Singapore’s Health Promotion Board (HPB) and Apple announced a partnership aimed at promoting a healthy lifestyle in Singapore through an application called LumiHealth. The HPB is a statutory board under the Ministry of Health (MOH) that implements programs and policies to promote healthy lifestyle in Singapore. The two-year health program – which will go live in late-October – is a part of Singapore’s Smart Nation initiative, a national effort to harness technology for innovation, sustainability and support better living for citizens and businesses in Singapore.
Commenting on the news, Ecosystm Principal Analyst, Sash Mukherjee said that “Singapore’s MOH has been making a concerted effort to improve health outcomes through digital technology for more than 10 years now. It is time for the nation-wide health record system to be leveraged for better population health management. The ultimate goal of all healthcare systems across the world is to be sustainable – and keep citizens out of the public healthcare systems by managing their health and wellness, outside of it. Singapore is geared up to deliver on their goals for 2025; technology-enabled population health; preventive health; and early diagnosis and intervention.”
LumiHealth to promote Healthy Lifestyle
The LumiHealth app has been created and designed with a team of public health experts and physicians; and encourages users to complete wellness challenges through their Apple devices. To participate in the wellness program, users need to have an Apple Watch and the LumiHealth app. The app will provide participants with personalised coaching, and will prompt users on sleeping habits, food choices, activity goals, health screenings and relevant immunisations based on their demographic profile.
The application also has a feature called ‘intergalactic explorer’ which gamifies the experience through adventure-based tasks. The tasks are personalised based on a user’s age, gender, and weight; and can be completed through walking, swimming, running, yoga, and other activities. Completing these challenges will enable users to earn rewards and vouchers worth up to SGD380 (USD 280). The eVouchers can be used at various establishments, including food and health outlets.
Creating a customised offering, and gamifying the experience should increase user engagement, “However, the products and offerings have to be more mass-market to promote universal adoption. Relying on citizens’ personal devices and their own wellness goals will only be attractive to a certain segment – that was already focused on health and wellness to start with. In the end the success of such population health initiatives will depend on GPs and other primary care providers being able to prescribe devices and apps, being able to access the data, and being able to base their treatment protocols on that data,” explains Mukherjee.
LumiHealth data privacy and security
To enroll in the program, users need to provide consent to share their information with LumiHealth to personalise their experience and they may opt-out any time. Singapore residents above 17 years and holding a SingPass account are eligible to participate in LumiHealth. The aim is to use insights from the captured data to enable betterment of future public health efforts, reduction in preventable deaths and disabilities and improve the quality of lives. The program is voluntary and guarantees data privacy and security through encryption and systems complying with Singapore’s data privacy and security laws as the collected data will be coded, secured and stored in Singapore.
“This project took close to 2 years to come to fruition” Mukherjee said, “and will hopefully lead the way for more healthcare apps aimed at wellness and chronic disease management.”
Singapore’s Health Programs
LumiHealth will complement Singapore’s other population health initiatives that are leveraging technology to enable wellness. The National Steps challenge program encourages Singaporeans to be physically active by engaging in various levels of challenges – involving activities ranging from brisk walking, stair climbing to doing sports.
The Singapore Government has also introduced other wearable tech and apps to promote a healthier lifestyle and emotional wellbeing of Singaporeans. For example, last year, the HPB collaborated with Fitbit to leverage their devices, services and apps.
The Singapore Government has also focused on wearables and TraceTogether tokens in curbing the spread of COVID-19. In June, the TraceTogether tokens were distributed to the elderly followed by a nationwide distribution of TraceTogether tokens that kicked off this month. “The Healthcare industry is at crossroads. It has had to pivot significantly from their transformation and technology roadmap to handle the COVID-19 crisis. However, there have been important learnings from the situation that the industry will carry forward. A lesson for Singapore was the real-life application of the C3 system (Command, Control and Communication). Singapore’s response to the crisis shows how governments can use policies and technology to combat healthcare emergencies,” Mukherjee concludes.
In January we wrote a blog on How Technology is Helping to Combat the Coronavirus – since then the COVID-19 outbreak has fast become a global threat, disrupting healthcare systems and economies. As the world struggles to contain the spread, Singapore’s response to the crisis shows how governments can use policies and technology to combat emergencies. While it is true that Singapore’s size is its advantage, and most of what it was able to do cannot be replicated in larger, more spread-out countries, there are still lessons there – in the simplicity and responsiveness of the measures. The threat is by no means behind us and the Government will need to implement many more policy changes in the near future. But it is worthwhile to look at what Singapore has done so far to contain the spread.
#1 Identifying and acknowledging the threat early
Like other Asian countries, Singapore suffered during the SARS outbreak in 2003. While the number of people infected during SARS was less at 238, at the end of the outbreak the country had recorded 33 deaths. Having learnt from that experience, Singapore knew that early response is key. Acknowledging the threat early allowed Singapore to have test kits made available to all major hospitals through the Agency of Science, Technology and Research (A*STAR). A*STAR is a statutory board under the Ministry of Trade and Industry, Singapore. The agency supports R&D that is aligned to areas of competitive advantage and national needs. By the time the first case was reported on 23rd January, health professionals were equipped with testing capabilities. Health authorities and biotech companies have continued to modify and launch newer testing technology – like the fast-track swab test kits launched in early March – as global research continues.
#2 Focusing on contact tracing
Right from the start, Singapore has been focused on contact tracing. Following the chain of the virus allows government agencies to identify and isolate people at risk, including their close contacts. This became more important as the virus spread into the local community with the first reported case on the 4th February. The contact tracing process has been a concerted effort using technology, manpower and dedication. As Singapore faces a second wave of spread from returning travellers, the Government launched Trace Together, an app that records distancing between users and the duration of their encounters. Individual consent is required to share the data which is encrypted and deleted by the Ministry of Health (MOH) after 21 days. This allows the MOH to contact citizens in the case of possible contact with an infected individual.
#3 Keeping the citizens in the loop
The speed in imposing border controls, meticulous tracing of known carriers and aggressive testing are all positive steps in combating a crisis like this. But arguably the most productive strategy was to get citizen buy-in. The need was felt most when the country’s Disease Outbreak Response System Condition (DORSCON) level was raised from yellow to orange on 7th February. With the raised DORSCON level, buildings and public facilities with a high volume of people were required to do fever screening and collect personal details for further communication and alerts, if required. Simultaneously, the Government started sharing clear, transparent, daily public communication through mobile phones. The messages contain anonymised details of the patients (to make people aware of their own possible exposure), as well as an update of the number of patients being treated and released. The 2 deaths were also reported promptly – but enough details were shared to avoid panic. Demonstrating cross-agency collaboration, the information disseminated comes from multiple government agencies – the same channel is also used to drip-feed hygiene guidelines and the evolving government policies on travel, trade and so on.
The message from the leadership has also been clear and timely, and an economic stimulus package was announced fairly early. The Government is currently working on a second stimulus package, as the threat to the economy continues.
#4 Dispelling misinformation
Taking this daily communication to the next level, the Government has been prompt in stopping the spread of rumours. Not only does the MOH website share all the latest details, any spread of misinformation (usually through social media) is being quelled by official statements. It is extremely important to be able to address issues such as these, because it impacts trust in the government and the healthcare system. The daily updates are now a ‘single source of truth’ on all COVID-19 related information. The Cyber Crime Portal has also been activated with the intention to track unverified messages especially regarding the treatment and cure of COVID-19.
#5 Empowering healthcare professionals and citizens with digital tools
Unfortunately, the community spread appears to be happening in waves, especially as Singapore has a high volume of returning travellers. Healthcare facilities continue to be stretched. Although Singapore has adequate healthcare facilities to cope with the number of current cases, the Government is also prepared with additional quarantine facilities. Meanwhile, hospitals have set up makeshift triage centres in their car parks to deal with the growing number of patients needing to get tested. To counter the need for more infrastructure and the cost to get additional facilities ready, the use of digital health, remote patient monitoring and online care planning is being explored to limit patients presenting themselves to providers. KK Women’s and Children’s Hospital has launched UPAL – Urgent Paediatric Advice Line – as a pilot online consultation channel. It is expected that more healthcare facilities will offer services such as these. Being cloud based, these solutions can be deployed within days and high-risk patients can be immediately onboarded, easing the burden on the healthcare system and providing relief to patients and families. Telemedicine and remote monitoring are not new, having been proven and tested by several healthcare systems. In these extraordinary times, the technology will help the healthcare system keep all in Singapore safe.
#6 Having a strong Data and Digital infrastructure
Singapore’s data and digital services infrastructure is the overarching factor that has allowed the Government to act quickly and efficiently to fight this community threat. While this is not linked directly to the current response measures against COVID-19, it is the true enabler. Firstly, the electronic health record system has access to records of all patients who have availed of the public healthcare system (private, primary care organisations have also started contributing to the system – enabling the vision of complete longitudinal health records). This is the backbone of the Government’s healthcare measures in these difficult times. Secondly, the network infrastructure allows the introduction of online consultation services. Moreover, people are able to work from remote locations seamlessly using collaboration tools such as Zoom, Skype and WebEx. This allows the Government to encourage people to work from home, to stay away from healthcare facilities and other measures to reduce overcrowding of public spaces to prevent the spread. And finally, Singapore has a strong access to eCommerce and online platforms, allowing people to access almost anything they choose to, online.
While the battle against the pandemic is far from over, Singapore has so far managed to avoid complete disruption by using technology to be responsive to the community’s needs.
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Commenting on the rollout of 5G, Ecosystm Principal Advisor – Telecommunication, Peter Wise said “5G promises much faster, more reliable wireless connectivity that will bring applications such as augmented reality, higher quality video and eventually smart cars, to life. Moreover, IoT will also be enriched by the increased data carrying capacity that 5G enables.”
Singapore pushing for four 5G networks instead of two
Instead of the two initially planned networks for 5G, there are now four networks proposed to be rolled out. Two networks will be used for full-fledged 5G networks whereas the other two will be smaller ones that will provide limited coverage. The two smaller networks of 800MHz will leverage on Millimetre Airwaves and will be used in small ports and factories and be Singapore’s most immediate use of 5G technology. “More networks would likely bring more competition and deeper coverage. The designation of some spectrum for port usage appears to enable applications to get up and running quickly and not have to wait for a wider rollout” said Wise.
The IMDA has called for proposals from the interested operators rather than going for an airwave auction. Proposals will be assessed on telcos’ financial capability, as well as network security design.
The introduction of 5G will be a costly and time-consuming activity in order to set up the infrastructure and provide customers with sufficient coverage. “Some existing 4G cell sites will be able to be upgraded to 5G through software or card swap outs, which are comparatively cheaper than acquiring and building whole new cell sites. However, over time, 5G will require a denser network of smaller cell sites, and there may need to be infrastructure sharing arrangements between MNO’s for acquiring these new sites for practical and economic reasons,” said Wise.
Only half of Singapore will have 5G coverage initially
IMDA announced that at least 50% of Singapore will be covered with a standalone 5G network by the end of 2022 and full island-wide coverage by 2025. “Many users may not initially notice whether they are on 4G or 5G speeds. 4G is still more than adequate for most of today’s applications, including video” said Wise. “However, over time as heavy data applications are introduced or very high definition video becomes more mainstream the benefits of 5G will become more apparent.”
A standalone network will use 5G-specific technologies for developing newer applications around IoT, smart factories, and autonomous vehicles. “Another fascinating development will be whether any operators use 5G to compete with fibre” said Wise. “Singapore is well served by high-speed fibre broadband so while the Singapore population is high in density (making 5G economics better), it may be that having 5G as a competitor to fixed broadband is more successful in other countries where most fixed broadband is still provided over older, slower copper-based technology.”
The recently held AWS Public Sector Summit in Singapore showcased some of the regional AWS implementations, and how organisations are leveraging the Public Cloud differently.
In her keynote address, Teresa Carlson, Vice President, Worldwide Public Sector set the tone for the industry show cases by saying that a successful Digital Transformation (DX) starts from a radical rethinking of how an organisation uses cloud computing technology, people, and processes to fundamentally change business performance.
AWS Empowering the Public Sector
Carlson is clear on what Public Sector organisations must do and where AWS can help them:
Define what Cloud refers to in the organisation. The first step in bringing about a Cloud First transformation is to be clear on the true definition of cloud computing.
Create a “Cloud First” policy. To adopt a Cloud First policy, it is imperative to have leaders with a clear vision who really drive technology initiatives forward for all the right reasons like security, cost reduction, scalability, privacy and rapid acceleration of citizen services.
Focus on Security & Compliance. AWS has global compliance certifications with 200+ services and key features focused on security, compliance and governance. New services such as the use of AI for threat detection have been implemented and are quickly evolving into a mainstream feature.
Modify your Procurement vehicle. A formal cloud procurement model must be adopted instead of creating ad-hoc processes and a rush to adopt cloud to meet the specific needs of individual departments. AWS has the expertise to assist government IT leaders in selecting the right acquisition approach for their agency.
Do not ignore Skills Development. Investing in cloud skills development – whether at the central IT level or in the individual business units in the Public Sector – is imperative, as roles evolve and new roles emerge. AWS has over the years offered free courses and industry certifications to Public Sector employees interested in learning the foundations of cloud computing, storage, and networking on AWS to advanced skills courses in emerging technologies such as AI.
While cloud may have started off as a means of offsetting CapEx, its role has since evolved into being a major vehicle for DX. Several governments across the world have adopted Cloud First policies to spearhead innovation, increase agility, and improve citizen services. Cloud is increasingly seen as a foundation for many emerging technologies that governments are experimenting with and implementing such as AI, automation, Big Data analytics and Smart Nation initiatives.
The skepticism around Public Cloud security seems to have diminished over the years, with the perception that cloud providers use state-of-the-art technologies to protect their environment and continue to upgrade their security features in the face of new and evolving threats. However, the Ecosystm Cybersecurity study finds that nearly 53% of Public Sector and allied organisations that use Public Cloud feel that the security measures offered are sufficient. Leading cloud providers such as AWS should make it clear that essentially it is a shared responsibility and impress on organisations that the responsibility to secure their own applications and the interface with the Public Cloud ultimately lies with the deploying organisations.
Industry Use Cases
There were several industry use cases presented over the 2 days and it was heartening to see so many Asia Pacific examples of transformation. Tan Kok Yam, Deputy Secretary, Smart Nation & Digital Government Office shared that the key to a successful Smart Nation initiative is to build user-centric services rather than having an agency-centric approach, in his presentation on Singapore’s “The Moments of Life” app. Edwin H. Chaidir, IT Manager at WWF Indonesia presented on how AWS’s machine learning capabilities has helped the organisation to automate identification of specific orangutans in the wild, freeing up resources (money and time) to reinvest in other wildlife protection initiatives.
One of the implementation stories that impressed the Ecosystm analysts was the one shared by Rookie Nagtalon, Consultant for Digital Transformation at the Chinese General Hospital and Medical Center (CGHMC) in the Philippines, where he spoke about how they were able to bring about transformation in their patient life-cycle management. Healthcare in Asia Pacific is a diverse and disparate market with organisations at different levels of IT and business maturity – against a backdrop of different country-level goals and healthcare policies. It was encouraging to hear about a transformation project in a not-for-profit organisation from an emerging economy.
The challenges that healthcare organisations face are unique in many ways:
Legacy systems that still work and hence there is no business case for replacing them
Approximately 2/3rd of the IT budget going into running the basics, leaving limited resources for emerging technology adoption and transformation projects
The shift to value-based healthcare and the need for data-driven insights to support it
The unpredictability of the workload and the need for an agile IT infrastructure
Security and compliance mandates that protect patient data and require storage of records over extended periods
Working with these challenges, how does a healthcare organisation bring about Digital Transformation?
Nagtalon’s team was assigned the task to bring about this transformation within a 10-month timeframe.
The key challenge.An awareness that no one vendor can provide the entire gamut of functionalities required for patient lifecycle management. In spite of recent trends of multi-capability vendors, hospitals need multiple vendors for the hospital information system (HIS), ERP, HR system, document management systems, auxiliary department systems and so on. Each of these vendors have their own development team and infrastructure requirement, which stresses the internal IT resources. DX involving multiple legacy systems requires a step-by-step approach. The challenge is to identify the right systems to start the journey with.
Vendor selection criteria.The need to find one solution that would enable seamless data sharing across the disparate systems. The vendor selection criteria that were used focused on ease of use and speed especially when working with multiple data sources. In keeping with the industry, the ability of the vendor to support mission-critical applications was put through the filter of what was referred to as ‘Code Blue’.
The solution choice.A cloud solution that can empower teams and remove worries about the infrastructure. The hospital chose AWS as their transformation partner, who used a system interface blueprint to integrate data from their SAP ERP system, Medcurial’s MeRx HIS, 128 HR system, Canon’s documentation system and multiple diagnostics systems.
The future roadmap.Enabling the organisation to be a Digital Hospital. The solution was implemented in 7 months and hit the right ROI requirements, reducing billing time and impacting the bottom line in terms of both recovery and revenue. It has created the base foundation for future plans such as device integration and the provider is well set on its journey of Cloud, IoT and Robotics.
Nagtalon raised an important point when he was asked the key reason for the success of the project – executive buy-in. Transformation projects work best when it is enterprise-wide and senior management sponsorship is a must to enable that. However, he also mentioned humorously that he had become extremely unpopular during the implementation. This is where a centre-of-excellence with ‘champions to the cause’ from each key department helps. Organisations should look to engaging with the stakeholders early and to get their buy-in as well as the executive’s.
AWS’s marketing message to healthcare providers includes allowing them to focus on their mission and create their differentiation, and enabling them to incorporate new and emerging technologies. This implementation certainly ticked those boxes. What was particularly positive was the big thumbs up the AWS implementation team received. Organisations will increasingly partner with platform providers in their transformation journeys and implementation capabilities and best practice guidance will be the key differentiators for vendors.