Keywords:

Digital healthcare; public safety; green IT; digital health information

Digital healthcare, also known as e-Health or Health IT, is impacting the national health system, especially in health logistics, diagnostics, pharmacy, and in-patient monitoring. Currently, advanced and high tech health services are available in most of the world’s megacities. Unfortunately, these are only available to the more affluent members of these communities and basic medical care is still a problem for a large population at the bottom-of-the-pyramid (BoP). Countries in ASEAN aim to leverage the region into a vibrant economic zone with a better living standard by 2020. Many countries are spending a high proportion of their national budget to leverage national education standards, universal access to information, the Internet, and surely – healthcare. Singapore has taken the lead in digitizing their national health system, followed by Malaysia and Thailand. Other member states are struggling with modernizing their visibly inadequate health infrastructure.

Scenario:

This article illustrates the future of digital innovations in shaping a global healthcare system and a new social platform that may potentially affect vulnerable groups in the next 10 years with a special relevance to Southeast Asia. In this scenario, there are three issues for the future of health service innovations, which will come to dominate digital healthcare in the region: digitization of health infrastructure, new threats from connected Health IT, and a convergence of health information.

Digitizing hospitals:

The majority of information systems departments in the typical Southeast Asian hospital are not web-oriented, and they are underfunded. There will be more use of the Internet as a replacement for and complement to existing information systems, communication infrastructures, and transaction services. Leading hospitals will compete with other industries for the talents of scarce web and graphic designers, program analysts, health technicians and engineers in their quest to modernize their health communications infrastructure and transaction services in order to gain smart hospital status. Electronic Medical Records (EMRs) will be widely implemented as the backbone to facilitate the “front end” of health service for a range of clinical systems. Local service providers will compete neck and neck with international firms—like Intel, Google Health, and Microsoft Health Vault—to win contracts from public hospital centers.

Infection, crime, and terrorism (ICT):

Computer virus attacks in healthcare are on the rise, and the spread of computer viruses into medical devices has increasingly been causing damage and affecting the safety of the lives and health of the world’s population, while the majority of physicians are still unaware of this silent threat. These include risks to healthcare delivery and health promotion, including the reports of machine errors. Furthermore, there is the threat of the leakage of patient data from hospital information systems lacking adequate protection, including damage to vital patient information that has been altered or destroyed by hackers or computer viruses, which may result in erroneous decisions to treat as well. Even if some healthcare institutes have capacity to provide technologies to safeguard electronic health information (EHI), the perception of a lack of security and resistance to change will inhibit the use of the Internet for personal clinical information. In the near future, identity fraud and digital corruption affecting the healthcare budget will become more visible and more severe, especially attacks from Cryptovirus and Conficker virus.^[1] Terrorism in Southeast Asia will also increase for two reasons: the region is one of the most important transportation hubs, and it has well-equipped medical facilities. An infected medical computer can cause an error in the treatment or a delay in treatment, and an intentional or unintentional medication prescription error on a pharmacy computer may cause patient death, both among a VIP group or in the public in general.

Creative eHealth Information:

Some health problems occur more frequently in megacities or are exacerbated by urban living, such as many mental health problems, drug and alcohol abuse, accidents, assaults including domestic violence, and illnesses arising from environmental degradation and air pollution. Some of the challenging issues in eHealth adoption and diffusion involve sociological and interpersonal aspects, rather than technology per se. Medical school curricula will have to be modified to prepare future physicians to use IT and blend it in with the art of treatment. There will be more demands placed on a different set of health related datasets, with unconventional interpretations needed.

Regional health data analysis in the near future will require a broader range of non-traditional types of health related information: digital elevation maps, urban maps, cartography, maps of water bodies, vegetation maps, land surface temperature maps, and monitoring of wind-blown dust, for a tropical epidemic early warning system (e.g., for malaria and meningococcal meningitis), in planning fieldwork campaigns for research in the management of development projects in public health (Gemperli et al, 2006). A dataset from the Earth observation is related to the prevention and management of emerging infectious diseases (EIDs) as well as mega-natural disasters.

This trilogy of changes will create a new legacy of socio-technological improvisation – “a biodigital Jazz,” like a term coined by the actor Jeff Bridges in the movie TRON – LEGACY.

Implications:

On greening health logistics:

Similar to the more advanced countries and following their lead in health logistics, emergency medical care has become a major concern because of the lack of a comprehensive and accessible ambulance service, along with an increasing demand for adequate hospital accommodation for both general and specialized treatment, and for long-term care of the aged, especially in most megacities in the region. There will be a possibility for such gap to be widened through the application of digital technology in society at large. eHealth in this region should place emphasis on these issues.

Learning by interacting:

Surprisingly, the status of digital healthcare development has been an under-represented issue for discussion, even among the majority of medical staffs. This will cause physician ambivalence when more equipment and processes become digitized. While the EMR is fast becoming a new hospital standard, it is still a long-term work-in-progress to make the regional health care personnel shift from their paper charts to a swipe tablet. A few comments from the early adopters shared in Southeast Asia show that they share a different view from their counterparts in the more advanced countries on the use of the Internet and electronic mail by healthcare professionals. In Southeast Asia, the email, and more specifically E-prescribing can be a technological innovation altering the physical doctor-patient relationship; while there will have to be more time-lag in the adoption of IT by physicians as the medical culture tends to be extremely conservative and cautious, especially when it comes to new technologies.

Early Indicators:

• There will be more major hospitals in ASEAN5 and Vietnam applying an electronic medical record (EMR) system within the next ten years, by the utilization of variously priced strategies offered from both international firms and local SMEs service providers.
• The Thai Controller’s General Department (CGD) experienced a Cryptovirus intrusion on public servant accounts as medical identity theft in 2009.
• There were more than 300 MRI machines around the world infected with the Conficker virus in the summer of 2009, according to a report of the Internet Storm Center.
• There are more than 300 human diseases found in the distribution of pathogens worldwide that are strongly linked to climate. The changes occurring in climate will lead to a massive increase in human vector-borne diseases, particularly in tropical regions which have high pathogen diversity and perfect weather conditions serving as key factors in disease transmission (Randerson, 2004).

Drivers & Inhibitors:

Drivers:

• An increasing impact and effects of climate change on the tropical regions and the emergence and re-emergence of infectious disease.
• The legacy from a lawsuit in a foreign country in which an error resulting from medical record mistakes occurred in the treatment of patients.

Inhibitors:

• Lack of resources for computer emergency response teams, especially in university hospitals or large medical centers, in order to monitor an increasing treat to network security from computer viruses invading sophisticated electronic medical equipment.
• There are too many healthcare standards and price ranges. The differentiated nature of standards and investment in health IT will inhibit and delay the investment of less privileged healthcare unit to move into the smart hospital.