Creating Viet Nam's Digital Health Web
If everything goes according to plan, Viet Nam will become the first middle-income country in Asia to implement a nationwide standardized digital health system.
Having worked in the last few years on digital health, I am excited to see that developing countries are investing in it. They recognize that legal frameworks in terms of data privacy and security are still nascent, that health informatics capacity is weak, and that stakeholders are struggling to understand concepts such as health data use, health informatics standards, interoperability, or enterprise architecture.
Countries are investing in digital health because they acknowledge that they need to leverage digital health to improve health services and achieve universal health coverage. They have also looked at lessons learned from developed countries on digitalizing their health systems.
In the case of Viet Nam, Ministry of Health officials are looking for instance at Canada, which has invested $2.15 billion in its digital Health Infoway and achieved an estimated $16 billion in benefits (in quality, access and productivity gains) from investments in tele-health, drug information systems, diagnostic imaging, and physician and ambulatory clinic electronic medical records.
Another developed country that Viet Nam can learn from is the Republic of Korea, which recently announced it would increase investment in the medical and healthcare sectors by more than $100 million in the next two years, with most of this activity concentrated in areas related to administrative simplification, claims adjustment/adjudication and electronic health records.
For Viet Nam, the case for long-term savings from going digital is best showcased by Denmark, where the government has spent about $335 million on e-health since 2009, about 1% of its healthcare spending at the time. This investment has yielded annual savings between $53 million and $78 million.
The advantage of developing countries is that they don’t have to build on legacy digital information systems from 20 years ago. They can leapfrog and apply the latest technology to their context, like Viet Nam is doing now by quickly moving from paper-based to digital.
Viet Nam is rapidly building its digital health capacity and solution suite. The government knows that digital health will become less hierarchical and more patient-centered in the future, when we will be concerned less about aggregated population data and more about data content relevant for the individual patient.
Better health information is crucial to manage more complex chronic diseases, which often require multiple specialists and a lot of patient data exchange.
For example, a diabetic patient with hypertension needs to see a primary care doctor for regular check-ups. He/she is also required to monitor blood sugar levels, record the results, and consult specialists to check for early signs of side effects from diabetes medication like hypertension. The patient also benefits from a complete record of his/her medical history via electronic health records. This is crucial for urgent interventions such as surgery, and overall reduces treatment errors, saves time, cuts red tape, and facilitates insurance reimbursements.
It is thus clear that digital health can decrease the administrative burden of care delivery, improving its quality, make it more efficient, and enhance patient self-management.
Long-term vision for digital health
Viet Nam has ambitious plans to introduce a nationwide electronic health record (EHR) system in the next months. This will help to manage patients at the local commune level, and to better understand the health needs of the population while assessing whether the national health insurance scheme has had actual impact.
However, introducing EHRs comes with many challenges. One of them is that Vietnamese health officials will need to agree on health information standards. This means they have to decide which information exchange codes to use.
Standardization is the foundation for seamless, secure health information exchange within the digital health system. It requires a digital health governance structure to enable officials figure out who has access to data, where and how the data securely stored and exchanges, or how privacy is protected.
Of course, digital health is complex, and mistakes will be made for sure. But it’s important to start somewhere, and then take the process forward step by step.
Moreover, digital health technology is rapidly changing with adoption of the internet of things (IoT). IoT technology will lead to more complex health information systems, since more devices and more sources of information will need to be connected, ideally linked to electronic health records to get a complete picture of patients. More detailed information will need to be exchanged, which again depends on good governance and standardization.
Viet Nam has decided to use the HL7 Fast Healthcare Interoperability Resources (FHIR) framework as a practical solution for health data exchange and information systems interoperability. HL7 FHIR is a draft standard describing data formats and elements (known as "resources") and an application programming interface for exchanging electronic health records, particularly in complex information systems, including IoT.
FHIR improves upon mere sharing of documents like PDF files by directly exposing discrete data elements as services. For example, basic elements of healthcare like patients, admissions, diagnostic reports, and medications can each be retrieved and manipulated via their own resource URLs. This makes health information exchange faster, and allows data mining from complex documents.
Although it is still early to fully demonstrate how HL7 FHIR will change digital health technology, experts predict that it will fundamentally change how health data is exchanged. HL7 FHIR will basically allow countries to create a digital “health web” by using the http protocol as an information exchange platform and thus create a distributed information system, which will provide relevant information to each user, while protecting privacy. It will also encourage strategic big data analytics, real-time patient monitoring, and feedback.
Viet Nam’s long-term vision is to develop a connected health web will ultimately result in enhanced coordinated care and health system efficiencies in cost, productivity and safety, with timely access to the information needed for decision-making in patient and population healthcare. If everything goes according to plan, Viet Nam will be the first middle-income country in Asia to implement nationwide standardized EHRs with HL7 FHIR.
It is a formidable endeavor, and probably many challenges will need to be faced, but I am very excited to be part of it.