The evolution of healthcare in Asia and other regions will be shaped by digital health ecosystems. The integration of technological innovations, including information technology, wearable technology, virtual reality, and the Internet of Things, has become integral to our daily lives. These advancements play a crucial role in reshaping healthcare business and operations, offering patients a broader range of healthcare choices, and fostering a patient-centric culture. Patients will experience a new era of healthcare centered around their needs, providing more thoughtful and extensive healthcare options. The landscape of personal and institutional healthcare transforms digital advancements. This article explores factors influencing mHealth adoption, highlighting associated challenges shaping the eHealth ecosystem. It also aims to contribute to the evolving discourse on eHealth by shedding light on its dynamic implementation in India, the influencing factors, and its transformative impact on different realms of medicine.
Integrating eHealth technologies becomes a strategic need as Asia navigates the intricacies of healthcare delivery in the twenty-first century. Across the continent, governments and healthcare stakeholders are becoming more aware of how these technologies might be used to solve persistent problems. But there are obstacles in the way of broad adoption, as concerns about data security, interoperability, and the requirement for robust legal frameworks. The ability of eHealth to provide affordable healthcare solutions is a key component of the eHealth revolution in Asia. By utilising digital technologies, Healthcare providers can enhance operational efficiency, minimise administrative costs, and maximise resource usage. For example, telemedicine reduces the requirement for physical infrastructure, increasing the affordability and accessibility of healthcare treatments. In addition to helping healthcare professionals, the affordability of eHealth solutions may also help patients financially, promoting a more inclusive and equal healthcare system.
One of the main components of eHealth, telemedicine, has become a significant factor in changing the healthcare system in Asia. Remote consultation with medical experts helps improve the speed and efficiency of healthcare delivery and address geographical distance concerns. This is particularly important in areas with high population density, as the traditional healthcare system may need help to keep up with the demands of an expanding populace. The development of telemedicine has improved access to healthcare services while facilitating the sharing of medical knowledge and enabling professionals to treat patients in remote locations. Taiwan’s proactive response to the COVID-19 pandemic showcased its preparedness, attributed to a robust healthcare infrastructure developed through prior experience with epidemics like SARS and H1N1. India faced challenges as it had not widely adopted telemedicine before the pandemic but quickly adapted making use of its already established digital identity system called Aadhar facilitating the second-largest vaccination campaign globally, streamlining vaccination processes and generating digitally signed certificates.
Technological developments in eHealth have the potential to alter healthcare in Asia drastically. The potential benefits of digitalising healthcare services are enormous, ranging from improving patient involvement to streamlining healthcare delivery. In addition to being a technological need, adopting and optimising the benefits of eHealth is a strategic route towards developing robust and adaptable healthcare systems for the future, as the region navigates the intricacies of contemporary healthcare.
Challenges in Asian Healthcare Landscape: A Comprehensive Overview
Healthcare in Asia is positioned at the intersection of five fundamental forces that propel transformation. These forces are not exclusive to Asia, and their impact varies across countries and regions within the continent. Nevertheless, when considered collectively, they exert a compelling influence to enhance healthcare delivery in ways that are more scalable, sustainable, and personalised. By 2025, Asia is anticipated to accommodate 456 million individuals aged 65 or older, constituting 10 percent of its population. This marks a 14 percent increase from 2021, signifying a swift demographic shift that heightens the potential demand for healthcare services while simultaneously diminishing the available workforce for care provision. Also except for three countries in the region, the average number of doctors per 1,000 people in Asia is lower than the OECD average. Additionally, the World Health Organisation has projected a global shortage of nine million nurses, with some of the most severely affected countries situated in Asia. Despite increasing investments in hospitals and physician health infrastructure, conventional, labor-intensive care delivery models are unlikely to meet the escalating health needs in Asia. Presently, Asian governments allocate an average of only 4.5 percent of their GDP to healthcare, a significant contrast to the OECD average of 12 percent. Despite this, governments remain the primary contributors, covering 64 percent of all health expenditures in 2018, whereas private insurers only covered 7 percent. Effectively managing the expansion of healthcare costs is a pressing public concern, emphasising the need to prioritise quality and access for patients. Consumers are dedicating more resources to health and wellness and are progressively seeking convenient and affordable healthcare options. Moreover, consumer research indicates a growing inclination to invest in health-branded products, especially in countries like China, where consumers have shown a willingness to spend more on health-related items during the pandemic. According to McKinsey research, 43.5 percent of Chinese consumers have reportedly increased spending on their health in the past 12 months, with 23.1 percent allocating more funds to their nutrition.
How India Implemented its digital infrastructure during a pandemic
The onset of the coronavirus showed that Taiwan was better prepared to handle any public health disaster, including the catastrophic COVID-19 pandemic because it had a robust healthcare infrastructure in place and had dealt with epidemics like SARS in 2003 and H1N1 in 2009. On December 31, 2019, the country was the first to alert the WHO, and on January 5, 2020, it was the first to mobilise experts against COVID-19. This was attributed to this well-laid digital infrastructure that paved the way for implementing telemedicine and eHealth strategies. But in contrast to Taiwan, India had not widely adopted telemedicine prior to the COVID-19 pandemic, and its early initiatives had not always proven fruitful. Nor was telemedicine obviously lawful prior to the guidelines’ release on March 25, 2020. With the launch of the Telemedicine Pilot Project in 2001, the Indian Space Research Organisation (ISRO) brought telemedicine to the country but it was much later in 2019 when infrastructure for telemedicine was properly established and realised with the rapid spread of coronavirus. It was only after receiving reports from nations where the pandemic had a more severe impact, Indian authorities had discovered that hospitals and other enclosed spaces were the superspreaders of coronavirus promoting hospitals to stop their outpatient sectors and turned towards telemedicine as an alternative and with around 500 million smartphones in use as of December 2019, the infrastructure for the implementation of telemedicine was partially in place. The remaining piece of the puzzle was building of Aadhar system by Manmohan Singh, the prime minister of India at the time, in September 2010. It is a distinct digital ID that is given to each person who satisfies specific requirements. For many Indian citizens, it was their first ID. The vast majority of adult Indians now have an Aadhaar number. The second-largest vaccination campaign in history has been made possible by Aadhaar, which has also made it possible for vaccinations to be administered without difficulty and for immunisation certificates to be generated instantly. The government can instantly provide each immunised person with a digitally signed vaccination certificate that includes a unique QR code by integrating Aadhaar numbers with mobile phone numbers Infrastructure innovation and investment in healthcare have increased as a result of the epidemic. The government developed the groundbreaking Aarogya Setu app for contact tracking, which combines Bluetooth and GPS data enabling people to self-evaluate for COVID-19 using a database of known infections. The digital infrastructure laid down by the Aadhar system gave individuals digital identity, financial independence and access to education and medical consultation. But even in the wake of the pandemic, these telemedicine initiatives ought to be mainstreamed in order to enhance the quality, equity, training, and accessibility of healthcare services in India. Setting priorities for short-, medium-, and long-term objectives is necessary for success. Longer term, it is imperative to improve internet infrastructure. Linking the smallest administrative and healthcare units, such as Public Health Centres (PHCs) and Health & Wellness Centres (HWCs), with larger hospitals and medical college hospitals is imperative in conjunction with government efforts to bring optic fibre to rural locations.
Specific Relevance to India: Ayushman Bharat Digital Mission
The Ayushman Bharat Digital Mission stands as a transformative initiative within the broader landscape of India’s healthcare system, leveraging digital technologies to revolutionise the way health information is managed, accessed, and utilised across the nation. Launched as a flagship program under the Ayushman Bharat scheme, the Digital Mission aims to address critical challenges in the healthcare sector and enhance the overall efficiency and effectiveness of healthcare delivery. The National Health Policy of 2017 marked the beginning of the government’s intention and goal to provide high-quality healthcare through the use of readily available and reasonably priced technologies in India’s healthcare system.
The development of a distinct, carriable digital health ID for each individual is central to the Ayushman Bharat Digital Mission as it supports the nation’s transformation of its digital health infrastructure is the Ayushman Bharat Health Account (ABHA) number. To standardise an individual’s identification process among healthcare providers and facilities, a unique identity number consisting of 14 digits is voluntarily generated at random. An individual’s medical history, prescriptions, test results, and other relevant data are all housed in one convenient location with their Health ID. Any individual can easily obtain their ABHA details because each ABHA number can be linked to several ABHA locations. Patients have complete control over their data as ABHA strives toward voluntary consent-based linking and sharing of personal health records (PHR). Online access to a person’s medical records is available for admission, treatment, and discharge. The data generated over time helps physicians better comprehend a patient’s medical history and past treatments. The goal is to facilitate information sharing and communication between different stakeholders, such as patients, government agencies, and healthcare providers, by creating a standard format for storing health data.
Promoting interoperability throughout the healthcare sector is one of the Digital Mission’s main goals. Interoperability guarantees the smooth communication and information sharing between heterogeneous healthcare systems and databases. Because of its interconnection, which makes it possible for medical personnel to efficiently access pertinent patient data and better diagnosis and treatment, it is essential for delivering holistic and integrated healthcare services.
Working together with a variety of stakeholders, including as government organisations, technology firms, and healthcare providers, is necessary to implement the Ayushman Bharat Digital Mission. This multifaceted strategy guarantees that the digital environment is both technically solid and in line with the real-world requirements of the Indian healthcare system. The creation of a distinctive ID for healthcare professionals will improve communication among all parties involved in the healthcare system, as well as the professionals’ online visibility and discoverability in India.
Factor affecting the implementation of mHealth and challenges
The rapid growth of mobile phones and their diverse functionalities in Asia have resulted in a notable surge in the advancement of wireless technology and mobile communications. Using mobile phones for health services, which can exchange data about patients’ conditions, is one of the most significant forms of mobile communication. Within the healthcare system, mobile health plays a significant part in raising the standard of care. Using smart mobile phones, PDAs, patient monitoring devices, and other wireless gadgets, mobile health refers to the process of offering medical services to individuals and patients. Furthermore, with accurate education and interventions, the utilisation of mobile health potentials can assist avoid contagious and communicable diseases. One extremely efficient method of delivering health services to rural places will be the use of information and communication technologies, particularly mobile health. In addition, mobile health has made it possible to diagnose and treat illnesses in addition to exchanging reliable information. Nevertheless, during the deployment stage, mobile health services will encounter numerous human and attitude issues despite all of these features and applications. There are some challenges like the impact of age on the adoption of mobile health could follow a U-shaped pattern, with behavioral intention being higher in the younger and older age groups but only moderate in the middle-aged group. Age is a major factor in determining opinions regarding the use of mobile health services, according to the moderator analysis. Users who are middle-aged and older place a higher value on perceived ease of use and recognise the significance of user-friendly interfaces. This is consistent with UTAUT’s findings, which show that older people are more likely to adopt technology if they believe it to be user-friendly. However, because they are more efficient and able to adjust to new technologies, younger consumers might put other considerations ahead of ease of use. Additionally, threat assessments are influenced by age, with middle-aged and elderly users displaying a greater worry for health-related issues. People who are older tend to be more concerned with keeping themselves well, which makes them more likely to use mobile health services to take preventive measures. This nuanced understanding of age-related dynamics provides valuable insights for tailoring mobile health interventions to different age groups.
eHealth in various friends of medicine
As we know that India’s healthcare landscape is marked by intricate socio-economic factors. Challenges include a shortage of primary care doctors in rural areas, a need for ongoing knowledge updates, and variations in the practices of qualified doctors. According to reports a significant portion of the population relies on non-allopathic medicine, with modern medicine penetration estimated at only 30 per cent. The prevalence of out-of-pocket expenditures, constituting 80 per cent of healthcare spending, is exacerbated by travel costs. Consequently, untreated conditions are common, managed with over-the-counter medicines or by faith healers, particularly impacting the 70 per cent residing in rural areas with limited healthcare access. Additionally, the lack of reliable epidemiological data hinders the design of effective preventive health programs. Leveraging Information and Communication Technologies (ICT) for healthcare (eHealth) holds the promise of enhancing various aspects, including enabling access to high-quality healthcare and health information. Additionally, it has the potential to enhance the quality of health-related data, as evidenced by successful implementations in other developing nations. The delivery of health-related services through eHealth may encompass remote clinical participation, which often incorporates mobile communications technology, referred to as mHealth. There are multifaceted ways in which electronic health technologies are transforming different facets of medicine in the region.
A new age in Asian healthcare is being ushered in by the incorporation of eHealth technologies. The many uses of eHealth, from telemedicine and mobile health apps to AI-driven diagnostics and blockchain-enabled security, are all working together to make healthcare more patient-centered, patient-accessible, and efficient throughout the continent. eHealth initiatives in India primarily focus on reaching individuals who have limited access to modern medicine, posing a challenge when attempting to run profitable programs in predominantly low-income communities. Charitable organisations, particularly those reliant on external funding, often struggle to have a widespread impact due to financial constraints. The issue of finance is a significant hurdle, given the already minimal fees charged. Attempts to increase the number of beneficiaries by reducing fees further may not be viable. Conversely, raising fees could potentially exclude current beneficiaries from accessing the service. Therefore, additional strategies are necessary to bolster the financial sustainability of these programs.
In the past decade, the rapid evolution of the Internet has significantly influenced societal needs and behaviors. With the global number of Internet users soaring from 3.7 billion in late 2017 to 4.1 billion in December 2018, people increasingly turn to the Internet for health-related information. This has given rise to a new type of patient, the “e-patient,” who actively seeks health information and desires a collaborative relationship with healthcare providers. While informed patients are better prepared for medical visits, there is a challenge of discerning reliable sources. The Internet’s vast accessibility can be both helpful and misleading, prompting questions about patient expectations and the influence of technology on health-related activities. The study aims to investigate how online health information impacts patients and influences their choice of healthcare providers, emphasising the significance of e-health services and the doctor-patient relationship in the evolving landscape of healthcare.
The surge of consumer-centric health ecosystems: a global response to healthcare transformations
The emergence of consumer-centric digital ecosystems is a global response to transformative forces reshaping healthcare. These ecosystems aim to seamlessly deliver precise care by integrating three key components: (a) a network of healthcare providers in various settings; (b) an intelligence system that uses behavioral, social, and medical data to assess patients’ needs and choose the best provider; and (c) a technological backbone that facilitates the exchange of information between providers.
Crucially, health ecosystems combine digital and physical health services, so while they are facilitated by digital, they are not exclusively digital. Furthermore, because of their complexity and breadth, health ecosystems cannot be captured by a single organisation; instead, they usually consist of a central orchestrator that is centered around a small number of independently developed business models. To cover a larger portion of the care continuum, they also oversee a number of partners, such as IT vendors, healthtech start-ups, and traditional clinicians. As discussed in “The next wave of healthcare innovation: The evolution of ecosystems,” future healthcare ecosystems are anticipated to be shaped by the diverse needs of patient populations and their effective care journeys. The consumer-oriented focus of these ecosystems aims to increase healthcare touch-points with the objective of modifying patient behaviour and enhancing outcomes. In Asia, a diverse range of players, including traditional healthcare entities and nontraditional entrants like consumer-technology giants, banks, telco-companies, and retail conglomerates, are actively defining their approaches to health ecosystems. Presently, emerging health ecosystems are already impacting over a billion lives across Asia, with notable examples surfacing in China, India, Indonesia, and other markets. There are four distinct archetypes of health ecosystems are currently unfolding, each anchored by unique use cases i.e broadening access to primary care, expediting access to acute care, managing and monitoring disease and improving health and wellness. The markets have responded positively to these emerging health ecosystems, with significant valuations for key players like Tencent’s WeDoctor. However, orchestrators must align stakeholders’ interests, integrate online and offline resources, and define sustainable business models to capitalise on the opportunities presented by these evolving ecosystems.
Although numerous players within the health ecosystem have already demonstrated impressive results, we contend that there is substantial potential for further expansion in both the range and extent of health ecosystems throughout Asia. Acting swiftly is imperative to seize value in this emerging market, given the winner-take-all dynamics that strongly favor those who lead the way or rapidly follow suit in ecosystem-based markets. Consequently, prospective orchestrators of health ecosystems should consider the following four crucial questions like what is the time horizon and risk appetite to invest, what is the source of advantage and how will stakeholders interact with regulators and government priorities for healthcare. The future of healthcare in Asia and beyond lies in digital health ecosystems. Both established healthcare entities and emerging players must delineate their prospective roles in either orchestrating or participating in these health ecosystems. Addressing these four questions enables ecosystem orchestrators to evaluate how they will unlock the significant value associated with constructing a digital health ecosystem, ultimately influencing the lives of patients across Asia.