Strengthening Health Systems in ASEAN Through Digital Technologies

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Strengthening Health Systems in ASEAN Through Digital Technologies
Ngiam Kee Yuan, MD
Associate Professor National University Health System, Singapore
28 Dec 2020
Digital Transformation, Health, Health and COVID-19

Healthcare is a significant cornerstone of every political system in the world. This is even more so in the post-pandemic world, where tectonic shifts in the way medicine is transacted have altered the dynamics between healthcare providers and patients. The pandemic has exposed opportunities for the quality of healthcare delivery to be improved dramatically, propelled by digital innovations such as artificial intelligence (AI) and automation, and the acceptance of new modes of healthcare delivery.

Due to movement and travel restrictions during the pandemic, telemedicine has become the primary means through which people gain access to outpatient healthcare services. With the increasing penetration of smartphones to rural communities, isolated communities now have more 1teleconsultation services made available to them.  This is only possible because of the increased demand for such services, which resulted in a corresponding improvement in the quality of such services and an increase in the number of such providers.

Teleconsultations open yet another avenue to automate healthcare delivery through the use of apps and chatbots. Mobile apps can  provide services to users, much like online merchants but for healthcare services such as teleconsultations, medication refills, and health products delivery.

Apps also offer a portal through which future AI services such as teledermatology and teleophthalmology can be delivered. These novel technologies may completely disrupt the way high demand specialist screening services such as diabetic eye screening is delivered, reducing the long wait-time and high costs associated with them.

Some apps now offer preventative health services with attractive incentives to encourage users to adopt a healthier lifestyle. Through a combination of gamification and rewards, these apps encourage lifestyle modifications to prevent the onset of chronic diseases, which is a major burden in both developing and developed countries. The same strategy is also employed to help patients who have been discharged from the hospital to manage their health at home, in the hope of bringing healthcare from the hospital to the community.

Given the accessibility to these digital applications, there are now as many as 325,000 health-related apps in the various app stores. This presents a dilemma to the consumer, as the reliability and ease of use of these apps are highly variable. Furthermore, these apps are not typically integrated with public healthcare systems due to high barriers of entry, internet separation, and complex health financing models. Healthcare apps would likely  go through a period of consolidation before an integrated app that addresses these issues would emerge as the dominant solution.

A special class of mobile apps, termed chatbots, is set to transform healthcare delivery using familiar messaging interfaces. Present chatbots have limited functionality and are largely Q&A bots that are subsidiary to current websites or apps. However, as this technology matures, more services or “skills” may be made available to users. For example, chatbots with AI conversational capabilities may replace most call centres and other service functions such as payments.

The messaging nature of chatbots is a familiar interface, given the popularity of messaging apps, and this facilitates access to multiple services without the need to navigate through menus. A well-designed AI conversational engine in a chatbot would allow healthcare institutions to scale-up their scope of services beyond institutional services to wellness coaching, patient education, and even patient counselling . 

This level of service provision and integration requires  healthcare institutions to invest in scalable IT architecture. For healthcare systems that have yet to migrate to electronic health record  systems or are in the initial stages of doing so, it is vitally important to consider hosting such services on a hybrid cloud architecture. This would allow for both rapid scalability and cutting edge capabilities at the lowest possible cost.

The decision to adopt cloud-based infrastructure is a revolutionary step, especially for some countries in Southeast Asia, where the digital infrastructure is more developed than healthcare IT systems. It presents a once-in-a-lifetime opportunity to leapfrog expensive incremental generations of technology by leveraging on ubiquitous cloud technologies that  many can access. As an illustration of such a technological  leap, Mongolia never built extensive telephone land-lines throughout its vast territory because they installed cell phone towers instead, which instantly provided widespread coverage to its largely nomadic population.

Similarly, when ASEAN countries contemplate improving their healthcare IT systems, they too can benefit immediately from adopting cloud-based technologies from the outset. This would save millions of dollars in the cost of implementing incremental IT technologies and open the door to AI technologies that can be easily integrated into cloud-based  systems. It would also empower engineers to actively build AI tools that would improve medical services, benefit doctors, and patients.

Some barriers to adopting this infrastructure are the lack of appreciation of the capabilities of cloud-based systems and the lack of confidence in the security of these platforms. Commercial cloud platforms are inherently more secure than most on-premise datacentres as multiple sites throughout the world monitor them. They are also more reliable due to the large number of datacentres they run, which achieves economies of scale and translates to lower costs compared to on-premise datacentres. Most healthcare IT systems are running on a “hybrid cloud” architecture, combining on-premise cloud servers and commercial cloud systems. The on-premise cloud servers provide independence to run critical services required by healthcare institutions, while the commercial cloud systems offer flexibility and lower costs. 

Government leaders need to familiarise themselves with the benefits and risks of implementing hybrid cloud systems for healthcare and design policies that promote its use. More importantly, if these policies provide data privacy and personal data protection from the outset, it would go a long way to reducing the cost and friction of transacting healthcare services. It would also catalyse research and development of new AI technologies that require large amounts of data to achieve highly accurate models.

The future of medicine would be dominated by digital technologies that improve the delivery of healthcare to patients. In the post-pandemic world, consumers would demand digital healthcare services that are more accessible, of better quality, and at a lower cost. This could be achieved through policy changes that promote the adoption of AI technologies on cloud infrastructure to deliver better healthcare services on mobile devices.