Healthcare Asia 2020

ISSUE NO. 15

The magazine for healthcare administrators and policy makers

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www.healthcareasiamagazine.com

Display to 30 September 2020

ON THE LOOKOUT FOR

CORONA Healthcare Asia

RESEARCHERS FROM THE UNIVERSITY OF HONG KONG LEVERAGED A REMOTE DISEASE SURVEILLANCE PROGRAM TO MONITOR SUSPECTED COVID-19 PATIENTS

HEALTHTECH ON THE RISE IN ASIA PACIFIC INDIA’S UNDERFUNDED HOSPITALS FACE PANDEMIC PRESSURES BEHIND TENCENT’S MED KNOWLEDGE PUSH FOR SENIORS WHAT’S DRIVING TELEHEALTH GROWTH IN CHINA?

www.punhlainghospitals.com

FROM THE EDITOR This issue of Healthcare Asia magazine delves into the rising popularity of healthtech in Asia Pacific.

Though people have better access to a smartphone than to a doctor in most parts of Southeast Asia, less than a quarter of skilled health workers are stationed in rural areas where half of the world’s population reside. Within that context, what will healthtech players need to do to successfully reach out to their market?

PUBLISHER & EDITOR-IN-CHIEF Tim Charlton MANAGING EDITOR Paul Howell PRODUCTION TEAM Clarist Mae Zablan Danielle Mae V. Isaac Janine Ballesteros GRAPHIC ARTIST Simon Engracial II

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ADMINISTRATION ACCOUNTS DEPARTMENT accounts@charltonmediamail.com ADVERTISING advertising@charltonmediamail.com EDITORIAL sbr@charltonmedia.com

We also explore the remote monitoring and disease surveillance programme developed by researchers from the University of Hong Kong to track symptoms of COVID-19 from suspected patients. Originally used for managing heart failure patients, the technology has found new use in these turbulent times, helping medical professionals monitor their patients safely and more accurately.

This issue also features a report on India’s healthcare sector, as well as its struggles in keeping up with the rising number of COVID-19 cases. Read on and learn more about the country’s complex response.

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

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

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CONTENTS

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CEO INTERVIEW NOVI HEALTH BRINGS HOLISTIC APPROACH TO LIFESTYLE-BASED ILLNESSES

FIRST 04 Healthtech assessment programmes suffer lags

HEALTHCARE INSIGHT 16 Doctor’s orders: The rise and rise of Asia’s healthtech industry

08 Hong Kong’s healthcare spending may double to $315b by 2033

08 Singapore digital health startup Gmedes launches delivery app for routine medications

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EVENT COVERAGE TENCENT’S MEDIPEDIA DRAWS TECH-CHALLENGED SENIORS VIA RICH STORYTELLING

OPINION 30 Preventing surgical site infections: Does a one-size-fits-all model work?

06 Travel restrictions spur telehealth in China

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FEATURE PROFILE CHECK OUT HKU’S REMOTE COVID-19 DISEASE SURVEILLANCE PROGRAMME

MARKET REPORT

32 Better healthcare decisions depend on better data collection

20 4 ways to fuel growth for Asia Pacific’s healthcare players

COUNTRY REPORT 24 Are India’s underfunded hospitals equipped to deal with pandemic?

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

To access the stories online, visit the website

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FIRST INDIA URGED TO HIKE HEALTH SPENDING INDIA

Uttar Pradesh

The pandemic has shown the need for India to hike its healthcare spending, which stood at 3.8% of GDP, according to GlobalData.

This is nearly just half of the APAC average healthcare spending of 6.64%, even though the country stands at the top in out-of-pocket expenditure with 62.4%.

India ranked 170 out of 188 countries in domestic general government health expenditure as a percentage of GDP, according to the Global Health Expenditure database 2016 of the World Health Organization (WHO).

The report noted that India’s extended countrywide lockdown until 17 May reflected the country’s dependency on the lockdown to contain the pandemic, with low sample testing and an under-funded and “patchy” public health system posing challenges to the country’s disease containment strategy.

Despite extending its testing facilities, the country still stands at the bottom compared to the rest of the world with respect to testing done, with a testing ratio of 760 subjects per million. India has tested 1,107,233 samples as of 4 May with the first case reported on 30 January.

“The country needs a robust healthcare system and infrastructure to combat outbreaks like this, which can only be done by strengthening the ability of healthcare systems to provide comprehensive care through increase in the health expenditure by government,” said Bhavani Nelavelly, pharma analyst at GlobalData.

However, whilst India has 42,505 confirmed cases, the fatality rate in the country was 3.27% compared to 7.06% worldwide, 5.59% in China, and 5.84 % in the US. GlobalData forecasts 10,177,238 confirmed COVID-19 cases in India in a high transmission risk scenario versus 132,388 in a low transmission risk scenario by 14 May. 4

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Some Asian countries have made efforts to put HTA programmes in place to inform medicine pricing and reimbursement decisions.

Healthtech assessment programmes suffer lags ASIA

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sian countries have been slow to adopt health technology assessments (HTA) in informing medicine pricing and reimbursement decisions, but countries such as Japan, Korea, and China have made relenting efforts to put HTA programmes in place, according to research published in the Value in Health journal.

Amidst the current HTAs of such countries, an analysis of the countries’ HTA performance shows that there is still room to enhance these programmes and address pain points in each of their healthcare systems, said in the research.

Japan had piloted a three-year HTA programme that started in April 2016, which was supervised by the country’s Central Social Insurance Medical Council (Chuikyo).

As part of the pilot programme, seven drugs, including sofosbuvir, daclatasvir, and nivolumab, and six medical devices were selected for cost-effectiveness assessment, and were reported using an incremental cost-effectiveness ratio (ICER).

The Japanese pricing and reimbursement system will make the incorporation of HTA challenging.

Subsequently, Chuikyo employed the ICER to adjust medicine pricing to be based on a quality-adjusted life year (QALY) threshold of 5 million yen for a 10% reduction in health insurance premium, after which the premium will be reduced by up to 90% until the threshold of 10 million yen is reached, said in the report.

Following the end of the pilot programme in April 2019, Japan instituted new HTA processes for ICER-based pricing, targeting new and existing drugs and medical devices of significant budget impact.

From the previous ICER pricing standard, the assessment route was changed into 3-step reductions of premium, by 30%, 60%, and 90% according to 5, 7.5, and 10 million yen per QALY, respectively.

As Japan looks to fully embrace HTA, several challenges lie ahead.

In particular, some unique features present in the Japanese pricing and reimbursement system, such as fixed-fee schedule, will undoubtedly make the incorporation of HTA into existing practices challenging for both the government and manufacturers, noted in the report.

In China, whilst HTA programmes continue to make progress internally, the country still holds room to fully incorporate HTA into the health policy-making process.

The use of HTA is fragmented, and there is currently no single HTA agency operating at the national level that supervises and coordinates all HTA activities, said in the report.

HTA would need to be fully and formally integrated into the existing pricing and reimbursement processes, and such integration would require an official and well recognised authority to regulate and implement its use.

xxx capita Per India slated total to lead expenditure pharma exports on health

Source: Fitch Solutions

FIRST Investors are continuing to look to international opportunities, including to assets that have a large exposure across the region.

The largest healthcare deal in 2019 was the $4.1b acquisition of Australian hospital provider Healthscope.

APAC healthcare deal value dropped 29% to $11.5b in 2019

T JAPAN

he total disclosed healthcare deal value in the Asia Pacific crashed by 29.01% from $16.2b in 2018 to $11.5b in 2019, according to a Bain & Company report. Despite the decline, the figure records the second highest amount since the 2008 financial crisis.

“Compared with prior years, deal activity was dispersed more widely across the region. China faced geopolitical uncertainties and

regulatory reform throughout the year, resulting in what should be a short-term dip in activity. Still, disclosed deal value was over 60% above its five-year average,” said Vikram Kapur, a partner at Bain & Company Singapore.

In 2019, the largest deal is Bermuda-based private equity (PE) firm Brookfield Business Partners’ $4.1b acquisition of Australian hospital provider Healthscope.

In addition, the deal value in Southeast Asia surged from nearly $720m in 2018 to $2.4b in 2019, which is noted to have historically constituted a small share of the APAC region’s total deal value.

Southeast Asia also saw the second-largest deal of the year, which is the $1.2b acquisition of the Southeast Asian assets of Malaysiabased Columbia Asia Hospitals by a consortium of Hong Leong Group and Australia-based TPG. “Investors continued to look across country borders to place capital, including assets that have a large exposure across the region, even if not headquartered in the region,” Kapur further added.

Case in point the report cited Baring Private Equity Asia that made two notable investments with this profile.

The fund acquired US-headquartered HCIT platform CitiusTech for over $1b. Baring Private Equity Asia also bought Lumenis, a medical equipment manufacturer that sells laser equipment for minimally invasive surgery from XIO Group, which is also valued above $1b.

Healthcare provider platforms account for 43% of the 2019 deals as investors continue to focus on consolidating hospitals and labs to execute buy-and-build strategies and develop scaled platforms.

“The private sector has stepped in to build hospital platforms where people lack access to care,” Kapur noted.

THE CHARTIST: ASIA-PACIFIC HEALTHTECH FUNDING PLUNGED 56% TO $703M IN Q1

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sia-Pacific’s healthtech funding Quarterly APAC healthtech deals dropped 56% YoY to $703m across 68 deals in Q1 2020, according to data from Galen Growth Asia.

China was the hardest hit, where funding plunged 78% during the quarter. Meanwhile, deal value in India soared 3.35 times, whilst South Korea and Japan accounted for 41% of all deals by volume, surging 43% YoY. The average deal value for healthtech funding slipped by 31% to $10.6m, no thanks to a global downward trend in valuations. “Unlike the USA, the reality of the pandemic struck Asia in January, which implemented measures earlier and significantly impacted its digital health Sources: Galen Growth funding momentum,” the first quarter report noted.

India records surge in deals

Source: Galen Growth

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PHILIPPINES RAMPS UP HEALTHCARE BUDGET PHILIPPINES

Travel restrictions spur telehealth in China

Per capita total expenditure on health xxx

CHINA

Philippine Health Insurance Corporation

The Philippines finalised its $81b (PHP4.1t) national budget in January 2020, a 12% increase from 2019’s budget, and allocated $3.2b (PHP164.7b) for the health sector.

About half, $1.3b (PHP67.4b), went to the Philippine Health Insurance Corporation, whilst $1.1b (PHP59.6b) went to hospital services, and the remaining $670m and (PHP34.2b) to public health services.

The budget also allocated $150m (PHP7.5b) for the National Immunization Program, $810m (PHP41.1b) for the Health Facilities Operations Program, $370m (PHP19.1b) for the purchase of drugs, medicines, and vaccines for distribution to various government health facilities.

The government also allocated $190m (PHP9.5b) for Human Resources for Health Deployment to hire 744 doctors, 19,700 nurses, 4,538 midwives, 222 dentists, 303 pharmacists, 200 nutritionist dieticians, 601 medical technologists, and 81 physical therapists, as well as $180m (PHP9.4b) for Medical Assistance Program to provide financial assistance to 1 million indigent patients.

According to a note by Fitch Solutions, the country’s Department of Health (DOH), being one of the major recipients of the national budget, will have increased capabilities to build and upgrade medical infrastructure nationwide and address the scarcity of employed health personnel across public health facilities, particularly for those located in hard to reach areas.

Fitch Solutions believes that due to the country’s concerted effort to improve the health and well-being of its population, the Philippines healthcare and pharmaceutical market is set to experience robust growth. With that, healthcare expenditure in the Philippines is expected to grow steadily through to 2029, rising from $17.2b (PHP897.4b) to $60.7b (PHP3.1t).

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hina’s online healthcare has grown explosively as many patients who have been trapped indoors are turning to Internet based options for diagnosis and treatment, according to Bain & Company’s report.

For instance, healthcare services platform Ping An Good Doctor had a nearly 900% MoM increase in new users in January, when the virus spread across China. The number of online users and visits likewise surged at online healthcare community Ding Xiang Yuan and telemedicine platform Chunyu Doctor.

Before the outbreak, the population typically visited physical institutions for their healthcare needs. According to a survey, only 24% had used telemedicine.

However, 97% expressed interest in using digital health services if the costs were covered by an insurance provider or employer. Nearly two-thirds or 64% are also expecting to use telemedicine within the next five years.

“If consumers develop digital habits and a greater willingness to pay for services during the epidemic, that timeline could be significantly shorter,” the report stated.

Bain advised that the digitisation of China’s healthcare system needs to rapidly advance to be able to prepare for future epidemics. In particular, services like electronic records and digital prescriptions, as well as AI and big data, could break down silos between hospitals.

It noted that whilst some technologies like AI-enabled feverdetection devices are being rolled out quickly, other developments such as the widespread adoption of electronic medical records could improve the system’s efficiency and transparency in times of crisis.

“Continuously develop digital capabilities through self-building, partnership or M&A. Use these capabilities to revamp patient and medical personnel experiences,

Online healthcare platforms such as Ding Xiang Yuan saw a surge in online users and visits.

Services like electronic records and digital prescriptions could help to break down the silos between hospitals in China.

while improving organizational transparency and efficiency,” the report noted.

A separate brief from Bain & Company also revealed this pattern across Asia Pacific. Singapore-based telemedicine platform MyDoc recorded a 60% rise in the number of daily active users in February, and more than doubled again in March.

Further, Bain’s research revealed that nearly 50% of patients in Asia Pacific expect to use digital health tools in the next five years. In addition, over nine in 10 or 91% also said they would use digital health services if the costs of using it were covered by an employer or insurance provider.

“What we are seeing is a step change in the acceptance of telemedicine,” said MyDoc co-founder and CEO Snehal Patel. “Having tracked users in this space for over seven years, this sort of rapid adoption is unprecedented.”

Telemedicine has also been receiving further government support since the pandemic, as they viewed it as a tool for containing the spread of the virus. For instance, Australia has extended Medicare coverage for telemedicine and South Korea eased restrictions on telemedicine to treat COVID-19 patients remotely.

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FIRST

Hong Kong’s healthcare spending may double to $315b by 2033 HONG KONG

H

ong Kong’s healthcare spending is estimated to double from $175b to $315b by 2033 on the back of increasing costs for healthcare services and proprietary medicines, which have been observed to be higher than CPI and general inflation, according to Asia Care Group’s (ACG) 2019 Hong Kong Healthcare market report.

The report found that proprietary medicines and supplies presented the most significant change in the past 15 years, with extraordinary increases between 79 and 134% in expenditure on this category of commodity per month, depending on the type of housing individuals reside in.

Meanwhile, ACG observed that spending remains focused on acutecentric models of care, with hospitalbased care accounting for total health expenditure of $9.57b (HK$75.1b), which is more than expenditure on all other categories of spend combined.

“Over a ten-year period, spending increased across all categories of healthcare delivery,” the firm said in a statement. “However, growth in spending on preventative care saw the lowest

increases of just 4.8% in public and 4.3% in private settings. This is problematic given the rise in non-communicable diseases (NCDs) that necessitate sustainable systems to place greater focus on primary care and prevention.

The total number of hospital beds for both public and private facilities is projected to reach nearly 40,000 by year 2026, the report highlighted. At the same time, ACG projects the bed to elderly patient ratio to drop in the coming decade, experiencing a compound annual growth rate (CAGR) of -2.67% between 2019 and 2026, which reflects that the planned increase in bed numbers will be insufficient to cope with the demands of an ageing population unless a new model of care evolves.

The report noted that over a 10-year period, there was a 16% CAGR in deaths attributable to dementia. Amongst those aged 65 and over, over 40% reported themselves as having one or more chronic condition.

“There is an urgent need to evolve new models of care, principally focused on better primary care. We must also find better ways of bridging the public/private

The medicines and supplies sector is experiencing record growth in expenditure

divide, either through public-private partnership (PPP) or, perhaps, through independent price regulation to cool the overheated private sector market,” Thalia Georgiou, managing partner for ACG, said in a statement.

ACG’s analysis estimated that the corporate primary healthcare market in Hong Kong reached $500m (HK$3.9b) in 2017, with the top five clinic chains accounting for 80% of market share by total revenue.

HEALTHCARE WATCH OFFICE WATCH

Singapore digital health startup Gmedes xxxx launches delivery app for routine medications

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ingaporean digital health startup Gmedes launched its clinic app service, G-MEDS, in February. The app enables private and specialist doctors to electronically prescribe, bill, dispense and deliver routine medication from clinics directly to the homes of patients.

The app targets convenience issues of patients and caregivers in obtaining prescription refills within long-term medication treatments.

The delivery service of the app is available from Monday to Saturday, allowing for same or next day delivery.

Via the G-MEDS app, clinics will also gain access to a broad ondemand stock of locally approved medications as well as over-the-

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counter drugs and supplements.

The G-MEDS app is currently available via integration with two of Singapore’s leading clinic management systems, Clinic Assist and Plato.

According to area Gmedes CEO Common Dennis Susay, the app has already helped clinics access a broad stock of 2,500 locally approved medications, over-the-counter drugs and supplements.

Since their launch in 2019, they have allowed several clinics and hospitals to deliver prescriptions directly to patients living in Singapore, Malaysia, and Indonesia in Southeast Asia, as well as the US, the UK, the United Arab Emirates and Sweden Community bar in the rest of the world.

Gmedes’ clinic app service The library

Singapore’s Doctor Anywhere team

Medicine delivery is now an even simpler task.

Pantry

National Hospital Bags the Healthcare Asia Awards 2019 on Its e-UDD Patient Centered Innovation National Hospital Surabaya innovated the first Electronic Unit Daily Na Dose (e-UDD) system in Indonesia. This system was innovated by the hospital incollaboration with Medinfras (PT. Quantum Infra Solusindo). Hospital’s e-UDD system optimises patient medication schedule in order to deliver medication more safely and precisely to patients. The innovation aims to make the delivery of medication to patients in the wards more efficient and more safe utilizing a match barcodes for both medicine and patients. For by u this, National Hospital won the Healthcare Asia Awards 2019 for ICT Initiative of the Year on 23 May 2019 at the Conrad Singapore.

The e-UDD system works by making it easier for nurses and pharmacists to prepare and administer medication to patients.

Firstly, the system allows the pharmacist to prepare each patient's medication on time by seeing their medication schedule. It also allows the pharmacist to know if the medication has already been given by the nurse. On the part of the nurse, they scan two barcodes: one on the medication label and one on the patient. If there's a mismatch, the e-UDD system will issue a warning. the Prof. Hans Wijaya the CEO of National Hospital Surabaya and Hanny Cahyadi the head of the hospital pharmacy during the interview stated, “Our e-UDD system is one of our effort to give a patient-centered approach on our health services. As the first hospital who developed e-UDD in Indonesia, we hope we could become a national pride of health service partner.”

contact us: +6231 2975777 website: www.national-hospital.com

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from left to right: Joanne Tay, Sue-Anne Toh and Kyle Tan 10

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INTERVIEW

NOVI Health brings holistic approach to lifestyle-based illnesses Its team of medical specialists, dietitians, and fitness coaches offers lifestyle interventions.

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ith an increasingly urbanised environment and greater calorie consumption, there has been a rise in lifestyle-related illnesses in the fast developing urban centres of Asia Pacific.

In particular, one in nine Singaporeans have diabetes, according to a government-backed study, which is expected to cause medical expenses and productivity losses of about $1.8b by 2050.

Realising this, three doctors came together to establish medical and digital health provider NOVI Health, with the shared goal of promoting a holistic approach to treating chronic conditions beyond prescribing medications. The business aims to seek ways for patients to better manage, prevent or even reverse lifestyle-related illnesses, such as diabetes and hypertension.

Since launching in March 2019, the company has been able to serve more than 300 clients, and has recorded a retention rate of over 98%. The clients they received in the early phase of their operations largely came from word-ofmouth referrals.

In an exclusive interview with Healthcare Asia, NOVI Health’s founders Joanne Tay, Sue-Anne Toh and Kyle Tan shared about the beginnings of their business, the healthcare situation in Singapore that informed their goals, and their upcoming initiatives to broaden digital access to their offerings.

Can you tell us the story of how you came together and founded NOVI Health?

We started NOVI with the intention to address unmet needs that we saw in the healthcare ecosystem. At NOVI, we do things differently—by integrating clinical treatment and lifestyle interventions with technology for a more personalised, holistic solution.

In our years of serving in Singapore’s public healthcare system, we have seen a steady rise in the number of patients with chronic conditions, such as diabetes and hypertension, coming through our clinics. This was no surprise to us, given that the lifestyle behaviours which increase our risk of these conditions, such as unhealthy diets and sedentary lives, are commonplace in our society.

At the same time, our population is ageing, and the risk of such conditions also increases with age. The concern with these conditions is that if not well managed, they can cause devastating consequences, such as heart attacks, strokes and kidney failure.

We wanted a way to help individuals better manage, prevent or even reverse chronic conditions, so that they could live, feel and look better.

To do this, we believed that two key elements were critical. First, we had to tackle the root cause of chronic disease, not just treat symptoms—this means helping

The founders have a shared goal of promoting a holistic approach to treating chronic conditions.

individuals better understand how their lifestyles influence their own health, and working with them on small sustainable changes to achieve their desired outcomes.

Second, we had to actively harness technology to enhance the effectiveness of care and increase efficiencies, whilst maintaining the human touch and emotional connection with our clients.

Our three co-founders come from different backgrounds—in internal medicine, metabolic conditions and preventative medicine—but our paths crossed when we worked together on healthcare programmes for the population at the regional and national levels. Working at the individual patient level as well as the broader healthcare system level gave us unique perspectives on how to help not just patients who step through our doors, but also how to drive change at scale.

It was this shared experience and belief that led us to found NOVI Health.

This ia a technology-enhanced health solution that seeks to prevent, reverse and treat chronic lifestyle diseases in a manner that is not only tailored to individuals, but can also be scaled up to larger communities.

What are the needs that NOVI Health would like to address for Singapore’s public health system?

We work with a broad spectrum of clients, from those who may be healthy, to those who are at risk of, or are living with, chronic conditions. We focus on lifestyle-associated conditions such as diabetes, hypertension, high cholesterol, fatty liver disease, and obesity.

To help people to better assess their risk of chronic conditions, we provide health screening programmes that not only include evidence-based tests and medical examinations, but also a comprehensive lifestyle assessment. Together, these work to identify opportunities to build healthier behaviours.

For those who are living with chronic conditions or precursor at-risk conditions (such as pre-diabetes), our multidisciplinary team, comprising medical specialists, dietitians, and health and fitness coaches, offers personalised lifestyle interventions, complemented by medications wherever appropriate.

We also have a proprietary mobile application that helps clients to track lifestyle behaviours and understand how the behaviours influence their health. This information helps our team to deliver tailored interventions, based on our assessments of each individual’s unique lifestyle circumstances. Importantly, the app allows us to stay in touch with our clients remotely, so that we can continue to offer advice to them even after they have finished their treatment or stepped out of our clinic.

Our care model is also exemplified in our collaborations HEALTHCARE ASIA

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INTERVIEW NOVI Health is enhancing its digital health offerings and leveraging data analytics to better predict risk patterns and profiles.

Inside NOVI Health’s clinic

with industry partners. For example, NOVI Health has partnered with Thomson Medical Centre to launch the HOPE Program. This program supports pregnant women with gestational diabetes in nutrition and lifestyle management, as well as glucose monitoring. It uniquely combines both in-person teaching and digital health coaching, so that pregnant moms can receive holistic care for their condition, whilst obviating the need for frequent trips to the clinic.

What are the key business milestones for NOVI Health?

We have grown quickly since launching in March 2019. We have served over 300 clients so far, with over 98% retention rate. These clients in the early phase of our operations are largely from word-of-mouth referrals. On top of walk-in clients, we now also have corporate partnerships with organisations, insurers, insurance brokers, employers, other healthcare providers, wellness providers, and medical concierges, all of which will help scale our reach. We will serve more than a thousand clients by the end of this year.

Take, for example, our recent collaboration with Great Eastern Life Insurance. Users of Great Eastern’s GREAT SupremeHealth have access to NOVI Health’s full suite of health and wellness solutions at preferred rates.

Separately, we are looking to expand beyond Singapore to the Southeast Asia market, including Malaysia and Indonesia, over the next two or three years.

How do you overcome the myriad of challenges as the executives and decision makers of Novi Health?

As a small and nimble company, we are able to continually evolve our products and service model in response to the changing needs of the market.

Take COVID-19 for example. The implementation of measures to contain the spread of infection, such as social distancing, has created an even stronger demand for telemedicine services. Our solution already includes a digital health component, wherein we provide remote health coaching and advice to clients through our app.

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In light of the current situation, we have ramped up our offerings to ensure that our clients continue to be able to seamlessly access our services and obtain their medications, without having to physically visit the clinic.

This means having the option of teleconsultations via video/phone calls, remote prescriptions and delivery of medications to their residence.

The health and safety of our clients is always our top priority, and we leverage technology to that end. Flash glucose sensors, for example, enable us to continue monitoring clients’ conditions remotely, and the messaging feature of the app provides our clients with continuous access to our advice and support when needed.

What is Singapore’s status in the global healthcare industry for metabolic diseases?

In Singapore, chronic lifestyle-related diseases, including metabolic diseases such as diabetes, pose a serious health and societal challenge. Factors such as modern lifestyles, an increasingly urbanised environment and greater calorie consumption have given rise to increased obesity, and attendant metabolic dysfunctions in children and adults.

As a result, the prevalence of diabetes has increased; one in nine Singaporeans has diabetes, and the prevalence of pre-diabetes or impaired glucose tolerance (IGT) is even higher. For those in the age group 60 to 69 years, almost one in three adults have diabetes.

These have a costly impact on society. Both medical expenses and productivity losses are expected to cost about US$1.8b by 2050. The shift from healthcare to health— from symptomatic treatment to an integrated and holistic approach—is more efficient in the long run, which can lead to positive outcomes.

There is thus an urgent need to identify and implement effective strategies to detect, treat, manage, and prevent metabolic diseases.

Can you share with us any new initiatives that other healthcare providers can emulate?

Healthcare challenges in Asia and globally, such as an ageing population and increasing prevalence of chronic diseases, provide a burning platform for innovations that can improve outcomes for all patients in a cost-efficient and sustainable manner.

Technologies that can empower people to better understand their health, widen access to care, and optimise outcomes could have a significant impact on changing the course of disease. As scalable tools, digital health interventions have enormous potential to improve health and healthcare delivery for those living with chronic diseases, by improving effectiveness, efficiency, accessibility, and personalisation.

Over time, we are working towards enhancing our digital health offerings and leveraging data analytics and AI to better predict risk patterns and profiles, so that interventions can be even more efficiently and optimally targeted to each individual’s unique genetic make-up and lifestyle. In this context, NOVI Health is well-positioned to be a trusted partner by offering holistic care that integrates clinical, behavioural and digital care.

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FEATURE PROFILE

The Hong Kong Hospital Authority is developing apps to improve the patient experience. The University of Hong Kong has been involved in the research on COVID-19 and the development of technologies to deal with the disease.

Check out HKU’s remote COVID-19 disease surveillance programme The data collected through the programme could be used to identify patterns for facilitating early detection of the disease.

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remote monitoring and disease surveillance programme has been used to manage heart failure patients by monitoring their physiological parameters remotely.

However, researchers from the University of Hong Kong (HKU) found another unexpected use for the device as a means for monitoring patients with diagnosed or suspected novel coronavirus disease, taking away the need for medical staff to regularly see their patients and risk exposing themselves to infection.

HKU Department of Medicine’s MD Prof. David Siu, along with infectious disease expert Dr. Ivan Hung as well as digital therapeutics firm Biofourmis and Harmony Medical Inc., conceptualised the detection and surveillance programme. It makes use of remote monitoring technology and analytics providing clinicians involved in 14

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HKU saw the potential to apply its heart disease monitoring equipment to different situations such as the COVID-19 outbreak.

the COVID-19 programme with clinical decision support to identify any physiological changes that could indicate a deterioration of health as soon as possible, so doctors could make early interventions for better clinical outcomes.

It also makes use of a biosensor, which is worn on the arm by patients quarantined in their homes or clinical settings. This is equipped with several medical-grade sensors, including optical, temperature, electrodermal, accelerometer and barometer, which can derive more than 20 physiological signals from the sensor data, including temperature, heart rate, blood pulse wave, heart rate variability, respiration rate, interbeat interval and others.

These signals are then fed through advanced AI and machine-learning techniques to flag key physiological changes that could indicate disease progression.

This also includes a smartphone app used for collecting qualitative data reported by patients as they respond to AI-generated “smart nuggets.”

Through the clinician-facing web dashboard, treating physicians will be able to observe and be alerted to any significant physiological changes and adverse events, so they can intervene when necessary.

“As you may know I am a cardiologist, and we have already been using the device in managing heart failure patients by monitoring physiological parameters remotely.

However, as these parameters that are used in monitoring heart disease are also applicable to other diseases, HKU saw the potential to apply this device to different situations such as the COVID-19 outbreak,” Siu told Healthcare Asia.

Currently, the programme is being used on patients under quarantine.

FEATURE FEATUREPROFILE PROFILE Reporting can be relayed to the dashboard via roundthe-clock monitoring by the device in hospitals, homes and quarantine facilities.

HKU’s Li Ka Shing Faculty of Medicine

Around 100 subjects will stay in the facility for 14 days, where they will be continuously monitored about their physiological parameters via the device. If they report parameters above the threshold of alert, like a higher temperature than usual, tests will be conducted and samples collected to confirm if they had an infection or other issue.

The patients will be monitored round-the-clock by their research team through a dashboard to trigger the confirmatory tests based on the reported data. As the device is fully automated, there was no need for them to look for additional manpower from the government, with further manpower only required from the university for the recruitment and monitoring of patient subjects.

Siu noted that whilst quarantined patients are currently advised to follow stringent guidelines such as regular temperature taking and reporting of symptoms at certain intervals, this reporting is highly subjective by nature. It requires patients to maintain significant degrees of both selfdiscipline and awareness.

“Not every individual would follow these guidelines, making reporting intermittent at best. Through this programme, reporting can be relayed to the dashboard in near real time via round-the-clock monitoring by the device in hospitals, homes and quarantine facilities,” he said.

Further, with some COVID-19 patients being asymptomatic, they may not be able to report symptoms such as fever. “We believe that no matter

how minor the symptoms a patient may report, there would be some physiological changes in the body that might not be easy to measure and cannot be done at home or in quarantine facilities,” Siu added.

The solution took them only less than two weeks to build. Siu noted that the extremely short time frame made it difficult for them to raise funding from other sources, hence relying on support from existing partners whom they have worked with some time in using the technology to detect and monitor heart failure. They were also able to clinch support from telecom service providers for data transmission via mobile phones and data plans, facilitating the data collection process.

The researchers are still relying on traditional parameters as of yet, but the data collected through the initial stages of the programme could be used to identify patterns through AI and machine learning to facilitate early detection and intervention of the

highly-communicable disease.

“The major outcome [of using AI-based detection technology for suspected COVID-19 patients] would be early detection as this shortens the interval between quarantine and positive detection of the disease. This will increase the proportion of early detection for early intervention, and when used on a large scale, can help reduce community spread by isolating positive cases from the community much earlier,” Siu said.

HKU has been conducting various research to better understand and combat COVID-19. For instance, the State Key Laboratory for Emerging Infectious Diseases of the university has partnered with the Coalition for Epidemic Preparedness Innovations (CEPI) to rapidly develop a vaccine candidate against COVID-19.

The HKU team led by Professor Honglin Chen, along with team members Professor Zhiwei Chen, Chief Innovation Officer Dr. Yiwu He and Professor Kwok-Yung Yuen, is the latest team globally to join CEPI for development of an effective vaccine for the COVID-19 pandemic.

In June, a research team of statisticians led by Professor Guosheng Yin, Head of the Department of Statistics and Actuarial Science, and Dr Bin Liu, a postdoctoral fellow with the university, has integrated radiography and computer vision to develop a digital online diagnostic system for COVID-19 based on chest CT scans.

The diagnostic system can help to screen suspected cases of COVID-19 and evaluate the probability of one contracting the disease.

Two in five North Asian hospitals feel prepared for patient intake

Source: L.E.K. Consulting and GRG Health Survey

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HEALTHCARE INSIGHT: HEALTH TECHNOLOGY

The Asia Pacific healthcare market is expected to grow 19% by 2026, according to data from Hong Kong Trade and Development Council.

Doctor’s orders: The rise and rise of Asia’s healthtech industry With Asia poised to be the world’s largest healthcare market, can specialist health technology help to chip away at entrenched inequalities?

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henever Andy needed to consult a doctor, he used to endure a long and stuffy motorcycle ride through Jakarta’s infamous, traffic-clogged streets. On a good day, it would take him at least an hour to get to his doctor’s appointment from his house in the outskirts of the city.

Now, these difficult rides are a thing of the past—all Andy has to do to get medical advice is to open an app in his smartphone, where he can talk to a doctor in real time.

Andy is just one among thousands of Asian patients who have benefitted from the rise in healthtech. Across Asia, digital technology is changing how patients access healthcare services, with telemedicine emerging as a rapidly growing mode of diagnosis and treatment. As sprawling urban centres become increasingly 16

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congested, telemedicine companies are delivering doctor visits and medication without delay.

“What we have observed is that there are many companies on the healthtech bandwagon today, offering a wide range of personalised patient services,” notes Sejal Mistry, Country Director, ACCESS Health International.

“Thanks to the work some companies have done to personalise patient services, a patient can wake up in the morning and receive a text message reminding them of their doctor appointment or their daily medication intake. If the individual visits the doctor for tests, they can now receive the results via a mobile app before they even make it home, and they can subsequently set up a telehealth appointment to go through the results with their physician in more detail.”

Companies that can harness large and varied datasets will have a leg up in tomorrow’s data-driven economy.

The doctor is online “We’re seeing more companies in Southeast Asia with tools that make it easier for healthcare workers to provide best-in-class care, efficiently.

Companies like Health Catalyst, which just expanded to Asia Pacific last year, bring expertise from some of the most well-known healthcare systems in the US, along with a data operating system that analyses data from across sources, to give hospital administrators and unit heads practical insights and a stepwise approach to improving care and cutting costs. Lifetrack Medical Systems and Alem Health are addressing the radiologist shortage with AI and a global network of radiologists, whilst Biorithm is using IoT to improve maternity care,” Mistry notes.

Figures from the Hong Kong Trade and Development Council

HEALTHCARE INSIGHT: HEALTH TECHNOLOGY show that the Asia Pacific healthcare market is expected to have grown 19% by 2026, reaching a value of $2.2t and making it almost double the size of the healthcare markets in the US and Europe. This will in turn drive growth in a wide range of industries, including traditional healthcare players such as pharmaceuticals and medical devices and non-traditional healthcare partners such as banks, supply chain management and telecommunications.

“Companies that can straddle several sectors and harness large and varied datasets will have a leg up in the tomorrow’s data-driven economy.

In ASEAN, we will see continued demand for technologies that power Big Data integration to consolidate and provide a unified view of very large healthcare databases to drive insights for clinical decision-making, policy-making, as well as to identify cost saving opportunities,” explains Shuchi Joseph, Asia Healthcare Lead at Finn Partners. “Notably, data collected from key sectors—finance, transport, e-commerce—are going to be increasingly integrated with healthcare data to provide important information on individual and societal behaviours that influence health and wellness trends.”

The success of healthtech players depends on how well they can bridge the gap in quality care across the region. A report by Finn Asia reveals that people have better access to a smartphone than to a doctor in most parts of Southeast Asia, with less than a quarter of skilled health workers stationed in rural areas where half of the world’s population reside. In contrast, even the most remote islands in Southeast Asia have internet connectivity.

“Healthtech innovation that streamlines the supply chain of care will play a big part in reducing operating costs whilst improving patient access to healthcare and health expertise,” notes Shuchi.

“What the world has is good medicines. Getting the right medicines and quickly is imperative.

If there’s one thing the COVID-19 crisis has demonstrated, it’s how important speed is to saving lives.”

A sector in the pink of health Amongst the most prominent healthtech startups in the region is Indonesia’s HaloDoc, which provides teleconsultation and pharmaceutical delivery to thousands of patients across the country. At the same time, Chinese healthtech firm Ping An Good Doctor has gone from providing online medical consultations to becoming China’s largest health care platform.

Singaporean firm DocDoc uses AI-powered doctor discovery, telemedicine, and cashless services on a unified platform, to help patients optimise healthcare outcomes and costs in eight countries.

Elsewhere, the Internet of Things (IOT) is enabling easier access to specialist care, including advanced diagnostics and monitoring.

Startups such as Biorithm in Singapore provide a wireless fetal heart rate monitoring device which could be used at home, whilst UELifeSciences—present in India and Malaysia—has two products to detect and diagnose breast cancer and cervical cancer.

The report further noted that digital technologies designed to treat or prevent a specific disorder or disease, namely digital therapeutic technologies, are on the rise, and they have been making health data collection and aggregation easier.

In June 2018, a data centre opened in China’s Guizhou province, and it was the final piece of the puzzle to complete China’s national health data network—an ambitious project combining five data centres across

Clinics observe improved care and reduced overall costs when deploying learning systems to pinpoint health issues in diagnostic settings.

the country, each tasked to collect detailed health profiles for citizens under the centre’s jurisdiction.

With improved digital technology, harvesting health data has been made easier, faster and less expensive for researchers. Researchers have also used computer simulations to test hypotheses about the efficacy of certain interventions, and machine learning and artificial intelligence are moving data-driven health research from simple testing of hypotheses into predictions.

“ASEAN markets have many reasons to be proud of gamechanging ideas.

“Beyond their ability to raise capital, they have the potential to change the face of how patients engage physicians and health products and shift drug discovery to a much more streamlined approach.

ASEAN-based companies like these can have a global impact,” Shuchi tells Healthcare Asia magazine.

Mistry is particularly impressed with the rise of electronic claims systems, which have already been implemented on a national scale in some countries. Electronic claim is a paperless patient claim generated by specialised software that is transmitted to a public/private insurer; or other third parties for payment or reimbursement.

“For example, in 2011, PhilHealth in the Philippines launched the eClaims project as an integrative system for all citizens. The userfriendly service is designed to help patients of all ages fast-track the claims and reimbursement processes,” he notes. “As mundane

Healthtech deals by category in Q1 2020

Sources: Galen Growth AsiaPac Healthtech Investment Landscape

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HEALTHCARE INSIGHT: HEALTH TECHNOLOGY E-claims can be an important starting point for the digitisation of health systems at a national scale.

China-based Ping An Good Doctor came from providing online medical consultations to becoming China’s largest healthcare platform.

as this sounds, e-claims can be an important starting point for the digitisation of health systems at a national scale. The rise of e-claims demonstrates the underlying benefit that technology has provided through the creation, management, and harmonisation of large databases, setting the stage for powerful data analytics and increasingly AI-driven decisionmaking. Following this example, many countries can leverage e-claims as a practical starting point to provide their citizens with meaningful and relevant personal data,” he says.

Bitter pills to swallow The Asian healthtech industry exceeded $6.3b in funding in 2018, making it the second-largest digital health ecosystem in the world, surpassed only by the US. Despite the boom in healthtech funding, Asian startups also have to grapple with a slew of challenges, including inconsistent domestic regulations, concerns about privacy, and lack of technical support.

“The biggest challenge faced by healthtech companies is scalability, often challenged by the hyperlocalisation seen within each market.

Specifically, you have a diverse consumer base with different levels of digital literacy and lifestyles consuming healthcare services in different ways and relying on different models of financing and 18

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reimbursements. In many markets, government schemes and private insurance offerings are not yet set up to cover healthtech services.

“We also observe an absence of regulation updates to reflect and support healthtech trends— innovators run considerable risk of unintentionally violating local regulations when penetrating new markets,” Mistry adds.

To remedy these issues, Mistry notes that companies should direct resources on building a comprehensive information bank on consumer needs in each local market and the regulatory landscape affecting healthcare decisions.

Companies should also seek out dedicated test environments such as regulatory sandboxes, engage regulatory consultants and internal champions, define key success metrics early on, and team up with partners experienced in commercialising successful experiments and proofs of concept.

Singapore, for instance, has launched a regulatory sandbox to better understand new innovative services, including telemedicine.

It has even introduced an online course to guide doctors on designing and delivering telemedicine services that prioritise patient safety and welfare. With the regulatory sandbox, policymakers can review an effective, efficient and appropriate way to support innovation, whilst delivering care that prioritises

patient safety and welfare.

Another key issue is overcoming the human response to new technology deployed within the healthcare system. “Surprisingly, the use of clinical decision-support technology or artificial intelligence to address patients’ needs isn’t the key challenge. Oftentimes, healthcare providers observe improved care and reduced overall costs when deploying learning systems to pinpoint health issues in diagnostic settings,” Shuchi says. “If the users themselves don’t embrace healthtech or understand the value it offers, they are not likely to accept any change. Savvy innovators in ASEAN countries and elsewhere are recognising that invention is not enough. It will take ongoing education and continued technical support to make significant strides in this area,” he adds.

Ensuring privacy and security Safeguarding patient privacy is another obstacle that many healthtech firms face. “One of the biggest stumbling blocks to advanced clinical research and patient care is ensuring individual privacy,” Shuchi says. He explains that for instance, people with serious chronic illnesses are often eager to share personal data with drug developers. “They are hoping for a quid pro quo, that a treatment will be found sooner.

This is understandably a very critical matter to these patients.

That said, there needs to be defined guidelines around this exchange of information. Healthtech companies must take the lead in this conversation and address the needs of the people they seek to mobilise‒people with serious health concerns‒as well as ethical and legal regulations. I cannot stress enough the importance of setting the right environment for change,” he notes.

To address this problem, Finn Asia’s report stresses that national governments should craft robust cybersecurity and privacy laws that evolve with technological advances.

Governments should invest in national digital health metadata and data standards, and ensure that

HEALTHCARE INSIGHT: HEALTH TECHNOLOGY there is sufficient human capital necessary to implement and enforce the relevant regulations.

“The pace of technology is outstripping efforts to maintain security and privacy, making it difficult for regulators to keep up.

Some countries respond with a heavy-handed approach to data sharing. Others, like Singapore, are experimenting in innovative approaches like regulatory sandboxes that help test promising solutions whilst imposing safeguards during this process,” Mistry highlights.

Closing the accessibility gap Despite these challenges, the Asia Pacific remains a bright spot for the development of healthtech. “Asia is the largest healthcare market in the health world outside of the United States, and a region where access to mobile technology and broadband is becoming the standard. Rather than fixating on the challenges, it’s time for the sector to recognise and claim its leadership position,” Shuchi, of

Finn Partners, observes.

Finn Asia’s report confidently predicts that technology will disrupt traditional healthcare service and bring about better and more patient-centric care, much in the same way that digital payments and e-commerce have disrupted the banking and retail industries.

“The good news is the current level of access to goods, entertainment, finance, and online education in small towns and even villages throughout ASEAN is unprecedented. We should look at the penetration of health services in the same way and identify ways to use existing technological infrastructures to our advantage,” Mistry notes.

Telcos and large corporations have identified significant business opportunities, and governments are also realising the social opportunities that arise from these technology trends. Mistry emphasises that countries that invest in national digital infrastructure

There is still a strong need for online-offline capabilities where, core functions of the technology can operate in areas of spotty connectivity or even frequent electricity outages.

will be better positioned to take advantage of the benefits that healthtech companies offer, such as heath apps, telehealth, data aggregation and insights “These innovations will allow health providers to reach remote areas that have been long underserved. Given the significant levels of mobile adoption and the rollout of 4G and 5G across ASEAN, connectivity and broadband are potential game-changers in healthcare delivery in remote areas,” he says. “However, whilst the region has seen tremendous progress in rural connectivity, there is still a strong need for online-offline capabilities where, for example, core functions of the technology can operate in areas of spotty connectivity or even frequent electricity outages.”

“Investors and inventors will be well served to direct their eyes towards the ASEAN region for ideas that will translate into improved and rapid patient care,” Shuchi says.

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MARKET REPORT: ASIA PACIFIC

The use of self-diagnosis apps, long-term illness management tools and electronic records is expected to rise over the next five years.

Four ways to fuel and recharge growth for Asia Pacific’s healthcare players Patients seek out greater ownership of their care, but struggle with the often-siloed nature of healthcare systems

E

xplosive growth combined with changing demographics and shifting consumer expectations will lead to significant transformation for healthcare players in the Asia Pacific, according to a report from Bain & Company.

By 2025, close to half a billion people across the region will be aged 65 or older. As the demand for chronic care management outpaces that for acute care services, expenditures will grow at double the rate of the rest of the world.

With this, consumers are increasingly frustrated by long wait times and high costs. They seek out more convenience, more emphasis on wellness and preventative services, and more control over their healthcare.

Meanwhile, physicians feel ill-equipped to deliver high-quality care given all the changes taking place.

Bain found that healthcare systems across the region needed to undergo transformational change. Consumers 20

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and physicians alike recognise that the status quo is unsustainable. At the same time, the region is the fastest-growing destination for healthcare investment globally.

But Bain & Company expressed that Asia-Pacific countries can improve the quality of care and hold the line on skyrocketing costs whilst doing a better job satisfying consumer and physician expectations. To achieve this, stakeholders are advised to empower consumers to manage their care, transition non-emergency care out of hospitals, increase consumer access to digital tools and platforms, and support physicians with new technologies.

Transforming Asia Pacific’s healthcare landscape To create a framework for transformational change that sticks, the report emphasized the six forces at work in their respective markets.

First, populations across the region

A new type of consumer is emerging, one who is more interested in overall wellness and more informed about conditions and treatment options than before.

are getting older and sicker. By 2025, 460 million individuals will be over 65 years of age. This population will make up approximately 60% of global growth in this age group, compared with approximately 22% from EMEA and 18% from the Americas. At the same time, an estimated 265 million people will be diagnosed with diabetes, and 250 million over the age of 18 are expected to be obese. All these factors will necessitate a shift from acute care services to chronic care management.

Second, costs are rising faster than real wages, with spikes in Australia and Singapore at 3.3 times and 7.8 times, respectively. Across the board, 57% of consumers find out-of-pocket medical bills to be unaffordable, and 42% find private insurance premiums to be out of control. Their concerns are shared by physicians across all countries.

Third, consumers were found to be frustrated with the current state of healthcare. Their top four sources

MARKET REPORT: ASIA PACIFIC of frustration involve wait times and healthcare costs. At the same time, a new type of consumer is emerging, one who is more interested in overall wellness and more informed about conditions and treatment options than before. Consumers’ changing expectations will only intensify their dissatisfaction with their local healthcare systems, Bain noted.

Fourth, Asia-Pacific consumers are fully embracing the digital era, with greater connectivity and digital penetration evident across the region.

For example, mobile wallet penetration is 65% in China and 60% in India, compared with 16% in the US and 12% in the UK. Whilst rates of digital uptake vary by country, data and analytics have already been changing the way healthcare is delivered across the region.

Technological advances also promise to disrupt medicine as we know it.

Personalised medicine could make the traditional notion of “one size fits all” healthcare obsolete, and resources are increasingly being deployed towards research and development.

Fifth, against this backdrop, physicians feel they can’t keep pace.

Fully 87% of respondents believe they need to be aware of a broader range of treatment protocols than five years ago, and 66% find it challenging to keep current on new treatment options.

More alarming, nearly half believe it will be more difficult to deliver high-quality care over the next five years, due to factors such as shortfalls in funding and resources, rising costs, changing patient expectations, perceptions of trust and the cost barriers to adopting new systems and technology.

Sixth, regulators are increasingly playing an active role in addressing access, cost and quality constraints. This trend is evidenced by moves towards universal healthcare in markets such as China, Indonesia and, more recently, India and the Philippines. Many regulators are also recognising that digital solutions will be critical to care delivery, which is shaping policy reform and creating opportunities for greater teamwork and coordination.

“The potential for a crisis in healthcare quality, accessibility and affordability looms large. However, this worst-case scenario is not assured.

Rather, the region is at a crossroads,

where some of the most promising trends can be used to reimagine care delivery in a way that puts consumers at the centre,” the report stated.

Opportunities for healthcare delivery Whilst each country’s specific situation will dictate the best path forward, Bain’s research revealed four universal opportunities that stakeholders can pursue as they look to reinvent their healthcare systems.

First, healthcare providers can empower consumers by providing a single touchpoint for care. Consumers increasingly want greater ownership of their care, but the often-siloed nature of healthcare systems makes this difficult.

Nearly 70% of respondents expressed the desire for a single touchpoint, either physical or virtual, for managing their healthcare. Healthcare players can empower consumers to take charge of their care by providing a single, trusted resource through which to navigate their options.

Second is transitioning care outside of hospital walls. Shifting nonemergency services from hospitals to outpatient settings or alternative delivery models will particularly be key to relieving the burden on overextended hospitals. Roughly half of consumers surveyed would be comfortable receiving services in an outpatient setting, and more than 80% of physicians believe a number of nonemergency services could be offered outside of hospitals. Moreover, physicians are open to shifting some services to digital or virtual platforms, or to relying on assistance from nonphysicians through the use of artificial intelligence (AI), data analytics, or machine learning.

“This shift in delivery will only be successful if consumers and physicians believe the quality of care is equal to or better than that delivered in a hospital.

Stakeholders will need to tread carefully here, weighing the potential for cost savings and improved access against deeply entrenched perceptions within the populations they serve,” the report made clear to readers.

Third is increasing consumer access to digital tools and platforms.

In response to consumers’ desire for anytime, anywhere access to healthcare, stakeholders are urged to invest in

This shift in delivery will only be successful if consumers and physicians believe the quality of care is equal to or better than that delivered in a hospital.

world-class digital tools and online platforms, including telemedicine.

Bain’s survey found that the use of self-diagnosis apps, long-term illness management tools and electronic records is likely to increase significantly over the next five years. Notably, 46% of consumer respondents expect to use telemedicine in the next five years—an increase of 109% over those who are using it today.

Despite the high levels of support for telemedicine, many consumers prefer face-to-face care. With that in mind, stakeholders will need to develop digital and bricks-and-mortar hybrids that integrate online and offline models.

Fourth is supporting physicians with new technologies. Physicians were noted to be cognisant of the growing chasm between consumer needs and their ability to deliver, and they fully expect to increase their use of AI and machine learning in the next five years to bridge the gap. Better clinical decision-making resources and tools are one area where respondents indicated the need for support.

Investing in new technologies and AI could be key to shoring up physicians’ capacity for managing chronic diseases and providing preventative care.

Recommendations Still, every country is advised to develop strategies to address its unique challenges and constraints. Each country is also starting at a different place in terms of consumer and physician satisfaction—which could make change more challenging for some than others.

In Australia, its world-class healthcare system is noted to be at a

Consumers’ preferences for healthcare services

Sources: Bain & Company

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MARKET REPORT: ASIA PACIFIC Single touchpoint preferred for healthcare management

Sources: Bain & Company

crossroads. Significant healthcare cost inflation, a private healthcare system facing a “death spiral” and a public healthcare system feeling the strain of declining government funding and growing patient volumes are leading to an impending crisis that can only be addressed with fundamental reform.

Both private-sector players and federal and state governments are advised to act to achieve the urgent structural change that is required. In particular, the healthcare system is advised to shift from an acute model of care for treating single health episodes to a chronic disease model that focuses on prevention and management. The government could encourage the shift through new policy initiatives focused on lower-cost primary care. There could also be a role for private health insurers to play, provided that reforms expand the scope of coverage beyond ancillary and hospital care.

Government reforms are also urged to clarify the role of the private sector, design the right incentives for private health insurance participation, and address the key causes of unaffordability, including medical device costs and transparency on outof-pocket costs for consumers. This is supported by Bain’s survey findings, which showed that physicians anticipate increased government involvement over the next five years given the scale of reform. Partnerships between private hospitals and health insurers could also identify efficiencies, develop win-win contracting arrangements and help consumers navigate the complex system more effectively.

Further, consumers want a userfriendly electronic platform that 22

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provides a central repository for their wellness and health information.

Australia is found to be lagging in this regard relative to other developed economies, but the government can continue to support the transition to digital health records. Furthermore, it is paramount that healthcare providers continue to equip physicians with new digital tools and technology to improve health outcomes whilst keeping costs in check.

In China, the healthcare landscape is challenged by costs and access to care. Consumers and physicians are well aware of the uneven distribution of resources across different tiers of cities. However, trust has surfaced as a third and significant challenge.

Consumer trust in emerging privatesector providers still meaningfully lags trust in public hospitals, and Chinese consumers increasingly trust digital health platforms over physicians.

As a result, healthcare players are advised to accelerate tiered healthcare and develop a primary care system.

To improve access, the government needs to bolster its efforts to move care outside of Tier 1 and Tier 2 cities and closer to where consumers live.

This can be accelerated by building hub-spoke networks—which could also help close disparities in consumer trust—and developing an infrastructure that supports a stronger primary care system.

Shifting to value-based payments was also recommended. By paying for outcomes rather than for services rendered, the government can elevate the quality of care whilst broadening access and managing affordability.

Diagnosis-related group pilots are

By paying for outcomes rather than for services rendered, governments can elevate the quality of care whilst broadening access and managing affordability.

beginning to emerge, but the system needs a catalyst to make faster headway.

They are further advised to prioritise innovative care delivery models. The future is digital, and healthcare stakeholders—including the government—should be exploring and incentivising online/offline models and AI-enabled diagnostics. Both will be key to alleviating overburdened hospitals and providers, whilst answering consumers’ calls for greater convenience and accessibility.

Lastly, they are told to encourage greater private-sector participation.

The uptake of private-sector providers has been slower than anticipated, as delivery systems learn to coexist in a landscape that has been dominated by public hospitals. The next wave of private-sector investment needs to focus on building asset-lite careprovision formats. The government can support this with innovative reimbursement models, redefined care pathways and the unlocking of medical resources historically “trapped” in public hospitals.

For India’s healthcare system, affordability, access and quality are all pressing needs. The government is attempting to address affordability by extending coverage to 500 million beneficiaries through the Ayushman Bharat national health protection scheme. Improved access, however, faces major bottlenecks at both the infrastructure and the physician levels.

Strong government regulatory action to control pricing is also prompting concerns about quality and cost/ viability issues amongst physicians.

With this, Bain recommended for them to invest in a strong primary care backbone. This will involve the government delivering on the second leg of its promise under Ayushman Bharat, with innovations in health and wellness centres, as well as investing in the private sector.

Bails urges mobilising innovative affordable care models. Survey indicates that the majority of consumers (53%) feel out-of-pocket medical bills are unaffordable. This, coupled with increasing price pressures from payers and increasing regulatory actions by the government, necessitates the creation of newer, affordable models that provide consistent,

MARKET REPORT: ASIA PACIFIC high-quality care. The promotion and adoption of value-based care models by the government in some areas could bolster these efforts.

They are also advised to use technology to empower consumers, improve quality and scale access. India is at the forefront of tech and digital innovation, and numerous healthcarerelated solutions—from teleconsultation to AI for diagnostics and clinical decision-making—are emerging. In fact, two-thirds of consumers expect their physicians to interact with them digitally via smartphone and instant messaging services.

Mainstream private players and the government can be catalysts by adopting an ecosystem approach and working with new players to create integrated omnichannel offerings.

Meanwhile, Indonesia’s hospitalcentric market is found to be struggling to meet both consumer and physician expectations for care. In addition to concerns about high costs and poor quality, respondents indicated that a lack of adequate insurance, insufficient healthcare talent and the absence of high-tech facilities are challenging the system. Change will need to happen rapidly, Bain said. The 2011 launch of BPJS Kesehatan has transformed affordability, but it has also unleashed an increased wave of demand on what is an already straining system.

In light of these challenges, they are advised to shift services to outpatient settings. Seeding a vibrant outpatient system would alleviate the pressure on the overloaded hospital system and improve access to care.

They are also recommended to invest in digital solutions. Digital health solutions can target system pain points with such tools as AI to triage patients, teleconsultations to bring healthcare to geographically dispersed populations and e-bookings to ease wait times.

Further, nurturing a more technologydriven healthcare environment will depend on government policy for digital innovators. The government is moving in a positive direction by passing regulation to enable digital prescriptions from teleconsultations, which has allowed digital platforms such as Halodoc to flourish.

In Singapore, one of the world’s most advanced healthcare markets, the sector

delivers measurably better outcomes at a fraction of the cost of the US. The country’s thriving outpatient ecosystem is triaging care away from hospitals and driving preventative behaviours.

However, healthcare costs are still escalating at a blistering rate of 10% annually, provoking a multipronged government response.

They are advised to concentrate on exploring innovative outpatient models. Developing new provider models, such as ambulatory care centres and home care, could improve efficiencies and put much needed services much closer to consumers.

They can also focus on incubating digital health platforms. Consumers are open to using a digital platform as a single touchpoint to manage care.

These platforms support the growing emphasis on wellness and encourage patient behavioural change to improve outcomes and reduce expenses.

However, regulators will need to strike a balance between supporting “test and learn” innovation and ensuring healthcare start-ups act responsibly, especially in light of data security risks and concerns.

In addition, they are advised to prioritise medicalise private health insurers. Insurers are quickly recognising that profitability pressures can only be alleviated by proactively managing medical costs.

Moving from an actuarial to a medical mindset will enable insurers to truly (and finally) control healthcare spending by managing providers and driving behavioural change amongst insurance policyholders.

In Thailand, there was observed to be a significant disparity in consumer satisfaction between primary and secondary care clinics. Despite consumer preference for secondary care centres, Thailand’s urban areas have a broad network of primary care clinics. Upcountry, district hospitals that serve as a point of primary care and local health centres have negative Net Promoter Scores, a metric Bain uses to measure customer loyalty and satisfaction. Thailand is the only country we surveyed where consumers rated access to care, availability of medical resources and quality of care as their top concerns—a legacy of the 30-baht healthcare scheme that was

Healthcare stakeholders with strategies that are responsive to consumers and physicians will quickly emerge as the front-runners in this dynamic environment.

first initiated in 2001.

To encourage transformation in this market, healthcare players are recommended to introduce more digital tools. Investing in new technology platforms could improve the outlook for patient care whilst closing the gap between rural and urban care. Many hospitals are already on the cutting edge, but the stakes will only increase as time goes on.

Further, they are told to modernise and affiliate with urban primary care centres. Most urban-based centres are unaffiliated clinics run by physicians, with no formal connection to Thailand’s large hospital chains and no clear referral system. If local clinics brand and affiliate with hospital chains, patient referral patterns would shift and patients would move back to those chains and franchises.

They are also recommended to use the increasing affiliation between primary care and pharmacies.

Partnerships and other types of formal connections between pharmacies, beauty clinics and primary care clinics are starting to emerge.

Outlook To stake a lasting claim in this new landscape, healthcare players must adjust rapidly to regulatory changes, advances in technology and medical developments, Bain said.

“The market will not wait for incremental change. The front line is demanding bold, structural transformation now. Healthcare stakeholders with strategies that are responsive to consumers and physicians will quickly emerge as the front-runners in this dynamic.

More consumers plan to avail telehealth services

Sources: Bain & Company

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COUNTRY REPORT: INDIA

The Indian government injected $1.98b in response to COVID-19.

Are India’s underfunded hospitals equipped to deal with a pandemic?

The country is unable to raise healthcare expenditure by more than 3.8% of GDP, compared to the Asia Pacific average of 6.64%

I

ndia has ramped up investments in healthcare in response to the COVID-19 crisis, but analysts have expressed worries that this will not be enough to address the problems faced by the country’s severely overcrowded and underfunded hospitals.

In April, the government injected US$1.98b, with US$1.03b set aside for immediate COVID-19 emergency response and the rest for mediumterm support (1-4 years), according to a press release from the Ministry of Health and Family Welfare. The support includes the development of diagnostics and COVID-19 dedicated treatment facilities, as well as the centralised procurement of essential medical equipment and drugs required for treatment of infected and recovering patients.

This will also include the strengthening and building of 24

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resilience for the national and state health systems to support prevention and preparedness for future disease outbreaks, the setting up of laboratories and bolstering of surveillance activities, bio-security preparedness, pandemic research and proactively engage communities and conduct risk communication initiatives and activities.

With these investments, Fitch Solutions projected the country’s healthcare expenditure to rise by 14.6% in 2020.

This came as no surprise for GlobalData’s pharma analyst Sasmitha Sahu, as the crisis has seen some unprecedented decisions taken swiftly by the government.

“So far, India has managed to keep the COVID-19 curve moderately steep with its key response strategies like early lockdown and isolation measures. With the lockdown further

The healthcare delivery systems in the public sector appear to be insufficient to match up with the growing needs of the population.

extended, concrete funding will help strengthen the Indian healthcare infrastructure to synergistically contain the spread of the pandemic, manage active cases, as well as bolster India’s preparedness to fight any future pandemic,” Sahu said.

However, analysts expressed that despite the additional funding, the budget for the country’s healthcare sector remained too low to deal with the pandemic. According to Fitch Solutions, the continued lack of medical funding and healthcare infrastructure could mean that the potential epidemic can turn for the worse in India if it is not adequately contained. With only 8.5 hospital beds per 10,000 people and 8 physicians per 10,000, its report stated that the country’s healthcare sector is simply not equipped for such a crisis.

“Moreover, the significant inefficiency, dysfunctioning, and

COUNTRY REPORT: INDIA acute shortage of the healthcare delivery systems in the public sector appear to be insufficient to match up with the growing needs of the population,” Fitch Solutions noted.

Further, India’s extension of lockdowns in response to a spike in cases reflected its dependency on such measures to contain the pandemic amidst poor healthcare spending and infrastructure, according to GlobalData. “Lockdown may not be the lasting solution for containing virus spread, as it will flare up again after the lifting of lockdown. Whilst the lockdown helped the government to prepare for adequate measures, the extension of lockdown is said to cause $234.4b economic loss and result in a stagnant GDP for FY 2020,” the data analytics company said.

GlobalData’s pharma analyst Bhavani Nelavelly noted that the pandemic exposed a need for a healthcare system bootstrap in India, as the country is unable to raise healthcare spending by more than 3.8% of GDP, as compared to the APAC average of 6.64%. This is despite the country standing at the top in outof-pocket expenditure with 62.40%.

Further, although India expanded testing facilities, the country still stands at the bottom compared to the rest of the world with respect to testing done, as the testing ratio is 760 subjects per million. India has so far tested 11,07,233 samples as of 4 May, with the first case reported on 30 January. The numbers are expected to rise if the testing sample increases, and unless there is extensive testing, the actual extent of the problem could not be understood.

“As per the current number of confirmed cases, India is not among the worst-hit countries. However, low sample testing, grossly under-funded and patchy public health system pose special challenges for the country’s disease containment strategy,” Nelavelly said.

She noted that even when India has already increased the funds to fight against COVID-19 by granting $1.97b, that is still not enough. “The country needs a robust healthcare system and infrastructure to combat the outbreaks like this, which can only be done by strengthening the ability of healthcare

systems to provide comprehensive care through increase in the health expenditure by government,” Nelavelly added.

Struggling hospitals Whereas the sector faces overcrowding from rising COVID-19 cases, private hospitals have suffered from a plummet in footfall as people at large become reluctant to visit hospitals due to fear of getting infected from other patients, according to a recently released report

by CARE Ratings.

“Elective surgeries are mostly an outcome of OPD [outpatient department] visits and with almost negligible OPD patients, elective surgeries are bound to go down.

Another important segment of revenue was from international patients in the form of medical tourism which has also completely dried up for hospitals with nationwide lockdown,” CARE Ratings senior manager Nitesh Ranjan said.

Inpatient occupancy has also felt the heat, as the Ministry of Health and Family Welfare (MoHFW) issued an advisory on 22 March, to postpone elective and non-essential surgeries and to discourage patients to visit for routine visits to OPD, or utilise OPD services in primary or secondary care facilities, rather than crowding tertiary care centres. Following this, the inpatient segment as well as hospitals have witnessed a significant decline in occupancy.

CARE Ratings estimated there has been a fall in occupancy level in the range of 40-50%, and the average occupancy levels for many corporate hospitals have come down to the range of 30-40%. Hospitals are expected to operate in the range of 30-40% occupancy levels for the first half of FY2021.

“Nonetheless, we may witness an uptick in the occupancy levels by H2FY21, once the lockdown is lifted and the incidence of COVID-19 cases subsides. CARE Ratings believes as a base case the average occupancy level for its portfolio will be around 46.25% during FY21 while the pessimistic and optimistic levels at around 40% and 51% respectively for FY21,” Ranjan said.

Private sector providers are increasingly preparing for very large volumes of patients.

Making healthcare more accessible Even before the pandemic, the government has been attempting to address the affordability of its healthcare system by extending coverage to 500 million beneficiaries through the Ayushman Bharat national health protection scheme in 2018, but improved access faces major bottlenecks at both the infrastructure and the physician levels, according to a report by Bain.

“In likelihood, many of these programs across the world, there is a little bit of learning as we’re going, because we now are providing access to many many people who historically did not have access to care. The government is stepping up to play an important role to provide the safety net of healthcare of the mass population,” Bain Capital’s Vikram Kapur said in an interview.

Further, strong government regulatory action to control pricing is also prompting concerns about quality and cost/viability issues amongst physicians.

With this, Bain recommends for healthcare providers in the country to invest in a strong primary care backbone. This will involve the government delivering on the second leg of its promise under the Ayushman Bharat healthcare policy.

“The market like India where apparently the private sector plays a very active role, private sector providers are starting to think increasingly about faster, more affordable, modern health care by thinking about preparing for very large volumes,” Kapur noted.

Projected healthcare expenditure in India

Source: Fitch Solutions

HEALTHCARE ASIA

25

EVENT COVERAGE: MEDIPEDIA

Internet giant Tencent’s knowledge platform Medipedia has attracted as many as 70 million elderly users.

Tencent’s Medipedia draws tech laggard seniors via rich storytelling Medical content can be viewed in the form of articles, animation, and videos.

S

ince the launch of Medipedia in 2017, the extensive medical knowledge platform developed

by China’s internet giant Tencent Holdings, has attracted elderly users in particular, with a staggering 70 million count.

Such an audience base reflects the present healthcare landscape of China where the country is seeing a rise in the ageing population.

The number one sighted problem of China’s healthcare system is the transition to an ageing society, particularly of working civilians, according to a report by Credit Suisse in 2019.

The report further revealed that primary care in the country, including those for the elderly, is virtually non-existent. Normally, patients go to a general practitioner following the onset of sickness, where they are later on redirected to a specialist for more targeted 26

HEALTHCARE ASIA

treatment. Such first response care does not occur in China, where patients have no choice but to be prompted to a specialist despite having only a mere headache.

In publishing medical information that caters to a holistic journey of prevention, pre-diagnosis, ongoing, and posttreatment, Tencent does not lose sight of the emerging reality in digitisation: that the elderly who need medical assistance the most are also the most technologychallenged population segment.

In addressing such concerns, Medipedia turned to a combination of science and the arts to water down complex knowledge and transform it to various forms of media, such as articles, animations and videos.

“We make the elders feel at ease to use our product. First, we simplify the medical content, and

Medipedia merges science with the arts to explain scientific knowledge through creative and engaging multimedia content.

borrow from the visual arts to make the information easy to understand.

We merge science with the arts to ensure that we are able to explain scientific knowledge through creative and engaging multimedia content. For a disease that can be explained by a graph or a picture, it’s important to know how to paint and tell a story,” said Zhang Meng, vice president of Tencent Medical, in a pre-interview at the Medical Enlightenment Summit on 4 November 2019.

Medipedia serves as Tencent’s answer to WebMD and Mayo.

The platform stands as a solution to what the company sees as a scarcity of a comprehensive medical database that is not just trustworthy, but also readily available to anyone, according to Meng.

Although Medipedia builds on references like WebMD, Tencent ensured that it creates a knowledge

EVENT COVERAGE: MEDIPEDIA AI technology is utilised to test the readability of the health information put out.

Medipedia launched a section in February focussing on the prevention, detection, diagnosis and treatment of the coronavirus.

structure unique only to the company’s vision.

“I don’t think there’s any similar product that organises medical content like we do, from the pretreatment, to ongoing, until posttreatment. Based on the patient’s online browsing history in the platform, they will be presented with the most asked and relevant information. Aside from that, you can also browse the platform’s multimedia content, as well as our Q&A section that will give you more tailored answers. You will also be able to access our live broadcast from our KOLs.” “To give an example of the depth of the level of writings in our content, whenever you search for example, small cell lung cancer, you’ll find 600 articles covering from the symptoms to the general treatment guidelines. You will also be able to access a more tailored content, if for example, cancer has metastasised, and you’re already in the phase II of the cancer, you’ll know what kind of treatments are available to you, and the NCCN and Chinese ASCO guidelines corresponding to the treatment.

You’ll get a sense of where the overseas content will be and get a tailored version for the Chinese situation,” Meng said.

Amidst the pandemic, Medipedia has also been offering resources on

the disease, including information about the virus and its effects on the human body, video instructions on how to wash hands, sterilise and use masks to protect oneself from it, and looking after one’s mental health whilst stuck in a quarantine.

“In the “COVID-19 Epidemic” section, users can learn more about COVID-19, including its prevention, detection, diagnosis and treatment, through various formats such as articles, videos and live streamings. Where there are any rumour circulating about the epidemic spreads widely, medical experts are invited to refute the rumour at the earliest possible time to help users discern accurate information,” the company said in a news release.

In addition, Medipedia introduced a self-screening tool that provides guidance for users with symptoms that the virus could cause by relying on AI technologies. Its “Volunteer Medical Consultation” section brings together more than 10,000 doctors from all over the country to provide users with remote consultation services relevant to COVID-19.

As contradictory as it sounds, a tech giant like Tencent still believes that human intellect is its best instrument in ensuring that whatever medical knowledge they publish, it is accurate and reliable

to the brim. In collating medical content, AI is leveraged, but medical editors share the brunt of content development.

“We use AI to select the topic of articles, to tell us what article is needed. AI technology is also utilised to test the readability of the information we put out, and once that is verified, we give it back to the medical editors and pinpoint the areas for improvement and revision.

It is then that our medical editors communicate with the doctors and get into the finer details of editing.”

When asked about Tencent Medical’s future plans, Meng said that they are determined to further enhance the present technology Medipedia has. It may go as far as adding on-site doctor messaging alongside knowledge sharing, but as a medical encyclopedia platform, it will focus first and foremost on its product baseline.

“At this stage, we are not capable yet to enable a feature that will link patients to a doctor, once a more personal medical question arises.

It’s hard to match those needs at this current point. Our goal is to satisfy one need first and then move on with exploring the other. It’s complicated, because you’d have to be able to make sure first that the doctor you’ll be connecting with is actually the right expertise in that medical area you wish to know about. We can do the math but it’s not in place yet. We want to make sure that, that type of user experience is relevant and trustworthy,” noted Meng.

Size of the Chinese Healthcare service industry

Sources: Credit Suisse

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29

OPINION

ESTHER SAGUIL

Preventing surgical site infections: Does a one-size-fits-all model work?

A

s the second-most commonly reported healthcare acquired infection (HAI), surgical site infections (SSIs) are a significant cause of negative outcomes, with the incidence in low- and middle-income countries reported at more than 10%.

In recent years, global efforts in preventing SSIs have intensified due to a better understanding of its impact on the mental and physical health of patients and their families, and the staggering financial burden they place on the healthcare system.

It should also be noted that one of the goals of SSI prevention is ultimately the avoidance of unnecessary or inappropriate antimicrobial usage, which directly contributes to the rise of antimicrobial resistance worldwide.

Asia Pacific is of particular interest to health policy makers.

Whilst it only comprises one third of the world’s land area, it is home to 60% of the global population. Mortality rates attributable to SSIs can reach up to 46% in the region’s lowincome countries and cost healthcare systems millions of dollars each year. Yet, sadly, it has been demonstrated that up to 55% of SSIs are preventable.

As healthcare providers, we aspire to deliver the best possible patient outcomes in a system that is under increased demand from a growing population, beset with the burden of chronic diseases and financial pressures from rising costs. These pose a unique challenge to the healthcare sector‒the need to develop and implement strategies that will promote SSI prevention, improve surgical outcomes and consequently reduce the economic burden to the healthcare system.

How do we do this?

In 2016, the World Health Organisation (WHO) published the Global Guidelines on SSI Prevention, which further highlighted the urgency of the problem and the need to address it through evidence-based approaches. These strategies, deployed as a bundled approach, aimed to simplify the processes through which SSI prevention could be targeted.

To illustrate, simple adherence to the “5 Moments for Hand Hygiene” in a large government hospital resulted in a 20% reduction in SSIs. Likewise, the use of Plus Antibacterial Sutures during the surgical procedure, the only triclosan-coated sutures made available by Ethicon globally, reduces infections by 28%.

Yet, as discussed at the recent Care+ APAC Masters SSI Prevention Symposium, it is also important for countries to consider the healthcare dynamics caused by cultural, economic and operational factors and resources available locally.

Understanding what can realistically be implemented helps shape country and hospital guidelines and provides a greater chance of engagement in implementation and compliance, ultimately 30

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ESTHER SAGUIL President Philippine Surgical Infection Society

resulting in better outcomes.

A case in point is the Philippines, which has been deeply committed to advancing its healthcare standards. In 2017, the Philippine College of Surgeons, alongside the Philippine Hospital Infection Control Society, Philippine Hospital Infection Control Nurses Association and Operating Room Nurses Association of the Philippines, spearheaded the development of consensus recommendations to manage and prevent SSIs. This had similarly been done in other countries like Japan, China, and Thailand, where SSI prevention guidelines were developed specific to their healthcare systems.

The participating panel of Filipino experts provided insight into how the global guidelines can be adapted to suit the Philippine context and was able to come up with consensus recommendations deemed attainable by most healthcare institutions in the country.

This was the first time ever that solid steps were taken to develop national standards in SSI prevention. These recommendations were envisioned to provide surgeons and other healthcare professionals with a benchmark to standardise SSI prevention practices and eventually lower incidence.

A key component of the bundled approach is the measure of its implementation and outcomes through a surveillance system. This is a critical step in SSI prevention and requires the compilation of accurate data that will be used to determine subsequent courses of action.

SSI surveillance is an aspect where there is much room for improvement. Manpower shortage in health systems is often cited as a barrier to effective surveillance. However, the use of technology presents opportunities to perform surveillance remotely or do so in a more efficient manner by harnessing the cooperation of all stakeholders. In the Philippines where text messaging and social media is highly utilised, patients are also empowered to play a role. In fact, they appreciate being part of the surveillance process and are willing to contribute to the success of the healthcare team.

Whilst global guidelines have been crafted with all countries and economies in mind, it is crucial to understand that a onesize-fits-all approach to SSI prevention may not always work for different markets. There are characteristics unique to each institution and culture that need to be understood and respected.

We should continue to learn from each other, share best practices, adapt to local circumstances, and gather feedback through surveillance in order to come up with meaningful data that will form the basis of preventive measures. Notwithstanding this, SSI prevention also needs champions, with the vision of a time where no patient will ever have to worry about infection after surgery.

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31

OPINION

MABEL C. CHOU

Better healthcare decisions depend on better data collection

T

he huge advances seen in healthcare over the past 50 years are amongst the greatest achievements of modern science. As a result, we are living longer than ever.

The downside to this is that whilst the average age of populations is growing older, chronic diseases are becoming more common and the medical needs of individuals are becoming increasingly complex. As a result, demand for healthcare and pressure on healthcare budgets is becoming ever more burdensome.

As healthcare costs mount, Singapore’s Prime Minister Lee Hsien Loong warned recently that “hard choices will need to be made” on where to spend and which drugs and procedures are considered the most cost-effective.

Adding to the challenge is that public expectations over healthcare are constantly growing, fuelling a culture of “more is better”. Patients expect that the latest medical treatments will be immediately available to them, and many doctors say they are often pressured to prescribe medicines, tests or procedures that patients do not need.

Especially in advanced economies, a significant and growing drain on health budgets is overtreatment and overconsumption of healthcare.

Studies have shown this approach can also cause actual harm to patients, leading to mistakes, injuries and contributing to an estimated 30,000 deaths annually.

How then can we continue to provide comprehensive healthcare yet also ensure that optimum choices are made that both maximise benefit to the patient and avoid unnecessary pressure on health budgets?

In medical decision-making, when so many uncertainties are involved, it is important to determine the optimal time for doctors to begin medical treatment.

In my work at NUS Business School, a major focus of my research is how analytical models used in business operations can be applied to healthcare decisions. In one recent study looking at chronic disease progression, we developed a framework related to a mathematical model known as a Markov Decision Process and then applied it to the different stages of a disease.

Markov Processes, named after 19th century Russian mathematician Andrey Markov, are often used to model resource optimisation decisions in situations where businesses and industries are faced with a range of random inputs and outcomes. For example, they can help businesses manage customer flow or hospitals to optimise patient scheduling decisions.

By taking elements of this process framework, our model of treatment decision-making takes into account the random factors influencing the progression of chronic diseases between different stages and levels of impact.

Intuitively, many patients suffering from chronic diseases will want to begin treatment as early as possible after diagnosis, seeing this as offering their best chance. Being told to hold off and simply “monitor the disease” often leaves patients frustrated, feeling that they are being denied treatment or even that, for some reason, the doctor does not want to help them.

32

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MABEL C. CHOU Director for Life Sciences National University of Singapore

Our model, however, provides a mathematical rationale for holding back until a more optimal time as a better course of action.

One reason for this is that starting medical treatment too early, when the patient is in a relatively good health state, could result in unnecessary suffering and lower quality of life. Many treatments, such as chemotherapy for certain types of cancer for example, can be highly effective in combatting the disease but can also have severe effects on the patient’s quality of life because of the inherent toxicity of the powerful drugs involved.

On the other hand, there is the risk that delaying treatment until the patient is in a worse health state may lessen the treatment’s effectiveness or even rule it out having any impact at all.

The key therefore is to find the best treatment time that delivers an acceptable trade-off between quality of life and prolonging survival.

Given the right data, our model enables doctors to map out the likely progression of the patient’s illness from within any given stage of the disease, providing simple guidelines on when starting treatment will deliver the best outcome for the patient.

Perhaps most importantly, the model also enables them to present this decision to the patient as a course of action that delivers maximum benefit to them.

Whilst there is more work to be done to refine the model for specific diseases, it shows the exciting potential that analytical modelling commonly used in non-medical industry situations could bring to making better healthcare decisions.

The crucial factor, however, is the quality of data.

Yet currently, in many cases gathering of medical data is patchy at best and frequently fails to provide a comprehensive picture. Patients switch between GPs, consultants and specialists, and whilst data is routinely captured in each instance, it often ends up recorded in different formats, lacks consistency, and is stored across different unconnected systems.

As demands on healthcare grow and patient needs become more complex, this outdated and even haphazard approach to gathering medical data will be one of the main issues hampering efforts to control ballooning health costs.

An emerging solution to this might be found in the fast-developing technology of blockchain. Through its decentralised structure, blockchain offers the potential for sharing medical information with vastly-improved data availability, integrity and interoperability, whilst also preserving patient security and privacy.

Recognising the potential opportunities some initiatives are already exploring this technology as a basis for new health information exchanges. Yet for the full benefits to be realised, such models will need to be adopted at scale, requiring governments to take the lead.

Our model shows that, with the right data, optimal decisions on medical treatment can be made swiftly and relatively simply bringing transformative effects on healthcare. But to be truly effective, new approaches to organising the comprehensive and standardised collection of patient health data will be essential.

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PARALYSIS

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