation is a way to ensure medical clinics and their parent companies meet measurable standards in terms of affordability and care. Insurance companies and brokers play an important role in monitoring and following up on these audits for businesses. Ideally this helps manage costs and improves the overall patient (and employee) care. An audit also provides a framework for improvements. Independent auditing is a vital part of keeping the health insurance market competitive. 4. Flexible Benefits Regional surveys suggest that employees want
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non-traditional healthcare benefits, such as critical illness coverage and life insurance, but tend to have a lack of understanding when it comes to the healthcare packages provided by their employer. Offering employees the choice of a flexible healthcare scheme is beneficial for both employers and employees, leading to higher employee satisfaction, and ultimately lower staff turnover. 5. Total Medical Journey Overseas, an increasing number of top employers are focusing on their employees’ total medical journey. It includes proactive initiatives such as in-office support (healthy meals provided at work), gym memberships, corporate team building through sport, and different types of healthcare coverage. The health of a company’s employees is one of the few competitive recruitment advantages a business can have outside of remuneration. If a business invests in the long-term health of their employees, including through the promotion of healthy lifestyles, this could lead to a motivated and more loyal workforce.
BY JOSHUA RICHHEIMER Lockton Companies Singapore Head, Business Development
What are the latest trends?