Thailand has been developing its digital health infrastructure through the Ministry of Health’s 2017-2026 eHealth Strategy. The backbone of this initiative is expanding high speed internet access in hospitals around Thailand. This will allow for community hospitals to connect with public health services, provide essential information and improve patient outcomes. In addition, the eHealth Strategy aims to increase connectivity in order to bolster telehealth access in rural areas and foster digital literacy to dispel health misinformation (MPH, 2017).
In this vein, the Thailand National Digital Healthcare Workforce Development Initiative (WDI) was launched in October of 2019 to increase digital competency and access to telehealth services. This 3-year pilot project will involve 8 major hospitals, including Khon Kaen University Hospital and the Bangpakok Hospital Group. First, the project will train hospital staff to become Certified Professionals in Healthcare Information & Management Systems (CPHIMS). Ultimately, these skills will be applied to increase the efficiency of telemedicine in rural areas of 8 provinces in Thailand. The WDI also aims to integrate high speed internet, IoT and AI to make up for a shortage medical professionals (Sharon, 2019). Eventually, a stronger digital infrastructure will integrate digital health devices into mobile apps, which will let doctors monitor their patients remotely in real time.
The WDI is part of a wider initiative called Thailand 4.0, an economic model that aims to support innovation, creativity and R&D. In this spirit, Thailand 4.0 aims to bring innovative practices into healthcare (RTE, n.d.). From 2018-2020, the government launched various mobile apps to allow for greater access to healthcare. For example, the H4U app gives Thai citizens access to a personal health profile, while the Primary Care Cluster app brings telemedicine to those without direct access to a clinic (Global Data, 2020).
These innovations in digital health are accelerated because of Thailand’s comprehensive public health insurance. For example, Thailand has been reimbursing precision health through pharmacogenomics, the practice of using genetic testing to alter prescriptions. For years, Thai people have received reimbursement for genetic testing that affect cancer treatment prescriptions (Jirawutkornkul, 2020).
Singapore is renowned for its effective and comprehensive healthcare system. However, according to Professor Patrick Tan Executive Director of PRECISE, due to an aging population, Singapore needs to innovate in order to maintain its high standard of medical care (2020, CNA).
Therefore, the government has actively been developing Singapore’s precision health sector since 2017. Five years ago, the government launched a 3-phase, 10-year National Precision Medicine (NPM) strategy. The first phase, which lasted from 2017-2021, aimed to validate the strategy’s conceptual elements by sequencing the genomes of 10,000 Singaporeans. The second phase aims to prove the value of the program by generating 100,000 additional genomes sequences and integrating the findings with other health records (PRECISE, n.d.).
A key portion of the NPM’s second phase was founding of Precision Health Research, Singapore (PRECISE). This agency coordinates Singapore’s nationwide initiatives in developing precision medicine. PRECISE hopes to encourage widespread genetic testing in Singapore to determine the significance of certain genetic variants in commonly found diseases (PRECISE, n.d.).
Places around Singapore, such as the recently opened Cancer Genetics and Genomics Clinic at Tan Tock Seng Hospital (CGGC), are putting such information into practice. Medical professionals at CGGC are boosting awareness on the efficacy of genetic testing while reducing the stigma around receiving genetic counseling. At CGGC, physicians provide genetic counselling directly to patients. Such services can affect cancer prescriptions and treatment based on a person’s individual genome (PRECISE, n.d.).
Singapore also hopes to contribute to precision medicine thanks to its unique demographics. Traditionally, most widespread genetic testing has been conducted in primarily Caucasian countries (CNA, 2020). Singapore’s diverse population contains 80% of the world’s Asian ethnicities (PRECISE, n.d.). Therefore, Singapore is positioned to study specific genetic variants that impact Asian populations.
For instance, Singapore was involved in a long-term, widespread study on the genetic factors for diabetes in Asians. In 2020, researchers at the National University of Singapore teamed up with 113 scientists around Asia to study genetic variants associated with diabetes. The research found that certain variants had larger effect sizes on Asian populations, and gave a deeper understanding of why Asians with low BMI still can develop diabetes (PRECISE, n.d.).
Such studies and work conducted at PRECISE is part of Singapore’s large-scale development plans. Since 1991, Singapore has divided economic development into 5 year phases. The latest, RIE2025 Plan, has included precision medicine as a part of deepening basic research and further developing of its innovation-driven knowledge-based economy (NRF, n.d.).
In the future, Singapore plans to keep national level agencies and efforts integrated with PRECISE. In 2020, Singapore created the Consortium for Clinical Research & Innovation (CRIS), an umbrella agency that will implement precision medicine in other agencies in charge of cancer treatment, cell therapy and clinical research. Through widespread, cross-agency coordination, Singapore aims to keep precision medicine relevant to the needs of patients, its healthcare system and researchers (CRIS, 2022).
Taiwan stands in an ideal place to implement widespread precision medicine due its robust ICT industry and advanced biotech sectors. According to certain experts, Taiwan’s precision medicine industry is comprised of “mobile health care, smart medical equipment, smart hospital solutions, 5G, AI, cloud computing” (Hsiao, 2022).
In particular, this means Taiwan has a huge corpus of interoperable medical health records and images. This high level of interoperability is the culmination of the three stage initiative that started through National Health Informatics Project back in 2004 (Wen, 2019). As of 2019, 90% of Taiwan’s hospitals were Stage 7 on the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) (Chiang, 2021). According to this model, data at these hospitals is highly secure and can be accessed rapidly (HIMSS, n.d.).
In 2021, the Ministry of Health and Welfare (MOHW) announced it would bring EMR to a higher level of integrated information by transforming Taiwan’s the Electronic Medical Exchange Center into the FHIR Exchange Center. The new system will improve information security and grant more medical facilities access to medical images, health records and other information (王若樸, 2021).
Taiwan is currently utilizing “one of the few healthcare big-data databases in the world,” over 25 years of health insurance records, to develop disease prediction models (Hsiao, 2022). Recently, the Taipei Veterans General Hospital teamed up with Taiwan AI Labs, a National Science and Technology Council (NSTC) funded institution, to develop DeepMets®, an AI-assisted diagnostic tool. DeepMets® can quickly identify certain tumors by comparing a patient’s condition to over 3,000 brain scans collected from the National Health Insurance database. This tool has cut down diagnostic times from 2 weeks to merely several hours (MOST, 2020).
NSTC is currently developing more sophisticated big data platforms that can assist developing diagnostic tools like DeepMets®. In conjunction with MOHW and the Ministry of Economic Affairs, NSTC launched a 4-year program called the “Sustainable Big Data Platform for Precision Health.” This project will help design powerful data platforms to assist in cutting-edge clinical research (MOST, 2020).
Healthcare providers in Taiwan are already putting AI and big data into widespread practice. Since 2022, Taiwanese individuals can see whether they are at risk for cardiovascular disease on My Health Bank, a cloud based service that provides individualized medical information (Hsiao, 2022).
Additionally, Taiwan is using its comprehensive ICT and internet infrastructure to start launching telemedicine projects. In 2018, Taiwan changed its laws regarding telemedicine, allowing giving underserved rural counties such as Taitung more access to primary care. In one study, patients on average saved two hours of travel time and reported high levels of satisfaction when receiving telemedicine consolations for ENT related issues (Wu, 2022).
Taiwan will also start utilizing its foundation in genomics to further develop precision medicine. Taiwan already has 35 biobanks connected through the National Biobank Consortium of Taiwan. This group has created standards for sharing and storing biological samples with researchers and the private sector that it has collected from over 160,000 people (Hsiao, 2022).
The National Applied Research Laboratories is assisting these biobanks by developing a database to share biological information. This high-powered national platform will link up genetic information collected at different sites, so researchers can share their findings and engage in further collaboration. According to Minister of Science and Technology Wu Tsung-tsong, researchers will eventually apply AI to this corpus of genetic information to “improve health solutions from prevention and diagnosis to treatment and care” (NARLabs, 2021).
Along with the data collected at Taiwan’s biobanks, Taiwan will expand genetic research through the Taiwan Precision Medicine Initiative. The project, which started in 2018, will perform gene sequencing on 1 million people by 2023. This information will also be applied to patient care, specifically the early detection and treatment of disease through gene therapy and lifestyle changes (TPMI, n.d.).
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