Customized Medical Care Making Thailand Healthier
 
Jul 25, 2017
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This cloud-based healthcare system, which is set to expand to hospitals throughout Thailand, made it to the ASEAN market after a detour in Africa provided valuable lessons on localization and customization.

At the King Chulalongkorn Memorial Hospital, one of Bangkok’s largest hospitals, a middle-aged man demonstrates the use of a smart health diagnostic station: After taking out his chip-embedded ID and scanning it to verify his identification, he measures blood pressure, blood oxygen level, forehead temperature, height and weight. As he does so, all the data is automatically transmitted to the cloud and entered into Thailand's Ministry of Public Health database, from which patients and their family members can access it via an app to keep them on top of all their health data at any time.

This particular cloud-based health information system comes from AdvMeds (先進醫資), a social enterprise based in Kaohsiung, Taiwan. King Chulalongkorn Memorial Hospital is the first to fully adopt the system, which will be expanded to full use at hospitals all around Thailand in the second half of this year.

Venturing Where Few Dare to Go

The middle-aged man is Doctor Somkiat Sangwatanaroj, a cardiologist at the hospital. Doctor Sangwatanaroj was one of the people instrumental in helping AdvMeds make inroads into Thailand’s national healthcare system.

Many people are unaware that they have high blood pressure because there are no apparent symptoms. Our hope is that more Thai people can take advantage of the diagnostic stations to stay on top of their blood pressure numbers at all times, and pay better attention to their health, he states. 

What are the advantages of this machine from Taiwan? Doctor Sangwatanaroj explains, saying that the average diagnostic machine cannot automatically upload data, instead only spitting out sheets of paper covered in numbers. These must in turn be keyed in manually, which introduces the possibility of errors or data loss, adding to the trouble of daily diagnostics. Hooked up directly to the Cloud, the machine automatically uploads the data for more effective collection of health information.

In addition, the machine can remind patients suffering from chronic illnesses to return to the hospital to refill prescriptions or to exercise. It also sends alerts whenever data appears to be in error or unusual. Doctor Sangwatanaroj believes that the service will contribute to the betterment of the Thai population’s health.

Arirat Banpavichit, general manager of Connect Diagnostics, AdvMeds’ local partner in Thailand, relates that last year, at the introduction of a customer, the company won the contract for a high blood pressure case management project funded by the Thai government and overseen by King Chulalongkorn Memorial Hospital at 100 hospitals around Thailand. They then came across AdvMeds’ cloud-based healthcare system, which was perfectly suited to the project’s big data and remote medical diagnostic needs, facilitating cooperation.

People might have reservations about uploading their personal information to the Cloud at first, so we can take our time, she stresses.

How did this advanced Cloud-based medical system wind up in Southeast Asia? Rather than taking a direct route, it actually began in Africa. Johnson Huang, AdvMeds' 34-year-old managing director, holds a Ph.D in information engineering from National Cheng Kung University. His field experience goes back to 2009, when he joined a team from Pingtung Christian Hospital on an outreach mission in Malawi to upgrade the local health information system.

We were a small company at the time, unable to compete. So we went where no one else did, relates Huang. Everything was a challenge in Malawi: Power was unstable, citizens had poor access to information, and servers would get drenched whenever it rained. This setting was a great place to hone one’s spirit and determination.

In Africa, AdvMeds gradually figured out how to use the fewest resources to do the most work. Many hospitals in Taiwan have information offices and engineering rooms, but in less resource-rich regions, mobile devices and the Cloud are employed to lower costs. The Cloud-based health data system uses inexpensive smartphones to bring the services into remote areas.

Smart Dialysis Enhances Safety

Pingtung Christian Hospital is not only AdvMeds’ close ally in Malawi, it was also a catalyst for expanding services into Thailand and Vietnam. Tsai Duujian, chief executive officer of Pingtung Christian Hospital’s International Medical Development Center, has an extensive network of international contacts. In recent years, he has led delegations on visits to Vietnam, Indonesia and Cambodia. When Khanh Hoa Province General Hospital - the largest hospital in central Vietnam - first began a cooperative relationship with Pingtung Christian Hospital, the latter brought AdvMeds along, their main area being a smart dialysis system.

According to Fan Szu-shan, vice superintendent of Pingtung Christian Hospital, the standards of dialysis treatment in Taiwan are so advanced that the mortality rate for first-year dialysis patients is just 0.5 percent, with life expectancy reaching 30 more years. In contrast, the mortality rate among first-year dialysis patients in Vietnam is 20 percent, and only one-half of patients live more than five years after undergoing treatment. Further, while the hepatitis B infection rate among dialysis patients in Taiwan is less than one percent, it remains high at 15 percent in Vietnam. What happens over the course of a patient's dialysis treatment is extremely important, and only by having a record can management be improved, he observes.

What exactly is smart dialysis? During conventional dialysis treatments, which last four hours, the nurse takes readings every 15 minutes, including blood flow and anticoagulant status, and monitors blood pressure every half an hour. When a nurse is caring for five patients at the same time, even the slightest oversight could be life threatening.

Johnson Huang relates that the defining characteristic of smart dialysis is full automation of the entire process for greater safety and convenience. Following Khanh Hoa Province General Hospital's adoption of smart dialysis, once patients lay down, the system records their name and automatically uploads all the data monitored until dialysis is over. The nursing station is alerted immediately when any issues arise, greatly improving safety.

As a heart surgeon himself, Fan Szu-shan sees the potential of information-based medicine.

We used to think that saving a life in surgery was good, but if you know how to use information technology properly, you can save multiple lives at once even if you're not physically there, says Fan.

The smart dialysis system has also made inroads in Thailand. AdvMeds has established a cooperative relationship with a chain of 100 dialysis clinics around Thailand, where equipment installation has begun.

The AdvMeds example helps us see opportunities for Taiwan’s medical information industry in Southeast Asia. Johnson Huang believes that Taiwan has a superb environment for development. There are over 100 medical information systems across Taiwan's major hospitals. Consolidated, this knowledge can be exported as soft power, he says. AdvMeds cloud-based healthcare system is highly customizable, with over 60 modules to choose from to set up a system.

The demand for better healthcare is rising along with consumption standards across Southeast Asia. Raising the example of Africa, Johnson Huang relates that information projects in Africa are often seen as charity donations, and locals show little interest in learning - typically coming late and leaving early. In contrast, local partners in Thailand and Vietnam arrive 15 minutes early, showing their eagerness to do better.

What is the right approach for the information industry’s southward move? Work together with local teams, says Tsai Duujian firmly. From Malawi to Sandimen to Vietnam, we do clinical work together, exploring, and searching for what is needed locally.

Local cooperative partners in Thailand have also taken notice of the competitive strength of Taiwan’s information teams. Arirat Banpavichit relates that, although quite a few information teams from China have pitched IT solutions to her, after testing them we found that the quality of Taiwan's information systems is better at a reasonable price, and the team’s capacity for customization is especially strong. Taiwan should put its advantages to work, she declares.

Translated from the Chinese by David Toman