Riding the crest of digital health in APAC

Riding the crest
of digital health
in Asia-Pacific

Executive summary 3
Flash-forward to 2030 4
Life sciences: today's challenges 7
Disruptions along the life sciences value chain 9
• Spotlight: Japan 14
• Spotlight: Australia 16
• Spotlight: Indonesia 18
• Spotlight: India 20
Key implications and conclusion 22
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2 | Riding the crest of digital health in Asia-Pacific
Contents

3Riding the crest of digital health in Asia-Pacific |
Executive
summary
Context and objective
The pharma and health care industry is rapidly transforming
in the data-driven world. At this juncture, a digital outlook
and continual awareness of the nuances of digital innovation
is key for Pharma and MedTech players. While commercial
and access interventions have been deeply tailored to the
needs and structure of a market, Pharma and MedTech’s
approach to digital has been opportunistic and broad based.
Through this paper, we cover the major developments in
digitalization of the sector in Asia-Pacific (APAC), with
country spotlights on Japan, Australia, Indonesia and India
to understand how its adoption in developed markets has
been different from that in developing ones.
Digital interventions occur across the value chain, from R&D
and manufacturing to the broader supply chain, commercial
engagement, and care delivery. In emerging markets, we
see much greater application in the commercial engagement
and care delivery part (through telehealth or use of mobile
platforms). At the same time in developed markets, digital
is also being used to accelerate drug development, with
the use of artificial intelligence (AI)-based techniques and
screening of molecules.
In this paper, we will provide insights on the relevant digital
interventions across specific markets. It also sheds light
on how the adoption of digitalization in developed markets
differs from that in emerging markets. We have highlighted
use cases and key trends to watch out for in 2020.

“Azumi, a professional in her mid 40s, lives in Mito, an
hour and a half away from the bustling city of Tokyo.
She has had asthma since she was 10. Her son Tora
often refers to her inhaler as the ‘superman,’ as it always
comes to her rescue and is never too far away. The
digi-inhaler comes with a band that Azumi wears on her
wrist, which monitors vital signs, such as heart rate,
nutrition and wheezing, and sends preemptive reminders
to her as well as her doctor when the inhaler needs to be
used. The band can also monitor external signs such as
pollen, dust and others to warn Azumi in advance. Azumi
usually doesn’t stock inhalers because she has signed up
to a plan where a new one gets delivered via a ‘six-hour
drone delivery service’ as soon as the level of her current
inhaler goes below 10%. Her medical history, including
asthma triggers, is available on a blockchain database.
And when she buys food, a connected app can simply
help scan the products and check for asthma-triggering
ingredients; she has had a few close calls with this one
while she was a kid and before the world of health care
became more accessible and connected.
The same medical history is also available to the pharma
company on an anonymous basis, and a year back, the
pharma company recommends her with superman v2.0
instead of v1.0 of her inhaler on the basis of her personal
requirements. Her doctor later told her that they had
sent a virtual reality (VR) device that helped with the
detailing of the new version — he showed it to her and
there was no going back. Superman 2.0 was a better fit.
The R&D team of that same pharma company has access
to data about patients’ health and food habits that helps
them redefine products to achieve broader objectives to
suit people’s lifestyles, just like v2.0 helped eliminate the
impact of eggs in Azumi’s diet.
1Flash-forward to 2030

Azumi consented to have a
sensory chip inserted in his
body to help monitor and
identify numerous symptoms
that might surpass the usual,
old-school tests.
Her son Tora was diagnosed with a mild kind of
muscular dystrophy a couple of years back and was
enrolled in a clinical trial on the basis of an open-source
registry kept by the British Government for various
diseases. It would have been hard to diagnose the
disease a couple of decades ago, but upon his birth,
“Ari, a carpenter in his early 30s lives in the remote
town of Bekasi, two hours away from Indonesia’s
capital city, Jakarta. A few years earlier, Ari had
collapsed while playing football. He was rushed
to a nearby clinic where he was attended to by
nurses. Because of understaffing and a lack of
specialist doctors at the clinic, the nurses had
to videoconference with a doctor stationed at a
major hospital in Jakarta to diagnose the problem.
They were able to pacify his cardiac arrest and, in
the process of doing so, discovered that Ari had
atrial fibrillation. The doctor advised Ari to get an
implantable cardioverter defibrillator (ICD) as soon
as possible.
The medical team shared a range of patient
assistance programs (PAPs), which offered various
discounts and value-added services. Ari opted for a
co-pay program (partially funded by a microfinance
institution) that was able to rate his credit based on
his digital footprint.
Azumi consented to have a sensory chip inserted in his
body to help monitor and identify numerous symptoms
that might surpass the usual, old-school tests. Because
of the clinical trial, he now gets free treatment for the
drug, which earlier cost Azumi thousands of dollars.”
1. Flash-forward to 2030

Once Ari’s ICD was inserted, Ari and the doctor were able
to monitor his recovery over the next few weeks through
an app programmed to trigger an alert to the doctor in
case of atrial flutters or anomalies.
The app has been an integral part of Ari’s life ever since.
Beyond monitoring heart activity, the app reminds Ari
of upcoming virtual appointments and even prompts
him to place orders for medicines, as needed. Whenever
a reminder pops up to place order for medicine, Ari
links the order to a super app that checks stock levels
Ari and the doctor were able
to monitor his recovery over
the next few weeks through
an app programmed to trigger
an alert to the doctor in case
of atrial flutters or anomalies.
at nearby pharmacies, and optimizes his price using
advanced analytics on the basis of his spending behavior
and upcoming uptake. Once the order is placed, it is
picked up by a delivery executive on a motorbike and
delivered to Ari’s kampong home.”
These views of a “day in the life ...” are not a time
traveler’s memoir. These are some of the many use
cases that the ongoing health care innovations will offer.
While many large multinational companies (MNCs) start
on this journey thinking ”be first and be big,” they soon
realize that the race to digital requires a ”be humble,
be nimble” approach. Big pharma and big Medical
Technology companies (medtech) have recognized
the need for partnerships in the value chain, and the
investment narrative has shifted from a solution play
to a platform play. However, while these are steps in the
right direction, with a lack of precedents to follow, the
sheer size of the opportunity and the breadth of options
have led to disparate niche approaches. The complexity
in APAC is further augmented by the heterogenous
nature of the markets and affordability levels.
At EY, we believe a fresh approach is needed. Based
on expertise and experience, we have leveraged
cross-industry teams to identify key areas for digital
investment in major APAC markets. We have also
considered the critical success factors required for
each market.
1. Flash-forward to 2030

2Life sciences:
today's challenges
When speaking with industry practitioners, the following
key themes emerge as challenges with life sciences
digital investments today:
• Picking the right bets: The opportunities for ”connected
care” are immense. While many niche technologies
seem promising, choosing the right set with maximum
impact is tricky. As a result, when organizations start
their journey of digitalization, they often go for the
technology available or known.
• Developing the broader ecosystem: Pharma and
medtech have usually followed a known path for
launching new technologies. This includes developing
educational content, educating key opinion leaders,
familiarizing regulators with the up-to-date trends,
developing the health economics case and then
preparing for launch; but in the digital consumer
technology world, they are realizing a broader set of
stakeholders’ matters. In addition to the regulators,
providers and physicians, some of the digital solutions
require them to work with data security authorities
and regulators, and in almost all cases, they have to
know how to deal with patient challenges directly.
Additionally, what they are also realizing is that the cool
technologies they are investing in might not seem as
appealing to the health care professionals (HCPs) who
could prefer a traditional approach, or might just be
unaware of the new standards or measurements to be
followed to effectively use these technologies.
• There is a lack of immediate return on investment (ROI),
which can lead to enervation after the initial excitement:
Various investments and partnerships are announced
with an eye toward the future. However, short-term
priorities, bottom-line considerations and a clear view
toward the specific needs being addressed come in the
way of fruitification.
In this section, we will aim to address the question on
what the right bets could be, followed by the implications
for the various stakeholders who are developing the
broader ecosystem.
There are two distinct choices to be made:
1. Implementing digital to improve cost efficiencies
Or
2.Embracing digital to advance care delivery through
transformative changes to the business model

Degree of change to health care value chain
Imapact
to health
care costs
Social
platforms
Artificial
intelligence
Connected
health
Drone delivery
Augmented
reality(AR) and
virtual reality
3D
printing
Blockchain
Customer
relationship
management (CRM)
Internet of
things (IoT)
Disruptive technology
Has the potential to disrupt the area
of play, and create changes in value
chain, organizational structure and
business model.
Emerging technology
Has limited use cases in the industry
of interest, but has the potential to
increase productivity and disrupt
existing business models.
Productive technology
Has the potential to reduce
operational costs, capital
expenditures and time to market.
According to EY teams, as we map technologies
according to these parameters, organizations can choose
which technologies best fit their agenda. They can be
disruptive, productive or emerging.
• Disruptive: Disruptive technology has the potential to
disrupt the area of play, and create changes in value
chain, organizational structure and business model.
• Productive: Productive technology has the potential to
reduce operational costs, capital expenditures and time
to market.
• Emerging: Emerging technology currently has
limited use cases, but it has the potential to increase
productivity and disrupt existing business models.
Figure 3: Technologies and impact on stakeholders in health care and life science
2. Life sciences: today's challenges
Impact to healthtech
Low High
High

Big data and advanced analytics with Artificial Intelligence (AI) and machine learning (ML)
Digital
platform
Digital engagement
platform and CRM
Connected
health
Connected
health
Blockchain
3D printing 3D printing
Drone delivery
1
2
6
3
7
4
8
5
9
3Disruptions along the
life sciences value chain
Figure 4: Types of technologies adopted across the pharma value chain
R&D Clinical trial Manufacturing Supply chain
Commercial
engagement
Diagnostics
and care
delivery
Globaldigitalenablers
RapidlygrowingBroadlyadopted
Social listening Social listening
IoT
AR and VR AR and VR

Investments into R&D are on the rise in Asia but face
continued pressure from budget constraints, lengthened
time to market and risks of failure. Big data and AI
have the potential to disrupt this by accelerating the
process of identifying high-potential molecules. Gunjan
Bhardwaj, CEO and Founder of Innoplexus, a company
focused on data analytics for pharma companies, says,
"There is a wealth of medical, research and patient data
that is often out of reach for researchers or it is spread
across hundreds of sources. AI and ML technologies can
democratize the field by reducing the time, effort and
cost of medical research."
To overcome the challenges of conventional combination
therapy, a research team led by the National University
of Singapore developed CURATE.AI.1
This powerful
AI tool uses the patient’s clinical data, such as their
drug doses and corresponding changes to tumor
sizes or levels of cancer biomarkers in the blood, to
calibrate his or her unique response to treatment. By
continuously optimizing novel drug combinations, the
solution was able to halt progression of advanced cancer
for certain patients in the clinical study. On the other
hand, oncology researchers are leveraging AI and deep
learning to train ML algorithms to recognize cancerous
tissue in scans, at a level comparable with that of trained
physicians.
IoT and 3D printing are rapidly being embedded into
drug manufacturing. The range of 3D-printable materials
continues to expand beyond plastics to include metals,
resins, ceramics and biocompatible materials. More
manufacturers have begun to use 3D printing for full-
scale production runs. The ability to print from electronic
files has given rise to new manufacturing-as-a-service
(MaaS) business models, allowing manufacturers to gain
operational flexibility and reduce ownership costs by
leveraging on-demand 3D-printing service bureaus.
Doctors in Ramathibodi Hospital2
, one of the largest
state-owned hospitals in Thailand, have started
experimenting with 3D printing to rapidly manufacture
prototypes of organs, such as the heart and lungs, to
aid pre-operative planning. ROKIT Health care, from
Korea, recently introduced a novel 3D-bioprinting and
regenerative medicine to treat scarred lesions. The
company’s 3D technology prints a patient’s autologous
tissues and cells into a dermal patch graft, which when
placed on a wound, enables the natural formation of
new blood vessels under the skin. While regulations
and durability of these products are yet to be seen, the
initial trial results are not discouraging when compared
with placebo.
3. Disruptions along the life sciences value chain
1. “NUS researchers use AI to successfully treat metastatic cancer patient,” NUSNEWS, news.nus.edu.sg/press-releases/nus-researchers-use-ai-successfully-
treat-metastatic-cancer-patient, 31 August 2018.
2. “HARN 3DMed congratulates Ramathibodi Hospital, Mahidol University, that opened Medical Innovations Development (MIND) Center with 3D-BIOPLOTTER, the
first 3D printing in the hospital in Thailand,” HARN Engineering Solutions, https://www.harn.co.th/news-events/harn_3dmed_mind_center/, 30 August 2018.

Leading Indian pharma manufacturers are using IoT
systems to track drug production and are using real-time
data from sensors installed in their equipment to predict
breakdowns. Proactively eliminating disruptions to
manufacturing allows drug manufacturing companies to
increase reliability of operations and quality of products.
With improved infrastructure and maturity of IoT assets,
these trends could be the mainstream themes soon.
Supply chains are poised to become more agile and
transparent while maintaining cost-efficiencies. A recent
initiative includes The Food and Drug Administration
of Chongqing teaming up with Prime Number Chain
Technology Chengdu Ltd. to implement a blockchain
solution that will increase traceability, and combat fake
and expired prescription of drugs.
Another digital supply chain area seeing significant
uptake in emerging markets is drone delivery. It is rapidly
expanding and helping health care reach patients in the
remotest of areas, e.g., JD.com, China's largest retailer,
has been developing and applying advanced technology,
such as drones and robots, to last-mile delivery to
increase efficiency for its business and partners for
several years. These technologies have proven especially
useful for emergency relief scenarios, such as to help
medical supplies and other necessities reach those in
need during the epidemic situation, e.g., NCP; reducing
human-to-human contact and enabling faster delivery.
AR and VR, and gamification are accelerating
personalized care and patient engagement. Nintendo
has partnered with Bayer to create a game that rewards
diabetic children for consistently testing their blood
glucose levels. They unlock new mini-games once enough
points are earned. Bayer has also created the “Three
curious cases at Roseville Retirement home” game
to inform individuals about the importance of patient
safety and adverse event reporting during treatment or
trials. Osso has leveraged VR to create a virtual surgical
ground, where surgeons can undergo training to use new
medical devices and, ultimately, master it.
The adoption of digital in developed and developing
markets has been vastly different — in developed
markets, digitalization has been focused on building
upon the existing developed infrastructure, partly
because of stricter regulatory barriers and established
systems that already meet the basic needs. In developing
markets, digital has picked up much faster. In some
cases, it is replacing existing infrastructure or its lack
thereof, and is focused on solving basic issues of access
and affordability.
ROKIT Health care, from Korea, recently
introduced a novel 3D-bioprinting and
regenerative medicine to treat scarred lesions.

Picking the right bets — spotlight
on four major markets
We have selected two developed countries —- Japan
and Australia, and two rapidly emerging economies —
Indonesia and India, to take a closer look at the adoption
of digital across the pharma value chain in APAC.
These four markets provide a fair representation of the
plethora of opportunities that digital health offers, and
the countries’ evolution to digital maturity may provide
a template for the various ecosystem players to follow in
other markets.
India with its young population, limited health care
budget but entrenched drive toward building better
care and a well-regarded private landscape through
innovative approaches, presents a picture of what mid to
large emerging markets could adopt. Like in the case of
diagnostics, reverse innovation in India could be a source
of innovative technologies in Africa.
Indonesia, on other hand, already has a commitment
to universal health care and established procurement
practices. Its private landscape continues to evolve
but the market is severely under-served with only
500 ophthalmologists. Therefore, it has one of the
highest rates of blindness in Asia. Indonesia, therefore,
represents an example of markets where supply trends
have largely remained tepid. We believe some of the
Latin American (LATAM) and Middle-Eastern markets
might be able to draw lessons from Indonesia’s case.
On the developed markets’ front, we focus on Japan
where there is a large ageing population in an economic
environment that has unfavorable macro-growth
prospects. Additionally, we focus on Australia, which
requires a unique health care market set up to cater to
large distances in order to provide patients with access to
health care as they on the community hospital network.
Australia could serve as a model for community health
care digitization in various developed markets.
Figure 5: Current digital adoption along the value chain in selected developed and developing markets
R&D Clinical trial Manufacturing Supply chain
Commercial
engagement
Diagnostics
and care
delivery
Developing
market
Developed
market
AI and ML
Digital clinical
trial
IoT sensors
Drone delivery
AI CRM
Remote
detailing
Chronic disease
management
Tele medicine
Electronic
health record
integration
Tele medicine
Japan
Australia
India
Indonesia
Low adoption: concept introduced but investment remains limited
Medium adoption: prototype created and test run ongoing
High adoption: currently implementing and used
Active
initiatives in
all markets
Active adoption in
developed markets
Active adoption
in developed
markets
Active adoption in
developing markets

Figure 6: Health care landscape assessment at country level
Drug
manufacturing
Fix the basics Strive for excellence Push for innovation
Logistics
infrastructure
Electronic medical
health records
Community
hospital setup
Outreach
in suburbs
Disease
awareness
Physicians' medical
education level
Government health
expenditure
PAPs
Universal health
coverage
Partnerships with
health start-ups
Partnerships with
other ecosystem
players
Health care
expenditure per capita
Health care
infrastructure
Health care
network
Access
Awareness
Affordability
Partnerships
Health care landscape assessment at country level
Australia Indonesia JapanIndia

Spotlight: Japan
Japan is one of the most advanced markets in the
region, supported by a rich EHR database - thanks to
a universal health care system that has been in place
since 1961 (76.3% of hospitals with more than 400
beds have EHRs). The parts of the value chain that have
seen high digital adoption are R&D and clinical trials on
the Pharmaco side, commercial engagement, and care
delivery on the patient and HCP side.
Use of AI and ML in R&D, and clinical trials have been
increasing because of the Government initiatives
enabling collaboration and sharing of data. For example,
Riken, a Government-owned research institute has spent
nearly US$100m on life intelligence consortium (LINC),
which comprises a group of over 100 organizations,
including IT, pharmaceutical firms, scholars and
research institutions working together to promote a new
AI-based drug’s development. Japan offers generous tax
credits for collaborative R&D, with companies claiming
R&D credit for up to or over 20% of their Japanese
corporate tax liability for the year. On the commercial
side, telemedicine has been promoted as a part of the
Government’s Health Care Vision 2035, focusing on
remote diagnosis, treatment and telesurgery. This push
toward remote treatments is in response to previous
natural disasters, which have hindered medical services
and accessibility.
The Government support has been supplemented by
initiatives in the private sector. Strategic partnerships
between AI providers and pharma companies have
helped combine real-world evidence data with advanced
AI and ML algorithms to enable drug discovery and to
support clinical trials. For example, Santen, a Japanese
firm specializing in ophthalmology has partnered with
twoXAR, an AI-driven drug discovery company to
discover and develop new compounds that can treat
glaucoma. TwoXAR has collaborated with another
Japanese company, Ono, to help fasten the discovery
and validation process for compounds to support their
neurological disease pipeline. These developments are
expected to improve the position of Japanese pharma
companies in terms of innovative treatments.
On the commercial side, high digital awareness and data
availability among both patients and HCPs presents
opportunity. Approximately 81% of population have
internet access and approximately 85% of physicians use

digital sources as their primary source of information,
making a strong case for AI-powered CRM for targeted
interactions with HCPs and telemedicine for easy
treatment access to patients.
The Japanese telemedicine start-up Micin has raised
nearly US$10m in funding for its smartphone app Curon,
which is already used by 650 health care institutions.
The company specializes in chronic disease management
where patients share personal health information
collected at home with doctors through the portal, and
data is retained and analyzed using AI-based technology.
Japan has also seen innovations in connected health —
Otsuka Pharmaceutical’s Abilify MyCite became the first
commercial “digital pill” with a sensor to get Food & Drug
Authority (FDA) approval. Partnering with Proteus, a
sensor start-up in the US, Otsuka embedded a Proteus
sensor in its pills that sends an electric signal to a
connected group of devices to improve adherence
among schizophrenia patients.
Going forward, there are three trends to watch in
particular:
• With a quarter of the population above the age of 65,
the incidence of chronic diseases, such as diabetes and
Alzheimer’s, is expected to increase. Combining this with
a highly connected population, mobile applications for
chronic disease management and adherence will be
increasingly adopted. There will be increased use of AI to
predict these diseases as well. In fact, recently, Bill Gates
recently invested in a US-based research firm that tries
to predict Alzheimer’s using digital markers, such as the
sound of one’s voice or changes in one's writing habits
over time when using a digital pen. Similar uses could be
adopted in Japan.
• The high cost of R&D and long time to market, combined
with pricing pressures from the Government mean that
AI- or ML-led drug discovery, and partnerships between
big pharma companies and innovative start-ups will
become more common going forward.
• The decreasing ROI on commercial engagement
and greater compliance requirements mean that
AI-powered CRM will disrupt the sales and marketing
functions of big pharma. Telemedicine will become
more adopted as technology improves and patient data
becomes more easily available.

Spotlight: Australia
Australia has one of the most developed health
care systems in the region. In 2018, the Australian
Government launched an electronic health record
system for every Australian. Since then, there have been
significant developments to harmonize how patient data
is shared. For instance, The Royal Melbourne Hospital
has partnered with the Peter MacCallum Cancer Centre,
Royal Women’s Hospital and Royal Children’s Hospital
to store medical history and treatment information
of patients in one secure location. The initiative also
includes a patient portal that allows patients to access
their medical records on the go. Standardization
and integration of medical records are driving better
coordination of care, which can ultimately lead to
better informed decisions for diagnosis, minimization
of duplicative diagnostic tests, and reduction in hospital
admission rates.
A unique challenge impacting access to health care in
Australia is the large distances that individuals need to
travel. Between 2014 to 2015, the number of public
hospitalizations requiring patients to travel outside their
home district ranged from 3,115 in Far West to 42,393
in Western Sydney. In the past year alone, the Royal
Flying Doctor Service had flown over 13,000 patients,
conducted over 1,600 clinic sessions and transported
over 900 patients to give them timely care. The costs of
the current set up are high and the ability to provide on-
demand medical care to 30% of the population that live
in the outskirts remains a challenge.

AR and VR can help to bridge this gap in access.
Silverchain and Microsoft Hololens VR glasses have
enabled nurses to travel to patients’ homes virtually
to check patients’ live biometric data hands-free while
speaking to a holographic doctor. Physitrack, a remote
patient engagement tool, leverages telehealth and direct
messaging with medical professionals to enhance patient
engagement and outcomes.
Community hospitals play an integral role in the health
care delivery system. They have traditionally focused on
a “GP-plus” model with inpatient, outpatient, GP-plus
dental, and Ob-Gyn services. However, as the nature of
diseases among the population evolves and prevalence
of non-communicable diseases increases (approximately
70% of residents have at least one chronic condition),
there are growing strains to the delivery of advanced
treatments, not offered by the community hospitals.
The shortage of skilled talent and lack of specialists are
compounding existing challenges.
Embedding digital to advanced treatment services can
help avert some of the issues. In 2018, Royal Perth
hospital, Emory Health care and Philips launched an
electronic intensive care unit (eICU) monitoring program.
The critical care physician and nurses will provide
medical care to patients in the US from their base at
Royal Perth Hospital using Philips’ remote intensive care
monitoring technology. By connecting all ICU patients to
the eICU, the critical care staff can monitor patients in
real time and the specialized health analytics can help
predict even small changes to vitals, such as heart rate
fluctuations, to alert before an emergency arises.
A growing concern in Australia is the increase in
ageing population. Australians aged 65 and above are
stated to increase to 22% of the population by 2057.
New technologies for geriatric care are being rapidly
brought to the market. BrainyApp created by Dementia
Australia and Bupa Health Foundation was launched to
raise awareness around risk factors that could lead to
Alzheimer’s. Painchek leverages AI and facial recognition
analytics to detect pain, especially among those who
have communication difficulties, because of dementia.
The FallScreen app tracks daily activities of the elderly
in order to calculate fall risk. The app has preemptively
issued alerts that has predicted falls with close to 75%
accuracy. Moreover, FallScreen has been used to monitor
the efficacy of companion drugs or medicines, such as
benzodiazepine.
The three trends expected in Australia’s digital health
landscape include:
• Electronic health records are rapidly being rolled out.
As a result, governments and hospitals can use
AI and ML to drive insights, and boost efficiency
in diagnosis and care delivery.
• With non-communicable diseases among the population
on the rise and a large number of untreated mental
health patients, more physicians will use AR and VR
in the treatment of patients.
• Life science firms will have a greater focus for
data analytics and will collaborate closely with
hospitals to derive insights from real-world evidence.
This will change focus from product-centricity to
solution-focused therapies.

Spotlight: Indonesia
Health care is an important pillar for development
in Indonesia that has witnessed steady increases in
expenditures over the last few years. One of the key
issues that Indonesia faces is the large regional disparity
in medical services and the lack of access to health
care, particularly in rural regions. Telemedicine and
remote platform-based care solutions are playing an
important role to bridge this gap. For instance, Halodoc
allows patients to consult a doctor through a mobile
app, obtain lab results online and arrange for home
delivery of medication. Siloam Hospitals has partnered
with BookDoc to provide round-the-clock online hospital
booking services for patients who can select doctors
from a range of specialties and availabilities, helping
them overcome inefficient wait times.
Indonesia's chronic disease burden has been on the
rise. Cardiovascular diseases account for nearly 50% of
deaths annually, while diabetes-related deaths increased
by 50% in 2017 from 10 years earlier. These increases in
non-communicable disease prevalence have been largely
because of unhealthy foods that are rich in cholesterol
and a sedentary lifestyle. Posyandu mobile health app
aims to increase awareness of healthy eating habits and
to promote early prevention of diseases among children.
The app was developed by World Vision Indonesia to
monitor a child’s nutritional and growth velocities, and
provide appropriate nutritional counseling to circumvent
diseases or illnesses. A large hospital chain has also
been experimenting early lung cancer detection and
prevention. A pilot study of the hospital’s treatment
reported reduced lung cancer deaths by 26% in men
and 61% in women.
Innovations in early prevention and proactive care are
also being applied to other conditions. CekMata, a web-
based platform utilizes AI and ML to detect potential
cataracts and advise on diagnosis. Sehati, a health
marketplace app, launched a campaign #VaccinEASY
to raise public awareness of cervical cancer. The app, in
conjunction with local health clinics, is providing human
papilloma virus (HPV) vaccination as home service.
Maternal mortality has been one of the highest in
Indonesia. Femtech has focused to bring more antenatal
care awareness among mothers to be. TeleCTG, a
maternal health telemedicine app enables pregnant
women anywhere in the country access to affordable
cardiotocography (CTG) scan. TeleCTG also enables
midwives to collect data and monitor fetal development.
Mothers to be can also receive pregnancy information
and tips, maintain an electronic maternal health
journal, and record contractions, etc. Mobile obstetrics
monitoring (MOM) system developed by Philips along
with local authorities, such as Indonesian Ministry
of Health, combines mobile monitoring to fast-track
treatment for high-risk pregnancies and improve
pregnancy outcomes through health information
awareness. An early foray of the MOM system found that
early detection of high-risk pregnancies rose threefold
while anemia among women during their first to third
semester reduced by 99%.

While the Universal health Insurance - Jaminan
Kesehatan Nasional (JKN), was implemented with the
goal to reach 100% coverage by 2019, uptake has been
less than anticipated because of a lack of compliance and
awareness. Financial penetration has been low but with
digital penetration on the rise, there is a strong case for
digital health insurance. Banking on opportunities such
as these, PasarPolis has developed a digital insurance
platform that provides micro and modular insurance
products, some of which cater to specialized health
insurance. Over two million policies have been sold so far
with a company target to capture 2% to 3% digital claims
by 2025.
Going forward, there are three trends to watch out for in
Indonesia:
• Leveraging apps that are integrated with other services
such as travel, insurance or delivery to improve
accessibility to health care
• Customized digital technologies, such as femtech or
halal-approved innovations to treat specialist conditions
impacting certain parts of the population
• Increasing prevalence of digital insurance platforms
that seamlessly integrate financial services and
health care

Spotlight: India
As much as India has been touted as a manufacturing
hub for generic medicines, in terms of health care
access, awareness and affordability, it lags behind.
Despite this, the market has huge potential for pharma
companies. The unique dynamics at play are the primary
reason that technology can be leveraged to bring about
quick change, lower costs and increased access.
There are multiple initiatives implemented by the
Government to promote digital in health care. The
Ministry of Health and Family Welfare has proposed
the creation of a National eHealth Authority (NeHA) to
be responsible for creating the regulations regarding
the security and interoperability of health data. The
Integrated Health Information Program (IHIP) intends
to provide EHRs to all the citizens in India and facilitate
the interoperability of existing ones. In 2015, the
Government also launched the online registration system
(ORS), an online patient registration and appointment
system, aiming to help cut down patients’ waiting
time at hospitals. Currently, most central government
hospitals and many state government hospitals
are linked to the system.

Telemedicine has also seen successful pilots by both
public and private companies. Aravind Eye Care operates
65 vision Centers, which have webcams and paramedical
staff for conducting preliminary eye examination.
The Indian Space Research Organization (ISRO) has a
telemedicine program across 306 remote hospitals and
18 mobile telemedicine units to help improve medical
access for citizens and defense personnel in remote parts
of the country.
Based on these, going forward, there are four major
trends to watch out for:
• Telemedicine would fill the gap of shortage of
availability of quality HCPs in remote areas. The
Government is working closely with telecos and health
care ecosystems in launching projects for telemedicine.
• The penetration of smartphones is expected to go up
to 66% by 2022, from 27% in 2017. Combined with an
already increasing diabetic population, this is expected
to lead to a greater use of CGM devices, and more
broadly speaking, wearable and mHealth applications
will see a multifold increase.
• To maintain cost competitiveness along with a quality
leader image, generics and domestic manufacturing
units of MNCs will increase their usage of IoT.
Rising material costs along with regulatory pressure
on medicine prices will lead to further use of IoT in
manufacturing to drive down costs.
• The use of blockchain to drive supply chain integrity
and even exchange of information to maintain
transparency in public medical distribution programs
are expected to pick up.
Considering the large manufacturing base in India,
the use of IoT in manufacturing has been quick to pick
up. Covacsis is an Indian start-up, which has created a
system to notify managers of events, such as machine
breakdowns in the factories and calculate potential
capital losses from these operations on the floor. The
software gets real-time data from monitoring gadgets
inserted in machines in the factory. Its clients include
Sun Pharma. Similarly, Alkem Laboratories, a local
manufacturer, remotely monitors and controls the
temperature in more than 25 of its warehouses across
India using a licensed software. This software can send
online notifications about deviation in temperature
to authorized employees to ensure optimal storing
conditions for products.
Recently, Niti Ayog in India has been working on a
blockchain platform for maintaining the integrity of the
supply chain. The initiative is aimed at ensuring the
traceability of drugs across the supply chain to prevent
counterfeit drugs.
Likewise, on the commercial side, the use of connected
health has picked up. Diabetes has been on the rise,
with over 30 million people diagnosed with the disease
and millions more expected to be diabetic while still
undiagnosed due to lack of awareness and access.
Smart continuous glucose monitor (CGM) has been the
latest trending technology. CGMs can connect to mobile
apps, and using data analytics, it can help predict future
drop in glucose levels and notify patients. Recently,
Eric Lifesciences, an Indian pharma company focused
on chronic disease management collaborated with
Medtronic India for the nationwide rollout of Medtronic’s
Guardian Connect, the world’s first smart CGM system.
This solution can help the user monitor their glucose
levels in real time on their smartphones, instead of using
a separate monitor.

4Key implications
and conclusion
In conclusion, these are very exciting times for health
care in APAC. Digital has the potential to significantly
impact every portion of the value chain, particularly
AI-based product development and personalized care
delivery.
In emerging markets, the applications around telehealth,
use of mobile platforms and blockchainfor supply chain
combined with IoT will open a plethora of opportunities.
While digital platforms bring convenience, their
role from a value-add perspective may need to be
reassessed. A long-term view on expanding the pool
through digital diagnostics, open data sets, developing
digital solutions for primary care could help HCPs unlock
large pools of patients.
In developed markets, drug development will accelerate
with use of AI-based techniques and screening, both of
which are expected to increase in accuracy with use of
supplementary digital technologies. As large pharma
companies and medtechs partner with health care start-
ups, these health care start-ups become nodal points in
the health care network, carrying vast amount of data
and information. Life sciences companies need to stop
viewing their product and goals in isolation but instead
tap into the broader network at play, and capitalize on
the insights available at these nodal points. Naturally,
a central concern going forward will be around data
privacy and security. In contrast, for emerging markets,
we believe that nodal points for information will arise
through non-health care data platforms, such as travel
aggregators, financial services and super apps.
For both developed and emerging markets, we note that
the viability of digital health depends on how life sciences
companies choose their partners. There needs to be a
rigorous criterion for screening. Moreover, the value
proposition to clients’ needs to be clearly articulated and
formed to address a real health care need in the market.
For instance, while great digital technologies exist,
e.g., digital wellness apps, few individuals are willing to
pay for it as they don’t see a real need to change their
status quo.
Overall, we expect digital health adoption in emerging
markets to leap frog to the levels being experienced in
developed markets, given the magnitude of challenges
present in health care systems. The relatively nascent
and moldable regulatory landscape along with the need
to address severe health care challenges will explain the
rapid pace of digital health adoption.

Today
Adoption of
digital health
Future
Emerging markets
Developedarkets
Growth in developed
markets expected to be
more incremental in nature.
Emerging markets expected to leapfrog to adopting
advanced digital health to solve the challenges
posed by the existing infrastructure.
Life sciences companies need
to become the gold standard for
collaboration. They should follow
the highlighted principles:
• Move from pipeline partnerships to platform
partnerships, to optimize clinical and real-world data
Currently, most pharma and device companies have
launched partnerships from a product enhancement
perspective. But if closely evaluated, they are now
a part of a larger network, which when tapped on,
can unlock deep insights. In developed markets, it’s
a clinical platform play. However, to achieve this,
life sciences will have to rethink the business case for
digital health. It should be less about the immediate
ROI or the demands of the street and more about
the long-term value that can be derived from the
platform play.
Figure 7: Difference in digital adoption across emerging and developed markets
4. Key implications and conclusion

In emerging markets, the platform play would be
different, and would be more with non-traditional
players, given the deeper focus on care delivery.
Here, life sciences companies need to think beyond
their brand positioning and identify players in the
ecosystem, where patients exist and live their digital
lives. Some examples include online market places,
social media sites, ride sharing platforms, general
entertainment content providers and online doctor
booking apps. Developing innovative partnerships
would help create access and care delivery options.
For example, a large pharma player is now planning
to use social media credit rating for its means-based
testing patient programs; similarly, a leading fertility
player has invested in social listening to pick up on
patient emotions and concerns.
• Work closely with governments and research institutes
The biggest constraint in developed markets on digital
health are some of the regulations on clinical data
access. While they are critical, life sciences companies
can draw inspiration from consumer-technology
industry that has worked closely with regulators
and governments to address concerns, and work on
shaping the policy landscape together. From France
to Japan, we are now seeing consumer technology
increase the levels of automation — robots being
a case in point.
While life sciences companies have made a lot of
progress in working with local research institutes
for developing drugs and devices for local markets,
we are yet to see the local digital ecosystem work
with life sciences companies. For instance, the cyber
security agency could help with running hackathons
on upcoming digitized devices.
In emerging markets, governments have often
benefited from interventions from MNCs to develop
policy on how to expand health care access. MNCs
could play a similar role in digital health, but also
go beyond they could form industry consortiums to
tackle the biggest health challenges facing the country
and aim to create digital solutions around them. For
example, a digital packing or smart packaging idea
could be used in emerging markets to track drug usage
and counterfeiting.
• Collaborate with peers and start-ups
Only 15% healthtech start-ups last for more than
five years since inception. While the usual assumption
that they have a challenge with funding, the bigger
challenge often is navigating the regulatory landscape
especially in emerging markets. MNCs could play a
significant role in helping the start-up community.
While there are innovation labs already in place for
some, MNCs need to bring a fundamental shift in
regulatory landscape. For example, we heard from the
CEO of an AI-based oncology start-up that it took them
three separate clinical protocols due to separate IRBs
in Singapore to test their product. MNCs could help
create a common IRB at least for start-ups or specific
therapy areas. Start-ups in the developed markets face
a challenge of long waiting times as regulatory bodies
are often burdened by a large number of applications
and trial results. MNCs could help advise start-ups on
how to approach fast-track applications and also invest
in developing additional capacity for trial results to be
conducted at a lower cost.

Regulators should play an
important role in promoting and
tracking new policy initiatives:
1. Fast-track path for commercialization: Given the
vast array of health care access and availability
challenges, AI-based solutions are in urgent need
for commercialization. Instead of traditional
multiyear approaches, a fast-track approach could be
implemented. In this regard, the steps adopted by
US Food and Drug Administration (USFDA) in
providing pre-certification to some companies
for healthtech is very encouraging.
Key requirements for fast track for commercialization
include:
• Standardizing protocol designs for AI-based
solutions, including institutional-level review board
processes
• Providing pre-certification to select entities
• Investing in real-time tracking of clinical trial results
2. Work across borders on large issues, such as privacy
and security: As products become digitized and more
solutions are launched, regulators could work in
close collaboration to develop uniform and consistent
guidelines with regard to privacy and security.
3. Developing avenues for proof of concept to be
tested: Today’s various digital solutions are often
drug-device combinations or a service. Regulators
could help with developing guidelines on how some
of the unique solutions can be tested — this would
require them working closely with the start-up
ecosystem to pick up upcoming ideas and accordingly
shape policy rather than waiting for a formal
application.

Governments have the most
important role to play in this
ecosystem, as the enabler.
They should pave the way to:
1. Reposition digital as a complementary rather than
a disruptive force: Increased acceptance of digital
health care technologies among HCPs will help
increase the overall penetration of the technology.
The resistance of HCPs in developed markets is
justified as decision-making follows well-established
protocols that may be hard to replicate with digital
solutions. It is important for public forums, health
care associations and governments to position
digital health as a way to augment existing health
care services, rather than replace them. Especially
in markets such as Indonesia, where there is severe
shortage of medical talent, technologies such as
AI could improve access in a cost-effective manner.
In most Asian markets, patients rely mostly on the
word of the physicians, and hence community-led
education programs funded by the government are
required to increase awareness and consumer or
patient engagement will be key to higher acceptance.
2. Skill upgrade: Governments globally are looking
to boost productivity, and digital health presents
an unparalleled opportunity. Governments need
to make continual investments through grants
and develop formal education curriculum focused
on experiential learning, in coordination with the
health care and deep technology industry players to
develop employable talent. Given the multitude of
priorities for Asian Governments, there is a need for
governments to balance funding with effectiveness.
3. Reimbursement models for digital health: As
most major APAC markets gear towards universal
health care, digital would play a key role in helping
bridge increase infrastructure and access needs.
However, models for reimbursement of digital
solutions are yet to be fully developed. Funding them
in a profitable manner are key to reduce budget
pressures, make preventative care pervasive and
drive adoption.

The future of digital health is promising. It’s an evolving
space where traditional rules are being broken and
nontraditional health care initiatives are driving change.
While the potential for impact is enormous, the speed
of change is yet to be seen. Nonetheless, the promise
of advancement encourages us to invest further.
EY teams have a number of initiatives to ride the
crest of digital health:
• Pointellis™, a new individualized cell and gene therapy
solution, provides information exchange infrastructure
to help enable safe and accurate delivery of truly
individualized cell and gene therapies (ICGT) to patients
at the right time and place, every time.
• EY Commercial Analytics Suite (CASE®) provides an
end-to-end commercial suite of value-driven analytics
that drive tangible ROI through actionable insights, in
order to help pharma clients with sales, marketing and
market access.
• EY Customer Journey Mapping Framework and the
Storybook® platform give us the ability to consistently
capture, record and analyze customer journeys on all
our experience engagements around the world.
• EY Health Outcomes allows transparent, end-to-end
and seamless contracting among life science companies,
providers and payers to improve patient outcomes and
reduce total health care costs.
• EY wavespace™ combines advanced facilitation
capabilities with a suite of tech tools, subject-matter
professionals across the globe and network of sites
to create an immersive, exciting but, above all,
collaborative experience.
• EY digital solution uses design thinking and a minimum
viable product (MVP) approach, to assist clients with
“concept sprints,” where we take up problem statements
and potential digital solutions in health care and life
sciences, and start developing digital prototypes within
two to three months, delivering real-life app screens,
analytics and visualizations.

The authors
Joongshik Wang
Partner, Strategy & Operations,
Digital
joongshik.wang@sg.ey.com
linkedin.com/in/joongshik-wang
Aditya Agarwal
Director, Strategy & Operations,
Life Science and Health Care
aditya.agarwal@sg.ey.com
linkedin.com/in/adiagarwal/
Krati Khandelwal
Strategy & Operations,
krati.khandelwal@sg.ey.com
linkedin.com/in/krati-khandelwal-
370039112/
Radhika Deb Roy
Strategy & Operations,
radhika.deb-roy@sg.ey.com
linkedin.com/in/radhika-deb-roy-
b4759472/
Philip Jose
Associate Director,
Strategy & Operations
philip.jose@sg.ey.com
https://www.linkedin.com/in/
philipjose/
Abhay Bangi
abhay.bangi@sg.ey.com
linkedin.com/in/abhaybangi/
Sol Magaz
sol.magaz@sg.ey.com
linkedin.com/in/solmagaz/
Tony Sherbon
Life Science and Health Care —
Australia
tony.sherbon@au.ey.com
linkedin.com/in/tony-sherbon-
7b36a361/
Keith Lostaglio
Sr. Advisor and Health Care leader
linkedin.com/in/keith-lostaglio-
42aa1a1/

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