This article first appeared in Digital Edge, The Edge Malaysia Weekly on April 12, 2021 - April 18, 2021
Innovations in healthcare can be slow because it is a highly regulated industry. The pandemic, however, has helped Malaysians get used to the idea of using an app for contact tracing, booking virtual health consultations and even registering for the Covid-19 vaccine.
The potential of digital healthcare is massive. More complex remote medical consultations and even surgeries can be possible with the use of the right technologies. The question is whether the momentum gained during the pandemic will last.
Digital healthcare also relates to portable digital health records. The much-discussed vaccine passports would be a global experiment to test whether this idea works. Opinions vary, however, on whether such a passport can be effective and inclusive.
Digital Edge spoke to three industry players to find out what they think about these issues.
Jaffri Ibrahim, CEO of the Collaborative Research in Engineering, Science and Technology (CREST), shares three main concerns regarding vaccine passports.
First is the complexity of using vaccine passports for international travel, as some countries may choose to recognise only vaccines approved for use in their own borders.
“Health experts have said that it is too early for countries to start pushing out vaccine passports, since data on the efficacy of vaccines in preventing people from contracting or passing on the deadly virus is still limited,” says Jaffri.
“Another growing complication is the emergence of more virulent strains of the virus, such as the UK, South African and Brazilian mutations, and whether vaccines will be able to offer adequate protection against future variants.”
Second, there are social, legal and ethical issues that must be weighed. Some people may be medically unfit to receive vaccines.
“It could discriminate against people who are currently not recommended to receive vaccines, owing to a lack of clinical and real-world data, such as children and pregnant or breastfeeding women,” he says.
Third, data privacy and security vulnerabilities are important points to consider. The government or responsible parties have to ensure that data of individuals is protected and comply with data protection laws.
“It is key to ensuring that our desire for normalcy does not come at the expense of public health, with serious considerations of social, ethical, legal and technical issues. While I am for the vaccine passport, there are concerns related to its implementation as well as operational challenges in global standardisation that have to be addressed for it to be effective,” says Jaffri.
On the other hand, the pandemic has reflected how digitalisation in healthcare is more important than ever, he says. “I hope to see new models of care using remote healthcare solutions and digital technologies such as artificial intelligence, Internet of Things, robotics and machine learning implemented across the care continuum.”
Data analytics, Jaffri notes, has proven its effectiveness in mitigating and preventing outbreaks. The government is using data from MySejahtera to perform contact tracing, for instance.
Some countries are using data analytics to project Covid-19 infections within a region, and optimise the distribution of medical resources based on that projection, according to data analytics company SAS.
“Therefore, the healthcare industry must embrace a better model for public health data that allows for widespread data aggregation to support organisations as they prepare for, prevent and recover from the pandemic and plan for the future,” he says.
The adoption of digital healthcare services, such as virtual health consultations and electronic prescriptions, was relatively low before the pandemic, observes Raymond Choy, CEO of Doc2Us.
“Hospitals were looking into telemedicine and digital healthcare solutions, but nothing much was done or things were just in progress. Because of Covid-19, however, hospitals began providing telemedicine solutions in a month. Usually, hospitals take three to four years to integrate this kind of technology into their systems,” says Choy.
As patients were less likely to visit hospitals during the pandemic, the hospitals had no choice but to set up virtual consultations, digital appointment systems and delivery of medications.
Doc2Us benefited, as many pharmacies and healthcare providers signed up for its electronic prescription and telemedicine services. The app is also linked to the MySejahtera app for virtual health advisory services.
As a result, Malaysians became familiar with digital health services as well. “People chose to do online consultations and refuel their medications remotely because they were not keen to go to the clinics during the pandemic,” he says.
That is how the pandemic catalysed the adoption of digital healthcare in Malaysia. Choy believes this will continue if the public is educated on the benefits of these technologies, and the infrastructure is ready to promote widespread adoption.
By infrastructure, he means having the right policies to govern digital healthcare and the hardware to support virtual health consultations. “Many Malaysians are still using 3G or weaker bandwidths. To have proper video consultations, you need a better bandwidth. I would like to see better infrastructure in this area,” he says.
As for the vaccine passport, Choy believes interoperability is the main challenge that must be addressed. There must be a standardised approach globally. “You can’t have Malaysia and China having different vaccine passports, with the latter accepting only those who received vaccines produced in China. Herd immunity has to be reached globally,” says Choy.
“How can we recognise the digital passports from other countries and vice versa? It has to be a standardised approach from the World Health Organization.”
The adoption of telemedicine by the Ministry of Health by integrating it into the MySejahtera app was an early catalyst for digital healthcare adoption, says Maran Virumandi, managing director and co-founder of DoctorOnCall.
His platform is linked to the app for clinic appointment bookings, alongside two other digital healthcare companies.
“I feel that the pervasive adoption of MySejahtera as the go-to app for Covid-19 status updates, tracking and the potential vaccine passport as a key feature in the app will contribute to the digital health mindset,” says Maran.
The stated goal in the MyDIGITAL blueprint to expand the use of blockchain and the Malaysian Health Data Warehouse is also commendable, he notes. “These initiatives will make it easier to share patients’ health records in a safe and secure manner.”
On a related note, the vaccine passport will play a key role in the sharing of patient records regarding vaccinations for travelling, hospitalisation, insurance and other use cases, he says.
“We strongly support the concept of a vaccine passport to provide authenticated vaccine-related data, including patient status, vaccine batch tracking details and expiry information.”
This could be an ongoing feature. If the virus mutates and Malaysians have to take boosters or annual shots, this vaccine passport can be useful as well.
What’s next? The government has to educate, assure and incentivise healthcare providers and medical institutions to embrace the digital age. They could also look at some long-standing issues in the industry.
“Currently, the combination of multiple traditional issues, including the long-overdue revision of professional consultation fees, dispensing separation, highly fragmented GP clinics and pharmacies landscape, and a glut of GP clinics in urban areas, does not create a climate to facilitate the adoption of healthcare innovation, which may require high capital investments and significantly different business models,” says Maran.
Malaysia should learn from Singapore, China and India, which are investing heavily in digital healthcare, he adds. “For example, [Indian] Prime Minister Narendra Modi has launched the National Digital Health Mission, enabling every one of its citizens to get an ID card containing all relevant information about his or her medical conditions and treatments.”
Meanwhile, Singapore’s Ministry of Health launched a regulatory sandbox for telemedicine and mobile medicine in 2018, and plans to transition to licensing under the Healthcare Services Act in 2022.
“We would like to see broader reforms and regulatory changes being initiated to serve as a catalyst to boost Malaysian healthcare beyond just digital health,” he says.
Israel: The country launched the Green Pass, which can be a paper certificate or an app. Citizens have to use it to gain access to facilities.
China: The country launched the International Travel Health Certificate, which is embedded in the WeChat instant-messaging platform. It contains the holder’s test results and vaccination records.
European Union: The EU has plans to introduce a Digital Green Certificate, whether digital or on paper, to allow vaccinated individuals to travel across its member states.
Malaysia: Health Minister Datuk Seri Dr Adham Baba was reported as saying that a vaccine passport could be incorporated in MySejahtera or take a physical form.
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