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The Digital
Healthcare Leap
Digital health in emerging markets
February 2017
www.pwc.com/global-health
www.pwc.com/gmc
In this paper
3	The digital healthcare
dilemma in emerging
markets
6	Do traditional digital health
business models have a role
in emerging markets?
10	The leap forward
Foreword
David McKeering
PwC Global Healthcare Markets Leader
PwC South East Asia Consulting
Whether we like it or not, technology has become part of our
lives. It has arguably helped us as individuals become more
informed and more connected. The use of technology is
embedded in the industries of banking, automotive, insurance
and retail. Today the health sector faces a daunting new digital
challenge: unleashing the power of technology to fundamentally
reinvent how care is delivered. On top of their existing technology
needs and priorities, today’s health providers need to address the
digital requirements demanded by health policy or by consumers
and other stakeholders.
Digital Health initiatives rely heavily on having the right
information in the right place at the right time for use by the right
clinician. To really use technology effectively in health, we need
systems to interact with one another to provide the data required
to make informed decisions about the delivery of care. ‘Digital
healthcare’ is not about the technologies, it’s about new ways of
solving healthcare problems, creating unique experiences for
patients and accelerating healthcare providers’ growth. Over the
longer term, digital healthcare will help system-wide operations
and organisations to deliver more powerful healthcare.
Yet these challenging financial times discourage all but the most
prudent, high-return investments. Advanced, enterprise-wide digital
health solutions should head many emerging healthcare providers’
lists of ‘must have’ capabilities; however, traditional digital
healthcare models often come with high costs. Our experience is
that digital health can dramatically improve an organisation’s
productivity and, in turn, provide benefits in both patient outcomes
and the bottom line. This means that if the costs of digital healthcare
solutions can be made affordable, digital health could be an answer
to the emerging markets’ challenge to achieve sustainable growth
and leapfrog the developed nations to provide quality, affordable,
universal and patient-centric care.
PwC | The Digital Healthcare Leap | 1
Growing population
Many emerging markets in the Asia-Pacific region
are yet to reach their ‘peak’ population3
Projected population growth (2015-2050)
Japan
7%
decrease
Population in 2050
93%
Philippines 65%
increasePopulation in 2050
165%
Malaysia 50%
increasePopulation in 2050
150%Indonesia40%
increase Population in 2050
140%
India46%
increase Population in 2050
146%
China8%
increase Population in 2050
108%
Growing middle class
of the global
middle class
will be in
Asia-Pacific
by 20304
2/3rds
Ageing population
•	 Emerging markets will account for
80% of the world’s elderly by 20501
•	 Some emerging markets should
expect a significant increase in the
portion of their population aged 65+
between 2015 – 20502
10%
30%
Thailand
7%
21%
Vietnam
2050
2015
Urban-rural divide
•	 Over 50% of the emerging market in
Asia-Pacific live in rural areas6
Percentage of population in rural areas (2015)5
50% 50% 56% 44% 66% 34% 67% 33%
Thailand Philippines Vietnam India
Urban
Rural
Increased prevalence of non-communicable
diseases (NCDs)
•	 68% of total deaths globally occur due to NCDs; emerging
markets account for 75% of these deaths7
•	 Almost 200 million of the world’s 370 million people
diagnosed with diabetes live in Asia8
Prevalence of diabetes
as % of population8
Characteristics of
healthcare in
emerging markets
Indonesia
3.4
2012
8.6
2030
Malaysia
3.2
2012
8.5
2030
Philippines
2.9
2012
8.1
2030
Vietnam
0.9
2012
2.6
2030
Thailand
2.3
2012
4.1
2030
Healthcare demandinemergingmarkets is growing,drivenby anumber offactors
suchasagrowingpopulationas well as anageingpopulation.Withthegrowing
middleclass andrisingincomes,peoplearespendingmoreonhealthcare.Non-
communicablediseases suchas diabetes areno longer‘richcountry’diseasesand
theirprevalenceis increasinginemergingmarkets.Inthesecountries mostofthe
healthcare infrastructureis concentratedinurbanareas,whilemorethan50%of
thepopulationlives inrural areas.
2 |  The Digital Healthcare Leap | PwC
The digital healthcare dilemma in
emerging markets
The healthcare gap
Expenditure on healthcare is increasing exponentially in
emerging markets (see Figure 1). As incomes are rising and the
middle class is growing in emerging markets, people are
spending more on healthcare and demanding better healthcare
services. With changing lifestyles and people living longer, there
is a tectonic epidemiological shift from communicable to chronic
disease such as diabetes, cardiovascular diseases and cancer.
While developed economies also have their challenges with
affordability of care, their fundamental infrastructure is in place,
for the most part, and their population growth remains relatively
steady. Improving healthcare access and quality is becoming a
priority in emerging markets. However, these countries have
significant strain on their health systems. Digitisation of health
services, if done in a different model, can help to improve the
quality of and access to care while reducing costs.
On the demand side, the patients/consumers in emerging
markets are becoming more discerning around their own health
and customer experience has become a key motivator for
providers. Healthcare providers that fail to adapt to this
consumer shift will risk consumers turning elsewhere to have
their health needs met. For example, in Indonesia, patients are
increasingly travelling to neighbouring countries such as
Malaysia and Thailand to access better healthcare services.
On the supply side, the healthcare system in the emerging
markets is characterised by underdeveloped infrastructure and
faces an acute shortage of resources (see Figure 2). Governments
are looking to improve healthcare access and affordability. They
are implementing universal healthcare coverage and increasing
national budget allocated to healthcare to upgrade the existing
Figure 1: Healthcare expenditure is increasing exponentially in emerging markets
9%
Source: Business Monitor International (BMI)
85% 78% 74% 71% 65%
15% 22% 26% 29% 35%
2005 2010 2015 2020 2025
Emerging
Developed
Healthcare expenditure developed vs. emerging markets (%)
There is a clear burning platform and
opportunity to address the growing burden
of healthcare costs and corresponding impact
on economic productivity due to ill health
(the impact of non-communicable diseases
like cardiovascular, cancer and diabetes is
estimated at 4-6% of GDP across the APAC
region). Solutions will require robust analysis
and foresight, leadership and multi-stakeholder
public-private partnerships.
CAGR between
2015 and 2020 in
emerging markets
facilities as well as to add new facilities. However, considering
the gap and what is needed to bridge it, the traditional model for
growth would not be sustainable.
For example, Indonesia is looking to expand its national
insurance programme to all its citizens by 2019. In 2015, it
allocated 5% of its national budget to healthcare.9
However, it is
already facing a funding gap and has an acute shortage of
healthcare resources. It would need an additional ~900k hospital
beds and ~700k physicians to provide healthcare services
comparable to those available in OECD (Organisation for
Economic Cooperation and Development) nations. To ensure the
long-term sustainability of its national healthcare program,
Indonesia needs to look at innovative technology and disruptive
business models.
Sarah Butler
PwC Australia National Healthcare Leader
PwC | The Digital Healthcare Leap | 3
By 2035 the global shortage of
healthcare professionals will
reach 13 million from
7 million today10
Over 1/3 of countries
suffering from this shortage
are emerging markets11
Weak tertiary and continuing
medical educational system limits
quality of knowledge distributed
in emerging markets
Figure 2: Emerging markets are characterised by underdeveloped infrastructure and face an acute talent gap
Source: Business Monitor International, 2015; OECD Data, 2014
Low
Gap
Moderate
Gap
High
Gap
Australia
3.9
4.4
Physicians
Hospital beds Indonesia
1.0
0.4
India
0.8
0.8
China
3.3
1.8
S. Korea
8.8
2.3
Japan
12.3
2.5
Philippines
1.1
1.2
Vietnam
2.9
0.8Thailand
2.2
0.4
Infrastructure and Talent Gap
OECD average
4.7
3.3
Singapore
2.0
2.3
Malaysia
2.0
1.6
4 |  The Digital Healthcare Leap | PwC
Adoption of traditional Electronic Health Records (EHR) is still
low in emerging markets (see Figure 3). These markets mostly
use paper-based solutions and outdated IT equipment.
The traditional EHR solutions have mostly been implemented in
developed markets and represent a monumental change
transformation which can be measured in decades, rather than
months or years. There is a significant up-front cost required to
purchase and install EHR as well as training costs and ongoing
maintenance costs. The USA Congressional Budget Office (CBO)
reported that, on average, EHR implementation costs for
hospitals amount to approximately US$14,500 per bed with
annual operating costs of US$2,700 per bed per year.12
For
example, USA based healthcare provider, Lifespan, announced
plans to implement Epic’s EHR in March 2013, and the health
system went live in April 2015. The implementation is estimated
to have cost US$100 million.13
Healthcare providers in emerging
markets are unlikely to be in a position to afford such
prohibitively expensive operating costs from major EHR vendors.
However, the adoption of digital healthcare solutions including
EHRs in emerging markets could change dramatically in the next
few years. With the internet and smartphone penetration growing
and the technology infrastructure moving to cloud-based services,
this presents the opportunity to develop innovative and cost-
effective solutions to deliver healthcare services. These new
digital healthcare models involve rapid prototyping, design and
implementation which presents a great opportunity for emerging
markets to leapfrog the developed markets.
Also it will be easier to implement innovative solutions in
emerging markets because of fewer sunk costs, given existing
infrastructure and equipment, lower fixed costs from building
overcapacity, weaker vested interests and less divided public
opinion than is typical in established markets.
Digital adoption in emerging markets
Figure 3: Digital adoption is still low in emerging markets
Source: Statista, HIMMS Analytics Electronic Medical Record Adoption Model, PwC Analysis
*Note: EHR Adoption includes usage of medical records, health records, and other digital solutions by hospitals and physicians to deliver healthcare service.
Over the next decade, developing countries
will need to spend billions on healthcare
infrastructure and services. Advancements
in technology must be considered with these
investments. Where urgent needs prevail
in emerging markets with limited access to
healthcare, the learnings from costly EHR
implementations in development markets must
be considered to determine a more affordable
path forward. Similarly to how wireless
solutions have allowed developing countries to
leapfrog fixed line infrastructure investments
for broadband access, emerging markets need to
consider innovative EHR solutions that will allow
them to leap towards improved healthcare that is
more affordable.
Vaughn Kauffman
PwC Global Healthcare New Entrants Leader
Low
25% 25%-70%
India
China
US
Philippines
VietnamIndonesia
Thailand
Singapore
Germany
S. Korea
Denmark
Netherlands
Japan
Canada
Australia
Malaysia
UK
70%
Population size
Medium
EHRAdoption*
Internet Penetration (2015)
High
Emerging
markets
PwC | The Digital Healthcare Leap | 5
Traditional digital
health model
Digital version of
patient information
Coded
Data centred
Siloed
Paper based health
solutions
All paper records
New digital
health model
Cloud based
Open source
Integrated
Social
Mobile
Do traditional digital health business
models have a role in emerging markets?
Traditional digital health models
Most developed countries have moved away from paper-based
healthcare solutions and have adopted or are in the process of
adopting ‘traditional’ digital healthcare models (see Figure 4). These
traditional models require the purchase or lease of hardware and
software as well as dedicated space to house servers/data centres.
These systems are coded, siloed, fully customised and require
highly skilled programmers and IT professionals to develop and
manage solutions. The developed markets are now moving to a new
digital health model with increasing adoption of cloud and mobile-
based technology in the healthcare system. But integration and
interoperability challenges of existing traditional models will make
this progress slower.
For example, in Singapore, the National Electronic Health Record
(NEHR) system was rolled out in 2011. It allows patient healthcare
records to be shared across the entire healthcare system. Currently,
all community hospitals, 56 community healthcare providers and
close to 40% of GP clinics have access to NEHR.14
The Singaporean
government aims to get the remaining private players on board as
well. It invested US$128 million to develop Phase 1 of the NEHR,
and is paying about US$15 million each year in maintenance costs.15
Singapore is now transitioning to a new digital health model. It is
looking to move health information to the cloud. Named as hCloud,
the project will cost US$37 million for the first ten years.16
However,
it will help to bring down the cost of running the Healthcare IT
system. Future developments will also include the use of data
analytics to support both decision making at the point of care and
national planning for the Ministry of Health (MOH).
Emerging markets will reset the delivery model for
EMRs and EHRs in the next few years. The lack of
legacy infrastructure can liberate health systems
(both public and private) from the financially
daunting capital costs which have led to
government-sponsored initiatives such as
Meaningful Use in the United States. Cloud-based
technology, mobile enablement and fees for service
models will lead to faster deployment and
increased benefits for patients. Perhaps then the
emerging markets will instead become the leaders,
with the followers quickly shedding their ‘on
premises’ technology.
Time
Improvedhealthoutcomes
John Forsythe
PwC Australia, Southeast Asia,
New Zealand Digital Healthcare Leader
Figure 4: Emerging economies will leapfrog developed markets and adopt the new digital health model
Em
erging m
arkets
6 |  The Digital Healthcare Leap | PwC
Emerging economies are unlikely to adopt the traditional digital
health models. There is a significant gap in most of the
parameters required for successful adoption of the traditional
digital healthcare model, including affordability. Figure 5
compares emerging economies in Southeast Asia to Singapore on
the ten parameters required to leverage information and
communications technologies (ICTs) for social and economic
impact. An emerging market such as Indonesia lags behind
Singapore in terms of the political and business environment,
infrastructure, affordability, skills and stakeholder readiness
required to adopt the traditional digital health model.
Source: World Economic Forum ‘Network Readiness Index’ 2015
1. Political and regulatory
environment
2. Business and innovation
environment
3. Infrastructure
4. Affordability
5. Skills
6. Individual usage
7. Business usage
8. Government usage
9. Economic impacts
10. Social impacts
Singapore
Malaysia
Indonesia
Thailand
Philippines
Figure 5: Fundamental gaps in every aspect of Information Communication Technology
8
6
4
2
0
In emerging markets the new digital health model will play a
pivotal role in overcoming many of the challenges impeding
healthcare delivery. It will help improve healthcare access,
affordability, quality and safety. Emerging markets will leapfrog
developed markets to move to the new digital health model
(see Figure 4).
Emerging markets are increasingly digitising health information.
Affordable EHR solutions are coming to market, such as cloud-
based EHR or open-source EHR, which can help emerging markets
digitise at a fraction of the cost and in a fraction of the time.
The Philippines has implemented an open source electronic
medical record system for government health facilities
called CHITS (the Community Health Information Tracking
system). CHITS is managed by the UP Manila – National
Telehealth Centre. The program has been able to improve health
care delivery in government health centres. Nurses and midwives
who usually record health data on paper were trained to use the
system to generate timely reports for DOH national vertical
health programs. Through the program implementation, delays
in accessing health data were minimised, giving more time for
health workers to give care to patients at the health centre.17
Many private sector providers in emerging markets have also
opted for cloud-based solutions. There is strong support for
healthcare cloud systems from both public and private hospitals
in Malaysia and the Philippines. Mary Johnston Hospital in
Manila, in the Philippines, implemented a cloud-based EHR
solution called HarmoniMD. This solution is built from the
ground up using the latest cloud technologies and helps leapfrog
over legacy server-based applications.18
Similarly, the Philippines-
based company Lifedata offers a web-based electronic medical
records system. It has also signed an agreement with the
Philippine Medical Association (PMA) for the ‘standardisation
and computerisation of clinical practices in the Philippines’.19
Digitising the health information lays the foundation of the
digital health model in emerging markets. For best outcomes,
other healthcare innovations such as telemedicine, mHealth
applications and e-prescriptions will be built around the digitised
health information.
New digital health models
PwC | The Digital Healthcare Leap | 7
The new digital health model is focused on four key elements –
disruption, engagement, integration and trust (see Figure 6).
Disruption – Transforming businesses through innovative
models that don’t exist in the market today.
Engagement – Enabling digital interactions between clients and
customers in a more engaging and patient-centred way.
Integration – Providing seamless access to health information
across systems and devices.
Trust – Ensuring secure information in a digital age to inspire
trust in the providers by the customers.
Making the transition to the new digital health model
Figure 6: New digital health model is focused on four key elements – disruption, engagement, integration and trust
From digitisation to disruption
New entrants are disrupting the traditional health model by offering
digital healthcare services in new and unique ways. They are
exploiting the cost-quality curve to deliver healthcare services in an
alternative setting. The new care delivery models introduced by
these new stakeholders will partially fill the healthcare gap.
The new entrants are increasingly collaborating with healthcare
providers and combining the use of EHRs and mHealth
applications. There will be an increasing influx of wearable
solutions in emerging markets that will support consumer and
healthcare desire for monitoring and tracking to be integrated into
daily life.
With fewer sunk costs and regulatory hurdles, emerging markets
will be able to transition quickly to these disruptive solutions.
A small start-up founded in 2009 in Myanmar offers web-based
and mobile application solutions related to healthcare. Its main
solution is offered in conjunction with the leading telecom
provider. The mobile application (app) helps users schedule
telemedicine consultation or appointments with doctors. Users
can also order medicine and seek health-related information
through the app. The app had a user base of around 7,000 in 2015
and the telecom partner has agreed to pre-load the app in 600,000
mobile phones in 2016, and 1 million phones the year after.
The start-up is further seeking partnerships with hospitals to
give the app to their patients. It has also developed a health
information system aimed at helping healthcare providers to
track patient data. It is also currently creating a human
resource information system to help healthcare providers keep
track of doctor entry and retirement.20
Integrated
Digitisation Disruption
Trust
Independent
Security
DigitisationPaper-based
Physician-centric Patient-centric
(Engagement)
New digital health model
Paper-based/Traditional
digital health model
8 |  The Digital Healthcare Leap | PwC
From physician-centric to patient-centric 
(Engagement)
Consumers are demanding better quality and customer service
through social, mobile analytics and cloud technologies. With
democratisation of data and increased usage of social media and
mobile, patients will play a more active role in clinical decision
making. The new digital model will focus on customer experience
and understanding patients in their everyday lives. The solution
will use customer relationship management technology to deliver
patient-centric care.
The digital solution will also act as a hub by sharing information
across a broad community to provide support, coaching,
recommendations and other forms of assistance. It will enable
patient involvement and the provision of ubiquitous and instant
feedback in order to realise new behaviours and/or sustain
desired performance.21
From independent to integrated
Consumers increasingly expect seamless management of their
information across their healthcare providers. Currently,
traditional healthcare models rely on disparate systems, multiple
sources of truth and silos of solutions that don’t support the
provider. The new digital healthcare model will transition towards
an inherent capability to ensure seamless information exchange
across system(s) of record.
Leading products must integrate data collected from disparate
devices and apps into external health ecosystems. It should be
integrated into existing activities and workflows of providers and
patients to provide the support needed for new behaviours.
As health data becomes more integrated and analytics and
Big Data becomes more prevalent, healthcare providers will
increasingly gain insight into real-time customer needs and pain
points. Analytics will help in early diagnosis, better treatment and
improved clinical decision making.
From security to trust
Cybersecurity is a growing concern in healthcare, especially given
recent disruptive ransomware incidents, and the increasing cost of
breaches. Data breaches happen for both malicious and benign
reasons, enabled by greater digital adoption. Health records are an
attractive target for criminals due to the breadth and depth of their
data, and healthcare organisations’ relatively low degree of focus
on security issues.
Ensuring secure information in a digital age to inspire trust in
consumers by their providers is critical. Security in the traditional
sense rested on a patient’s level of comfort about the protection of
the privacy of health related information and threats of
cybersecurity breaches. In the new digital health model where
measures have been established to ensure the security of this type
of information, the patient’s focus has shifted to how to establish a
trust based relationship with their healthcare provider who may or
may not be physically present.
Healthcare providers and governments are rethinking strategies
for avoiding these attacks. Employee education is a key tactic for
avoiding attacks. The players are also looking at innovative
solutions such as cloud-based initiatives, Big Data analytics and
advanced authentication to improve security and build trust.22
PwC | The Digital Healthcare Leap | 9
The leap forward for the emerging markets
There are substantial potential benefits of digital healthcare
solutions in addressing business challenges caused by the current
systems and processes associated with paper medical records. The
benefits are not unlike those that could be achieved in a developed
market; however, with a much lower cost base, and much broader
diversity of solutions that cross the continuum of care, they could
be significantly enhanced (see Figure 7).
Figure 7: Summary of benefits of digitising healthcare for patients, providers and payers
* EMR – Electronic Medical Records; EHR – Electronic Health Records
Technology can bridge the growing gap between workforce
supply and consumer demand and clinicians are beginning to see
how care can be amplified through mobile technology. In a recent
PwC Health Research Institute survey, 85% of clinicians said they
would use data from apps and wearables in future treatments.23
However, it is well documented that 80% of large organisational
change initiatives fail to achieve their intended objectives,
particularly in technology-related programs.
Digital health initiatives offer the opportunity to have a
fundamental impact on the business model of the implementing
organisation. With the introduction of new ways of solving
business problems, creating unique experiences for the customer
and engaging people through digital mechanisms, many tasks
may also become automated or be eliminated, and result in new
workflows to complement digital solutions. As a result, any
company looking at digital healthcare needs to provide
substantial support to the business in order to manage people
through this change process. Attempting to implement a digital
change in a healthcare environment requires the active
involvement of clinical leaders and sponsors who are committed
to the change process and can help lead the organisation through
the change. These individuals or groups are sponsors and
champions who play a key role in driving the change.
Healthcare providers and administrators need to set strategies
that harness technology for mutual interests and mutual gain as
they build care delivery models with patients – not patient
encounters – at their centre.
The companies that will emerge as winners in this new
marketplace will be those that can articulate how technology can
add value, align incentives, strategically share and analyse data,
and redeploy, extend and expand their workforce to embrace
digital enablers. The following elements are key:
•	 Understanding which digital health technologies
healthcare providers and consumers value should shape
digital strategies
•	 Generating meaningful, actionable insights
through analytics will focus investments and yield better,
faster results
•	 Understanding what motivates both caregivers and
consumers to adopt and continue to use digital technology
will be critical for sustainability
•	 Rethinking the workforce and informing workflows will
fuel the Digital Health return on investment.
Benefits of moving to the new digital
health model
Key considerations in moving to the new digital health model
The benefits of digital healthcare can be felt
beyond patients. By assisting the prevention of
illness and supporting the provision of care
through alternative locations such as clinics,
fewer new doctors and nurses will need to be
trained and fewer additional beds and hospitals
created, which can help to reduce the overall
financial healthcare burden on governments in
emerging markets, enabling them to fund other
key areas of the economy. A whole nation benefits
from digital healthcare.
Patients Providers Payers
EMR Easier to read and understand Easy storage and retrieval; improved efficiency
and productivity
EHR Better diagnosis and treatment Coordination and informed decision-making Faster reimbursements
Personal Health
Records
Personal wellness management Consistency of information Links to healthcare plans
and lower claims
Remote Diagnostics Reduces duplicated tests and referrals Easy access Lower cost
Remote Monitoring Patient-centric integrated care Reduce emergency and re-admissions Lower cost
Telecare Access to specialist care Improves productivity and reduces burden of
healthcare resources
Lower cost
mHealth
applications
Greater patient engagement and
saves time
Proactive and targeted care
Big Data/Analytics Accurate diagnosis, better treatment Improves diagnostics and accuracy of treatment Lower cost
David Wijeratne
PwC Growth Markets Centre Leader
10 |  The Digital Healthcare Leap | PwC
Conclusion
After decades of slow progress, it’s time for healthcare to take the
leap into the new digitally enabled healthcare era. The magnitude
of the challenge facing the health sector is considerable. Its
implications are far reaching for all aspects of society and the
economy. It is clear that the challenge of affordable and
sustainable healthcare is common across both emerging and
developed economies. Finding a sustainable solution to enable
better healthcare delivery is no longer the responsibility of the
public sector. There is a collective responsibility across both the
public sector and private sector to redefine traditional healthcare
business models to find new pathways to sustainability.
Innovative companies are empowering healthcare customers
with new solutions and forcing the entire industry to rethink the
way it does business. With the patient/customer becoming more
discerning around their own health, customer experience has
become a key motivator for providers. Consumers are no longer
passive patients, but have become more engaged and more
discerning, wielding new tools and better information to compare
providers. The near future will be marked by how well the
industry responds to this consumer shift. Hospitals and
healthcare providers that fail to adapt will risk declining
revenues as consumers turn elsewhere to have their health needs
met. The message is clear for healthcare delivery: digital is here
and if as a provider you are not prepared, you may be left behind.
Healthcare companies should look to how they will integrate and
connect their existing systems with new digital technologies and
merge the data locked inside them to generate meaningful,
actionable insights for caregivers. In the new digital health era,
digitally enabled care is no longer going to be a nice-to-have, but
rather a fundamental business imperative. Industry leaders across
providers, insurers, medical technology and the pharmaceuticals
all see major shifts in how care is being delivered. Digital
technology has the potential to bridge time, distance, the
affordability of healthcare and the expectation gap between
consumers and clinicians.
PwC | The Digital Healthcare Leap | 11
About the authors
David McKeering
PwC Global Healthcare Markets Leader
PwC South East Asia Consulting
T: +65 9382 5658
E: david.mckeering@sg.pwc.com
David is the South East Asia Consulting
Public Sector and Healthcare Leader and
Global Healthcare Markets Leader. Prior to
moving to Singapore, David was the
National Healthcare Leader for PwC
Australia as well as the Consulting Site
Leader for Queensland.
He has a recognised track record in both
private and public sectors, and across the
value chain of public sector and healthcare
services. David has recently led engagements
around eHealth Programs, National Health
Reform Blueprinting, Divisional Culture and
Change Projects, Clinical Services Redesign
Projects, Workforce Planning and major
technology implementations.
Christopher Norton
Director
T: +65 9784 6255
E: christopher.norton@au.pwc.com
Chris is a Director in the Australia, Southeast
Asia and New Zealand Healthcare Consulting
team. As senior member of PwC’s Southeast
Asia Consulting practice Chris leads the
healthcare consulting team in the region
working with private and public sector clients
to solve their most complex challenges.
Chris has extensive experience in Health IT,
productivity and efficiency, health service
planning, project management and change
management. Chris has over 16 years’
experience in the healthcare sector and is a
qualified registered Nurse. Prior to working
with PwC Chris worked in frontline clinical
delivery and hospital executive roles.
Aastha Gulati
PwC Growth Markets Centre
Healthcare Lead
T: +65 9861 7515
E: aastha.gulati@sg.pwc.com
Aastha leads the Healthcare sector within
PwC’s Growth Markets Centre. She
specialises in supporting organisations to
enter and expand into the emerging markets.
She has international experience in
leading and delivering strategy and
operations projects including go to market
strategies, operating model assessment
and design, business model transformation
and program management.
Acknowledgements
Kelly Barnes
PwC Global Health Industries
Consulting Leader
Benjamin Isgur
Health Research Institute
(HRI) Leader
Rachel Caoili
PwC Growth Markets Centre
Asia Pacific Lead
Spotlight authors
David Wijeratne
PwC Growth Markets Centre
Leader
Sarah Butler
PwC Australia National
Healthcare Leader
John Forsythe
PwC Australia, Southeast
Asia, New Zealand Digital
Healthcare Leader
Vaughn Kauffman
PwC Global Healthcare
New Entrants Leader
12 |  The Digital Healthcare Leap | PwC
References
1.	 World Economic Forum, ‘Why ageing is an issue for emerging markets’, 12 Feb 2014
2.	 Business Monitor International (BMI) Database
3.	 United Nations, 2015 World Population Prospects (High fertility variant, 2015 – 2100)
4.	 PwC, Changing demographics demand healthcare reforms, 2015
5.	 The United Nations Development Program's Human Development Report 2013, ‘The Rise of the South: Human Progress in a
Diverse World’
6.	 United Nations Department of Economic and Social Affairs, ‘Population Facts – Our urbanising world’, Aug 2014
7.	 World Health Organisation, ‘Global status of NCDs’, 2014
8.	 MDDI online literature review, 2014
9.	 Indonesia Ministry of Finance, 2016
10.	 WHO, ‘Global health workforce shortage to reach 12.9 million in coming decades’, 11 Nov 2013
11.	 Oxford Journal, ‘Health professionals' migration in emerging market economies: patterns, causes and possible solutions’, 2013
12.	 Congress of the Unites States – Congressional Budget Office, ‘Evidence on the Costs and Benefits of Health Information
Technology’, May 2008
13.	 Becker’s health IT and CIO Review, ‘8 Epic EHR implementations with the biggest price tags in 2015’, July 2015
14.	 Singapore Ministry of Health Website, ‘Future phase of NEHR’
15.	 Singapore Worker’s Party, ‘Easing the cost of healthcare for Singaporeans’, 2013. Cost data converted from SGD to USD based on
exchange rate of 1SGD = 0.75USD
16.	 Integrated Health Information Systems (IHIS), ‘IT boost to keep health care humming’, October 2014. Cost data converted from
SGD to USD based on exchange rate of 1SGD = 0.75USD
17.	 CHITS Philippines Website (https://chits.ph/)
18.	 Healthcare IT News, ‘Manila hospital implements cloud-based EHR’, 18 Apr 2012
19.	 LifeData System Inc. Company Website (http://lifedata.ph/?page_id=16)
20.	 KoeKoe Tech Compnay Website (http://www.koekoetech.com/)
21.	 PwC ‘Emerging mHealth: Paths for growth’, 2012
22.	 PwC ‘Cybersecurity in Health Services’, 2016
23.	 PwC Health Research Institute (HRI) Clinician Workforce Survey, 2014 and 2015
PwC | The Digital Healthcare Leap | 13
This publication has been prepared for general guidance on matters of interest only, and does not constitute professional advice. You should not act upon the
information contained in this publication without obtaining specific professional advice. No representation or warranty (express or implied) is given as to the accuracy or
completeness of the information contained in this publication, and, to the extent permitted by law, PricewaterhouseCoopers LLP, its members, employees and agents
do not accept or assume any liability, responsibility or duty of care for any consequences of you or anyone else acting, or refraining to act, in reliance on the information
contained in this publication or for any decision based on it.
© 2017 PricewaterhouseCoopers LLP. All rights reserved. In this document, “PwC” refers to the UK member firm, and may sometimes refer to the PwC network. Each
member firm is a separate legal entity. Please see www.pwc.com/structure for further details.
170215-231110-SS-OS

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The Digital Healthcare Leap | PWC

  • 1. The Digital Healthcare Leap Digital health in emerging markets February 2017 www.pwc.com/global-health www.pwc.com/gmc In this paper 3 The digital healthcare dilemma in emerging markets 6 Do traditional digital health business models have a role in emerging markets? 10 The leap forward
  • 2.
  • 3. Foreword David McKeering PwC Global Healthcare Markets Leader PwC South East Asia Consulting Whether we like it or not, technology has become part of our lives. It has arguably helped us as individuals become more informed and more connected. The use of technology is embedded in the industries of banking, automotive, insurance and retail. Today the health sector faces a daunting new digital challenge: unleashing the power of technology to fundamentally reinvent how care is delivered. On top of their existing technology needs and priorities, today’s health providers need to address the digital requirements demanded by health policy or by consumers and other stakeholders. Digital Health initiatives rely heavily on having the right information in the right place at the right time for use by the right clinician. To really use technology effectively in health, we need systems to interact with one another to provide the data required to make informed decisions about the delivery of care. ‘Digital healthcare’ is not about the technologies, it’s about new ways of solving healthcare problems, creating unique experiences for patients and accelerating healthcare providers’ growth. Over the longer term, digital healthcare will help system-wide operations and organisations to deliver more powerful healthcare. Yet these challenging financial times discourage all but the most prudent, high-return investments. Advanced, enterprise-wide digital health solutions should head many emerging healthcare providers’ lists of ‘must have’ capabilities; however, traditional digital healthcare models often come with high costs. Our experience is that digital health can dramatically improve an organisation’s productivity and, in turn, provide benefits in both patient outcomes and the bottom line. This means that if the costs of digital healthcare solutions can be made affordable, digital health could be an answer to the emerging markets’ challenge to achieve sustainable growth and leapfrog the developed nations to provide quality, affordable, universal and patient-centric care. PwC | The Digital Healthcare Leap | 1
  • 4. Growing population Many emerging markets in the Asia-Pacific region are yet to reach their ‘peak’ population3 Projected population growth (2015-2050) Japan 7% decrease Population in 2050 93% Philippines 65% increasePopulation in 2050 165% Malaysia 50% increasePopulation in 2050 150%Indonesia40% increase Population in 2050 140% India46% increase Population in 2050 146% China8% increase Population in 2050 108% Growing middle class of the global middle class will be in Asia-Pacific by 20304 2/3rds Ageing population • Emerging markets will account for 80% of the world’s elderly by 20501 • Some emerging markets should expect a significant increase in the portion of their population aged 65+ between 2015 – 20502 10% 30% Thailand 7% 21% Vietnam 2050 2015 Urban-rural divide • Over 50% of the emerging market in Asia-Pacific live in rural areas6 Percentage of population in rural areas (2015)5 50% 50% 56% 44% 66% 34% 67% 33% Thailand Philippines Vietnam India Urban Rural Increased prevalence of non-communicable diseases (NCDs) • 68% of total deaths globally occur due to NCDs; emerging markets account for 75% of these deaths7 • Almost 200 million of the world’s 370 million people diagnosed with diabetes live in Asia8 Prevalence of diabetes as % of population8 Characteristics of healthcare in emerging markets Indonesia 3.4 2012 8.6 2030 Malaysia 3.2 2012 8.5 2030 Philippines 2.9 2012 8.1 2030 Vietnam 0.9 2012 2.6 2030 Thailand 2.3 2012 4.1 2030 Healthcare demandinemergingmarkets is growing,drivenby anumber offactors suchasagrowingpopulationas well as anageingpopulation.Withthegrowing middleclass andrisingincomes,peoplearespendingmoreonhealthcare.Non- communicablediseases suchas diabetes areno longer‘richcountry’diseasesand theirprevalenceis increasinginemergingmarkets.Inthesecountries mostofthe healthcare infrastructureis concentratedinurbanareas,whilemorethan50%of thepopulationlives inrural areas. 2 |  The Digital Healthcare Leap | PwC
  • 5. The digital healthcare dilemma in emerging markets The healthcare gap Expenditure on healthcare is increasing exponentially in emerging markets (see Figure 1). As incomes are rising and the middle class is growing in emerging markets, people are spending more on healthcare and demanding better healthcare services. With changing lifestyles and people living longer, there is a tectonic epidemiological shift from communicable to chronic disease such as diabetes, cardiovascular diseases and cancer. While developed economies also have their challenges with affordability of care, their fundamental infrastructure is in place, for the most part, and their population growth remains relatively steady. Improving healthcare access and quality is becoming a priority in emerging markets. However, these countries have significant strain on their health systems. Digitisation of health services, if done in a different model, can help to improve the quality of and access to care while reducing costs. On the demand side, the patients/consumers in emerging markets are becoming more discerning around their own health and customer experience has become a key motivator for providers. Healthcare providers that fail to adapt to this consumer shift will risk consumers turning elsewhere to have their health needs met. For example, in Indonesia, patients are increasingly travelling to neighbouring countries such as Malaysia and Thailand to access better healthcare services. On the supply side, the healthcare system in the emerging markets is characterised by underdeveloped infrastructure and faces an acute shortage of resources (see Figure 2). Governments are looking to improve healthcare access and affordability. They are implementing universal healthcare coverage and increasing national budget allocated to healthcare to upgrade the existing Figure 1: Healthcare expenditure is increasing exponentially in emerging markets 9% Source: Business Monitor International (BMI) 85% 78% 74% 71% 65% 15% 22% 26% 29% 35% 2005 2010 2015 2020 2025 Emerging Developed Healthcare expenditure developed vs. emerging markets (%) There is a clear burning platform and opportunity to address the growing burden of healthcare costs and corresponding impact on economic productivity due to ill health (the impact of non-communicable diseases like cardiovascular, cancer and diabetes is estimated at 4-6% of GDP across the APAC region). Solutions will require robust analysis and foresight, leadership and multi-stakeholder public-private partnerships. CAGR between 2015 and 2020 in emerging markets facilities as well as to add new facilities. However, considering the gap and what is needed to bridge it, the traditional model for growth would not be sustainable. For example, Indonesia is looking to expand its national insurance programme to all its citizens by 2019. In 2015, it allocated 5% of its national budget to healthcare.9 However, it is already facing a funding gap and has an acute shortage of healthcare resources. It would need an additional ~900k hospital beds and ~700k physicians to provide healthcare services comparable to those available in OECD (Organisation for Economic Cooperation and Development) nations. To ensure the long-term sustainability of its national healthcare program, Indonesia needs to look at innovative technology and disruptive business models. Sarah Butler PwC Australia National Healthcare Leader PwC | The Digital Healthcare Leap | 3
  • 6. By 2035 the global shortage of healthcare professionals will reach 13 million from 7 million today10 Over 1/3 of countries suffering from this shortage are emerging markets11 Weak tertiary and continuing medical educational system limits quality of knowledge distributed in emerging markets Figure 2: Emerging markets are characterised by underdeveloped infrastructure and face an acute talent gap Source: Business Monitor International, 2015; OECD Data, 2014 Low Gap Moderate Gap High Gap Australia 3.9 4.4 Physicians Hospital beds Indonesia 1.0 0.4 India 0.8 0.8 China 3.3 1.8 S. Korea 8.8 2.3 Japan 12.3 2.5 Philippines 1.1 1.2 Vietnam 2.9 0.8Thailand 2.2 0.4 Infrastructure and Talent Gap OECD average 4.7 3.3 Singapore 2.0 2.3 Malaysia 2.0 1.6 4 |  The Digital Healthcare Leap | PwC
  • 7. Adoption of traditional Electronic Health Records (EHR) is still low in emerging markets (see Figure 3). These markets mostly use paper-based solutions and outdated IT equipment. The traditional EHR solutions have mostly been implemented in developed markets and represent a monumental change transformation which can be measured in decades, rather than months or years. There is a significant up-front cost required to purchase and install EHR as well as training costs and ongoing maintenance costs. The USA Congressional Budget Office (CBO) reported that, on average, EHR implementation costs for hospitals amount to approximately US$14,500 per bed with annual operating costs of US$2,700 per bed per year.12 For example, USA based healthcare provider, Lifespan, announced plans to implement Epic’s EHR in March 2013, and the health system went live in April 2015. The implementation is estimated to have cost US$100 million.13 Healthcare providers in emerging markets are unlikely to be in a position to afford such prohibitively expensive operating costs from major EHR vendors. However, the adoption of digital healthcare solutions including EHRs in emerging markets could change dramatically in the next few years. With the internet and smartphone penetration growing and the technology infrastructure moving to cloud-based services, this presents the opportunity to develop innovative and cost- effective solutions to deliver healthcare services. These new digital healthcare models involve rapid prototyping, design and implementation which presents a great opportunity for emerging markets to leapfrog the developed markets. Also it will be easier to implement innovative solutions in emerging markets because of fewer sunk costs, given existing infrastructure and equipment, lower fixed costs from building overcapacity, weaker vested interests and less divided public opinion than is typical in established markets. Digital adoption in emerging markets Figure 3: Digital adoption is still low in emerging markets Source: Statista, HIMMS Analytics Electronic Medical Record Adoption Model, PwC Analysis *Note: EHR Adoption includes usage of medical records, health records, and other digital solutions by hospitals and physicians to deliver healthcare service. Over the next decade, developing countries will need to spend billions on healthcare infrastructure and services. Advancements in technology must be considered with these investments. Where urgent needs prevail in emerging markets with limited access to healthcare, the learnings from costly EHR implementations in development markets must be considered to determine a more affordable path forward. Similarly to how wireless solutions have allowed developing countries to leapfrog fixed line infrastructure investments for broadband access, emerging markets need to consider innovative EHR solutions that will allow them to leap towards improved healthcare that is more affordable. Vaughn Kauffman PwC Global Healthcare New Entrants Leader Low 25% 25%-70% India China US Philippines VietnamIndonesia Thailand Singapore Germany S. Korea Denmark Netherlands Japan Canada Australia Malaysia UK 70% Population size Medium EHRAdoption* Internet Penetration (2015) High Emerging markets PwC | The Digital Healthcare Leap | 5
  • 8. Traditional digital health model Digital version of patient information Coded Data centred Siloed Paper based health solutions All paper records New digital health model Cloud based Open source Integrated Social Mobile Do traditional digital health business models have a role in emerging markets? Traditional digital health models Most developed countries have moved away from paper-based healthcare solutions and have adopted or are in the process of adopting ‘traditional’ digital healthcare models (see Figure 4). These traditional models require the purchase or lease of hardware and software as well as dedicated space to house servers/data centres. These systems are coded, siloed, fully customised and require highly skilled programmers and IT professionals to develop and manage solutions. The developed markets are now moving to a new digital health model with increasing adoption of cloud and mobile- based technology in the healthcare system. But integration and interoperability challenges of existing traditional models will make this progress slower. For example, in Singapore, the National Electronic Health Record (NEHR) system was rolled out in 2011. It allows patient healthcare records to be shared across the entire healthcare system. Currently, all community hospitals, 56 community healthcare providers and close to 40% of GP clinics have access to NEHR.14 The Singaporean government aims to get the remaining private players on board as well. It invested US$128 million to develop Phase 1 of the NEHR, and is paying about US$15 million each year in maintenance costs.15 Singapore is now transitioning to a new digital health model. It is looking to move health information to the cloud. Named as hCloud, the project will cost US$37 million for the first ten years.16 However, it will help to bring down the cost of running the Healthcare IT system. Future developments will also include the use of data analytics to support both decision making at the point of care and national planning for the Ministry of Health (MOH). Emerging markets will reset the delivery model for EMRs and EHRs in the next few years. The lack of legacy infrastructure can liberate health systems (both public and private) from the financially daunting capital costs which have led to government-sponsored initiatives such as Meaningful Use in the United States. Cloud-based technology, mobile enablement and fees for service models will lead to faster deployment and increased benefits for patients. Perhaps then the emerging markets will instead become the leaders, with the followers quickly shedding their ‘on premises’ technology. Time Improvedhealthoutcomes John Forsythe PwC Australia, Southeast Asia, New Zealand Digital Healthcare Leader Figure 4: Emerging economies will leapfrog developed markets and adopt the new digital health model Em erging m arkets 6 |  The Digital Healthcare Leap | PwC
  • 9. Emerging economies are unlikely to adopt the traditional digital health models. There is a significant gap in most of the parameters required for successful adoption of the traditional digital healthcare model, including affordability. Figure 5 compares emerging economies in Southeast Asia to Singapore on the ten parameters required to leverage information and communications technologies (ICTs) for social and economic impact. An emerging market such as Indonesia lags behind Singapore in terms of the political and business environment, infrastructure, affordability, skills and stakeholder readiness required to adopt the traditional digital health model. Source: World Economic Forum ‘Network Readiness Index’ 2015 1. Political and regulatory environment 2. Business and innovation environment 3. Infrastructure 4. Affordability 5. Skills 6. Individual usage 7. Business usage 8. Government usage 9. Economic impacts 10. Social impacts Singapore Malaysia Indonesia Thailand Philippines Figure 5: Fundamental gaps in every aspect of Information Communication Technology 8 6 4 2 0 In emerging markets the new digital health model will play a pivotal role in overcoming many of the challenges impeding healthcare delivery. It will help improve healthcare access, affordability, quality and safety. Emerging markets will leapfrog developed markets to move to the new digital health model (see Figure 4). Emerging markets are increasingly digitising health information. Affordable EHR solutions are coming to market, such as cloud- based EHR or open-source EHR, which can help emerging markets digitise at a fraction of the cost and in a fraction of the time. The Philippines has implemented an open source electronic medical record system for government health facilities called CHITS (the Community Health Information Tracking system). CHITS is managed by the UP Manila – National Telehealth Centre. The program has been able to improve health care delivery in government health centres. Nurses and midwives who usually record health data on paper were trained to use the system to generate timely reports for DOH national vertical health programs. Through the program implementation, delays in accessing health data were minimised, giving more time for health workers to give care to patients at the health centre.17 Many private sector providers in emerging markets have also opted for cloud-based solutions. There is strong support for healthcare cloud systems from both public and private hospitals in Malaysia and the Philippines. Mary Johnston Hospital in Manila, in the Philippines, implemented a cloud-based EHR solution called HarmoniMD. This solution is built from the ground up using the latest cloud technologies and helps leapfrog over legacy server-based applications.18 Similarly, the Philippines- based company Lifedata offers a web-based electronic medical records system. It has also signed an agreement with the Philippine Medical Association (PMA) for the ‘standardisation and computerisation of clinical practices in the Philippines’.19 Digitising the health information lays the foundation of the digital health model in emerging markets. For best outcomes, other healthcare innovations such as telemedicine, mHealth applications and e-prescriptions will be built around the digitised health information. New digital health models PwC | The Digital Healthcare Leap | 7
  • 10. The new digital health model is focused on four key elements – disruption, engagement, integration and trust (see Figure 6). Disruption – Transforming businesses through innovative models that don’t exist in the market today. Engagement – Enabling digital interactions between clients and customers in a more engaging and patient-centred way. Integration – Providing seamless access to health information across systems and devices. Trust – Ensuring secure information in a digital age to inspire trust in the providers by the customers. Making the transition to the new digital health model Figure 6: New digital health model is focused on four key elements – disruption, engagement, integration and trust From digitisation to disruption New entrants are disrupting the traditional health model by offering digital healthcare services in new and unique ways. They are exploiting the cost-quality curve to deliver healthcare services in an alternative setting. The new care delivery models introduced by these new stakeholders will partially fill the healthcare gap. The new entrants are increasingly collaborating with healthcare providers and combining the use of EHRs and mHealth applications. There will be an increasing influx of wearable solutions in emerging markets that will support consumer and healthcare desire for monitoring and tracking to be integrated into daily life. With fewer sunk costs and regulatory hurdles, emerging markets will be able to transition quickly to these disruptive solutions. A small start-up founded in 2009 in Myanmar offers web-based and mobile application solutions related to healthcare. Its main solution is offered in conjunction with the leading telecom provider. The mobile application (app) helps users schedule telemedicine consultation or appointments with doctors. Users can also order medicine and seek health-related information through the app. The app had a user base of around 7,000 in 2015 and the telecom partner has agreed to pre-load the app in 600,000 mobile phones in 2016, and 1 million phones the year after. The start-up is further seeking partnerships with hospitals to give the app to their patients. It has also developed a health information system aimed at helping healthcare providers to track patient data. It is also currently creating a human resource information system to help healthcare providers keep track of doctor entry and retirement.20 Integrated Digitisation Disruption Trust Independent Security DigitisationPaper-based Physician-centric Patient-centric (Engagement) New digital health model Paper-based/Traditional digital health model 8 |  The Digital Healthcare Leap | PwC
  • 11. From physician-centric to patient-centric  (Engagement) Consumers are demanding better quality and customer service through social, mobile analytics and cloud technologies. With democratisation of data and increased usage of social media and mobile, patients will play a more active role in clinical decision making. The new digital model will focus on customer experience and understanding patients in their everyday lives. The solution will use customer relationship management technology to deliver patient-centric care. The digital solution will also act as a hub by sharing information across a broad community to provide support, coaching, recommendations and other forms of assistance. It will enable patient involvement and the provision of ubiquitous and instant feedback in order to realise new behaviours and/or sustain desired performance.21 From independent to integrated Consumers increasingly expect seamless management of their information across their healthcare providers. Currently, traditional healthcare models rely on disparate systems, multiple sources of truth and silos of solutions that don’t support the provider. The new digital healthcare model will transition towards an inherent capability to ensure seamless information exchange across system(s) of record. Leading products must integrate data collected from disparate devices and apps into external health ecosystems. It should be integrated into existing activities and workflows of providers and patients to provide the support needed for new behaviours. As health data becomes more integrated and analytics and Big Data becomes more prevalent, healthcare providers will increasingly gain insight into real-time customer needs and pain points. Analytics will help in early diagnosis, better treatment and improved clinical decision making. From security to trust Cybersecurity is a growing concern in healthcare, especially given recent disruptive ransomware incidents, and the increasing cost of breaches. Data breaches happen for both malicious and benign reasons, enabled by greater digital adoption. Health records are an attractive target for criminals due to the breadth and depth of their data, and healthcare organisations’ relatively low degree of focus on security issues. Ensuring secure information in a digital age to inspire trust in consumers by their providers is critical. Security in the traditional sense rested on a patient’s level of comfort about the protection of the privacy of health related information and threats of cybersecurity breaches. In the new digital health model where measures have been established to ensure the security of this type of information, the patient’s focus has shifted to how to establish a trust based relationship with their healthcare provider who may or may not be physically present. Healthcare providers and governments are rethinking strategies for avoiding these attacks. Employee education is a key tactic for avoiding attacks. The players are also looking at innovative solutions such as cloud-based initiatives, Big Data analytics and advanced authentication to improve security and build trust.22 PwC | The Digital Healthcare Leap | 9
  • 12. The leap forward for the emerging markets There are substantial potential benefits of digital healthcare solutions in addressing business challenges caused by the current systems and processes associated with paper medical records. The benefits are not unlike those that could be achieved in a developed market; however, with a much lower cost base, and much broader diversity of solutions that cross the continuum of care, they could be significantly enhanced (see Figure 7). Figure 7: Summary of benefits of digitising healthcare for patients, providers and payers * EMR – Electronic Medical Records; EHR – Electronic Health Records Technology can bridge the growing gap between workforce supply and consumer demand and clinicians are beginning to see how care can be amplified through mobile technology. In a recent PwC Health Research Institute survey, 85% of clinicians said they would use data from apps and wearables in future treatments.23 However, it is well documented that 80% of large organisational change initiatives fail to achieve their intended objectives, particularly in technology-related programs. Digital health initiatives offer the opportunity to have a fundamental impact on the business model of the implementing organisation. With the introduction of new ways of solving business problems, creating unique experiences for the customer and engaging people through digital mechanisms, many tasks may also become automated or be eliminated, and result in new workflows to complement digital solutions. As a result, any company looking at digital healthcare needs to provide substantial support to the business in order to manage people through this change process. Attempting to implement a digital change in a healthcare environment requires the active involvement of clinical leaders and sponsors who are committed to the change process and can help lead the organisation through the change. These individuals or groups are sponsors and champions who play a key role in driving the change. Healthcare providers and administrators need to set strategies that harness technology for mutual interests and mutual gain as they build care delivery models with patients – not patient encounters – at their centre. The companies that will emerge as winners in this new marketplace will be those that can articulate how technology can add value, align incentives, strategically share and analyse data, and redeploy, extend and expand their workforce to embrace digital enablers. The following elements are key: • Understanding which digital health technologies healthcare providers and consumers value should shape digital strategies • Generating meaningful, actionable insights through analytics will focus investments and yield better, faster results • Understanding what motivates both caregivers and consumers to adopt and continue to use digital technology will be critical for sustainability • Rethinking the workforce and informing workflows will fuel the Digital Health return on investment. Benefits of moving to the new digital health model Key considerations in moving to the new digital health model The benefits of digital healthcare can be felt beyond patients. By assisting the prevention of illness and supporting the provision of care through alternative locations such as clinics, fewer new doctors and nurses will need to be trained and fewer additional beds and hospitals created, which can help to reduce the overall financial healthcare burden on governments in emerging markets, enabling them to fund other key areas of the economy. A whole nation benefits from digital healthcare. Patients Providers Payers EMR Easier to read and understand Easy storage and retrieval; improved efficiency and productivity EHR Better diagnosis and treatment Coordination and informed decision-making Faster reimbursements Personal Health Records Personal wellness management Consistency of information Links to healthcare plans and lower claims Remote Diagnostics Reduces duplicated tests and referrals Easy access Lower cost Remote Monitoring Patient-centric integrated care Reduce emergency and re-admissions Lower cost Telecare Access to specialist care Improves productivity and reduces burden of healthcare resources Lower cost mHealth applications Greater patient engagement and saves time Proactive and targeted care Big Data/Analytics Accurate diagnosis, better treatment Improves diagnostics and accuracy of treatment Lower cost David Wijeratne PwC Growth Markets Centre Leader 10 |  The Digital Healthcare Leap | PwC
  • 13. Conclusion After decades of slow progress, it’s time for healthcare to take the leap into the new digitally enabled healthcare era. The magnitude of the challenge facing the health sector is considerable. Its implications are far reaching for all aspects of society and the economy. It is clear that the challenge of affordable and sustainable healthcare is common across both emerging and developed economies. Finding a sustainable solution to enable better healthcare delivery is no longer the responsibility of the public sector. There is a collective responsibility across both the public sector and private sector to redefine traditional healthcare business models to find new pathways to sustainability. Innovative companies are empowering healthcare customers with new solutions and forcing the entire industry to rethink the way it does business. With the patient/customer becoming more discerning around their own health, customer experience has become a key motivator for providers. Consumers are no longer passive patients, but have become more engaged and more discerning, wielding new tools and better information to compare providers. The near future will be marked by how well the industry responds to this consumer shift. Hospitals and healthcare providers that fail to adapt will risk declining revenues as consumers turn elsewhere to have their health needs met. The message is clear for healthcare delivery: digital is here and if as a provider you are not prepared, you may be left behind. Healthcare companies should look to how they will integrate and connect their existing systems with new digital technologies and merge the data locked inside them to generate meaningful, actionable insights for caregivers. In the new digital health era, digitally enabled care is no longer going to be a nice-to-have, but rather a fundamental business imperative. Industry leaders across providers, insurers, medical technology and the pharmaceuticals all see major shifts in how care is being delivered. Digital technology has the potential to bridge time, distance, the affordability of healthcare and the expectation gap between consumers and clinicians. PwC | The Digital Healthcare Leap | 11
  • 14. About the authors David McKeering PwC Global Healthcare Markets Leader PwC South East Asia Consulting T: +65 9382 5658 E: david.mckeering@sg.pwc.com David is the South East Asia Consulting Public Sector and Healthcare Leader and Global Healthcare Markets Leader. Prior to moving to Singapore, David was the National Healthcare Leader for PwC Australia as well as the Consulting Site Leader for Queensland. He has a recognised track record in both private and public sectors, and across the value chain of public sector and healthcare services. David has recently led engagements around eHealth Programs, National Health Reform Blueprinting, Divisional Culture and Change Projects, Clinical Services Redesign Projects, Workforce Planning and major technology implementations. Christopher Norton Director T: +65 9784 6255 E: christopher.norton@au.pwc.com Chris is a Director in the Australia, Southeast Asia and New Zealand Healthcare Consulting team. As senior member of PwC’s Southeast Asia Consulting practice Chris leads the healthcare consulting team in the region working with private and public sector clients to solve their most complex challenges. Chris has extensive experience in Health IT, productivity and efficiency, health service planning, project management and change management. Chris has over 16 years’ experience in the healthcare sector and is a qualified registered Nurse. Prior to working with PwC Chris worked in frontline clinical delivery and hospital executive roles. Aastha Gulati PwC Growth Markets Centre Healthcare Lead T: +65 9861 7515 E: aastha.gulati@sg.pwc.com Aastha leads the Healthcare sector within PwC’s Growth Markets Centre. She specialises in supporting organisations to enter and expand into the emerging markets. She has international experience in leading and delivering strategy and operations projects including go to market strategies, operating model assessment and design, business model transformation and program management. Acknowledgements Kelly Barnes PwC Global Health Industries Consulting Leader Benjamin Isgur Health Research Institute (HRI) Leader Rachel Caoili PwC Growth Markets Centre Asia Pacific Lead Spotlight authors David Wijeratne PwC Growth Markets Centre Leader Sarah Butler PwC Australia National Healthcare Leader John Forsythe PwC Australia, Southeast Asia, New Zealand Digital Healthcare Leader Vaughn Kauffman PwC Global Healthcare New Entrants Leader 12 |  The Digital Healthcare Leap | PwC
  • 15. References 1. World Economic Forum, ‘Why ageing is an issue for emerging markets’, 12 Feb 2014 2. Business Monitor International (BMI) Database 3. United Nations, 2015 World Population Prospects (High fertility variant, 2015 – 2100) 4. PwC, Changing demographics demand healthcare reforms, 2015 5. The United Nations Development Program's Human Development Report 2013, ‘The Rise of the South: Human Progress in a Diverse World’ 6. United Nations Department of Economic and Social Affairs, ‘Population Facts – Our urbanising world’, Aug 2014 7. World Health Organisation, ‘Global status of NCDs’, 2014 8. MDDI online literature review, 2014 9. Indonesia Ministry of Finance, 2016 10. WHO, ‘Global health workforce shortage to reach 12.9 million in coming decades’, 11 Nov 2013 11. Oxford Journal, ‘Health professionals' migration in emerging market economies: patterns, causes and possible solutions’, 2013 12. Congress of the Unites States – Congressional Budget Office, ‘Evidence on the Costs and Benefits of Health Information Technology’, May 2008 13. Becker’s health IT and CIO Review, ‘8 Epic EHR implementations with the biggest price tags in 2015’, July 2015 14. Singapore Ministry of Health Website, ‘Future phase of NEHR’ 15. Singapore Worker’s Party, ‘Easing the cost of healthcare for Singaporeans’, 2013. Cost data converted from SGD to USD based on exchange rate of 1SGD = 0.75USD 16. Integrated Health Information Systems (IHIS), ‘IT boost to keep health care humming’, October 2014. Cost data converted from SGD to USD based on exchange rate of 1SGD = 0.75USD 17. CHITS Philippines Website (https://chits.ph/) 18. Healthcare IT News, ‘Manila hospital implements cloud-based EHR’, 18 Apr 2012 19. LifeData System Inc. Company Website (http://lifedata.ph/?page_id=16) 20. KoeKoe Tech Compnay Website (http://www.koekoetech.com/) 21. PwC ‘Emerging mHealth: Paths for growth’, 2012 22. PwC ‘Cybersecurity in Health Services’, 2016 23. PwC Health Research Institute (HRI) Clinician Workforce Survey, 2014 and 2015 PwC | The Digital Healthcare Leap | 13
  • 16. This publication has been prepared for general guidance on matters of interest only, and does not constitute professional advice. You should not act upon the information contained in this publication without obtaining specific professional advice. No representation or warranty (express or implied) is given as to the accuracy or completeness of the information contained in this publication, and, to the extent permitted by law, PricewaterhouseCoopers LLP, its members, employees and agents do not accept or assume any liability, responsibility or duty of care for any consequences of you or anyone else acting, or refraining to act, in reliance on the information contained in this publication or for any decision based on it. © 2017 PricewaterhouseCoopers LLP. All rights reserved. In this document, “PwC” refers to the UK member firm, and may sometimes refer to the PwC network. Each member firm is a separate legal entity. Please see www.pwc.com/structure for further details. 170215-231110-SS-OS