The new Digital Health model : Disruption, Engagement, Integration and Trust


Traditional digital health models 


Most developed countries have moved away from paper-based healthcare solutions and have adopted or are in the process of adopting ‘traditional’ digital healthcare models (see Figure 4).


These traditional models require the purchase or lease of hardware and software as well as dedicated space to house servers/data centres. These systems are coded, siloed, fully customised and require highly skilled programmers and IT professionals to develop and manage solutions. The developed markets are now moving to a new digital health model with increasing adoption of cloud and mobile- based technology in the healthcare system. But integration and interoperability challenges of existing traditional models will make this progress slower.


For example, in Singapore, the National Electronic Health Record (NEHR) system was rolled out in 2011. It allows patient healthcare records to be shared across the entire healthcare system.


Currently, all community hospitals, 56 community healthcare providers and close to 40% of GP clinics have access to NEHR.14 The Singaporean government aims to get the remaining private players on board as well. It invested US$128 million to develop Phase 1 of the NEHR, and is paying about US$15 million each year in maintenance costs. 


Singapore is now transitioning to a new digital health model. It is looking to move health information to the cloud. Named as hCloud, the project will cost US$37 million for the first ten years.


However, it will help to bring down the cost of running the Healthcare IT system. Future developments will also include the use of data analytics to support both decision making at the point of care and national planning for the Ministry of Health (MOH). 



Emerging economies are unlikely to adopt the traditional digital health models. There is a significant gap in most of the parameters required for successful adoption of the traditional digital healthcare model, including affordability. Figure 5 compares emerging economies in Southeast Asia to Singapore on the ten parameters required to leverage information and

communications technologies (ICTs) for social and economic impact.


An emerging market such as Indonesia lags behind Singapore in terms of the political and business environment, infrastructure, affordability, skills and stakeholder readiness required to adopt the traditional digital health model. 




New digital health models


In emerging markets the new digital health model will play a pivotal role in overcoming many of the challenges impeding healthcare delivery. It will help improve healthcare access, affordability, quality and safety. Emerging markets will leapfrog developed markets to move to the new digital health model (see Figure 4).


Emerging markets are increasingly digitising health information. Affordable EHR solutions are coming to market, such as cloud- based EHR or open-source EHR, which can help emerging markets digitise at a fraction of the cost and in a fraction of the time.


The Philippines has implemented an open source electronic medical record system for government health facilities called CHITS (the Community Health Information Tracking system). CHITS is managed by the UP Manila – National Telehealth Centre. The program has been able to improve health care delivery in government health centres. Nurses and midwives who usually record health data on paper were trained to use the system to generate timely reports for DOH national vertical health programs. Through the program implementation, delays in accessing health data were minimised, giving more time for health workers to give care to patients at the health centre.


Many private sector providers in emerging markets have also opted for cloud-based solutions. There is strong support for healthcare cloud systems from both public and private hospitals in Malaysia and the Philippines. Mary Johnston Hospital in Manila, in the Philippines, implemented a cloud-based EHR solution called HarmoniMD. This solution is built from the ground up using the latest cloud technologies and helps leapfrog over legacy server-based applications. 


Similarly, the Philippines- based company Lifedata offers a web-based electronic medical records system. It has also signed an agreement with the Philippine Medical Association (PMA) for the ‘standardisation and computerisation of clinical practices in the Philippines’.


Digitising the health information lays the foundation of the digital health model in emerging markets. For best outcomes, other healthcare innovations such as telemedicine, mHealth applications and e-prescriptions will be built around the digitised health information. 


Making the transition to the new digital health model


The new digital health model is focused on four key elements – disruption, engagement, integration and trust (see Figure 6).


Disruption – Transforming businesses through innovative models that don’t exist in the market today.


Engagement – Enabling digital interactions between clients and customers in a more engaging and patient-centred way.


Integration – Providing seamless access to health information across systems and devices.


Trust – Ensuring secure information in a digital age to inspire trust in the providers by the customers. 




From digitisation to disruption


New entrants are disrupting the traditional health model by offering digital healthcare services in new and unique ways. They are exploiting the cost-quality curve to deliver healthcare services in an alternative setting. The new care delivery models introduced by these new stakeholders will partially fill the healthcare gap.


The new entrants are increasingly collaborating with healthcare providers and combining the use of EHRs and mHealth applications. There will be an increasing influx of wearable solutions in emerging markets that will support consumer and healthcare desire for monitoring and tracking to be integrated into daily life.


With fewer sunk costs and regulatory hurdles, emerging markets will be able to transition quickly to these disruptive solutions. 


From physician-centric to patient-centric (Engagement)


Consumers are demanding better quality and customer service through social, mobile analytics and cloud technologies. With democratisation of data and increased usage of social media and mobile, patients will play a more active role in clinical decision making. The new digital model will focus on customer experience and understanding patients in their everyday lives. The solution will use customer relationship management technology to deliver patient-centric care.


The digital solution will also act as a hub by sharing information across a broad community to provide support, coaching, recommendations and other forms of assistance. It will enable patient involvement and the provision of ubiquitous and instant feedback in order to realise new behaviours and/or sustain desired performance. 


From independent to integrated


Consumers increasingly expect seamless management of their information across their healthcare providers. Currently, traditional healthcare models rely on disparate systems, multiple sources of truth and silos of solutions that don’t support the provider. The new digital healthcare model will transition towards an inherent capability to ensure seamless information exchange across system(s) of record.


Leading products must integrate data collected from disparate devices and apps into external health ecosystems. It should be integrated into existing activities and workflows of providers and patients to provide the support needed for new behaviours.


As health data becomes more integrated and analytics and Big Data becomes more prevalent, healthcare providers will increasingly gain insight into real-time customer needs and pain points. Analytics will help in early diagnosis, better treatment and improved clinical decision making. 


From security to trust


Cybersecurity is a growing concern in healthcare, especially given recent disruptive ransomware incidents, and the increasing cost of breaches. Data breaches happen for both malicious and benign reasons, enabled by greater digital adoption. Health records are an attractive target for criminals due to the breadth and depth of their data, and healthcare organisations’ relatively low degree of focus on security issues.


Ensuring secure information in a digital age to inspire trust in consumers by their providers is critical. Security in the traditional sense rested on a patient’s level of comfort about the protection of the privacy of health related information and threats of cybersecurity breaches. In the new digital health model where measures have been established to ensure the security of this type of information, the patient’s focus has shifted to how to establish a trust based relationship with their healthcare provider who may or may not be physically present.


Healthcare providers and governments are rethinking strategies for avoiding these attacks. Employee education is a key tactic for avoiding attacks. The players are also looking at innovative solutions such as cloud-based initiatives, Big Data analytics and advanced authentication to improve security and build trust.


Benefits of moving to the new digital health model


There are substantial potential benefits of digital healthcare solutions in addressing business challenges caused by the current systems and processes associated with paper medical records. The benefits are not unlike those that could be achieved in a developed market; however, with a much lower cost base, and much broader diversity of solutions that cross the continuum of care, they could be significantly enhanced (see Figure 7). 


Key considerations in moving to the new digital health model


Technology can bridge the growing gap between workforce supply and consumer demand and clinicians are beginning to see how care can be amplified through mobile technology. In a recent PwC Health Research Institute survey, 85% of clinicians said they would use data from apps and wearables in future treatments.


However, it is well documented that 80% of large organisational change initiatives fail to achieve their intended objectives, particularly in technology-related programs.


Digital health initiatives offer the opportunity to have a fundamental impact on the business model of the implementing organisation. With the introduction of new ways of solving business problems, creating unique experiences for the customer and engaging people through digital mechanisms, many tasks may also become automated or be eliminated, and result in new workflows to complement digital solutions. As a result, any company looking at digital healthcare needs to provide substantial support to the business in order to manage people through this change process. Attempting to implement a digital change in a healthcare environment requires the active involvement of clinical leaders and sponsors who are committed to the change process and can help lead the organisation through the change. These individuals or groups are sponsors and champions who play a key role in driving the change.


Healthcare providers and administrators need to set strategies that harness technology for mutual interests and mutual gain as they build care delivery models with patients – not patient encounters – at their centre.


The companies that will emerge as winners in this new marketplace will be those that can articulate how technology can add value, align incentives, strategically share and analyse data, and redeploy, extend and expand their workforce to embrace digital enablers. The following elements are key:


• Understanding which digital health technologies

healthcare providers and consumers value should shape digital strategies

• Generating meaningful, actionable insights

through analytics will focus investments and yield better, faster results

• Understanding what motivates both caregivers and consumers to adopt and continue to use digital technology will be critical for sustainability

• Rethinking the workforce and informing workflows will fuel the Digital Health return on investment. 



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