OPENING ADDRESS BY:

THE DIRECTOR GENERAL OF HEALTH MALAYSIA

THE 1^ST TELEMEDICINE CONFERENCE 2015

Wednesday, 5 August 2015 @ 9 am

Swan Convention Centre, Sunway Medical Centre KL

• Professor Helen Bartlett, CEO and President, Monash University Malaysia
• Mr Lau Beng Long, Managing Director, Sunway Medical Centre
• Mr Jaffri Ibrahim, CEO of CREST
• Associate Professor Dr Wong Chee Piau, Chairman of the organising committee
• Speakers of the conference, health professionals, members of the media, distinguished guests,
• Ladies and gentlemen,

Asslamualaikum wbt and a very good morning

Today, I am very honoured and delighted to stand in front of all of you to deliver the opening address of the 1^st Malaysian Telemedicine Conference, held here at Swan Convention Centre, located in Sunway Medical Centre. Congratulations are in order to Monash University for organising this conference.

This is the first telemedicine conference in Malaysia, which aims to bring together key stakeholders namely policy makers, industries, academia, medical practitioners and the medical providers to deliberate, discuss and collaborate on key issues and challenges faced by the field of telemedicine. The conference theme of Policy, Innovation & Research, offers a more pragmatic approach to discuss and address key issues on the ground to help propel Malaysia into the information technology age.

Immerse yourself in this 2-day event to learn and share your experiences and knowledge, network with your fellow participants. Let this be the platform to cross-fertilise ideas and create a potpourri of solutions in Malaysian Telemedicine.

I must also congratulate the Telemedicine Innovation Challenge participants for taking the courage and passion to innovate healthcare solutions. This clearly demonstrates how the creative and inventive minds of Malaysians are able to rise to the occasion and innovate leading edge healthcare solutions. The winning team will also be nurtured into successful commercialisation. I look forward to congratulate the winning team.

When Dr Wong proposed the idea of telemedicine conference earlier this year, I could immediately see the importance and many benefits of this platform, and agreed to it without much hesitation. MOH, which is involved in all three aspects of policy, innovation and research; has to be an active participant. In the past, MOH has traditionally adopted a top down approach in driving healthcare innovation, but this approach is rather slow, ineffective and full of challenges. The healthcare scene in Malaysia is complex and pluralistic. At least 40% of the healthcare services in Malaysia is currently being delivered by the private sector. To be effective, a collaborative approach will be more engaging and helps to improve the outcome of our efforts.

I am also delighted to see that the National Internet of Things (IoT) strategic roadmap launched in July 2015 has also been focusing on healthcare as one of its iconic project, with CREST leading its implementation.

Ladies and gentlemen,

Malaysia’s achievement in delivering a world-class health system is undeniable. Our health care system is acknowledged internationally as a successful, modern government-regulated health system that provides effective health services. According to a survey conducted by the media company, Bloomberg in 2013, based on 3 criteria i.e. life expectancy, relative per capita cost of healthcare and absolute per capita cost of healthcare, Malaysia is among the world’s top 20 countries with the most efficient healthcare system.

In 2014, a survey by US-based International Living stated that Malaysia’s healthcare system was rated the third best system (after France and Uruguay) out of 24 countries in its Global Retirement Index. The United Nations has also acknowledged our success in addressing the Millenium Development Goals, in particular maternal health and our fight against HIV and Malaria.

While we are happy and proud of this fact, we cannot be complacent. The current system may not be sustainable in the long term, with an ageing population, increase in chronic diseases and rapid rise in health expenditure and high out-of-pocket spending. The total health expenditure as a percentage of GDP has increased from RM8,303 million (2.95%) in 1997 to reach RM44,748 million (4.53%) in 2013. In comparing public to private financing for health, the ratio has been constant at 52+% for public to 47+% over the period of 1997 to 2013.  In 2013, of the total private health expenditure, 81.13% was out-of-pocket spending increasing the risk of catastrophic health expenditure.

Some of the other challenges in the delivery of healthcare in Malaysia include:

• A growing and ageing population (15% of population by 2030)
• Increased prevalence of non-communicable disease as the major cause of mortality and morbidity. NCDs place a substantial economic burden on society.
• Changing trends in disease pattern, socio demography and new emerging diseases.
• Ensuring equity in health for disadvantaged groups
• Increased demand and over reliance on curative care causing hospital congestion.
• Lack of integration of dichotomous healthcare system and unequal distribution of resources between public and private healthcare system.
• Ensuring universal access
• Clinical workforce-supply difficulties, which have put pressure on service reliance.
• Rising public expectations including the role of ICT/social media

Malaysia’s Vision For Health is for Malaysia to be a nation of healthy individuals, families and communities through a health system, which is equitable, affordable, efficient, technologically appropriate, environmentally adaptable and consumer friendly. It should emphasise on quality, innovation, health promotion, respect for human dignity and community participation towards an enhanced quality of life. Integration of public and private healthcare deliveries is also very much required to optimise healthcare resources for more choices and availability of providers in a multidisciplinary teams approach and for better quality of care.

Thus taking into consideration all the above factors, MOH has come up with the strategic plan for health under the 11^1th Malaysia Plan with 8 areas of focus:

• Strengthening Primary Healthcare – through Family Doctor Concept, long term healthcare needs of the family and community, promotive-preventive care, early detection of disease and NCD management
• Health System Delivery and Work Process Reengineering – improving efficiency
• Human Resource and Organisational Capacity Development – Payments linked closely to performance of provider
• Infrastructure Planning and Development
• ICT Transformation for Health
• Public-Private/Inter-agency Collaboration including promoting the development of more private non-profit health provider organisations
• Enhancing Healthcare Financing Mechanism while the government will continue improve its financial support and protection for the poor and vulnerable
• Creating a Healthy Ecosystem towards healthy lifestyle and disease prevention

The above strategies need to take into account the international best practices while adapting to the local setting. Experiences from around the world will benefit us as we plan our future ahead. Charles Kattering once said, “I expect to spend the rest of my life in the future. So I want to be reasonably sure of what kind of future it’s going to be. That is my reason for planning!”

To this note, it is crucial to plan for healthcare transformation – to set the foundations for the country’s health system as Malaysia seeks to become a high income nation in less than 5 years. The driver to transform the Malaysian health system is the increasing demand placed by the public and the desire to serve the people better by ensuring improved health outcomes for the population. Besides the strategies in 11^th Malaysia Plan as I mentioned earlier, we are currently planning the health system reform holistically by restructuring the services delivery, organisation and financing mechanism of the health system.

The details of the health system transformation plans are still being worked out with experts on health sector reform and various stakeholders including private sector providers, the community, academicians and NGOs. The Ministry of Health (MOH) has engaged Harvard School of Public Health, Health System Team (HSPH HST) as an advisory team for this plan. HSPH HST is worldwide renowned and has had a distinguished reputation in providing single advisory services networking including transfer of knowledge and technology. HSPH HST has a vast experience in health transformation of various countries such as Turkey, Taiwan and Hong Kong.

At the end of the study, HSPH HST is expected to produce strategic transformation options to the Government. These options will have to ensure social justice, appropriate care, fair financing and financial protection to those who can afford. The health transformation is to develop a sustainable health system which addresses the needs of Malaysia, now and in the future.

In transforming the health sector, we will need to innovate. We will have to move away from the normative approach and embrace a new model. And we must do this by taking into account local and historical perspectives while preserving the strengths of the current system. Leaders, in public and private sectors that shape the health system; must come together to collaboratively design the reforms with the above values. There is a need to enhance smart-partnership that aims on a win-win arrangement, among agencies in government, private and NGOs, resting on a mutual understanding and shared-benefit. The use of available health resources in the public and private sectors should be optimised by strengthening the collaborative mechanisms.

ICT plays a crucial role in our healthcare delivery system today and years to come, hence it is one of the strategic thrust for the 11^th Malaysia Plan of 2016-2020. It will be further deliberated in this conference by the MOH speaker in Symposium 1.

However I would like to highlight some of the IT potentials in healthcare especially in addressing some of the challenges ahead. For e.g. accessibility and availability of services depend on financial, organisational and social or cultural barriers that limit the utilisation of services. Issues affecting accessibility and availability include

• Rural urban divide
• Private vs. public
• Manpower constraint
• Expertise constraint

ICT has a potential to bridge this divide:

• Bridge rural urban divide
• Reduce healthcare cost
• Complement resource
• Substitute some aspects in medical service e.g. Active video game based virtual rehabilitation system which is currently being developed by Monash University.

In the healthcare restructuring, we are moving from institutional based system towards ambulatory, primary care and home monitoring. We need to create incentives for promotive, preventive and team-based care; and additional incentives for achieving performance targets.

Regionalisation, the care network concept and telehealth services that would facilitate greater access to specialised care will also need to be more fully implemented. Information and communication technology is a prerequisite of the re-structured health system and the use of electronic medical records will increase opportunities to improve continuity and coordinated care as well as develop the capacity for performance management based on targets, coverage and key performance indicators.

The future should be patient-centered care with data belonging to patient. Centralisation of data is also being strategised for the coming years with the Lifetime Health Record project and Malaysia Health Data Warehouse. Both would have portals for the consumer or patients.

Ladies and Gentlemen,

Opportunities for mobile technologies to play a formal role in health services, are undeniable. This is a great potential for promotive and preventive approach of healthcare delivery. The use of wearable and deployable sensors, portable electronic devices and software applications (‘apps’) to provide interventions and therapies, health services, and to manage personal and patient information has exploded into all of our lives. Social media by itself has a great impact on health care.

The smart phone penetration is way above 100% in Malaysia and estimated 55% of the world’s citizen own one. Patients who are knowledgeable, involved and empowered by this communication tool have been associated with a positive impact on behavioural changes and patient self-care management. They seem to have higher satisfaction and improved experience.

Some of the uses for mobile technologies include:

• Text based reminder
• Text based health education
• Online consultation and counselling
• Accelerometer – exercise, physiotherapy, gait training etc
• Camera – adapted to grade DM retinopathy
• Camera – heart rate capture
• Epilepsy diary (Emmy)
• Diagnose an ear infection
• Track heart rhythms and ECG
• Mental health
• Wireless glucometer
• Blood-pressure readings
• Colposcopic Imaging

However, adoption is still lagging and more innovation is still needed in the marketplace. The issues of security, privacy, ethical issues, regulatory, quality and awareness needs to be addressed. In Malaysia, the Telemedicine Blueprint “Leading Healthcare into Information Age” unveiled in 1997, provides the conceptual framework for the future health system by harnessing the power of information communication technology for transforming healthcare and improving health outcomes. The basic concept provided by the Telemedicine Blue Print has supported the development of the National eHealth. However, with the changes in the landscape of healthcare over the years, this blueprint has to be revisited along with the move towards health system transformation.

I believe that through concerted efforts and cooperation between all players within our health system, we can reap the benefits from lessons learned from countries in this region and around the globe, in thrust Malaysia’s healthcare into information technology age. Hence, this Conference is a perfect opportunity for all of us here to share own challenges, views and ideas that can contribute to a better healthcare system in Malaysia. Once again, I congratulate the organising committee for its visionary approach and I am very pleased indeed to note that my colleagues in other relevant public agencies share my view and are participating in this conference as well.

Last but not least, let’s envisioned Malaysia’s Future Health System with a restructured integrated health system that is responsive and provides choice of quality health care, expanding universal coverage for the health care needs of the population based on solidarity and equity. Let us all, as a nation work together for better health.

I wish you all a successful conference.

Thank you

Datuk Dr Noor Hisham Abdullah

Director General of Health Malaysia

5 August 2015