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Riding the crest of digital health in APAC

A primer on key areas where Life Sciences companies can prioritize digital investments across the value chain in APAC.

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Riding the crest of digital health in APAC

  1. 1. Riding the crest of digital health in Asia-Pacific
  2. 2. 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 1 2 3 4 2 | Riding the crest of digital health in Asia-Pacific Contents
  3. 3. 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.
  4. 4. “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. 4 | Riding the crest of digital health in Asia-Pacific 1Flash-forward to 2030
  5. 5. 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.” 5Riding the crest of digital health in Asia-Pacific | 1. Flash-forward to 2030
  6. 6. 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. 6 | Riding the crest of digital health in Asia-Pacific 1. Flash-forward to 2030
  7. 7. 7Riding the crest of digital health in Asia-Pacific | 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
  8. 8. 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. 8 | Riding the crest of digital health in Asia-Pacific 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
  9. 9. 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 9Riding the crest of digital health in Asia-Pacific | 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
  10. 10. 10 | Riding the crest of digital health in Asia-Pacific 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, 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,, 30 August 2018.
  11. 11. 11Riding the crest of digital health in Asia-Pacific | 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.,, 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. 3. Disruptions along the life sciences value chain ROKIT Health care, from Korea, recently introduced a novel 3D-bioprinting and regenerative medicine to treat scarred lesions.
  12. 12. 12 | Riding the crest of digital health in Asia-Pacific 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. 3. Disruptions along the life sciences value chain 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
  13. 13. 13Riding the crest of digital health in Asia-Pacific | 3. Disruptions along the life sciences value chain 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
  14. 14. 14 | Riding the crest of digital health in Asia-Pacific 3. Disruptions along the life sciences value chain 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
  15. 15. 15Riding the crest of digital health in Asia-Pacific | 3. Disruptions along the life sciences value chain 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.
  16. 16. 16 | Riding the crest of digital health in Asia-Pacific 3. Disruptions along the life sciences value chain 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.
  17. 17. 17Riding the crest of digital health in Asia-Pacific | 3. Disruptions along the life sciences value chain 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.
  18. 18. 18 | Riding the crest of digital health in Asia-Pacific 3. Disruptions along the life sciences value chain 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%.
  19. 19. 19Riding the crest of digital health in Asia-Pacific | 3. Disruptions along the life sciences value chain 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
  20. 20. 20 | Riding the crest of digital health in Asia-Pacific 3. Disruptions along the life sciences value chain 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.
  21. 21. 21Riding the crest of digital health in Asia-Pacific | 3. Disruptions along the life sciences value chain 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.
  22. 22. 22 | Riding the crest of digital health in Asia-Pacific 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.
  23. 23. 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. 23Riding the crest of digital health in Asia-Pacific | Figure 7: Difference in digital adoption across emerging and developed markets 4. Key implications and conclusion
  24. 24. 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. 24 | Riding the crest of digital health in Asia-Pacific 4. Key implications and conclusion
  25. 25. 25Riding the crest of digital health in Asia-Pacific | 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. 4. Key implications and conclusion
  26. 26. 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. 4. Key implications and conclusion 26 | Riding the crest of digital health in Asia-Pacific
  27. 27. 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. 4. Key implications and conclusion 27Riding the crest of digital health in Asia-Pacific |
  28. 28. The authors 28 | Riding the crest of digital health in Asia-Pacific Joongshik Wang Partner, Strategy & Operations, Digital Aditya Agarwal Director, Strategy & Operations, Life Science and Health Care Krati Khandelwal Strategy & Operations, Life Science and Health Care 370039112/ Radhika Deb Roy Strategy & Operations, Life Science and Health Care b4759472/ Philip Jose Associate Director, Strategy & Operations philipjose/ Abhay Bangi Partner, Strategy & Operations, Life Science and Health Care Sol Magaz Partner, Strategy & Operations, Life Science and Health Care Tony Sherbon Partner, Strategy & Operations, Life Science and Health Care — Australia 7b36a361/ Keith Lostaglio Sr. Advisor and Health Care leader 42aa1a1/
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