Soaring costs, a chronic shortage of medical professionals and infrastructure, as well as evolving consumer needs are forcing the cumbersome healthcare industry to rethink the way it serves people. Technology is playing a big role in a revolution that is creating a fresher, more efficient and sustainable system.
Digitisation of healthcare services through the Internet of Things (IoT), big data, artificial intelligence (AI) and other advances can help improve access to treatment while reducing costs. At the same time, it can create unique and personalised experiences while enabling precision diagnosis and better treatment for patients, say experts.
"The application of technology in healthcare addresses the challenges facing the industry today. It enables us to invent new diagnostic capability by extending the reach and coverage of care delivery," said Dr Loke Wai Chiong, healthcare sector leader at Deloitte Southeast Asia.
Technology-enabled care (TEC), for instance, provides a cost-effective solution for rising demand and lack of adequate coverage in remote areas. Telecare, telehealth and telemedicine applications have allowed healthcare professionals and patients to have access to information more easily and improve the quality of diagnosis and treatment.
"Point-of-care diagnostics can now reach remote areas. Data is being transmitted immediately and wirelessly. Doctors can interpret the data and provide appropriate intervention to the patients from long distances," he told Asia Focus.
Technology also helps clinical practitioners by augmenting decision-making in diagnosis and predictive healthcare, based on AI-driven learning, Dr Loke added.
Healthcare expenditure globally has been growing to the point where it is no longer sustainable or possible for the public sector to support in its entirety. According to Deloitte, global healthcare spending is projected to reach US$8.7 trillion by 2020, making up 10.5% of the world's gross domestic product (GDP), driven mainly by the needs of emerging and low-income countries.
"If the smart healthcare system is affordable, then more people will be able to benefit from it," says Dr Nina Kao, CEO of Overseas Medical Mission Centre. Photo: Tanyat orn Tongwaranan
"Patients need quality, safe and efficient healthcare that is accessible and affordable. Technology such as telemedicine will decrease the medical resources gap between urban and rural areas," said Dr Nina Kao, CEO of Overseas Medical Mission Centre, the overseas medical service and missionary arm of Taiwan-based Changhua Christian Hospital.
In the globalised, hyper-connected world, consumer expectations are rising as fast as costs, noted Dr Loke. "Consumers are so used to e-commerce and on-demand services, so they'll ask why they can't have that for doctors and medicine."
The on-demand economy and digitisation are particularly advanced in China where the overall retail landscape has shifted dramatically toward online, according to Dr Manaen Ma, a consultant with Deloitte's healthcare sector services in Southeast Asia.
"Consumers are so used to e-commerce and on-demand services, so they’ll ask why they can’t have that for doctors and medicine" — DR LOKE WAI CHIONG, Healthcare sector leader, Deloitte Southeast Asia
"In China, digitisation isn't initiated by healthcare itself. People, especially the younger generation and tech natives, don't want to go to retail stores," he said. "They now buy almost everything from e-commerce platforms. This is the same with the case of hospitals. They don't want to go through the long process of queuing and waiting for doctors."
According to Dr Ma, healthcare technology applications in China are mostly concentrated in Tier 1 cities but lower-tier cities are catching up quickly. The digitisation rate for healthcare in Tier 2 cities is close to 60% while in Tier 3 or below cities it is around 40%.
Common applications in China include online registration in which patients can request a face-to-face or video consultation. Through deep learning AI, the system can also match patients' symptoms with the right doctors.
On the payment side, most government hospitals in China now allow e-payment through ubiquitous applications including Alipay or WeChat Pay. The system is also directly linked to government insurance. "Things have become much more efficient," said Dr Ma.
"In China, the challenge is not technology infrastructure but more toward the clinician talent," he said, adding that the country has only 1.8 physicians per 1,000 people compared with 2.4 in the United States.
In addition, good physicians prefer to go to Tier 1 or 2 cities to practise, so there's a lack of talent in smaller cities.
"In China, the challenge is not technology infrastructure but clinician talent," says Dr Manaen Ma of Deloitte healthcare sector services.
SUPPLY SHORTAGE
This lack of physicians and care is even more pronounced in developing Asian countries where the average is just 0.6 physicians for every 1,000 people, according to Business Monitor International and Organisation for Economic Co-operation and Development (OECD) data.
The ratio is 0.4 in Thailand and Indonesia, 0.8 in India and Vietnam, and 1.2 in the Philippines and Malaysia, but 2.3 in highly developed Singapore. That compares with 2.3 in Singapore and 2.5 in Japan, and an average of 3.3 in the developed economies of the OECD.
"In Asia, people have longer life expectancy now, so more countries in Asia, especially in Southeast Asia, will face the problem of an ageing population," said Dr Kao.
Furthermore, the prevalence of chronic diseases such as diabetes is higher than ever before, and cancer is also on the rise.
In her view, smart healthcare system should be designed to give both healthcare providers and patients a better user experience by providing more immediate and accurate information, which can reduce the potential for mistakes that may be made by medical personnel, as well as paperwork.
"Providing affordable healthcare solutions is also crucial as the gap between rich and poor is getting wider than before. If the smart healthcare system is affordable, then more people will be able to benefit from it," she said.
In emerging markets, governments are placing greater emphasis on healthcare programmes and infrastructure construction. Indonesia, for instance, has increased its national budget for healthcare development and aims to achieve a nationwide insurance programme by 2019.
Zubin J Daruwalla, director of healthcare at PwC Southeast Asia, said in a recent report that emerging markets need to look at innovative technology and disruptive business models in order to fulfil the goal of having sustainable national healthcare programmes.
"The traditional model for growth will not be sustainable considering the gap and what is needed to bridge. … Digitisation of health services can help to improve the quality of and access to care while reducing costs," Dr Daruwalla wrote.
"In order to build a more digitised system for the healthcare industry, infrastructure will have to be put in place and this will be the challenge. However, the time taken will be much shorter compared to the time it takes to build hundreds or thousands more hospitals," Deloitte's Dr Loke said.
Policymakers are now asking themselves whether it is necessary to wait for 100 or 1,000 more hospitals to be built in currently underdeveloped countries in order for the population to have access to healthcare.
"Infrastructure in many parts of Southeast Asia might not be accessible and technology is now being used to overcome these infrastructure challenges," said Dr Loke.
"There is a business opportunity here if you can provide the care through technology without having to wait for roads or hospitals to be built."
SMART HOSPITALS
Dr Kao said the biggest roadblock that impedes hospital development in Asia is the funding and enabling environment, including government policy, and construction permits.
The lack of knowledge about smart hospital design, an absence of materials and technology for construction as well as the shortage of professional specialists to operate and manage facilities are also challenges, she added.
Developing countries aspiring to adopt technology-driven and smart healthcare systems need an appropriate regulatory atmosphere and investment policy.
In emerging economies such as China and Indonesia, the regulations related to new technology are not always clear-cut, so more technology players are coming in to explore the market and disrupt the business-as-usual practice of traditional healthcare providers.
"Rather than try to overregulate and slow down innovation, there should be a more flexible, adaptive and nimble approach from the government sector," Dr Loke said.
"[Government] needs to be at the cutting edge and see where the technology is heading and be able to react and respond in a timely manner."
Dr Kao said key success factors for establishing smart hospital in Asia are resources such as funds and manpower, as well as the support from the government including investment incentives. Alliances with related medical industries and local players are also important.
Regulations that allow nascent technologies to grow will also help lower the cost of digitisation.
"A lot of Asian home-grown technologies are developed at a fraction of what the Western providers charge. This is because the technology is so ubiquitous now," Dr Loke said.
For emerging countries to start adopting new technologies in healthcare, experts suggest that practitioners need to be able to identify the most critical steps in the value chain that need to be digitised. Then they can start by modernising their IT systems to support those important areas without having to opt for top-of-the-line technology across the board.
"We increasingly see that instead of wholesale and full-scale IT renewal, hospitals are using something like robotic process automation (RPA) layered on top of legacy systems, instead of having to replace them," said Dr Loke.
This allows practitioners to obtain and deliver actionable insights, without necessarily being expensive, he added.
Dr Daruwalla of PwC acknowledged, however, that policymakers and hospital administrators may have some reservations about the seemingly high costs of transformation, as the return on investment is not always obvious.
He recommends that healthcare practitioners define, prioritise and establish qualitative and qualitative metrics to measure returns when considering the adoption of new technologies.
"Simple technological and digital solutions may turn out to have the greatest impact," he said. "Effective integration of digital solutions into care delivery is sustained by several enablers. … These will be the key drivers in keeping costs low and clinical outcomes optimal, which will translate into long-term, positive return on investment for organisations."
