Photo: (L – R) Dr. Eric Wong National Healthcare Group, Mr. Maarten Kelder Zuellig Pharma, Dr. Beh Swan Gin Chairman Economic Development Board, Ms. Penny Wan Amgen, Regional VP and General Manager, JAPAC, Amgen, Dr. David SP Tan National Cancer Institute Singapore, discussing digital solutions for healthcare

Dr. Beh Swan Gin, Chairman of Economic Development Board, Singapore spoke about the future of the healthcare sector in Asia and Singapore at the launch of a Singapore-based innovation centre by Zuellig Pharma last week on April 5.

He said that although global healthcare revenue is expected to grow at a CAGR of 5.6% to 2025, the Asian market is projected to grow at double that rate at around 11.7%, according to a Frost & Sullivan report.

Dr. Beh highlighted the challenges faced because of Singapore’s ageing population and the demands of a growing middle class for increasingly sophisiticated solutions (ASEAN’s middle class is projected to more than double from a 190 million in 2012 to 400 million in 2020) and said that the innovation centre will strengthen Singapore’s capacity to develop and deploy new digital products and services that will help to address the healthcare needs in Asia.

“If we look at some of the fundamental changes that will impact the industry in a fundamental way, it is the same familiar changes and disruptions that have already occurred in other industries. Mobile health, personalised medicine, data analytics and digitalisation. These developments will improve the speed and accuracy of diagnosis, lower the cost of delivery, reduce waste and equally importantly improve health outcomes”, Dr. Beh said about technological disruptions.

Zuellig Pharma is investing over S$50 million in Zuellig Health Solutions (ZHS) over a 5-year period to develop data, digital and disease management solutions. ZHS will employ over 50 Singapore-based healthcare, technology and data specialists. A Memorandum of Understanding (MoU) has been signed between ZHS and the National Healthcare Group (one of the three public health clusters in Singapore, with a network of nine primary healthcare polyclinics, acute care and tertiary hospitals, national specialty centres and business divisions) to develop predictive models for early health screening and carry out treatment cost versus quality analysis using data analytics. Zuellig Pharma has also shifted its headquarters from Hong Kong to Singapore, in order to be closer to its clients and benefit from the breadth and depth of the healthcare talent pool here. 

Dr. Eric Wong, Group Chief Medical Information Officer at NHG, said, “Effective analytics will allow us to better manage early population health screening, gain insight into ways to reduce preventable admissions and avoidable readmissions, decrease the length of hospital stays and improve cost-effective prescribing.”

A fascinating panel discussion followed. It was kickstarted by Mr. Maarten Kelder, Senior Vice President Strategy & Innovation, Zuellig Pharma, talking about access and affordability. He said that historically the medical world has focused on curing people. The next big innovation will be moving to prevention. Data analytics will play an important role in that domain.

Ms. Penny Wan, Regional VP & General Manager JAPAC, Amgen, added that sometimes having the right drug is not enough. You have to find the right patient to treat. Data analytics can help in getting the right drug to the right patient in time.

From there on, it moved into an exploration of the many different ways in which data can be used and the challenges faced. The Singapore government and its various agencies are working to overcome those challenges.  

Challenges in using data

Relative lack of local clinical studies

Dr. David SP Tan, Consultant, Department of Haematology-Oncology at the National University Cancer Institute, Singapore (NCIS) highlighted the relative paucity of local clinical studies. The medications developed in the west might not necessarily be applicable across the board, across different ethnic groups in different countries.

He gave the example of a type of ovarian cancer commonly seen in Singapore but which makes up only 2-5% of clinical studies in the west. So, the data from the Western studies might have limited utility. Singapore has to come up with its own trials and standards.

Drilling down from cohort to the individual level

Dr. Eric Wong, Group Chief Medical Information Officer at NHG, brought up the challenge of context. Context is important because each individual patient is different. The data can be aggregated and analysed, correlations found, but how to distil that down and translate it to treatments for individual patients.

Another example, could be predicting who are the patients who might need to come back to the hospital and get readmitted. Many parameters can be considered but without context it would be difficult to pinpoint which areas the hospital needs to focus on for finding and dealing with those patients.

Validating hypothetical solutions derived from analytics

When asked about the challenge of analysis, Dr. Tan responded that data crunching itself is not difficult, as long as you have the data. But those are still only potential solutions, hypotheses that needs to be validated. He said, “Finding a hypothetical solution using lots of data is one thing. Validating it in the real world is another thing”.

There are also concerns regarding privacy. For getting useful results, data from many different sources has to be brought together. Data has to be shared across the medical sector, across public and private organisations and across countries. It includes possibly sensitive personal data. In a small country like Singapore, three or four data points might be enough to identify a person.

And there cannot be a black and white approach to it. You cannot say it is patient data and no way industry can look at this.

So, these questions have to be tackled, anonymisation tools have to be explored, regulatory frameworks in different countries negotiated. 

In the end, it comes down to what the individual countries and their health systems want to achieve. If you want to use data analytics, the government should proceed with conviction, setting up the go right infrastructure and not putting up unnecessary hindrances.

From a siloed ecosystem to an integrated approach

Mr. Kelder noted that the healthcare ecosystem is still operating in silos to a large extent, with all the players focusing on their own interests. This hinders the generation of optimal solutions. This needs to change.

Dr. Tan added that Individual hospitals coming up with own solutions to own challenges with their own preferred partners, poses a problem in the evaluation of technology. A suitable national body should integrate all of this together and clearly lay down the criteria for defining value for patients.

Morevoer, doctors don’t have all the answers today. They need to work with physiotherapists, pharmacists, nurses and many others playing their own crucial roles. Technology can help tie all of these together to provide holistic healthcare.

From healthcare to health

Currently 1 in 25 Singaporeans work in the healthcare industry. By 2030 it will be 1 in 30. Thus, an ageing population deals a double whammy. While rising numbers of the elderly will need more care, there will be a manpower shortage to take care of them. That’s where technology will have to step in.

If Singapore doesn’t prepare for the future, it could end up in a situation where all resources have to be dedicated to firefighting mode and there will no resources left for innovation.

On top of that, a significant proportion of patients wait till last m
inute to get medical treatment, which is taxing on the medical system. As patients go down the slippery slope, resources consumed are higher, quality of life is lower, patients are unhappier and doctors feel they are not doing their job.

That is the future which must be avoided. And for that, there has to be a shift from healthcare to population health, from curing to prevention.

Mr. Kelder gave the example of a recent pilot programme in partnership with a company in Malaysia to reduce the number of new cases of preventable chronic disease among its employees. This is done by identifying the people at high risk of getting sick but are not yet sick. They are placed on a consultation, well-being programme to avoid them from getting sick in the first place.

Dr. Wong said,” How do I encourage more patients to be more aware of their health? That’s one of the key challenges. NHG has been very keen to drive this through the use of data, through workflows.”

Systems and workflows have to be designed in such a way that patients can be provided with the right service by the right person at the right time. Data will be indispensable for this. If from the individual level, it can be replicated a few million times, then population health would have been achieved.

Conclusion

Dr. Beh acknowledged that the challenges brought up in the discussion are all too real. But that shouldn’t stop us from starting to use data in a much more intelligent way. The technologies are already out there. We just need to figure out the problems we want to address and apply the technologies.