Health Record Paves Way for Digital Health in Sri Lanka
The application of information and communication technology in healthcare is in a state of rapid evolution. It is undergoing transformative change that we could not have anticipated a decade ago when telemedicine was still the buzzword. We have moved from a phase of telemedicine to eHealth to mHealth to now digital health.
Where is all this heading? Can we foresee the future? Will the future be driven by private sector health care providers? Will the government-run nation health care system lag behind? Do those driving this transformation understand how the ICT domain and the healthcare domain should merge to bring better health outcomes for people?
Last week we saw the ‘first blood’ drawn, so to speak, in the eHealth space in Sri Lanka when a stock market disclosure announced that the telecom giant Dialog Axiata had entered into a joint venture with Asiri Hospital Holdings to launch an e-commerce company in the health sector. It was reported that this was in the backdrop of a court injunction obtained by eChannelling against Dialog.
The immediate observation made by us in the Health Informatics Society of Sri Lanka was that if the new joint venture was to compete in the same space with eChannelling, to route patients to doctors, it would have no value either to the patients or the hospitals.
In fact, in a country like Sri Lanka, where the doctors command the respect of the patients, and take patients to hospitals with them, rather than the other way around, one may argue that one centralised electronic appointment booking system is good and anyone breaking away from such a system risks losing business at least in the short term.
Innovation in the healthcare space should not be confused with replication. More of the same may have been good in the past, but what is going to drive healthcare in the future is innovation around personal healthcare. We should however understand that e-channelling or e-commerce in the health sector is not digital health.
Telemedicine was about using ICT to take healthcare to distant places that could not be reached easily. Telemedicine failed in Sri Lanka because there are no such distant remote places. There is a healthcare facility within three km of any person’s residence in Sri Lanka, wherever you may live.
eHealth was about using ICT to improve processes within the healthcare sector – both patient care and other. mHealth was about doing the same using mobile devices. eHealth and mHealth in Sri Lanka, in the past decade, have been plagued by a mysterious disease called ‘pilotitis’. In other words everything ends in a pilot project with no up-scaling to national level except for the eIMMR system, which I described in my column a few months ago. If you ask anyone about digital health most people would plead ignorance, and even deny that such a thing exists.
Digital health is empowering people to better track, manage, and improve their own and their family’s health, live better, more productive lives, and improve society [Wikipedia]. It’s also about helping to reduce inefficiencies in healthcare delivery, improve access, reduce costs, increase quality, and make medicine more personalised and precise.
Digital health was made possible by several disruptive advances. They are Mobile Internet, Automation of Knowledge Work, Internet of Things, Cloud, Advanced Robotics, Next Generation Genomics, 3D Printing, and Advanced Nano Materials. Taken individually, all these technological areas are expected to have an economic impact of over a trillion US dollars each, by the year 2025. So those who drive such businesses should not only have an understanding of the technology, but also have an understanding of the demographics of the population, prevalence of disease in the country, and foresee what the healthcare needs of the country would be, in the short as well as the long term, if they are to truly innovate and add value to our economy and contribute to better health outcomes for our population.
One may ask whether digital health is truly necessary for our country. The answer is yes. Here are some realities, in brief. Sri Lanka has a fast aging population. Our demographic pyramid is already middle heavy, and in another 10 to 20 years we will be burdened with an aged population that is afflicted with chronic disorders such as diabetes, hypertension, ischaemic heart disease, stroke, cancer and chronic kidney disease to name a few. It is increasingly clear that one size fits for all medicine that we practiced in the past is not going to be effective to deal with these health issues. We need to move into personalised healthcare based on a person’s genetic makeup. That transition is already taking place in the west, and we cannot be left behind.
The CKDu epidemic in the North Central part of the country should be an eye opener for everyone that we need to wake up and face new challenges. Interestingly, health catastrophes in the North Central Province have driven ‘modernisation’ of the healthcare system of Sri Lanka in the past. As it happens the Colombo Medical School, where I work, the second oldest Medical School in Asia established in 1870, owes its existence to the “prevalence of an obstinate and loathsome disease” in the island in the 1860s, which caused much misery and suffering and led to an alarming de-population of the Vanni district.
One of the recommendations of the commission that looked into this issue was the establishment of medical training in the country. Today, we have a similar issue in the North Central Province, the cause of which is unknown. To deal with it effectively, however, in the absence of a cure, we need to be able to monitor the population, track the health status of the population, identify those who develop sign and symptoms early, and treat them so that the end stage disease can be delayed as far as possible. This concept is true not only for CKDu, but also for other health conditions, such as diabetes, which is today affecting about 20 per cent of our population.
The recent announcement of the ‘Google Loon’ project to cover Sri Lanka therefore comes at the correct time. It will give the much-needed connectivity to the most remote parts of the country. To go with it, we should implement a cloud-based Central Personal Health Record System for our entire population, managed by the government. In this system, the personal health record of every individual should be owned and controlled by that individual via mobile Internet access using smart phones. The individual could give access to any healthcare providers anywhere in the country both in the public and private sectors when the need arises.
Healthcare institutions and individual doctors will upload the individual’s clinical data, laboratory reports, and radiology reports to the system. Such systems have already been piloted in the country, and have received awards from the ICT Agency at their annual eSwabhamni awards. What is required today is the political will to scale up and implement such innovative solutions. Such a revolutionary project could open the door for digital health in Sri Lanka.
(The writer, Prof. Vajira H.W. Dissanayake, is the president, Health Informatics Society of Sri Lanka; the past president, Sri Lanka Medical Association; the president-elect, Commonwealth Medical Association; and a Fellow of the National Academy of Sciences of Sri Lanka. He can be contacted via email@example.com).