Precision medicine is an emerging sector in healthcare that focuses on prevention and treatment. It also differs from traditional approaches that treat illness only after it has appeared. While practicing precision medicine, physicians examine in an individual’s genetics, environment and lifestyle. In this context, physicians can propose interventions after determining whether someone is at high risk for chronic illness such as diabetes and heart disease.
According to Stanford University, precision medicine is composed of four smaller areas: pharmacogenomics, genetic testing, digital health devices and prediction (Stanford Thailand). By certain accounts, pharmacogenomics is the most advanced portions of precision medicine. This practice studies the individual genetic makeup of an individual to optimize drug treatments. Pharmacogenomics relies on a wide pool of genome sequencing, which requires a highly sophisticated equipment and facilities.
In addition, physicians that practice precision medicine rely on digital health devices. These are devices that patients wear outside of a clinic that record their vitals. Physicians later may use this information to proposed lifestyle changes.
However, innovative sectors such as pharmacogenomics and digital health devices both on a sophisticated system of highly connected and interoperable electronic medical records. Physicians can only determine high-risk individuals by comparing them to the health records larger demographic groups. More and more, this type of intensive analysis occurs with the help of AI and cloud computing.
However, before physicians can practice individualized preventative healthcare a country must have certain preliminary infrastructure in place. First, reliable high-speed internet at all hospitals and clinics nationwide. Second, a system of secure electronic medical records (EMR) that are interoperable and universal. And third, a nationwide team of physicians and medical staff trained in recording and using EMRs. Only then can researchers and physicians utilize EMRs taken over years in any practical fashion.
Countries with vastly different levels of development see precision health as a task worth the huge effort. Public health policy makers are turning to technology in the face rising deaths from non-communicable disease, aging populations and a shortage of physicians. Without precision medicine, the quality of care even in developed nations with currently functioning healthcare systems will begin to deteriorate.
Even developing countries such as Cambodia have officially stated the need for precision medicine. However, Cambodia in many senses is starting from the ground up by developing widespread high speed internet access in rural clinics across the country. Simultaneously, Cambodia is making efforts to transition from paper to electronic EMRs.
Vietnam and Thailand already have universal internet access, and now are working on improving the scope of EMRs. In both countries, policies are in place to bring electronic records to all parts of the healthcare system in a timely fashion. This will allow for physicians to practice telemedicine, bringing higher quality care to rural areas.
In developed countries like Singapore and Taiwan, there are already comprehensive EMRs and nearly universal digital records in all hospitals. Singapore and Taiwan have the ICT infrastructure and widespread health data to initiate more advanced precision medicine. This includes providing treatment based on AI and genetic testing that compares an individual’s health information to the population at large.
The details of the policy differences and scope of focus are listed by country below. At the end there is a discussion on points of potential future collaboration.
As a developing country, Cambodia faces unique issues in terms of adopting precision medicine. Currently, 90% of the country lives in rural villages with limited access to health services (WB, 2020). Therefore, the government has been focusing most of its attention on expanding health coverage and improving the quality of clinics nationwide.
Cambodia has increased access to basic healthcare through the Cambodia Health Equity and Quality Improvement Project (H-EQIP). This project has covered 2.6 million poor households since 2017 (WB, 2020).
While developing basic health services, Cambodia has also found it necessary to develop digital health. This is due to the increase of non-communicable disease nationwide. In 2000, 33% of deaths in Cambodia were due to non-communicable disease, which increased to 64% in 2018 (WB, 2020). Therefore, the government hopes to develop a primary care system that utilizes digital health records to refer patients to hospitals for specialized treatment.
Currently, Cambodia’s medical records are still primarily paper-based. Patients must bring records of medical tests to subsequent consultations. If patients lose the records, they must retake tests, which burdens the healthcare system and increases costs (Raksmey, 2020).
In the Health Strategic Plan 2016-2020, the Department of Planning and Health Information formally outlined the need to expand its digital health infrastructure. This is partially because Cambodia hopes to collect more health information to formulate more comprehensive public health policy (DPHI, 2016).
Currently, Cambodia collects most of its real-time medical data through the Health Management Information System. In this system, health facilities nationwide submit information such as consultation numbers and birth records for compilation and analysis (DPHI, 2016). However, due to Cambodia’s patchy internet infrastructure, information isn’t always computerized at the point of record. This makes the information unreliable because it sometimes contains errors (Vor, n.d.).
Another source of health information is the Ministry of Health’s Patient Management and Registration System (PMRS). This system provides users with a profile that records their previous access to health services and insurance reimbursement. As of 2019, 1,123 health centers used the PMRS (PCA, n.d.). However, the PMRS faces similar to the challenges to the Health Management Information System. 44% of health centers lack a computer with internet access making widespread integrated information on patients impossible (Nagpal, 2019).
Despite this, Cambodia hopes to develop further sources of digital health data beyond the current indicators of the Health Management Information System and the PMRS.
According to Dr. Or Vandine, Secretary of State at the Ministry of Health, Cambodia recognizes the importance of technology in improving health care (KT, 2022). However, the country lacks skilled professionals who can run expensive and complex hospital management systems (Raksmey, 2020).
Therefore, Cambodia applied for a loan with the World Bank to fund the second phase of H-EQIP. During this phase of H-EQIP, Cambodia plans to develop decentralized digital health services that provide services beyond the scope of traditional medical care (WB, 2020).
Similarly, another project that relied on foreign aid was the Leveraging Technology to Upgrade Cambodian Healthcare initiative. In 2020, the US Department of State provided a grant that commissioned Cambodian-based hospital management software company, Peth Yoeung, to execute the project (Kunthear, 2020).
Over the span of two years, the project digitized 108,750 individual medical records at 20 hospitals (PY, 2022). According to Peth Yoeung’s CEO, Pong Limsan, digital health records are cheap, reliable and fast, but only effective if medical professionals recognize their value (Vor, n.d.). Therefore, the project also emphasized training 867 health professionals to make the transition to digital health records (PY, 2022).
As a middle-income country, Vietnam faces particular challenges in establishing precision medicine. The precursor to a robust precision medicine sector, is the digital infrastructure that allows for the rapid seamless transfer of information. Therefore, the Vietnamese government has enacted policy in recent years to develop the capacity for digital transformation in health.
According to a report in the Journal of Medical Internet Research, the government has enacted policies in recent years that will “inform the adoption of digital health systems in Vietnam [and] are comprehensive and useful for hospitals” Tran, 2022). These policies revolve around establishing standards for hospital information technology (HIT) and electronic medical records (EMR). Proper HIT will allow medical facilities to access EMRs, medical images as well as conduct electronic payments and engage in telemedicine (Tran, 2022).
In 2018, the government enacted the HIT Maturity Model, which formulated a seven level accreditation system for Vietnamese hospitals. The criteria for HIT level 1 is relatively basic, merely having computer terminals with internet access that can send information to the national health insurance system for reimbursement. However, HIT level 7 facilities must be fully paperless and cashless with protected EMRs that are integrated with other digitally developed facilities (Tran, 2022). As of March 2022, 99.5% of hospitals were HIT level one and connected to the healthcare insurance payment verification system. 20 public hospitals at that time had met the criteria for HIT level 7 (VIR, 2022).
Vietnam enacted the Regulations for EMRs in 2019 to stipulate clear norms for when medical facilities can go paperless. For a facility to adopt a paperless system EMRs must be cyber-secure, have a unique ID, and a digital signature. In addition, all traditional records must be able to have a digital equivalent (Tran, 2022).
The timeline for to enact these goals were stipulated in later policies, chiefly the Smart HIT Scheme (decision 4888/QD-BYT) and the Medical Digitization Program until 2025 and Orientation to 2030. The Smart HIT Scheme aims to promote information technology in hospitals and transition to a digital, cashless system by 2025. The scheme will achieve these goals through establishing norms, building IT infrastructure and international cooperation (Tran, 2022).
The Medical Digitization Program aims to extend the aforementioned goals to 2030 and transform the medical sector through “smart disease prevention, smart disease treatment and smart medical administration.” By 2025, the program aims to provide 95% of the population with digital health records and transform 50% of the hospitals to a completely paperless system (Tran, 2022). In April 2021, Vietnam made substantial strides in this aim that electronic medical records from all hospitals nationwide would be connected. This means that patients no longer need to bring paper records with them to follow-up appointments (VP, 2022).
One of the aims of digital transformation is to allow for telemedicine. The Ministry of Health and Hanoi Medical University started the initial testing of Vietnam’s digital medical infrastructure in April 2020. During a two month pilot, the “Remote health examination and treatment from 2020 to 2025” linked 1,000 medical facilities in rural areas with 30 tertiary hospitals in Hanoi and Ho Chi Minh City (Bui, 2021).
Additionally, Vietnam leveraged its digital infrastructure in disease prevention at the beginning of the COVID-19 epidemic. The Ministry of Information and Communications launched, Bluezone, a contact tracing app that notified users if they were in proximity to a confirmed COVID-19 case (Bui, 2021).
Vietnam also aims to transition from digital health to precision medicine through the policies it has formulated in recent years. By 2030, Vietnam aims to have big data capacities that can utilize AI to predict medical conditions in certain populations. Vietnam hopes to use apply these capacities to genetic testing at a proposed DNA center of Vietnamese through Ho Chi Minh City University and the Hanoi Medical University (MH, 2020).
The private sector has also collaborated with the government to engage in widespread genetic testing. In October, 2021, genetic engineering company Genetica teamed up with the Vietnam National Innovation Center to open a genome sequencing facility in Vietnam. The facility will cut down on genetic testing costs by 30%, and still provide internationally recognized results. In the future, it will provide information that can help treat genetic diseases that affect the Vietnamese population in particular (Kiet, 2021).
This type of private sector collaboration occurs because there is “a disparity in information technology literacy of physicians and health workers at all levels” (Bui, 2021). Therefore, Vietnam relies on private companies to provide IT knowhow to develop digital health. For instance, 92% of local hospitals outsource their IT solutions to Vietnamese companies and large multinationals, such as IBM and Microsoft, to provide cloud services and AI adoption solutions (KPMG, 2020).
According to KPMG, Vietnam, because of its aging population, is vested in coming up with technological solutions to make up for a lack of medical personnel and to prevent overcrowding in hospitals (KPMG, 2020). However, digital transformation in Vietnam’s health sector is still nascent. Therefore, there is space for international collaboration in providing digital solutions that can be used in telemedicine, automated solutions and AI diagnostics (KPMG, 2020).
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