From telemedicine booming through the COVID-19 era, the rise in wearable devices to the latest advances in artificial intelligence and big data analytics: digital applications have the potential to unlock immense opportunities for public and private organisations in the realm of healthcare. And startups are well placed to take advantage of such nascent technologies and opportunities.

"Startups are important players in the digital health ecosystem,” says Siu Loon Hoe, Associate Professor of Information Systems (Practice). “They introduce new inventions to existing practices, which generally represent shifts in the industry or solutions to address customer pain points."

However, before leaping forward, it is crucial to understand the current state of play. In a bid to do so, Assoc Prof Hoe published a study in 2022 on digital health providers and policymakers in Southeast Asia, the current state of digital technology applications in the region and the challenges that impede widespread adoption. 

Mobile connectivity and healthcare innovation

Healthcare faces a unique set of obstacles in Southeast Asia, with its diverse population and vast geographical landscapes. Particularly in countries such as Indonesia, where the distances between remote areas and healthcare facilities are substantial citizens may struggle to access medical services.

Concurrently, Southeast Asia has witnessed an extraordinary rise in mobile phone usage, with a staggering number of people relying on their phones as primary devices for internet access. For instance, in Indonesia, the country with the largest population in SEA, the number of mobile phone users has reached over 258 million. Similarly, in Thailand, mobile phone penetration stands at over 140 per cent, with over 101 million mobile phone connections. 

This combination of high mobile phone usage and the pressing healthcare needs in the region makes Southeast Asia a promising frontier for digital health startups aiming to improve access to quality care for all.

How they can grow is the question.

Digital health startups in Southeast Asia

These startups faced challenges aplenty -  such as regulatory barriers, funding limitations, and infrastructure requirements that need to be addressed. Assoc Prof Hoe reported this in his paper “Digital health in Southeast Asia: Startups and digital technology applications”, when he did a deep dive of 260 companies. Only then could startups effectively collaborate with healthcare practitioners to leverage opportunities and drive the widespread adoption of digital health solutions in the region, he noted.

His study showed that startups focusing on Internet of Things (IoT) technologies made up the lion's share, accounting for 196 of the sample collected, while there were 30 Artificial Intelligence (AI) -related and 13 Big Data Analytics-related companies. The remaining companies traded in Medical Devices – health-related hardware that could range from simple disposable items such as plasters and syringes to complex devices such as imaging machines and robotic devices.

Ensuring public trust in health data security 

Despite societal and geographical differences, Assoc Prof Hoe found that issues hindering digital health adoption in Southeast Asia are not unique to the region, but common around the world. 

“For example, concerns over the privacy of health information is a key barrier for user adoption,” says Assoc Prof Hoe. The public fears such things as continuous data collection beyond consumer knowledge; unauthorised secondary use; improper access and horror stories about “hacking” and data leaks; not to mention the possibility of errors that are not supervised by humans – these have resulted in overall user hesitance in medical technology.

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Standard measures for personal health data protection such as anonymisation, notice, and consent have thus far been effective, but run the risk of losing effectiveness if overused or launched with insufficient resources to back their full usage. 

To counter such issues and build a more sustainable environment for digital health startups, Assoc Prof Hoe suggests an “open discussion” among key stakeholders, along with enhanced public education about digital security. Doing so would help individuals as well as the community gain a better knowledge of initiatives and preventive actions. 

Organisations and governments could take the lead in this area. For example, engagement and collaboration efforts with both users and experts should be stepped up to address digital health challenges. He also urges practitioners to consider strengthening cybersecurity with tools that include real-time monitoring, threat mitigation, and remediation.

“There are no short-cuts in overcoming resistance to change in organisations,” says Assoc Prof Hoe. “People need to be informed, motivated, and trained to do things differently. Thus, there is a need to design organisational initiatives that address the people-side of change.”

The benefits and challenges of going hybrid

Lockdowns during the COVID-19 pandemic accelerated the global uptake of digital solutions in all forms around the world. People were simply unable to meet face-to-face, paving the way for the rise of online video conferencing from one’s own home. Using the same technology, medical startups were able to overcome barriers as well as long-standing issues such as medical service to sparsely populated rural areas that had previously been less well served. 

“The most common challenge these startups addressed was the need to be physically present during health consultation,” says Assoc Prof Hoe. In rural areas, the increased adoption of technology allowed companies to overcome large geographical distances and scattered population clusters in the delivery of health services; while in urbanised environments, they helped to connect healthcare providers to patients who were quarantined. “In all cases, there are many savings in terms of time and costs”, he says.

He cites the example of Ooca, a startup from Thailand, that makes use of video technology to enable patients to consult with psychologists and psychiatrists regarding their mental health, regardless of their location. Doing so allows patients to seek treatment while avoiding social stigma, complicated logistics, and superfluous cost. 

Nonetheless, the fear of potential overreliance on technology remains an underlying issue that hinders digital health adoption. For example, while AIs currently largely function as assistants in medical consultations, they may eventually evolve into independent decision-makers that would work without human supervision, as Assoc Prof Hoe cited in his paper. Before that happens, society must tackle ethical issues regarding responsibility and accountability in such cases, especially where AI-assisted medical decision-making leads to errors. Furthermore, all AIs work on enormous data sets – but what happens when the data has a bias, such as in the imbalance of data on reactions to heart problems in minority groups?

Assoc Prof Hoe suggests a more measured, hybrid approach to mitigate such dilemmas: digital health technology should be used alongside human supervision and judgement to evaluate the benefits and costs of potential treatment options for the best clinical decision-making. This approach will open up more opportunities to advance the medical field and improve the quality of care.

Increasing digital health adoption sustainably

Assoc Prof Hoe urges organisations to take more active steps in promoting a culture that can embrace digital health technologies. “There are no shortcuts in overcoming resistance to change in organisations. People need to be informed, motivated, and trained to do things differently,” he says.

From redesigning organisational initiatives to widen technology adoption to providing ongoing funding to advance research and development in digital health and identifying best practices, any changes to existing health practices involving digital technology would need to take into consideration many factors. “After all, lives are at stake,” Assoc Prof Hoe emphasises.