Digitalisation and big data are playing an increasingly crucial role in connecting healthcare stakeholders and bridging gaps in patients' access to treatments for chronic diseases.
In recent years we have seen unprecedented advances in therapies for chronic diseases such as cancer. One of the more recent advancements in cancer therapies is immunotherapy, which utilises substances made by the body or in a laboratory to boost the immune system and help the body find and eliminate cancer cells. The first form of immunotherapy, an immune checkpoint inhibitor (ICI) was approved by the United States Food and Drug Administration (USFDA) in 2011.
More recently, the groundbreaking technology used to create messenger RNA (mRNA) vaccines is setting the stage for further breakthroughs that could help combat chronic diseases such as autoimmune disease and cancer, in the next five to 10 years. mRNA vaccines have been effective in reducing hospitalisation and deaths from the SARS-CoV-2 virus during the COVID-19 pandemic.
However, in spite of the significant advances made in our understanding of cancer and how to treat it, there are still ongoing and wide-ranging disparities in access to cancer care. These disparities continue to grow between and within countries, particularly among socially disadvantaged populations living in low-and-middle-income countries (LMICs), who not only experience poorer health generally, but have higher proportions being diagnosed at an advanced stage when prognosis is worse, have poorer access to effective and affordable treatments, and lower survival rates.
Like cancer, the majority of rare diseases are life-threatening and chronically debilitating. Despite being characterised as having low prevalence, in Southeast Asia, over 45 million people, or about 9% of the region’s population suffer from rare diseases. This number could be even higher as research and active monitoring of rare diseases are not priority in that region due to a lack of resources and inadequate funding.
Given the low prevalence of rare diseases compared to other conditions such as cardiovascular and metabolic diseases, and the widely disperse and small patient base for each disease, there may be a disproportion in the availability of treatments and resources to manage patients, train healthcare practitioners (HCPs), and initiate research.
Barriers to healthcare access in ASEAN
For patients to access life-saving treatments for chronic diseases, pharmaceutical companies must invest billions of dollars in the research and development (R&D) of innovative medicines, and in licensing and preparing them for regulatory approvals by health authorities in different countries. This makes them very expensive, sometimes so expensive that only the very wealthy can afford them. The high cost of these innovative treatments makes them inaccessible to even patients covered by private health insurance, while national health insurance schemes rarely cover them.
Healthcare access in LMICs is further impeded by the lack of comprehensive connectivity in the healthcare systems. Patients end up falling through the cracks even in countries with a robust healthcare infrastructure, and despite epidemiologic data revealing the high incidence of chronic diseases in their population.
“Many LMICs lack a centralised system, so hospitals do not communicate patients’ health records to each other, creating a complex environment for patients to navigate. As a result, patients often lose their way within the healthcare system. Additionally, many patients, including those with chronic diseases, are not diagnosed or receive delayed diagnosis, sometimes several months after the first symptoms appear or after their initial visit to the doctor,” says Dr Joseph Saba, Co-founder and Chief Executive Officer of Axios International, a global healthcare access company.
He adds, “Financial barriers are not the only challenges for patients seeking life-saving cutting-edge therapies. There are two institutional barriers that must be addressed in healthcare systems in Southeast Asia to enable patients to access innovative treatments for chronic diseases: the lengthy drug registration processes, and the gap between patients and care outside of the conventional hospital setting."
Digitalisation in healthcare
While COVID-19 has uncovered significant inequalities in the healthcare ecosystem, it has also accelerated the digitalisation of technologies and solutions in the sector. A McKinsey survey reveals that companies accelerated the digitalisation of their customer and supply chain interactions and their internal operations by three to four years during the pandemic.
Technologies and solutions that would have taken years to approve or implement were fast-tracked at unprecedented speed, which was especially evident in the healthcare and pharmaceutical sectors, where consumers’ needs reflected the new health and hygiene sensitivities, as well as an increasing preference for remote interactions.
Between 2020 and 2021, ASEAN nations saw rapid adoption of virtual health solutions with the digital health market in the region predicted to grow at an annual growth rate of 12.97%, to US$10.85 billion by 2027. A global survey by Accenture revealed that MedTech executives are adopting digital health as a core part of their approach to improve patient outcomes. It also revealed 86% of its respondents agreed that success in digital health will depend on companies targeting the entire care pathway rather than specific products and services.
“People are starting to take more control of, and becoming more involved in, the decision-making concerning their own health. This has increased the emphasis on the consumer-physician experience and intensified the pressure on healthcare practitioners (HCPs) to adopt digitalisation or integrate digital tools into their practices,” says Timothy Chen, Chief Executive Officer of DocMed Technology, the digital pharmatech arm of Hyphens Pharma and a key player in ASEAN’s digital healthcare landscape.
Currently the only business-to-business-to-consumer (B2B2C) platform in Singapore, DocMed Technology’s platform connects healthcare stakeholders, by integrating the entire supply and distribution chain from pharmaceutical manufacturers to HCPs to patients.
DocMed Technology’s medicine delivery service via their WellAway e-pharmacy is designed to cater to elderly patients and those with low mobility, as well as those with long-term chronic illnesses such as diabetes and high blood pressure who need to replenish their medications regularly. It is the only e-pharmacy certified by Singapore's Health Sciences Authorities (HSA) to deliver medications directly to patients and designated caregivers.
Connecting the dots with big data
With the advancement of technology, especially the Internet of Things (IoT) and the increasing use of health information systems, there has been a massive growth in healthcare data volume. Research published by Universiti Putra Malaysia (UPM) explains how Big Data Analytics enables large volume of data to be acquired, stored, managed, analysed, and subsequently transformed into insights that can inform decision-making, similar to how Asian countries leveraged on big data technology to enable timely communication and interventions during the pandemic.
DocMed Technology, which has been distributing medicines and medical consumables to clinics, healthcare facilities, and pharmacies via its e-commerce site, began amassing data since the year 2000.
“Through our POM platform, which is like an amazon.com for HCPs, we have been supplying medications and medical consumables such as gloves, aprons, etc., to 80% of doctors in private practice in Singapore. We have been gathering data and mapping procurement trends among HCPs and clinics, as well as periods when certain medications are in high demand and when they run out, for example, which could clue us into bigger health concerns such as infectious disease outbreaks,” says Chen.
“For example, in March 2022 there was a surge in the demand for respiratory medications, outside of what was perceived as a seasonal flu cycle, heralding the fourth wave of COVID-19 in Singapore. This was occurring just when pandemic restrictions had begun to ease in Singapore, and large-scale gatherings and international travel were resuming,” Chen recalls.
“Such data can be very useful to various stakeholders in the healthcare space. Although we are still at the nascent stage of data mining and sharing, we are continuing to develop our capabilities in predictive technology and artificial intelligence (AI) to analyse valuable data which could help healthcare stakeholders predict and prepare for new waves of infectious diseases in the future.”
The company has recently begun operations of its Virtual Medical Hypermart service in Vietnam and Malaysia, known as POM and POMacy respectively.
Ensuring patients' compliance to treatments for chronic diseases
To ensure cancer and rare disease patients continue to be on treatment after they leave their healthcare facilities, Axios International has built proprietary digital tools and systems to reach and follow-up with patients who have enrolled in their patient programmes. Dr Saba elaborates, "We have built digital tools enabling physicians to refer patients to different access programmes and track their patients' progress remotely, and digital tools for pharmacists so they can track product supply."
Rather than disrupt the local healthcare ecosystem in the countries they operate in, Axios International is collaborating with local healthcare stakeholders with the objective of improving patient outcomes.
“We are more interested in increasing our capabilities to complement the existing healthcare system than disrupting it. We are not interfering or intervening with the existing healthcare system in that the doctor is still prescribing the medicines and treating the patient. What we do is track and monitor the patients' progress after they leave the hospital, and ensure they are able to reap the full benefits of their medication,” says Dr Saba.
“We need more interconnected healthcare systems, like those we see in the finance or banking world; systems that allow you to use your debit card to order goods online from the other side of the world from you, or to pay for your groceries at your local supermarket or withdraw cash from an ATM in another country while on holiday, and track your interactions with different service providers. And if the system picks up something unusual it will send you a notification prompting you to check and confirm if it was you doing those things,” he adds.
Real world data is a core part of Axios International's operations. Real world data in medicine is data gathered from sources that are associated with a patient's outcomes when receiving healthcare, from diagnosis through to treatments, in real-world settings. They may include but are not limited to electronic health records, health insurance claims, and patient surveys. Using real world data can provide more insight into benefits or potential uses of certain treatments or drugs, and allow for long-term follow-up of patients on medication.
"Drawing, charting and analysing data from 25 years' of experience in 100 countries and 9.5 million patients enables us to pick up patterns in patients' behaviour, such as what practices are most likely to increase patients' likelihood to stay on treatment, and helps us improve on how we provide services and receive and measure feedback from patients. No matter where in the world we work in, the data is gathered in ways which are compliant with privacy standards such as the General Data Protection Regulation (GDPR) and any local privacy data laws where we have ongoing patient programmes," says Dr Saba.
Axios International is present in several countries in Southeast Asia including Indonesia, Thailand, Malaysia, Vietnam and The Philippines.