Malaysia – Delivering Digital Health within a strategic framework

In 1997, Malaysia set out a strategy to enable people and health professionals to access, manage or

deliver healthcare by using digital tools and technologies. This “Telemedicine Blueprint” reflected

Malaysia’s “Vision 2020”. It covered the period 1997-2020. The strategy began with a big bang

approach. Five key high impact projects were started, focusing on teleconsultation, continuing

professional development, “Health online” services, a virtual library and a Lifetime Health Record.

Malaysia made foundational investments in developing an enterprise architecture, high speed and

secure networks, high-resiliency data centres, a National Health Data Dictionary, personal identifiers

using both national identity cards as well as local hospital patient master indexes, as well as

registries of people and places.

However, progress was slow and after 10 years it was clear the business model needed changing,

coupled with adapting to meet the new technologies that were emerging. The shift from internal

capital expenditure to an operational expenditure model of having managed services and public

private partnerships is one example. Also, Malaysia harnessed cross-sectoral support (with

academia, industry and government) for nurturing innovation.

Having a long term strategic framework has enabled shorter-term programs to evolve to account for

emerging requirements, technologies and user feedback whilst enabling greater continuity,

consistency and collaboration amongst the many partners involved.

Key lesson: Long term strategies are needed to guide the direction of travel, but must be adapted to

deal with the obstacles and opportunities encountered on the journey.

Taipei,China – Increasing the value of data

Taipei,China has now got in place the social, governance and technical infrastructure to enable it to

extract value from the data generated by its systems. Its National Health Insurance (NHI) Authority

processes 1m new records per day; it has 12 years of de-identified claims data for 23m people, along

with a disease-specific data base for 16 disease groups, as well cohort data bases and random

sample databases.

A National Health Data Center is being developed in Taipei,China that consolidates data to present a

unified view of a single patient and a single visit. In addition to the NHI, these sources include:

• The Department of Health, Bureau of Health Promotion
• Providers
• Local Health Bureau.

Data from clinical data systems (such as Electronic Health Records) and financial systems will be fed

into a central repository, and aligned with data from disease notifications, registrations, archives,

screening and surveillance and health research.

Combining these different data sources enables considerable cost savings, such as:

• Avoiding surveys
• Reduced time delays in providing analyses.
• Better understanding of the determinants of health, and indicators of health service provision.

But there are privacy issues to be considered, and Taipei, China is considering giving each citizen

control of their personal health data.

Key lesson: With the right (technical and social) foundations in place, analysis of big stores of data

can now enable better informed decisions

Viet Nam – Partnerships with digital solutions providers

Public and private sector collaborations play a key role in advancing sustainable digital health

solutions in Viet Nam.

In 2014, the Viet Nam Ministry of Health, the US CDC, and private sector international partners began

collaborating with Viet Nam’s electronic health disease surveillance system (eCDS). A major goal

was to implement a digital health solution to ensure case level immunization (measles) identification

and coverage of timely reporting for all notifiable diseases, as mandated by Viet Nam health policy

(circular 48 and subsequently circular 54). The system was linked with Viet Nam’s National

Immunization Information System (NIIS) for interoperability. Viettel (a large, partially state-owned

telecom) worked closely with the government of Viet Nam to implement the disease surveillance

system. In February 2017, the Ministry of Health and the Asian Development Bank convened a

convergence meeting to identify a strategy and actionable steps for collaborations in health

priorities. Further strengthen disease surveillance at local health facility levels was identified as a

priority with system interoperability and provincial trainings as a next step.

The government-owned system is maintained by the General Department of Preventive Medicine

(GDPM). Viettel remains actively engaged in the health sector including the Electronic Health Record

(EHR) initiative. It is making its own investments in patient portals and cloud-based health

information systems to support standardized health facilities and national information systems.

Benefits from the system include reduced time needed to generate disease surveillance reports,

access to coverage rate of vaccines and enhanced early outbreak detection. Orchestrating

governance and incentives for optimal investments in digital health by government, donors and

commercial organisations is an ongoing process in the country.

Key Lesson: Public-private partnerships can deliver national scale, sustainable information systems

when partners share a commitment to health priorities and adequate investments, capacity and

governance is in place.

DHIF

There are five illustrative DHIF models which are referred to in parts II and III of the Manual,

and are used to illustrate the application of DHIF. They are:

• mHealth for telemedicine dermatology, with no extra access for patients who have no previous access, only for current patient cohorts;
• mHealth for telemedicine dermatology, with extra access for patient cohorts who had no previous access, so a Universal Health Coverage (UHC) initiative;
• short message or messaging service (SMS) for advice and checkup reminders for pregnant women;
• digital surveillance for malaria; and
• interoperable electronic health records (EHRs).

DHIF has been used in three settings:

• strategic affordability and benefits;
• immunization information system (IIS); and
• comparison of immunization performance with and without IIS.