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Barriers to smart healthcare

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While technology can help improve the quality of healthcare, it comes with its own set of complications

Singapore aims to be the world's first Smart Nation. National connectivity, electronic medical records, robotics and big data and analytics have been proposed as ways to improve healthcare through better technology.

With the help of a smartphone and Internet connection, many big and small inventions could improve efficiency and quality of care for patients.

Today, appointments can easily be booked via electronic means such as e-mail, SMS, WhatsApp, Facebook messages, apps and Internet platforms.

Medical test results are instantly available on the doctors' mobile phones, which can also receive patients' parameters, like heartrate and blood pressure, in real time.

Increasingly, WhatsApp chat groups, which allow instant communication platform among different doctors involved in the care of their common patients, are used for better discussion on patient care. WhatsApp and Skype are sometimes used as communication between doctors and their patients.

Despite the advances that have resulted in much convenience and efficiency, implementing smart healthcare nationwide is also not as simple as pressing a button.

A smart healthcare system works on cloud platform. A seamless and faultless Internet service is essential. The whole system will be affected if the Internet system is down or hacked. With the recent incidents in Internet security, like ransomware and hacking, many doctors have doubts about cybersecurity.

Maintaining patients' privacy and confidentiality is also important. Only the doctors involved in a patient's care should be allowed to access the patient's medical records.

Currently, most systems in patient care only require a login ID and a password to access. Adding a two-factor authentification may be needed to enhance security.

Cost is another issue. Though some technology appear cheap or even free on installation, many have hidden costs. Some applications are cheap on purchase, but they require specific hardware, specific maintenance team and annual updates which could sometimes cost more than the initial purchase.

Electronic communication between doctors and their patients is also a grey area. The Singapore Medical Council's ethical guidelines dictate that consultation with patients should preferably be done in person for proper assessment. As a result, many doctors are still reluctant to communicate with the patients via electronic means.

A 24/7 kind of communication between patients and doctors, and among doctors, also poses a toll on a doctor's personal and social life.

Traditionally, a doctor's working hours are parallel to the clinic's opening hours. With electronic communications, there will be no end to a doctor's working hours as patients and other medical staff may send information to the doctors involved round the clock.

Data back-up at the local server is a must to ensure our system can continue to function when the Internet is down (or hacked).


Most experts recommend back-up to a local server or harddisk be done on a daily basis.

Before investing into any new technology or equipment, doctors and administrators ought to do their due diligence to assess the full cost involved, and to determine if any new systems or programs are truly cost effective.

We do need more secure yet convenient authentification of identify. If it takes too many steps or too much time to access a patient's data, it would negate the improvement in efficiency. New technology like fingerprint or iris recognition, which is convenient and accurate, can be used to improve security without compromising speed and efficiency.

Lastly, doctors must learn when to set limits.

A doctor does not have to respond to all queries instantly. Any patient with urgent problems should be advised to proceed to the clinic or hospital for proper in-person assessment. For non-urgent requests, a doctor can choose to attend to, and reply to all the requests at a designated and convenient time.

Healthcare has undergone major technological revolution over the last two decades. But at the end of the day, doctors and medical staff also ought to remember that technology cannot replace a human touch in medical care.

Dr Desmond Wai is a gastroenterologist in private practice.