What digital health strategies and initiatives can resonate with markets in Asia? Find out in this briefing report.

1. Digital Health Breakfast Briefing in Asia 2017
Singapore
Healthcare
EXECUTIVE SUMMARY
DIGITAL HEALTH IN ASIA
February 22nd 2017 • Breakfast Briefing, Singapore
an Economist Intelligence Unit business Healthcare

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Digital Health Breakfast Briefing in Asia 2017
Singapore
EXECUTIVE SUMMARY
THREE FOCAL POINTS FOR HEALTHCARE COMPANIES IN
SHAPING THEIR DIGITAL HEALTH STRATEGIES FOR ASIA
CONSUMER POWER
Consumers and end users are becoming more
proactive about deciding what is important
to them, and they want to be involved in
contributing to the whole process of care.
A single consumer has a sphere of influence
larger than just him- or herself, as Chee Hew,
points out: “If I am looking for the right doctor,
it is not going to be only for myself, but also for
my parents.” For companies, this means that
it has become necessary to engage consumers
around a diverse set of needs.
It has also become important for healthcare
companies to develop a deep understanding
of how consumers are using their products.
In healthcare, getting insights on physicians’
behaviour and their interaction with products
and solutions can be challenging. As Ms Hew
shares, “When companies approach doctors to
ask what they need, the physicians are not going
to tell them about the products that they don’t
use right now. But if we can really observe the
doctors closely, we can see what products can
align with their workflows and how they deliver
care to patients.”
Healthcare companies can take a cue from how
consumer companies have been extracting
consumer insights. Samsung, for example,
“Healthcare
companies need
to incorporate the
focus on driving
patient-centric
outcomes across the
whole value chain,
from research to
commercialisation.”
Rie Ruby
Senior Associate
Consultant
Clearstate,
The Economist
Intelligence Unit
Consumer health delivery innovation and frugal health are concepts that are quickly rising in
prominence in Asia. The opening presentation by Chee Hew, Senior Principal Consultant at Clearstate,
The Economist Intelligence Unit, highlighted three key themes that underlie why these concepts are
catching on in Asia, and how companies that truly understand and strategise around these core issues
can add value in the digital health space.

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Digital Health Breakfast Briefing in Asia 2017
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tracks how consumers use its mobile devices
and televisions; this can provide valuable
information to help the company to understand
the ways that its products are used, thereby
assisting it in developing new and improved
services and products. “The same way that
consumers go about picking the best phone
or the best television, patients are looking at
picking the best care,” says Ms Hew.
BUSINESS MODEL EVOLUTION THAT
FOCUSES ON PATIENTS AND PHYSICIANS
Rather than focusing on a single drug or
device, to be successful, companies need to
think about the solutions that benefit patients
and physicians in the long run. One startup in
China, Trusted Doctors, got its formula right by
helping to connect patients to high-quality care
by helping physicians build their own private
practices through its platform. The company’s
model is interesting for two reasons: it helps
patients who find it challenging to seek out
doctors who can provide the care that they need;
and it helps physicians raise the quality of care
through its platform which provides them with
tools to improve the management of their clinical
work and professional learning.
However, this business model would not be
feasible without government support. The
loosening of regulations in several provinces
has permitted physicians working in hospitals
to practise privately – doctors do not need
their hospital’s approval to practise outside
the hospital for one day a week. About 400,000
physicians, or roughly 10% of all doctors, across
China have begun to build their private-practice
business through the Trusted Doctors platform
since it started up in 2013.
THE ECONOMICS OF DIGITAL HEALTH
The question of the economics of digital health
solutions—who will be financing their use,
and what are the benefits that they bring to
different stakeholders—often emerge during
conversations about launching these solutions
into the market. “If you do not address the
economics of how they are going to operate or
how they will benefit, there will be no buy-in
from the stakeholders to implement or use such
programmes,” said Ms Hew.
Companies will need to consider how their
digital health products and solutions add value
and costs at all levels: patients, physicians and
payers. For payers, the economic argument is
straightforward: How much money am I saving,
and am I really providing better care for the
same amount of money? Meanwhile, consumers
who are paying out-of-pocket for medical
services care about how their entire healthcare
experience could be augmented by these new
solutions.
In the following section, The Economist
Intelligence Unit and a panel of industry
executives take a closer look at how companies
are addressing these themes and at the progress
of digital health initiatives in Asia.

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PANEL DISCUSSION
WHAT DIGITAL HEALTH STRATEGIES AND INITIATIVES
CAN RESONATE WITH MARKETS IN ASIA?
DIMENSIONS OF DIGITAL HEALTH
Each panelist brought to the discussion their own
distinctive notion of digital health, leading to
a richer understanding of how different players
in the digital health ecosystem think about and
define digital health.
Ms Olszewski offered two ways of looking at
digital health. The first is from an organisational
point of view: “When I think about digital
health, it’s about digital innovation across the
whole value chain of healthcare of a pharma
company. I think about everything from our
“As a pharma
company, just
launching a drug
is not enough
anymore. We have
to think about how
that drug is being
used in the overall
healthcare scenario
and what is the
actual outcome.”
Julie Olszewski
Executive Director
MSD Global IT Hub
Healthcare is a complex space that does not lend itself readily to disruption in the same way that
the rise of Uber has shaken up taxi services. Through the lens of a panel of speakers from the
pharmaceutical and medical technology sectors and a physician who is no stranger to digital health
innovations in clinical care, the panel sparked a wide-ranging conversation around the current reality
and future of digital health in Asia.
Moderator:
Ivy Teh, Global Managing Director, Clearstate, The Economist Intelligence Unit (Healthcare)
Panelists:
Lawrence Ho, Clinician Innovator, National University Health System (NUHS), Singapore
Julie Olszewski, Executive Director, MSD Global IT Hub
David Vu, General Manager, GE Healthcare Digital, Asia-Pacific

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R&D activities—understanding disease and
looking for new therapies—all the way through
our manufacturing process and to helping our
consumers having access to our products, and
how we make them digital.” Also contained in
this holistic understanding of digital health is
the other viewpoint: the consumer aspect, which
is a key point of emphasis for digital health.
Professor Ho emphasised the need for an
outcomes-based understanding of digital
health. This can be broadly categorised into
four areas: prevention, prediction, precision
and participation. Different stakeholders have
varying degrees of influence over each outcome.
Both physicians and patients/consumers
play significant roles in contributing to the
prevention of diseases. However, physicians
control the two areas of prediction and precision
in healthcare. In Asia, physicians also wield a
strong influence over patients across all areas of
healthcare.
Importantly, the healthcare industry will need
to de-emphasise the ever-evolving technology
platforms and shift its focus towards solutions.
Mr Vu highlighted how hospitals in Asia are
moving away from thinking about devices and
equipment as ends in themselves. Increasingly,
as medical practice is reoriented towards
outcomes, hospital executives are talking to
their vendors in terms of the desired outcomes
in their health systems. This has influenced how
medtech companies like GE Healthcare need
similarly to move beyond delivering department-
level solutions and drive their solutions towards
outcomes. “For me, digital health is about having
devices, analytics and software that deliver
outcomes that matter to whatever stakeholder—
either the user or the patient. The confluence of
those three—devices, analytics and software—is
driving outcomes,” said Mr Vu.
IS ASIA READY?
Assessing Asia’s readiness for the adoption of
digital health is not a straightforward matter.
A highly fragmented healthcare market in the
region means that the challenges for digital
adoption vary from country to country, between
different sectors within the healthcare industry,
and among different stakeholders in healthcare.
“We need to be cognizant of the fact that there
are different sectors in healthcare which are
shaping up differently. Reimbursement models
and the digital maturity of the entire system
are evolving at different speeds in different
countries. We have to look at these markets
separately,” said Professor Ho.
For instance, the industry needs to approach
the primary-care market differently from the
specialty care market. Professor Ho likened
the differences in the two healthcare markets
to the distinction found between products in
the consumer information and communication
technology (ICT) industry, “Primary care is
centred around the patient and the home,
while hospitals, in my mind, are what I call
ward-centric. Similarly, desktop devices are
centred around the office, while mobile devices
are designed for users on the go. There are two
different markets to be addressed.”
However, unlike in consumer electronics markets,
adoption will remain a challenge in healthcare
until reimbursement for digital health solutions
is made available for patients. Governments,
payers and providers remain to be persuaded
that the benefits of digital technology for patient
outcomes and care delivery justify the costs.
Solutions to these challenges could lie outside
the traditional healthcare space. One important
development in this regard is that Asia’s digital
health startup community is strengthening. From
the hundreds of digital health startup companies
around the world that MSD has scouted for
partnership opportunities, Ms Olszewski notes a
key differentiating point found in such startups
in Asia: their strong partnerships with hospital
networks. Companies need to begin driving
collaboration both across and beyond healthcare
institutions.
“Information
needs to flow more
easily from one
clinician to another.
If we look at the
treatment of cancer,
it’s no longer just
an oncologist
that is providing
the prescription.
It involves many
actors—radiologists,
oncologist,
pathologists—who
all need access to
data.”
David Vu
General Manager,
GE Healthcare Digital,
Asia-Pacific

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DIGITAL CHAOS DRIVES SUCCESS
Rather than being an impediment to digital
health adoption, could messiness in healthcare
systems actually enable it? This was one bold
suggestion put forward by the panel.
“You need a very disordered system to succeed,
” said Professor Ho. “Then later on, you evolve
to an ordered system. I think digital health is
going through that shift from disorder to order.
Countries such as China and India are likely to
succeed faster in the consumer market because
they are a bit more disordered than countries like
Singapore.”
“In Singapore, where the health system is very
regulated, digital health initiatives will probably
find better success in areas of deep technology,
such as precision medicine, where regulation
plays an important role to ensure safety,”
continued Professor Ho.
WHEN THE SOLUTION TO THE PROBLEM
BECOMES A PROBLEM
Digital technology creates new challenges
alongside the potential benefits that it
brings to healthcare. As Mr Vu points out, the
technological ability to leverage data in order
to improve outcomes comes with its own set
of challenges in Asia, “We are very much in a
protectionist phase where data—especially
patient data—cannot transverse national
boundaries. We need to have one data centre
that serves the region. To do that, we need to
address the issue of data sovereignty.”
The realisation that partnerships are essential in
driving digital health has really hit home in the
healthcare industry. “We can’t do it alone. We
need to do this as an ecosystem, and now we are
trying to figure out what that actually looks like,”
said Ms Olszewski.
However, partnerships are becoming increasingly
challenging to manage as the number of partners
grows. “We try to partner a hospital and a
tech company, then a startup company and a
university. Suddenly, I have six people at the
table. And everybody has a slightly different
agenda,” said Ms Olszewski, illustrating the
complexity of the digital health ecosystem that
companies encounter when trying to engage
other stakeholders. This increasing complexity
of digital health initiatives and collaborations
means that healthcare companies need to be able
to navigate relationships with different partners
and unify contrasting perspectives and concerns
around a common goal.
One crucial partner that healthcare companies
must engage successfully if digital health is to
take off is the physician group. Professor Ho,
himself a physician, points out that physicians
can be the hardest partners to engage for
digital health initiatives among stakeholders.
“Unlike in other industries like technology,
where engineers are paid to disrupt, physicians
carry out medical procedures and pay for the
equipment and devices they use. So they may
[well] ask why they should be disrupted,” said
Professor Ho.
DISPLACE, NOT DISRUPT
“Physicians are valued for their work, and they
don’t want to be disrupted, because that will
diminish their value,” said Professor Ho.
For physicians, the drive to maintain their own
value and relevance can perpetuate a lack of
innovation in healthcare. Professor Ho went
on to offer his understanding that it is for this
reason that the healthcare system has not been
disrupted.
Companies need to work with physicians and
successfully engage them. To do that, they need
to ensure that physicians continue to be valued
even as the adoption of digital technology moves
ahead.
To design the right digital health solutions,
the industry needs to understand the point of
view of physicians and to become clear on what
they really want. “There needs to be a lot more
‘look and listen’, and the design thinking aspect
of how to approach digital health,” said Ms
Olszewski.
“The consumer and
the government
have to recognise
where the value lies
with digital health.
When that happens,
a new value system
will be created
within healthcare.”
Lawrence Ho
Clinician Innovator
National University
Health System (NUHS),
Singapore

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Singapore
Rather than disrupting the workflows of
healthcare professionals, digital health solutions
should be designed to help to modify workflows
in order to improve them by eliminating gaps in
the healthcare system. “If you introduce a step
within the system, which is what digital health
is all about, you must [also] remove a step.
Otherwise, it adds another layer, and also adds to
the workload of healthcare professionals,” said
Professor Ho.
MSD IT helped to tackle the problem of antibiotic
resistance in India by simplifying the steps
involved in helping physicians to make the right
decision about which antibiotic to prescribe.
This was done by making the existing hospital
protocols and decision trees, contained in a thick
manual, available digitally for physicians who
had too little time to decide which antibiotic
to prescribe. “At MSD, we call this our digital
antimicrobial stewardship,” shared Ms Olszewski.
“The programme has not only gained popularity
in India, we received requests for the programme
in Vietnam and Indonesia because they face
similar challenges. It is a programme that needs
customisation for each hospital since each
hospital has a different distribution of infections
coming through it.”
THE NEXT FIVE YEARS
A positive outlook on the digital health market
was shared by the panel. “It will just be a matter
of 5-10 years before the healthcare system and
technologies will converge and the challenges on
reimbursement get sorted out,” said Professor
Ho.
It is not just physicians and patients who are
embarking on an exploration of new digital
technologies. Healthcare businesses and their
executives have to start synchronising their
efforts with ongoing developments in digital
health. Healthcare companies need not only
to influence external stakeholders, but also to
inaugurate an internal cultural shift among their
staff.
For further information about the issues raised in
this executive summary please contact us at
eiu_enquiries@eiu.com

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