*This is 3 part series. Episode 2 will be published next month on our website.
Dear Esteemed Readers,
Welcome to our panel discussion on "Innovations in Digital Health: Transforming Patient Care." Our questionnaire is divided into three series, each exploring different facets of the transformative landscape of digital health.
Our Panel Experts:
Series 1: Introduction to Digital Health Journeys
In Series 1, our experts shared their stories and knowledge, giving you a sneak peek into the world of digital health innovations. Get ready for a captivating journey through the evolving landscape of healthcare innovation.
Piyanun, as the Founder and Managing Director at APUK Co., Ltd., can you share your journey into digital health and highlight any specific projects or initiatives that define your commitment to transforming healthcare through innovation?
Sure thing! My journey into digital health started when I was working as a nurse. I first recognized how Technology could be in supporting clinical operations. This insight sparked my transition into the IT domain, leading me to the role of IT Director. In this capacity, I played a pivotal role in helping the hospital achieve the HIMSS EMRAM Stage 6 Standard which was a significant milestone to measure the effective use of IT and management outcomes in clinical.
Understanding the critical importance of IT in hospitals, my focus shifted to integrating technology with business processes. This was not just about adopting new technologies, but ensuring they seamlessly supported patient safety and streamlined processes. It also involved leveraging technology to drive business growth.
In my current position as Founder and Managing Director at APUK Co., Ltd., I've carried forward this philosophy. We've initiated various projects and initiatives aimed at transforming healthcare through innovative technology. Each project is a step towards enhancing patient care and operational efficiency, reflecting our commitment to innovation in healthcare.
Dr. Vicknesh, with your role in medical devices and technology industry, could you provide insights into how digital health innovations are being integrated into large-scale medical care facilities, and what impact they are having on patient outcomes?
Integration of digital tools to improve overall patient experience, which eventually is aimed at building more trust, confidence and retain loyalty.
Digital health tools are also incorporating preventive measures, where consumers’ state of health is assessed to understand the needs before a care can be delivered, before and after discharge. This gives a personalized touch to patients to improve outcomes and at the same time build their trust and improve satisfaction.
The buzz now is all about the patient journey and how this is reimagined to accommodate the needs and demands of care in healthcare. Seamless integration for eg telehealth to remote monitoring is turning heads to embrace new-age care. The eyes are on digital-first health systems which is the platform to improve and enhance patient outcomes and sustainability with quality of care.
Dr. Patel, as a Digital Health Thought Leader and Educator, how can education play a role in overcoming challenges related to user adoption and ensuring healthcare professionals are well-versed in leveraging digital health tools effectively?
Education is crucial to overcoming challenges related to user adoption. There are several ways this can be accomplished. First, offering continuing education courses focused on digital health tools and technologies can promote lifelong learning while ensuring they remain current with new technologies. Second, providing research and development opportunities can help clinicians better understand the value of these innovations and aid in a hands-on experience in the development of the tools while meeting the needs of the users (clinicians) and patients. Third, preparing leaders to manage transitions to digital health systems is essential. Education can empower leaders to drive adoption and shape organizational culture to be accepting of the shifting landscape of healthcare. Finally, overarching policy and interprofessional education can prepare the entire healthcare team to learn from each other.
Dimitrios, with your extensive background in AI and medicine, where do you see the most promising opportunities for AI-driven digital health solutions to improve patient outcomes and healthcare delivery?
While research publications continue to grow exponentially in the digital health space, implementation and evaluation of digital technologies that use AI functionalities to support patient-centric care are lagging. Relatively few follow the path to regulatory approval and market validation. Most startups that make it to the clinical setting support clinical workflows and augment the field of applications and efficacy of radiology. Remote patient monitoring is also a promising field of application for AI; one which can revolutionise precision medicine and individualise access to care for patients with suboptimal outcomes with current standards of care, for example many oncology patients. AI applied to precision medicine and individualised evidence-based medicine emerged twenty years ago a few years apart and against a background of systems biology. The combined application of the disciplines aims to improve clinical research, translation and healthcare delivery, addressing disease heterogeneity and genetic variability that leads to the poor efficacy of one-size-fits-all health care. AI helps with drug-diagnostic co-development and the use of predictive safety and efficacy biomarkers. Deep learning further evolved the field with the aim to individualise the practice of evidence-based [stratified] medicine and eventually led to numerous meaningful modern day large language model (LLM) applications. Among other things, LLMs are being applied to the interpretation of digital pathology images or in research data curation, to discover biomarkers in electronic health records and to alert clinicians about hidden comorbidities.
An important goal for AI has been to accelerate personalised knowledge mobilisation for secondary uses in research and health care without the need for human supervision during multimodal learning. To have such a transformational impact, AI needs access to real-world population-level outcomes to deal with variability and bias impacting treatment outcomes negatively or when using foreign data sets to train clinical translation models. The challenge for researchers is that despite the many notable efforts to strengthen the role of primary care in health systems, silos and fragmentation in health informatics and digital innovation persist. AI holds the potential to address this adaptive challenge by empowering a workforce adept to collaborative leadership and innovation and with that to change the tide of personalised medicine further upstream. This opportunity is offered by LLMs as foundation models that shift the overarching digital health adoption paradigm from offline fit-for-purpose innovation to adaptive continual learning AI for upstream innovation that is underpinned by downstream market validation.
Today’s healthcare setting is a highly complex and comorbidity challenged ecosystem. Demographics and climate impact add complexity and limit treatment options for many patients. Drug repurposing, biomarker discovery and precision treatment selection offer important solutions for rational use of drugs and targeting defined subsets of patients for patient-centric outcomes. To be able to respond, health systems need to evolve to support adaptive innovation that factors in individuals’ social, genetic and digital determinants of health. AI is uniquely positioned to access that evidence dynamically and to identify interactions and pathways to predicted outcomes. With connected health and adoption of telehealth technologies there is a unique opportunity to bridge the growing innovation divides to address the gaps in data and reciprocally knowledge, to deliver upstream AI solutions that weave clinical and research decision streams into patient-centric care delivery models. This leads to meaningful evidence; AI uses and innovation that incrementally drive improved outcomes with timely and targeted prevention.
Future improvements in health care will come from AI innovation that resists the ephemeral and reductionist view of siloes, in favour of scalable, transformational and sustainable innovation, equity and inclusion. Empowering patients with new forms of participation will lead to collaborative innovation ecosystems. At the current pace of progress in conversational and generative AI, soon, if one can describe a concept in natural language, AI will be able to unpack it and predict alternative futures based on the concept structure and past evidence; futures that we simply cannot see at the current level of disease detection enabled by standard-of-care medical devices. To get to such a capacity responsibly, it is critical that we carefully consider the quality of used evidence with digital inclusion. For that we must couple AI capabilities with the reach and ecological validity offered by telehealth innovation and robust industry standards for governance in addition to market regulation.
Piyanun, how can digital health innovations be designed to empower patients, especially in regions where access to healthcare may be limited?
Nowadays, with the advancement of telemedicine technology, distance has become a less significant barrier in healthcare. But it's essential to have a reliable IT infrastructure in place to support effective two-way communication. We can innovate in this space by integrating our clinical knowledge and experience apply with technology to create interactive tools for patients.
These tools empower patients, especially in regions with limited healthcare access, by allowing them to perform symptom-checker, self-assessments, and monitor their health with key data elements like blood glucose levels, systolic and diastolic blood pressure, and pulse rate can be tracked.
This approach not only empowers patients by giving them tools to manage their health but also allows for close monitoring by healthcare providers. It bridges the gap in healthcare accessibility and ensures continuous patient care, regardless of geographical limitations. Through these innovations, we're striving to make healthcare more inclusive and patient engagement.
Dr. Vicknesh, within the context of your previous industry experience, how do you see personalized medicine evolving with the integration of digital health technologies, particularly in the realm of renal care?
It is as rapid as one can imagine – digital technology is revolutionizing renal care by enabling a more personalized, data-driven and patient-centric approach to diagnosis and treatment.
A few key trends can be named to have fueled this transition, namely genomic and biomarker profiling, precision diagnostics, data analytics, patient engagement and education AND the need for and importance of an integrated health system.
The ultimate aim is for early patient involvement, empowering them to make informed + shared decisions and enabling them to have quality of care.
Dr. Patel, what guidance can you provide to emerging digital health startups navigating the complex regulatory landscape, ensuring compliance while fostering innovation?
Navigating the regulatory landscape is important for the success of digital health startups. Startups should familiarize themselves with the relevant regulations based on their region, sector, and type of technology. For example, understanding the specific requirements of ISO 13485 if it applies to your product, is important for scalability. Furthermore, proactively reaching out to regulatory bodies can provide valuable insights into compliance requirements and can save time by navigating the regulatory hurdles early in the development process. Additionally, it is important to build an interprofessional and cross-functional team with expertise in healthcare, technology, and legal compliance. This approach allows for the consideration of diverse perspectives and assure that regulatory requirements are integrated into the product development of the lifecycle. Throughout the process, patient privacy and data security should be kept at the forefront, with a focus on aligning value-based care principles and patient outcomes. Finally, transparent communication with stakeholders and partners will aid in maintaining a healthy balance of growth, scalability, and trust.
Dimitrios, how can global collaboration and standardization efforts in digital health contribute to addressing both regulatory and ethical considerations on an international scale?
The pressures applied to health and healthcare systems during the Covid-19 pandemic exposed global health systems lacking in fundamental resilience. Most of the world’s population was neglected or underserved regarding their fundamental needs. In response, international development, regulatory agencies, and normative organizations, realigned their strategies and policies with the need for collaboration. The United Nations, the World Health Organization, the Organization for Economic Cooperation and Development, the World Economic Forum have all published relevant approaches. The many challenges facing health systems and technology adoption require a new culture of adaptive leadership. Regulatory agencies need to adapt and to embrace continual learning, providing improved support for participatory care. With that, digital health technologies aim to disrupt the standard of care; however the industry has been focused on point measurements of health services access and utilisation not on the integrated patient experience. The advent of general-purpose AI challenges this practice and necessitates changes in evidence-based medicine, to no longer aggregate data on disease trajectories but to dynamically interpret an individual’s experience and to answer new research questions that challenge traditional care models. In this context, transparency can no longer be pursued solely as an ethical consideration at the level of leadership and decision-making regarding AI governance but to also deliver meaningful patient-centred uses of AI. Transparency must be a cross-cutting regulatory and standards-setting consideration on an international scale. Transparency leads to clinically robust collaboration and the mitigation of underrepresentation in AI uses that entrench healthcare disparities. There are numerous good startups out there that respond to unmet patient needs and to then need to improve and personalise the standard of care. The question is how we can enable collaboration between those startups globally with competitive-collaborative shared-value ecosystems to tackle transparency collectively and to address the data asymmetries and innovation disparities that undermine global health. For that we need integrative international standards that raise the bar for digital innovation.
Piyanun, could you share examples of successful collaborations or partnerships within the digital health ecosystem that have driven positive outcomes or innovations?
In my view the digital health ecosystem, which encompasses 3Ps Patients, Providers, and Payors, we've seen some dynamic collaborations that have driven positive outcomes and innovations. The rapid growth of healthcare technology has been instrumental in improving operational flow and patient safety.
However, a major challenge in this ecosystem is the financial support from payors, such as health insurance companies.
One key strategy is embedding data science with medical logic into the system to support patient financing. This approach not only benefits patients by making healthcare more affordable but also aligns the interests of providers and payors. By integrating financial considerations with medical logic, we ensure that patient care is not compromised due to financial constraints.
This approach not only streamlines the process for patients and providers but also allows payors to make informed decisions based on medical necessity and cost-effectiveness. Such collaborations are essential in creating a more efficient, equitable, and patient-centric healthcare system.
Dipu Patel, how can startups and established corporations collaborate effectively to accelerate the adoption of digital health solutions, ensuring a balance between innovation and scalability?
This is something that all corporations struggle with in different ways. One way to begin is to define common goals and cultural alignment while moving together towards a shared vision; this can be improving patient outcomes, increasing accessibility, or even reducing costs. Whatever the goal, leveraging the strengths of each corporation can help effectively scale digital health solutions. Another way to scale, is by implementing pilot programs. This can help test solutions in beta and get quick feedback to improve, pivot, or adapt from real-world users. This can help in continuous improvement for both the startup and the established corporation. Furthermore, established corporations can provide resources and access to networks that can be mutually beneficial, allowing for knowledge sharing and mentorship. In sum, the alignment of overarching goals and culture can go a long way in creating synergy for both startups and established corporations.
Dimitrios, which emerging technologies do you believe will play a crucial role in shaping the future of digital health, and how might they redefine the patient experience?
There is an array of innovative digital health solutions and devices out there, many supporting new virtual care models and already transforming healthcare access, quality and outcomes. As market approval can be complex and expensive, the majority are supported in this regulatory path to commercialisation and health reimbursement by private equity and venture capital, as well as national and international grants and public-private accelerator programmes. They include numerous innovations in remote care, treatment personalisation and intelligent automation. Invariably they aim to expand access to care, to redefine the patient experience, and hold the potential to improve equity in universal health coverage. An impediment is that the traditional concept of access to care on which they focus – that of service availability and utilisation, is no longer sufficient. The question is how these technologies can be operationally connected to expand access to care in a patient-centred manner to deliver the hospital at home and to improve the patient experience in both chronic and acute care.
We are not short of innovative ideas that enhance the patient experience leading to opportunities for participation and collaboration. What we consistently fail with is to scale innovation and for that we need a new culture of open collaboration. Creating an inclusive and trusting health care environment in which everyone can contribute fully is critical. So is strengthening connections between organisations for more coordinated primary care and public health services. However, introducing processes that create a more open and participatory environment can be a challenge. This is where emerging technologies come in. The power the development of new industry standards that are fit-for-purpose to change ecosystem building and enable a connected health paradigm that spans the entire ecosystem, from services that monitor and respond to climate-induced comorbidity and social determinants of health, to shadow prevention, a more cost-effective referral system, and disease management with individualised treatment targets, precision care plans and improvements in patient outcomes. Redefining the patient experience requires connecting these dots with data repurposing/ recycling.
Dr. Vicknesh, how do you foresee the continued evolution of telehealth services within the broader landscape of digital health, especially in the context of patient care in Malaysia?
Gaining popularity during the COVID-19 pandemic, the utilization of telehealth services in Malaysia has increased over the past several years, with 88.8% being assisted consultations with e-prescriptions and 11.2% being direct consultations. This is already showing us that what’s going to brew further is enhanced telehealth services that will aim to improve access and fill existing gaps in the healthcare system. The need for remote monitoring is rising within the country where early intervention is a key element to seek greater outcomes.
The future looks bright with the emergence of health technology startups and the promising adoption (which is about 50%) of teleconsultation in public primary care clinics.
What’s notable to say here is also that the first connected healthcare service (which includes telehealth and remote monitoring) was launched by a private hospital in Malaysia in 2023, spelling further growth of this need in the country?
Thank you all for the invigorating & gripping session. Your insights contribute to both a concise magazine feature and in-depth online discussions! I am sure there is a lot for our readers to take back home.