by Jorn Bettin, S23M
The APEC digital health policy dialogue events came about as a result of the pandemic. This year’s dialogue with the theme “Narrowing Health Inequity Gaps through Telemedicine in Adapting to the New Normal” was the third dialogue and was the first held in person. As part of the Aotearoa New Zealand Interoperability Lab (ANZIL), Jorn Bettin (Partner, S23M) was invited to a panel on The Role of Interoperability in Health System’s Digital Transformation and presented on the topic of Distributed – The Future of Data Governance.
The pandemic has shown that fast and efficient data sharing is essential for local healthcare and national and international public health surveillance. Collaboration, trustworthiness, and reliability are among the biggest challenges in a digitally networked healthcare sector. Barriers to access, poverty, and educational failures create a wicked problem for equity in healthcare provision to marginalized groups. Increased collaboration could improve outcomes for individual patients and organizational efficiency/effectiveness, but there is tension between open standards and commercial information architectures designed to keep competitors out.
Simultaneously, the volume and variety of data relevant to healthcare are increasing, and monolithic data repositories are increasingly impractical. The desire to shift to a federated approach highlights the need for an improved understanding of trust in data use/ownership and data quality/validity. This was one of the key messages which was well received.
The two-day conference consisted of several panel discussions and local experience reports from Taiwan, the US, the Philippines, Thailand, Malaysia, Vietnam, Singapore, Japan, and New Zealand. Prof. Chien-Yeh Hsu from the Taiwan eHealth Association used the opportunity to align everyone in the APEC Digital Health Policy Dialogue working group behind the following goals and focus areas:
- Interoperability in the broadest sense
- Distributed patient-centric data governance
- Health data security and privacy, based on a distributed approach
These goals are consistent with the discussions of the Asia eHealth Information Network’s Community of Interoperability Labs (AeHIN COIL) at the APAMI 2022 conference in October, which was also hosted in Taipei by the Asia-Pacific Association for Medical Informatics.
At APAMI 2022, AeHIN COIL members agreed to send a powerful message to governments of Asia that they should:
- Hasten the creation of interoperability labs and
- Catalyze knowledge exchange for secure data sharing in Asia
The interoperability labs involved in this collaboration include:
- SIL-Sri Lanka
- ANZIL-New Zealand
- HDIIL – Hong Kong
AeHIN envisages these country-level efforts to be pooled and used to source funding for pan-Asian investments in digital health infrastructure and develop protocols for use in global emergencies.
Furthermore, the COIL members agreed to adopt and further develop the AeHIN framework “Mind the GAPS, Fill the GAPS” as its message for governments to focus on their Governance, Architecture, People/Program Management, Standards, and Interoperability.
The available regional domain expertise and collective tacit knowledge within the COIL network allow to jointly address wicked problems that:
- No country is in a position to tackle in isolation
- No market / EMR vendor has an incentive to tackle
- No vendor consortium-developed technology standard is equipped to handle
- No university is resourced to tackle in a timely manner
Consistent with the conclusion reached at the APEC Digital Health Policy Dialogue 2022, the AeHIN COIL representatives identified the imperative to establish a dedicated space to come together and solve their common problems.
Three initiatives proposed and supported by S23M address important pan-Asian digital health architecture challenges, as well as the need for a trustworthy space for knowledge sharing and knowledge co-creation, in alignment with the APEC Digital Health Policy Dialogue goals and the AeHIN goals:
- Document and formalize the healthcare service delivery landscape in each country, region, city, and local community (services, collaborations, staff, funding models, insurance/payment integration, etc.)
- Document and formalize local health data governance standards in line with local legislation (data custodianship & privacy legislation, indigenous data sovereignty, etc.)
- Identify and formalize reusable patterns (knowledge) between regions and communities (and between countries) relating to the International Patient Summary (IPS), health data governance, and healthcare delivery services.