Imagine being able to predict the likelihood of a stroke or a heart attack with a wearable device. Imagine having access to artificial intelligence that can analyse your health needs and customise a plan to manage anything from your diet to symptoms. This is the future of healthcare – are we ready for it?
Tan Sri Dr Abu Bakar Suleiman, Chairman, IMU Group, Prof Zaharin Yusoff, Data Science Specialist, IMU, and Dr Raymond Choy, co-founder and CEO of Doc2Us share their insights.
Digital health seems like a complex concept but in truth we have all been exposed to it in many different ways.
“Much of our lives have already been digitised, and this will grow faster and faster in the future,” Dr Abu Bakar IMU Group said.
The recent experience in Malaysia with the MySejahtera app is an example of how technology has been used to help streamline the health sector.
The MySejahtera app provided an avenue for information sharing—from both the authorities and the public—where the government could post updates and latest news while people could input data regarding their health and vaccination status as well as check-ins for contact tracing.
According to Dr Abu Bakar, the app is now being developed into a format that will allow people to continue using it as part of their personal health record and possibly as part of their personal health plan in the future.
“But digital health is not a new concept,” he said.
Digital health has long been touted as the way forward.
In 1996, when Malaysia’s Multimedia Super Corridor was established, the government rolled out a national project to develop telehealth.
A year later, the Telemedicine Blueprint was produced. In that blueprint, eight health service goals were identified.
Among other things, the goals included the provision of accurate and timely information and the promotion of knowledge to enable a person to make informed health decisions; to empower and enable individuals and families to manage health through knowledge and skills transfer; and to provide services into rural and metropolitan homes, health settings and community centres.
“Many of the eight goals have been implemented through MySejahtera and other tools during the pandemic,” Dr Abu Bakar said.
In 1998, there was also an initiative to establish health ICT systems in hospitals and clinics, and this was implemented in the Selayang and Putrajaya Hospitals, enabling them to become paperless and filmless.
Today, the government is looking at implementing Electronic Medical Records (EMR) in all government hospitals and clinics around the country.
This is important as EMRs will allow us to build lifetime health records (LHR) which is essential to the lifetime health plan (LHP).
The LHP is one of the three pilot initiatives of the Telemedicine Blueprint (see sidebar for more on the blueprint’s pilot initiatives).
Why digital health?
Digital health together with artificial intelligence can help the health sector to develop in four important areas. Firstly, it will allow healthcare to be predictive, i.e. the ability to predict what’s going to happen tomorrow in terms of health—such as pandemics—through the development of prediction models.
Secondly, it will be preventive, where predictions can help us to prevent issues even before it becomes a problem.
“This is where identifying and managing risk factors are going to be very important,” Dr Abu Bakar said.
Dr Abu Bakar gives an example of an artificial intelligence system that was implemented in the intensive care unit at Singapore’s Mount Elizabeth Novena Hospital in 2017.
The nurses in the hospital reportedly found the system very useful because it helped to predict which patients were more likely to have problems and therefore what mitigating actions needed to be put in place.
Thirdly, healthcare will be personalised.
“This is where lifetime health plans come into play and the ultimate goal would be where we are even subconsciously educated about health conditions that are relevant to us,” IMU’s Data Science Specialist, Prof Zaharin Yusoff said.
This means that custom-curated information that targets a person’s individual needs can be pushed to individuals, effectively taking away the challenge of filtering the tremendous amount of information available to us.
He explains that this is crucial to empower people to manage their own health and which leads us to the fourth area of participation. This is already evident in our everyday lives where people are using available tools at home—such as wearable devices and oximeters—to manage theirs and their family’s health.
While this may sound like scenarios that have become attainable only with the latest technology, digital health really has roots in the simplest innovative actions.
In the 1970s and 80s, Dr Abu Bakar was already treating patients on remote dialysis at home. Dialysis machines were provided to patients who were trained to use the machines on their own.
Patients were then monitored through call centres specifically set up for self haemodialysis and ambulatory peritoneal dialysis. “We monitored and managed the patients using merely the telephone from our call centres,” he said.
From the first patient in Sibu, and a second from Kota Kinabalu, Dr Abu Bakar eventually had over 400 patients from all over the country.
By the mid-90s, as technology evolved, dialysis centres such as one in Adelaide were remotely monitoring patients through computers.
In 1993, a small remote hospital in Sarawak started taking digital photos of X-rays which were then emailed over to a radiologist at the main hospital in Kuching for analysis. This saved patients the long journey to the capital city and made doctor visits more accessible to those who could not travel so far. “I was really impressed because it was very helpful to the patient,” Dr Abu Bakar said.
Today this has evolved to tele-imaging X-ray machines which produce digital images that can be sent to a radiologist anywhere, or even analysed by artificial intelligence tools that can help in the interpretation of the images.
It was also around the same time when a consultant physician at the Kuching General Hospital was monitoring his patients in an intensive care unit through a computer at home. This enabled the consultant to give advice in real time even before getting to the hospital.
In other countries such as the US and Australia, teledermatology and telepsychiatry were also in place in the mid-90s, where psychiatrists could be in Melbourne, but were delivering services for psychiatric patients in the small towns in the state of Victoria.
“It was very effective,” Dr Abu Bakar said.
Ready or not
Malaysians though have yet to see full and widespread telemedicine initiatives available to us.
According to Dr Choy, Co-founder and CEO of Doc2Us, the challenges of implementing a technologically advanced healthcare system lies in the readiness of the ecosystem, made up of the five P’s, i.e. patient, provider, policymaker, payer and platform.
One of the main challenges is patients’ acceptance and readiness towards digital health solutions.
The public still sees healthcare as a face-to-face service, and this mindset makes it difficult to convert them to using virtual platforms.
“There is scepticism and sometimes they don’t see the value of the consultation online,” Dr Choy said.
The public’s wariness in sharing personal data also hampers the growth of digital health, especially the growth of artificial intelligence.
“We collect headless data which is not connected to IC numbers and not attributed to individuals, so it is very safe as no one knows who the medical conditions belong to,” Prof Zaharin said.
Healthcare providers on the other hand are also grappling with teleconsultations. Dr Choy explains that today’s doctors were taught in the conventional way, saying that students did not learn about digital health, how to use electronic medical records, or how to consult remotely.
“What we were taught were bedside manners, how to pick up cues from the patient face-to-face,” Dr Choy said.
To support this technological drive forward, policymakers also have to be open to constant updates and evolutions.
Questions that need to be asked include whether our policies are open to accept digital health innovations as well as whether the policies are relevant to today’s and tomorrow’s digital health solutions.
Prof Zaharin also adds that current diagnostic systems are only used to support doctors and are not readily accessible by the public because of legal and liability issues. For example, if the system misdiagnoses a patient, the legal landscape doesn’t cover any malpractice lawsuits that a patient might want to file.
“The legal landscape must catch up,” Prof Zaharin said.
There is also the readiness of payers (the people who pay for healthcare) which are the government, insurers, employers and patients themselves.
Payers need to have the proper procedures in place to assess payments for virtual consultations, which lies in them seeing the value of digital health.
The last hurdle is that of the readiness of platforms.
This includes infrastructural support such as a stable and wide-reaching internet network as well as security and safety.
Things are moving forward though especially with the pandemic acting as a catalyst to push the existing digital health agenda forwards. In the US, during the pandemic, 74 percent of doctor visits were virtual. While this dropped down to around 46 percent after the pandemic, it is still much higher than pre-pandemic levels.
What will healthcare look like as digital initiatives become more and more a part of our daily life?
Dr Abu Bakar painted a scenario – a patient is admitted for an elective operation at 6am. At 8am, the surgery is done and by 7pm on the same day, he or she is discharged. At 8pm, the doctor or the nurse can check on the patient at home through digital devices. Each day, the nurse can check in by looking at the data (sent through home monitoring devices) and report to the doctor. The patient may not even have to go back to the hospital.
“This type of capability will make life very convenient for the patient,” Dr Abu Bakar said.
“You can deliver services more effectively and more efficiently. And you’ve got the potential to reduce the cost of healthcare,” he adds.
Health innovations, the development of technology and the way it is integrated has the power to help individuals and families achieve their potential in health and maintain their wellness in their lives and will help them make good decisions regarding health. What we need, according to Dr Abu Bakar, is major investments in evidence-based research, more laboratory, clinical and field research and commitment from various stakeholders. The dream going forward? Tan Sri Dato’ Dr Abu Bakar answers: “To provide personalised, customised and patient-centred care, driven by precision health and precision medicine. That is our dream going forward.”
Three pilot initiatives were outlined under the Telemedicine Blueprint (1997):
- The Mass Customised/Personalised Health Information and Education pilot project is about creating and delivering high quality health information and education content to the person using information technology particularly multimedia technology and telecommunication. This will include the provision of Continuing Medical Education (CME) through distance learning methods for healthcare professionals in Malaysia using appropriate multimedia information technology.
- The Teleconsultation system pilot project application is essentially an interactive discussion which involves medical specialists from a tertiary hospital providing remote consultation for patients and providers in health centres or clinics, incorporating digitisation and transmission of patients’ relevant medical records, including text, diagnostic images and medical charts between the referring and consulting practitioners. It is also in essence meant to generate EMRs which will build LHRs and therefore make the LHP achievable.
- The ultimate objective of the Lifetime Health Plan (LHP) is to design, develop and implement a personalised, proactive and prospective lifetime health plan to achieve a continuum of care in order to keep the individual in the highest possible state of health.
These pilot projects are still in the process of being implemented at various stages in the country.
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