At the end of December 2017, Susann Roth, senior social development specialist at the Asian Development Bank (Philippines), delivered on the website HealthInvestor Asia her analysis of the eHealth market in Vietnam, and more precisely on how the country is developing its digital health capacity.
Among the government projects are the introduction of a nationwide electronic health record (EHR) system during the year, the development of IoT technologies within the industry, and the implementation of the HL7 Fast Healthcare Interoperability Resources (FHIR) framework to improve health data exchange and information systems interoperability.
Canada, Denmark and South Korea: 3 examples to follow in eHealth
Roth said that Vietnam can be inspired by other countries in the digital health sector :
- The Ministry of Health is closely watching the situation in Canada, which has invested US$ 2.15 billion (€1.8 billion) in its digital Health Infoway and achieved an estimated US$16 billion (€13.4 billion) in benefits in quality, access and productivity gains from investments made in tele-health, drug information systems, diagnostic imaging, and clinic electronic medical records.
Denmark and eHealth: interesting long-term savings from going digital case
- According to the specialist, Denmark is one of the best example of a long-term savings from going digital for Vietnam. Since 2009, the Danish government has spent nearly US$335 million (€280 million) on eHealth, about 1% of its healthcare spending at the time. This investment has generated annual savings between US$53 million and US$78 million (between €44 million and €65 million).
- The Asian country can also draw inspiration from South Korea, which recently announced that it would increase investments in the medical and healthcare sectors by more than US$100 million (€83.5 million) over the next two years, « with most of this activity concentrated in areas related to administrative simplification, claims adjustment (…) and electronic health records », Susann Roth said.
Developing countries can directly « apply the latest technologies to their context »
« The advantage of developing countries is that they don’t have to build on legacy digital information systems from 20 years ago, » she added. « They can leapfrog and apply the latest technology to their context, like Vietnam is doing now by quickly moving from paper-based to digital. »
Data: an increasingly concern about data content relevant for the individual patient
Vietnam is rapidly building its digital health capacity, the expert observes. The government knows that digital health will become less hierarchical and more patient-centered in the coming years.
Sector stakeholders will be less concerned with aggregated population data and more with data content relevant for the individual patient. Better health information is indeed essential for managing more complex chronic diseases, which often require several specialists and a lot of patient information exchange.
The example of a patient with diabetes
In order to shed light on the importance of digital data, Susann Roth takes as an example a diabetic patient with hypertension.
- He/she needs to consult a primary care doctor for regular checkups.
- He/she is also required to monitor his/her blood sugar levels, record the results, and consult specialists to identify any early signs of side effects due to the use of diabetes medication like hypertension, for example.
- He/she also benefits from a complete record of his/her medical history through various electronic health records, crucial documents for emergency interventions such as surgery, and which reduce treatment errors, save time, cut red tape, and facilitates insurance reimbursements.
« It is thus clear that digital health can decrease the administrative burden of care delivery, improving its quality, make it more efficient, and enhance patient self-management. »
« Ambitious plans » to introduce a nationwide EHR
« [In particular,] Vietnam has ambitious plans to introduce a nationwide electronic health record (EHR) system in the next months. »
Goal : to better manage patients at the local community level, and to better understand the health needs of the population « while assessing whether the national health insurance scheme has had actual impact ».
The introduction of EHRs, however, comes with many challenges, Mrs. Roth noted. One of them is that Vietnamese health officials will have to agree on health information standards. They have to decide which information exchange codes to use.
« Standardization is the foundation for seamless, secure health information exchange within the digital health system. It requires a digital health governance structure to enable officials figure out who has access to data, where and how the data securely stored and exchanges (…). Of course, digital health is complex, and mistakes will be made for sure. But it’s important to start somewhere, and then take the process forward step by step. »
Towards an adoption of IoT technology
Digital health technology is also rapidly evolving with the adoption of the internet of things (IoT).
IoT technology will lead to more complex health information systems, « since more devices and more sources of information will need to be connected, ideally linked to electronic health records to get a complete picture of patients. More detailed information will need to be exchanged, which again depends on good governance and standardization, » the expert said.
FHIR: a framework for setting standards in the industry
Vietnam has decided to use the HL7 Fast Healthcare Interoperability Resources (FHIR) framework as a practical solution for health data exchange and information systems interoperability.
HL7 FHIR aims to set standards in the healthcare sector. It is a draft standard describing data formats and resources as well as an application programming interface for the exchange of electronic health records, particularly in complex information systems, including IoT.
The solution improves the sharing of documents such as PDF files by directly exposing discrete data elements as services. For example, basic information such as patient data, admissions, diagnostic reports, and prescribed medications can each be retrieved and manipulated through their own resource URLs. This speeds up the exchange of health information and allows data mining from complex documents.
« Although it is still early to fully demonstrate how HL7 FHIR will change digital health technology, experts predict that it will fundamentally change how health data is exchanged, » Susann Roth said. « HL7 FHIR will basically allow countries to create a digital “health web” by using the http protocol as an information exchange platform and thus create a distributed information system, which will provide relevant information to each user, while protecting privacy. It will also encourage strategic big data analytics, real-time patient monitoring, and feedback. »
EHR: Vietnam could become an example to follow in Asia
The long-term goal of Vietnam is to develop a connected health web that will enhance coordinated care and will improve health system efficiency in terms of cost, productivity and security, with quick access to the information needed for decision-making.
« If everything goes according to plan, Vietnam will be the first middle-income country in Asia to implement nationwide standardized EHRs with HL7 FHIR, » said Mrs. Roth, who will be part of this transformation as a senior social development specialist at the Asian Development Bank.
