Newsletter is available here. You can also download our newsletter via PDF file and catch up to them later on your computer or your devices.
HEALTH SERVICE INNOVATION
“Biodigital Jazz” in Digital Healthcare
By Pokrath Hansasuta, MD, DPhil (Oxon), FRCPath
Cain, M. and Mittman, R. (1999). The Future of the Internet Health Care: A Five-Year Forecast. Retrieved from http://www.chcf.org/documents/intreport.pdf
Dedmo, R. E. (2008). US health care reform: reality and implications for Asian health care providers, administrators and policy makers, Asian Biomedicine, Vol. 2 No. 5, October 2008, p. 431-440. Retrieved from http://abm.digitaljournals.org/index.php/abm/article/viewFile/215/134
Gemperli A, Vounatsou P, Sogoba N, Smith T (2006) Malaria mapping using transmission models: Application to survey data from Mali. Am J Trop Med Hyg 163: 289–297. Retrieved from http://aje.oxfordjournals.org/content/163/3/289.full
Rockefeller Foundation (2008). Making the eHealth Connection: Global Partnerships, Local Solutions. New York. Retrieved from http://www.rockefellerfoundation.org/media/download/f3235b45-704f-412e-8ba6-20d92c82ef75
Tegart, G. and Jewell, T. (2001). Healthy Futures for Asia-Pacific Megacities, Foresight, vol. 3, No. 6, December 2001, Emerald. Retrieved from http://www.technology.am/conficker-worm-hits-hospital-devices-032629.html
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.
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.
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.
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. 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.
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.
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.
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.
 Cryptovirus is a cyber-intimidation and extortion threat that attacks the computer system, while Conficker, also known as Downup, Downadup and Kido, is a computer worm targeting the Microsoft Windows operating system that was first detected in November 2008.
The author would like to thank Thailand Chief Information Office 16 Forum and Dr. Arida Chandacham for the insights and comments on issues and trends on digital healthcare in Southeast Asia.