The Future of Healthcare in the APAC Region

The healthcare sector is going through an exciting transformation. More medical practices are integrating digital health solutions, championing more efficient digital workflows and, in turn, providing patients with better care and clinical outcomes.

Hong Nguyen, regional manager at Wolters Kluwer Health, is responsible for scaling the use of clinical decision-making tool UpToDate in the APAC region. He discusses on AZK Media podcast, Target Market, how medical professionals are working together during the pandemic and some of the challenges and opportunities for the medical community.

When approaching healthcare professionals, what are some of the common issues UpToDate solves for them?

There are many studies on clinical decision support. One found by the end of the day, a patient would have 11 unanswered questions, and 60% of those questions would actually remain unanswered. Studies have also found if those questions were answered, they would have resulted in five to eight different patient management decisions.

So what if you could solve that problem? It could be trusted with peer-reviews by the world's leading clinicians, available at the point of care, integrated with EMR and take less than 60 seconds to find the answer that you're looking for. It could also cover every major clinical specialty across 11,700 topics, with evidence-based and graded recommendations. That's exactly what UpToDate does for the clinician.

There have been over 100 independent studies on the benefit of UpToDate for the clinician and hospitals. I'll talk briefly about three of those studies. The first is a study by Solucient which is a Thomson Reuters company. What they did is compare hospitals which had access to UpToDate to hospitals to those that didn't, and they found hospitals with access to UpToDate had a significantly shorter length of stay, lower complication rates, and better patient safety outcomes.

There was another study in the Singapore Medical Journal, where researchers at Singapore's National University found clinicians who engaged and consulted with UpToDate actually changed their patient management decisions 37% of the time.

In other words, when a doctor is actually consulting and looking at UpToDate, it changes the way they engage and decide on a patient management plan over one-third of the time.

There was a retrospective study in Japan on the effectiveness of UpToDate in reducing diagnostic errors. It found doctors who actually consulted UpToDate had a diagnostic error of 2% and doctors who didn't have a diagnostic error of 24%.

So to answer your question, UpToDate solves a number of clinical issues for clinicians by enabling evidence-based medicine at the point of care, which saves time and produces a better patient outcome.

We also solve a broader health challenge for hospitals, health services, and governments by partnering with them to decrease diagnostic errors, decrease the length of patient stay, and improve financial performance. Ultimately, all of this improves patient outcomes. Over 9% of hospitals in Australia trust UpToDate on a daily basis.

What hurdles are healthcare providers facing when it comes to implementing clinical decision-making tools within their organisations?

Traditionally, when people think about clinical decision support, they think about pop up notifications within their EMR. Solutions like Medi-Span, which would integrate with your Epic Systems.

But clinical decision support is much more. It's about how we assist clinicians to actually make the right decisions at the point of care.

The biggest challenge is changing human behaviour. Doctors train for over 10 years, they become specialists in their field - they're the people we expect to know everything.

We put a lot of pressure on them, they are time-poor, they've got back to back patients, they're under-resourced, they have financial pressure, they have legal pressure - and the Government continually changes the rules of engagement with them.

Changing human behaviour is challenging. What we do is make it easy and seamless to access evidence-based information at the point of care. This means putting information within the clinical workflow so they can't miss it. This can be through a single sign on, it can be through EMR integration, or can be providing the solution through a mobile app, so it's easy to access at the point of care. Our research shows it takes a clinician less than 60 seconds to actually find the answer they're looking for.

The second thing is, clinicians are extremely busy. They're not always available for training, so we have a dedicated engagement team that goes out and trains and works with clinicians. We do all the standard stuff and we also host regular webinars. We previously did a lot of onsite training, which changed a little bit with COVID-19.

We have a "train the trainer" program. We train clinicians within the hospital so they can provide support to other clinicians. We now have a whole raft of digital content and digital assets that clinicians can also access in their own time based on their own schedule.

How long does the training normally go for?

It's ongoing because you're engaging with an entire health service. In the first training session, for example, you might have 10 or 20 clinicians - it really depends on when they're available.

As I mentioned, they're extremely busy. But what we found is onsite engagement makes a big difference as you're working with the clinician, you're doing the rounds with them, or there's a registration day or a training day that you can participate in.

What is something that excites you about the healthcare industry?

Being in the healthcare industry is exciting in itself. We get up every day, and we have the opportunity to help the clinician make a difference in patients’ lives. We're helping enable them to practice the best health care they can. This is pretty rewarding.

But what I've seen recently is the industry itself is coming together. When I think about health care, compared to other industries like finance, we are quite a slow-moving beast, it takes us a long time to evolve. But COVID-19 has really forced us to change overnight.

When COVID-19 hit and was first identified in China, within two weeks, Wolters Kluwer had our first COVID-19 topic. Since then, we've published over 50 COVID-19 related topics, we've done multiple drug reviews, we've updated our vaccination information. We've updated all of this content over 1000 times over the last year. We've put this on the internet for the world to access for free. The last time I looked, the content has been accessed over 17 million times. We've had letters from around the world thanking us for our contribution. We've actually created one of the most reliable COVID-19 information portals in the world right now.

It's great to be part of something you believe is making a difference. But it's not just us, there are examples of organisations and people everywhere coming together making a difference and that is exciting.

Looking at the next 12 months what challenges and opportunities do you think will emerge within the healthcare space?

There are a couple of opportunities, right now, there's a great opportunity in virtual care. This area is changing and adapting on a daily basis, we see some great examples in the industry. Telehealth platform Coviu has been able to scale to great heights, in a very short period of time with telemedicine.

There's another organisation called My Emergency Doctor, which has really taken the pressure off emergency care delivery in Australia. What this will lead to is a different type of healthcare workforce in the future. Previously, I've spoken about putting the patient at the centre of what we do. Over time, we will see our healthcare workforce evolve into having the patient at the centre, it probably will take a little bit longer than 12 months, but it will eventually happen.

There's also a massive challenge around medical information and the amount of medical information that's being generated at the moment. There was a study done by Peter Densen, who predicted that by 2020, the amount of medical information in the world would double every 73 days. I was in a webinar recently, they referenced a study that found there were over 2000 COVID-19 studies being published on a weekly basis.

There's not one person that can stay up to date with all of this information, or be able to synthesise it and be able to work out how to best treat this patient based on what the latest evidence is saying. There's an opportunity there to be relevant, but also to evolve and make sure we're enabling clinicians to stay up to date.

The third is around patient engagement. There's a great opportunity to enable patients to take more control of their own care because what we know is an empowered patient produces a better patient outcome. There's a great opportunity to improve health literacy and to make it easier and more relevant. But also make the information more personalised for patients. If you do that you're engaging them and that will produce a better patient outcome in the long term.

What should health software providers stop doing? And what should they start doing?

It is hard to tell other people what to do, but if I think about health tech, there are a lot of solutions out there that solve clinical challenges and improve patient outcomes. But they actually don't have a commercialisation model that sits behind them or a revenue model.

This is because the revenue models are not linked to the improved patient outcome itself. I think about SaaS organisations in other industries, and a lot of the time what they try to do is solve a customer problem, grow their customer base, and the commercialisation model follows.

The reality is it's extremely hard to do this from a business perspective and you need significant financial backing in order to achieve that. I firmly believe if we focus and we have a passion for improving the patient outcome, we stick to our core principles, we listen to our customers, and we pivot when we need to, we can build a sustainable business for the long term.

The bottom line is always important. As leaders, we need to make sure we achieve those annual goals; revenue goals, to me, are probably a bit more short term. At the same time, we need to make sure we have a strategy that meets and exceeds the needs of our customers, clinicians, and patients. If we don't think about the medium to long-term and invest now, by the time we get there, we will probably miss the boat.

In terms of what we should start doing, it's all the same stuff: listen to customers, pivot, giving things a go, failing fast. One of the things I see in the industry is there's a great opportunity for partnerships. We don't need to reinvent the wheel and if we sat there, we could probably do it in a year or two. But by partnering, we can actually achieve the same outcome and accelerate growth. To me, that's a win-win for the organisation but it's also beneficial for the clinicians and also for the patient as well.

​Target Market, a podcast series by AZK Media, where the world’s most premium thought leaders across technology, marketing and data come together to share their insights.