An ASEAN Vision: Bring Telecom-Infrastructure Enabled Healthcare & Remote Doctor Access to Everyone

Telehealth is the term used to describe the intersection of the telecom and healthcare industries.  However, to me, the prefix “tele” puts the emphasis on the mere connection or electronic tethering of medical monitors, say, to sick patients and senior citizens.  But.  .  .

• What if the larger goal is to go beyond “telehealth” monitoring to full healthcare via remote delivery?
  
• What if telecom and healthcare were fused together so that telecom infrastructure performs many of today’s hospital infrastructure functions?
  
• What if telecom-enabled healthcare reaches all people — the sick, the healthy, and even those who live hours from a hospital — to receive remote, better and more real-time healthcare than ever before?
  

This is the society transforming vision I heard in an enlightening video conversation (10 min.) between Geok Chwee of Bridge Alliance and Dr. Yong Chern Chet, an experienced digital health innovator who has held a variety of roles within the healthcare industry leading digital transformation initiatives across Southeast Asia.

I contacted Dr. Chet to get more details and here is our conversation:

	Dan Baker, Editor, Black Swan Telecom Journal: Dr. Chet, in your video talk, you mentioned the “Iron Triangle”, a 1990s theory on the limits of healthcare delivery, but you are actually challenging that theory.

That’s right.  The Iron Triangle theory says the three key elements of healthcare: access, cost and quality cannot be delivered simultaneously.  For example, if you lower cost, your quality of care access to doctors will decline somewhat.

But given the tremendous advances in digital connectivity over the last two decades, the Iron Triangle no longer makes sense because when we bring the operations and services from the physical world onto the digital world, we’re able to address all three points simultaneously.

Everyone’s familiar with how healthcare is being delivered through our traditional healthcare infrastructure, namely the clinics, hospitals and the physical facilities.

But we’re using digital and connectivity technologies such as automation and the offline-online platform model to tackle the problems of access.

As we try to innovate and re-imagine the delivery of healthcare, we think of it from a tier-by-tier basis.

The starting point for us is to match the healthcare service to the level of communications available between the patient/user and doctor/medical personnel.  And you can look at this communications availability from both a distance/area coverage and social strata perspective.

If only mobile service is available, the level of service depends on the mobile data bandwidth and how advanced the mobile handsets or equipment are on the user’s side.  Even still, some basic healthcare counseling can be delivered with a simple IM Chat function on a mobile app.

And from there, you can expand by attaching photo, audio, video clips or upgrade to live video or telemetry feed — it all depends on the availability of underlying technology infrastructure.

In a couple generations, technology has done wonders to improve healthcare already.  I grew up in rural Massachusetts, and when I got sick as a kid, my Mom would take me to old Dr. Howes’s home for a visit.  His dark office was a bit scary.  His instruments were crude by today’s standards (electronic devices didn’t exist then) and his desk had medical books scattered about.  But we were lucky to have Dr. Howes because few doctors lived nearby and he charged prices my parents could afford.

Access to doctors is certainly a key pain point in Southeast Asia.  Doctors are usually located in core urban areas and they’re not evenly distributed throughout the country.  Of course, in highly populated cities like Singapore, Bangkok, and Jakarta, access to medical specialists is very good, but across the rest of the region access is not so good.

Yet digital and communications advances are testing the boundaries of what can be delivered remotely.  In fact, Covid-19 forced the healthcare industry to implement remote consult capabilities in a hurry, and those efforts have delivered some good results.

Now because in-person visits with a doctor are so well-established and familiar in modern societies, we tend to believe in-person visits are the best delivery point for healthcare.

But is that always true?  And how would you evaluate that?  Well, one measure of healthcare quality is the amount of clinical data we can gather about the patient in order to make the most informed diagnosis.

For example, if I were to examine a patient’s respiratory system in person, I would listen to his or her breath sounds via a stethoscope, do percussion (finger tapping) on the chest wall, and listen to the characteristics of the sounds based on the amount of air in the lungs of the patient sitting in front of me.

However, if the patient were remote, I might get the same or alternate clinical data by looking at the breathing sound waves from a wearable respiratory device.  Second, I could couple that data with the oxygen saturation reading from the patient’s smart watch.  Further, I might be able to call up the digital Xray results or report which was done by an imaging center located conveniently near the patient.

Ironically, if you compare the in-person and remote scenario I just shared; the doctor in the remote setup actually has a higher quality of clinical data available for him/her to make a more accurate diagnosis of the patient’s respiratory condition.

So now we see that with better/faster connectivity, we can provide a better experience to patient and doctor alike — and we really can deliver healthcare services at a more accessible channel or price point.

	How do you see telcos playing a part in what Good Doctor is starting to enable — the transformation of the healthcare industry into something far better than it is today?

Well, the journey begins when over-network or online linking of medical devices and active patient monitoring becomes more common.  And when healthcare starts being delivered across regions, that’s another tipping point.

But in the meantime there’s plenty of work to do to mature the platforms and get the processes tested and worked out so the system can scale.  In my view, there are three crucial areas that will enable faster tele-healthcare adoption:

• Patient identification and authentication — When you think about seeing a doctor, many of the processes start by determining who you actually are — and whether or not you are the right party and are accessing the records of the right person.  This step is a crucial starting point because all the medical safety procedures are linked to that. 
  
  And getting the right ID of a person is harder in developing countries because the patient may not have a driver’s or government ID card because the country’s personal identity infrastructure (via banks, credit bureaus, and government) are not so highly developed.  In fact, the widespread use of mobile phones in Southeast Asia has opened up opportunities for telcos to help identify people.
  
• Privacy and security — Secondly, as we bring all our data and our processes from offline to online, we need to be able to protect the privacy and the security.  Here we’re talking about cybersecurity and data privacy, which is increasingly important due to growth in the digitization of patient records.
  
• Capability and reliability of the new infrastructure — Obviously when you build a hospital, your systems have to be reliable.  They cannot fail because they are running a lot of critical processes on this infrastructure.  Likewise, as we try to bring healthcare out of the hospital and into the home or an online platform, the infrastructure that we run our processes and services on has to be equally as reliable and capable.
  

	In the U.S.  I notice the pharmacies are expanding.  My local Walmart supplies drugs, but they also vaccinate people.  What’s the model look like in Indonesia right now?

Pharma retail are not so advanced here in ASEAN and regulatory license requirements does make things somewhat rigid.  But I would say innovative models and hybrid services are beginning to gain support because of the intrinsic problems of access coupled with shortage of talent.

Hub and spoke type of services are beginning to get traction and decentralized distribution channels for both products and services are beginning to form.

In Indonesia, for example, people routinely go to retail clinical labs/pharmacies for blood tests.  At times they also go to a central location for access to internet (e.g. broadband is not available everywhere).  Hence, for rural locations like this the role of telcos in establishing mobile connectivity and networks are important to open up regions to development and commercial activity.

When I was on work assignment in Cambodia a few years back, I witnessed first-hand the value of having mobile broadband networks because the fixed or cable infrastructure was poor or not available.  The best internet connectivity speeds we could get were over newer mobile networks.

	Do you see 5G opening up new opportunities and possibilities, also in the healthcare area?

Dan, I would say: denser, faster, and wider bandwidth is absolutely crucial to where we want to go.

Remember, we are trying to broaden health services and offerings beyond the fixed physical medical infrastructure to the larger world outside that.  We are actually trying to begin your health journey before you go into a hospital.

In fact, whether visiting a hospital is part of your journey or not, you will end your journey outside because you’re maintaining a chronic disease or you are trying to monitor a certain recovery.  The idea is to deliver healthcare from anywhere and anytime, whichever is convenient for the patient.

For that reason, we are keen about anything we can do remotely.  We want “distance” to no longer be a barrier to our service.  Secondly, “real-time” is part of everything we want to do, because if you think about it, when it comes to health, we never want a situation where, let’s say, the status of the patient changes and we haven’t picked it up or sensed it until much later on.

So realtime-ness for us is a great asset on how we deliver healthcare.  So that very much ties into what I hear about 5G — it’s really fast.  Speed is also essential because you want to be responsive and you want to be able to detect changes in status right away.

So, remote, realtime and really fast.  That’s how I like to look at how 5G is enabling for us in the healthcare space.

If you compare to what the traditional approach is, normally for us to render health services, we always need to ensure we’re running on infrastructure such as clinics or hospitals.  But the fact that if we want to digitize the health delivery system, we need other forms of infrastructure to actually run our services on.

So I see telcos as being literally the digital infrastructure that is outside of the health system.  So that way, we can go on a reliable support system or a trusted partner in order for us to build our services.

I find Telecoms tend to downplay their enabling role in creating the digital world.  So I like how you’re urging telecoms to think bigger and help lead the future of healthcare — because as you’ve shown, advanced communications is absolutely essential to its success.  Sounds like telecom-enabled healthcare is another moonshot — the mission to put a man the moon in the 1960s.  It’s about overcoming the gravitational force of healthcare traditions (like in-person and location-based care) to lower costs and gain better access to doctors without sacrificing quality.  It’s like fitting each patient with an invisible spacesuit — a mobility-enabled life support system that listens to vital signs while keeping the patient in constant monitoring — and direct conversation with doctors where it’s needed.

The “spacesuit” notion certainly fits with the upcoming 5G network service and edge computing capability.  We are hoping this will enable real time AI/ML processing, as well as real time analytics and natural language processing from video feed data.

If you take the example of a growing regional startup, most often operations will have to be established in one geography with expansion efforts subsequently planned for country No. 2, No. 3 and so on.  So, as they go into new regions, working with the local telcos in each of the geographies will be a great asset.

And if we can work with a consortium of local telecoms, such as Bridge Alliance, it will be easier to build partnerships and ecosystem from region to region.  There’s even the potential of co-creating a regional offering like a travel health service that can be offered across many geographies..

I’ve recently heard about multi-cloud capability for great system reliability.  And that sounds perfect for healthcare: we use the term “Hybrid Cloud” when we talk about meeting an organization’s preference or regulatory requirements in storing patient medical data or sensitive data on on-premise servers or in a private cloud.

Meanwhile, general computing infrastructure can be supported by a public cloud for system availability or easy scaling etc.  Either way, I reckon having more multi-cloud flexibility and options will be welcomed by healthcare organisations.

	Dr. Chet, it’s a wonderful vision you and your team are making happen.  We’ve already seen how telecom connectivity, clouds, and IoT bring more convenience and digital entertainment to life.  So it’s nice to see it can also help bring more affordable, accessible, and higher quality healthcare to people across the globe.  It even sounds like our pets will get better care someday soon.

They already can, Dan.  We have vets on our platform in Indonesia offering teleconsult services to our users who are pet owners.