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Payoff in the Pacific

August 1, 1998
by root
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Asia Pacific economies are struggling to cope with the past year’s series of financial catastrophies and regain the market stature and confidence they once enjoyed. Despite the turmoil, all industries including healthcare continue to demonstrate their commitment toward privatization and modernization through technology. Advances in healthcare IT in the Asia Pacific region are narrowing the differences in healthcare between East and West. Is the information age speeding healthcare toward a global standard?

If you envision the United States as 50 separate nations, each with its own language, culture and healthcare system, then you can begin to understand the complexity of healthcare in the Pacific Rim. The same can be said for the application of information technology. Technologically advanced countries like Japan--which has been developing applications in medical informatics since the 1960s--are neighbors with developing economies such as Vietnam and Thailand where telephones are far from ubiquitous, and high tech may mean a standalone PC-based patient administration system at best.

Still, the needs are universal, and evidence is emerging that diverse cultures readily agree on both common problems and fixes for the healthcare challenges of the 21st century. As Asia Pacific governments confront large elderly populations and shrinking public coffers, leaders are offering new payor models, preventive health programs and information technology as relief for strained healthcare systems. "There is an awareness that IT can really move the healthcare system forward in both the public and private sectors," says Kurt Miller, Andersen Consulting partner and head of global medical management in Pittsburgh.

Kwok Chan Lun, M.D., director of medical informatics at the National University of Singapore and founder of the Asia Pacific Assocation for Medical Informatics, says that hospitals in the region are quickly seeing the urgency to automate, developing into sophisticated purchasers of healthcare IT and relying less on patchwork, home-grown systems: "The way to see quick return is to buy proven applications from the shelf." As this environment matures, so will the market for U.S. providers of healthcare information technology and services who have a strong track record at home, he says.

Trend setter: Japan and the CPR
Japan has perhaps the richest legacy of investment in information technology in the region--thanks to the country’s strong domestic industry and competitive business environment. Japan alone represents 73 percent of the total IT spending in the region, according to statistics compiled by IBM, and is IBM’s biggest healthcare market in the Asia Pacific region, says Jozef Wysen, marketing manager for IBM Asia Pacific Healthcare in Brisbane, Australia.

Wysen says healthcare IT in Japan is comparable if not more advanced than in the U.S., citing a high level of clinical systems integration in Japanese healthcare organizations. And because the Japanese have an insurance-based healthcare system, they have shared similar needs with the U.S. to automate claims processing since the 1970s.

"Some of the best systems I have seen come from Japan," agrees Lun. "I have seen fully automated laboratories where the specimens were never touched by human hands."

A shining case study of Japan’s progress in healthcare informatics is the private, family-owned Kameda Medical Center, a 350-year old organization located in Kamogawa, a seaside resort town southeast of Tokyo. The organization has been developing an enterprisewide electronic medical record and patient management system with IBM since 1990. It has been up and running now for nearly four years across every department--inpatient, outpatient, home health and laboratories. The Windows-based system runs in a mainframe environment over ISDN lines, connected to 1,000 PCs. The system is not entirely paperless yet since Japanese healthcare organizations are required by law to keep paper records. The system provides access to all radiology and ultrasound images, and supports outcomes and cost measurement, clinical guidelines and alerts, according to John Walker, executive VP of the medical center.

Walker says that all but one physician in the enterprise is using the system. Adds Toshitada Kameda, MD, chairman of Kameda Medical Center: "Patient satisfaction has gone up dramatically, and also collaboration between the hospital and the clinics has improved dramatically. All data is shared among all departments and staff." Dr. Kameda says that the system has cut wait time in the outpatient clinic to a mere three minutes. Lun calls Kameda Medical Center a "showcase for Asia."

The organization has spent roughly 2.5 percent of its budget on IT over the last several years and shows no sign of slowing. It will upgrade to a Java and Windows NT version later this year, and a lifetime clinical data repository is in development. Through a spin-off company called Kameda Health Informatics Institute, Dr. Kameda plans to market one of the software modules--a clinical navigation system for disease management and clinical pathways developed by Kameda physicians and patented in Japan. "We are developing relationships between processes and outcomes and cost, and revising the processes systematically," he says. The U.S. and Europe are potential targets for the product.

Singapore: experimental island
A much smaller country with a population of only three million, Singapore is one of the few survivors of the Asian economic crisis, and the island has a number of national healthcare IT initiatives under way. Broadly, Singapore plans to become the medical hub of Asia and is busy drafting deals with Western investors (see accompanying story, "U.S. Providers Bring Innovations to Asia," page 56).