Digital Health: Humble Beginnings, Future Potential — Dr Abu Bakar Suleiman, Prof Zaharin Yusoff & Dr Raymond Choy

Digital health, together with artificial intelligence, can help the health sector to develop in several important areas.

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 has already been digitised, and this will grow faster and faster in the future.

Digital health is not even actually a new concept. 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.

The app is now being developed into a format that will allow people to continue using it as part of their personal health records, and possibly as part of their personal health plans in the future.

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, and eight health service goals were identified — many of which have been implemented through MySejahtera and other tools during the pandemic.

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) at 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).

Why Digital Health?

Digital health, together with artificial intelligence, can help the health sector to develop in four important areas.

Firstly, it will allow health care to be predictive, i.e. habing 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 can 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.

For example, there was 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, health care 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.

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.

This is crucial to empower people to manage their own health, and this 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 their health and their families’.

Humble Beginnings

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 1980s, I (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 peritoreal dialysis. We monitored and managed the patients using merely the telephone from our call centres.

From the first patient in Sibu, and a second from Kota Kinabalu, I eventually had over 400 patients from all over the country. By the mid-1990s, 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.

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.

Ready Or Not

Malaysians though have yet to see full and widespread telemedicine initiatives available to us. The challenges of implementing a technologically advanced healthcare system lies in the readiness of the ecosystem, made up of the five Ps, 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 health care as a face-to-face service, and this mindset makes it difficult to convert them to using virtual platforms.

The public’s wariness in sharing personal data also hampers the growth of digital health, especially the growth of artificial intelligence, even though in actual fact, it is very safe and anonymous, as the data collected is not connected to IC numbers, and not attributed to individuals.

Health care providers on the other hand are also grappling with teleconsultations. 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.

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.

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.

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 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.

Pushing Forward

Things are moving forward though especially with the pandemic acting as a catalyst to push the existing digital health agenda forwards. What will health care look like as digital initiatives become more and more a part of our daily life?

Here’s a possible scenario. A patient is admitted for an elective operation at 6.00am. At 8.00am, the surgery is done, and by 7.00pm on the same day, he or she can be discharged.

At 8.00pm, 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 and ensure more effective and efficient delivery of services while potentially reducing the cost of health care.

The dream going forward? To provide personalised, customised and patient-centered care, driven by precision health and precision medicine. That is our dream going forward.

Dr Abu Bakar Suleiman is chairman of the IMU Group, Prof Zaharin Yusoff is a data science specialist at IMU, and Dr Raymond Choy is the co-founder and chief executive officer of Doc2Us.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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