COVID-19 has accelerated the digital transformation of Malaysian healthcare systems. During the 'Building a Successful Digital Transformation Roadmap in Malaysia' webinar held on 6 May, Derrick Chan Kum Keong, CEO of Sunway Medical Centre Velocity, shared how they were able to design a digital health ecosystem that prioritises patients.

Bruce Winzar, executive director for Innovation and Digital Services and regional CIO of Australia-based Bendigo Health, also joined the session to share insights that his organisation gained in their digital health journey.

Empowering patients through systems interoperability

Derrick shared about his work at a diagnostics company prior to joining SMCV, where systems are integrated to provide patients with access to their records. In turn, this empowers patients to use their records at their own discretion.

"To be able to connect other systems together give us a lot of flexibility because we are empowering the patient to be able to bring their records to wherever they want, such that it doesn't hamper them in terms of critical medical treatment," he said.

Emphasising patient data privacy, Derrick mentioned that medical facilities must seek patients' approval first before drawing their information from the system. "The patients themselves must be the ones [to send] medical records or images to the clinicians… so they still hold authority and control over their own medical records," he continued.

In order to have their various systems integrated, Derrick shared that it took a bit of convincing to have Health Information System (HIS) vendors open up their systems to other vendors that provide data analysis. This led to a creation of a dashboard that not only presents data, but analysed data. "It takes a little bit of effort to convince them to see the beauty about having data connected in that sense," he said.

Derrick is now able to manage the hospital's entire ecosystem, from clinical to housekeeping operations. "All this appears in front of me as a dashboard using our HIS," he added.

SMCV was designed with digitalisation in mind, Derrick said. The digital hospital was launched in September 2019, months before the global outbreak of COVID-19. Since it was set up, the hospital has been totally paperless and only uses electronic medical records. "We have automated registration process, online booking, e-claims, digital reporting, teleconsultation. There is also seamless integration with all the medical devices and filmless imaging," he said.

By the end quarter of 2021, the digital hospital hopes to launch its laboratory information system through the SunMed Go app and its PACS system, which will provide patient access to reports via their mobile phones.

'More than just a clinical portal'

While Bendigo Health has made great strides in building its digital platform and architecture, it has room for improvement with regard to patient engagement, Bruce admitted.

For him, patient engagement is more than just a clinical portal. "Patient experience and patient engagement [are] more about how you are providing a front door to your organisation or to your business and what the front door look[s] like; how do you empower and provide the appropriate information to each of your patients or to your consumers."

Bruce observed that patients and customers today want more information than just clinical information. "They may want bits of information around pre-care and post-care. They might want information about what's the experience, what [it is] going to be like when they go into a renal department or cancer centre."

"I think our portal has got to have much stronger searching algorithms on it… so we are able to provide more information than just the 'brochure' way," Bruce said. However, many of the EMR vendors, he said, "would not have a comprehensive portal package that can do that."

"So, it's probably looking at what other portal packages are available on the outside, along with what's required on our side," he said.

Challenges in running multiple systems

Bruce shared that Bendigo Health has "a very robust, fully integrated, real-time system." In addition to EMR, they utilise integrated digital systems powered by Microsoft's integration machine BizTalk. The care provider also jointly operates a digital hospital, which was launched in 2017, with the state government of Victoria.

However, running multiple systems made it difficult for them to continuously monitor staff and measure members' performance in their use of digital health. In the past three years, they have also had to deal with various concerns such as cybersecurity, ongoing education, network monitoring, among others.

Bruce highlighted that one particular difficulty when it comes to digital transformation in public health is infrastructure. "It's all about your legacy applications and moving those legacy applications, data migration and transferred conversion of data, and also the replacement of expensive black boxes," he said.

"You [are] continually in this mode of replenishing your network, replenishing the wide-area network, replenishing equipment, and also replenishing your legacy applications and upgrading systems," he added.

Strong leadership to move forward

Bruce spoke about his organisation's very supportive leadership in their digital transformation journey.  The officers in medical information, allied health and nursing are "all leading right from the front," matching the group's operational and strategic plans for a successful digital health implementation.

But it takes strong leadership to bring together the workforce. Effective change management is needed to bring together all clinicians, nurses and other staff to retrain and learn how to use new systems, according to Bruce, who said that funds must also be set aside for this. "If you want to go forward, everyone's got to come," he shared.

Still, getting their staff to adapt to new services remains a challenge for Bendigo Health, along with the adoption of virtual care. "I think everyone has a good understanding of telehealth, but when you expand it to virtual care – virtual care actually encompasses a lot more than just face-to-face telehealth or a specialist consult," Bruce said.

Managing security risks

Even with a well-structured digital system, physical policies and controls must still be in place to protect patient data and privacy, according to Derrick. During the first few days of the pandemic, information about patients contracting COVID-19 easily got out, he said.

"We need to make sure that access to very sensitive information within the hospital is being controlled," he added.

In order to do this, hospitals must have internal structures so that access to certain information will be provided on a needs basis. "And if there are clusters that occasionally need [that] information, then what we do is we identify a certain person in charge within the cluster, such that information will only be available to that person," Derrick shared.

Bruce cautioned that despite policies, standards and constant monitoring of risks, "the reality is that you will, at some point, probably be on the wrong side of a cyber attack."

"I think we just have to live with it," he said. Nonetheless, he suggested that hospitals must assess their risk profiles, like what they have been doing with the board members of Bendigo Health. "Each board [member] – we have 7-8 boards – goes through a risk profile exercise [to find out] which end of the stick they sit."

While there are "significant risks" inside hospitals, regardless of whether it's digital or not, Bruce maintained that "we're in a safer environment at the moment than we were 20 years ago when it was all paper."

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The HIMSS Digital Maturity Series delves into the essence of enabling a meaningful digital transformation journey for healthcare organisations through a series of panel discussions with healthcare providers around the Asia Pacific region. The goal of each session is to gain insight into what it takes for health systems to advance towards a digital health ecosystem and ultimately, digital maturity and excellence.

Our next Digital Maturity Series session will centre on Indonesia. To register, click here. Upon registration, more information regarding the session will be shared with you over the next few weeks.