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 in the future,” says Tan Sri Dato’ Dr Abu Bakar Suleiman, Chairman, IMU Group.
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 adds.
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,” explains Dr Abu Bakar.
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.
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.
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,” explains Dr Abu Bakar.
Dr Abu Bakar gave 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. IMU’s Data Science Specialist, Prof Zaharin Yusoff
explains, “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.
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.
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 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 peritoreal 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, Tan Sri Dato’ 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,” said Dr Abu Bakar. 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,” said Dr Abu Bakar.
