#45 - The Future of Digital Healthcare - Dr. Yong Chern Chet

 

 

“A lot of us in clinical practice always thought of technology as a tool. Today, technology has become not just a “what”, but it’s become a “how”. That means how you practice medicine can be enabled through technology itself."

Dr. Yong Chern Chet is the founding COO of a Southeast Asian region early stage digital health start-up headquartered in Singapore with a simple mission of enabling “Better Healthcare for All”. In this episode, Dr. Chet shared about the current challenges in healthcare and how technology can be used to overcome those challenges. He then shared about his 5C model that outlines the areas where technology can play a part in the digital healthcare, as well as the various technologies and adoption drivers that enable the future of digital healthcare.  

Listen out for:

  • Career Journey - [00:03:54]
  • Current Challenges in Healthcare - [00:13:14]
  • Solving Healthcare Challenges - [00:16:52]
  • Digital Healthcare 5Cs- [00:26:15]
  • Digital Healthcare Technologies - [00:32:05]
  • Digital Healthcare Adoption - [00:42:11]
  • 3 Tech Lead Wisdom - [00:47:12]

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Dr. Yong Chern Chet’s Bio
Dr. Yong Chern Chet (Chet) is the founding Chief Operating Officer with a Southeast Asian region early stage digital health start-up headquartered in Singapore offering key healthcare services such as 24/7 direct access to doctor teleconsultation services, an ePharmacy platform and health & wellness content.

Prior to this, Dr. Chet held various senior management roles leading innovation and digital transformation from within the healthcare industry and beyond. His corporate innovation achievements have been acknowledged via awards like the Enterprise Innovation Award at the 24th Asia IoT Business Platform for the use of Big Data and Machine Learning technology to enhance business operations and IDC’s Asia Pacific Digital Transformation Awards (DXa) 2018 under the Operation Model Master category for Thailand.

Early career experience included time in management consulting as the Healthcare Industries Sector Leader and a Director with the Risk Consulting Practice for Deloitte Southeast Asia. Dr. Yong is a qualified medical doctor trained in the field of surgery and orthopaedics.

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Quotes

Career Journey

  • Technology here is basically used to gain not only more insights but (also) to standardize as well as to improve the customer experience; it meant the doctors were getting their service better. It also meant that their patients were getting their results more accurately and delivered to them in a more timely manner. So it was almost like what we call the triple dividend outcome. The wins on all sides.

  • It’s about how to apply technology not as a “what”, but it’s basically the new “how”.

Current Challenges in Healthcare

  • Whenever you try to access medical services, you either have to get yourself to a clinic, or you need to rush to a hospital, or you need to, let’s say, maybe take half a day off to turn up for appointment with the doctors. If you realize that the situation that most of us will always be in is there’s a lot of wait. Then after that, you get a chance to see a doctor and this doctor is almost never not rushed, always very busy, very hectic.

  • The healthcare system is only mostly available to most of us via a facility-based set up. So it’s anchored on a clinic, a medical center, a hospital, it’s always facility-based.

  • And then you have limited talent within the healthcare field. When I say limited, meaning doctors and nurses are not exactly the most available type of manpower or talent in the region. In fact, there is a global shortage of medical personnel, literally. Not just in the world, but especially in Southeast Asia, which is even lesser in terms of their numbers. So, their time is very compressed, is very valuable.

  • Because of this limitation or the fact that the system is bounded by these physical limitations - access, cost and quality, it’s the three points of this Iron Triangle - means it’s very difficult to get access to healthcare services or talent at a reasonable cost while maintaining great standardized quality. Because you have to compromise in either one or even two in whatever the situation, for most of it.

Solving Healthcare Challenges

  • Number one, if we can create the situation where we do not have the physical constraints.

  • Number two, can we have a better siting of care? So what it means is, let’s say, a surgical specialist should be allowed to do what he or she is best trained for in the most efficient manner and not having to switch the roles or the function every now and then, in fact, a few times a day.

  • The third thing is that we have gone down the track of specialization and super specialization in terms of how we train our doctors for quite some time. But if you recall, long time ago, or rather in the origins of medicine, physicians or doctors have always been generalists.

    • When you look at how we evolve in terms of our disease conditions, a lot of us now have burdens of chronic disease. Chronic disease is potentially also linked to a big lifestyle factor, as well as a general health and wellness influence. So I think we are starting to see our health burdens start to gravitate back towards generalist type of conditions or rather the preconditions before the disease happens.
  • If you take all these three, then you apply a digital lens, it’s basically about focusing on creating better access to health services.

  • How I view what the doctor’s consultation is, you are basically seeking access and you’re seeking advice from a professional. And this professional needs information or data to make a decision.

  • You’d be surprised that nowadays, wearable technology has come quite a way, and you have such rich and advanced medical grade data available.

  • People think that you can just randomly take little bits of tech and put it together. But I think it’s just an acknowledgement to the professionalism of the doctors that we always do things in accordance to the best practices. In fact, we do not say that we are disrupting what the clinicians are doing, but we are actually trying to enhance and enable them.

  • So we create the connectivity functions. That means we link the user or the patient to the doctor over a distance. This will help to take away the access issue.

  • From a cost perspective, of course, you take away the physical infrastructure, as well as the fact that we can help enhance the productivity of the doctor.

  • If it’s online consultation, if it’s very focused, and if it’s assisted, that means before the patient even puts him or herself in front of the doctor, there’s a simple triage where the symptoms are presented and data is already collected.

  • The doctor can then focus on what we call clinical decision-making, which is the key function and the value of the clinician in terms of a medical consultation. It’s about focusing and it’s about removing the waste.

  • We create this capability, where we connect patients, we enhance the doctors' productivity. And if you notice, I talk about the triage process and the ability to channel the right patients to the right doctors. So everything’s done digitally. That means you don’t even need to travel from one clinic to another, or you don’t need to go to a GP and then you have to take another transport to the hospital and enter the hospital.

  • A lot of us in the clinical practice always thought of technology as a tool. A tool meaning: is it a device? Is it an electronic medical record? Or is it an X-ray? But today, technology has become not just a “what”, but it’s become a “how”. That means literally how you practice medicine can be enabled through technology itself. And this is basically the power of digital and the whole cloud capability.

Digital Healthcare 5Cs

  • Where digital health is going, I use a 5C analogy:

    • We’re talking about Consult capabilities, which includes tele-medicine, remote consultation, remote monitoring, wearables and all that.

    • Second C, which I refer to as a Commerce function. Access to medication and treatment can be technically done remotely as well. Imagine, with a proper safeguards and processes as well as safety considerations, if we can get medicines literally prescribed and fulfilled and delivered to us.

    • The third C to me is Content, a place where we can get access to trusted and relevant medical content, and this will help with our health and wellness awareness.

    • The fourth C is the Care component or rather C for chronic disease. The health burden that we will have going forward, a lot of us, or at least the people we know, will have one form or another of chronic disease. For example, diabetes, hypertension, even cancer is considered a chronic disease today. You’re talking about chronic disease management, close follow-up, and of course monitoring and maintenance.

    • Ultimately, if you talk about empowerment, is the Community, meaning it is our own self-action in terms of taking care of ourselves as well as coming together as a community. In terms of having the support, and knowing that there’s someone out there as well, who’s in a same situation.

  • I think the first 3Cs - so consult, commerce, and content - actually come hand in hand.

  • This 5Cs I think is the challenge as well as opportunity for digital health. Because if you think about it, if technology can solve the problems that are captured in these five areas, this is where the impact will be.

Digital Healthcare Technologies

  • The first technology is the upcoming 5G space. This is basically connectivity infrastructure. It’s basically about low latency, high bandwidth transmission of data. The colloquial term I like to think about 5G is remote. That means it enables remote connections. It’s really fast, and it’s real time. This technology enables a better way to connect people over distances. It’s enabled to transmit a lot more information, a high resolution.

  • Building on 5G, we have this concept of edge computing. So instead of having to send that information to a centralized server for AI processing, for example, you can actually bring the processing capability nearer to the edge, meaning nearer to where you are actually needing the capability.

  • Now from 5G, I’ll move to cloud computing. And of course, what is the application of cloud is basically about running, let’s say, AI processes or AI functionalities. The AI system, or the machine learning algorithm, actually starts to learn from the process, and then eventually it starts to become an assistant to the process. Later on, it might be the primary party doing the interpretation where then the doctor just performs the role (of) the reviewer.

    • When the doctor is paired with the AI assistant or AI capability, straight away the doctor becomes like a superhero. It’s like enhanced detection capability, enhanced knowledge, faster processing, more efficient.
  • Robotics, at this point today, is still a bit in the less-advanced stage. To me in medicine, the robots that I’m most excited about are not the robots that look like human beings. There are roles for companion robots and physical assistant robots, but the robots that I’m most excited are the really tiny ones, the ones that potentially can go nanoscale. We’re talking about interventional robots: robots or assisted tools that can go inside the body, visualize internal structures (and) provide extremely enhanced degree of articulation.

    • The weird analogy here is imagine the surgeon can become an octopus. An octopus (that) can operate on you because with the tentacles, it gives the doctor a way better capability of getting around the organs and the body to do the procedure. So that to me, I think it’s where robotics can be applied.

Digital Healthcare Adoption

  • Adoption to me, I look at 3 areas:

    • One is what is the overall level of acceptance of technology that we have. That’s to me, a change of behavior.

    • The second thing is from a needs basis. A lot of times we are very reluctant to change. But if let’s say our environment changes and there is a need for us to adopt a new way of doing things, likely that will actually help the transition.

    • The third thing is actually the people in healthcare themselves. We’re talking about the practicing community, and the fact that we might be a bit risk averse. I will say that, there’s a very good reason why people are risk averse in healthcare. I mean, no one wants to take unnecessary risks with anyone’s health.

      • It’s very important that we are able to show the benefits very clearly, very professionally, and using data. So it’s not about hearsay, it’s not about because it’s trendy or anything like that. No. It’s really about, “Is it truly better for the patient?”

      • You can even create a scenario where the technology or the new alternative can even give you better data. And then I would offer that as a solution. So to me, we have to offer things that are better. It’s never about compromising.

  • It’s always between these three factors. It’s about going in reverse. It’s about providing a better solution. The third point is about getting the actual practicing community to buy in and to support. Then the second one is very much asking about what is the prevalent level of acceptance. And of course at the very most fundamental basic: is there overriding need or urgent change in environment that caused a new solution to be found?

3 Tech Lead Wisdom

  1. How you approach things in life, you always need to be curious about how things are.

    • Always ask questions. Don’t be shy to do it. You need to be comfortable in creating new things. Because if you’re not able to create new things, technology will always remain a tool. Nowadays, we want technology to be a new " how", a way of doing things.

    • You are never able to do it alone because I think tech is why things are happening everywhere all the time. A personality trait that I will say that technology leaders should have, which is (curiosity), to be able to create, and to be collaborative across all industries and specialties.

  2. Look for good mentors.

    • Be exposed to their thinking, their aspirations and their vision. Mentors make all the difference.
  3. Empathy is very important.

    • Relating back to how you design technology to be used by others, kindness and understanding is key.
Transcript

Episode Introduction [00:00:59]

Henry Suryawirawan: [00:00:59] Hi everyone. It’s great to be back here again with another new episode of the Tech Lead Journal podcast. Thanks for spending your time with me today listening to this episode. If you haven’t, please subscribe to Tech Lead Journal on your favorite podcast apps and also follow Tech Lead Journal social media channels on LinkedIn, Twitter, and Instagram. And you can also make some contribution to the show and support the creation of this podcast by subscribing as a patron at techleadjournal.dev/patron, and help me towards producing great content every week.

For today’s episode, I am happy to share my conversation with Dr. Yong Chern Chet, or Dr. Chet in short. Dr. Chet is the founding Chief Operating Officer of a Southeast Asian region early stage digital health startup headquartered in Singapore with a simple mission of enabling better health care for all. In this episode, Dr. Chet shared about the current challenges that we are facing in healthcare and how technology can be leveraged to overcome those challenges. Dr. Chet strongly believes that technology should become not just a “what”, but it must become a “how”. He then shared about his 5C model that outlines the areas where technology can play a part in the digital healthcare, as well as the various technologies and adoption drivers that could eventually enable the future of digital healthcare.

I hope you will enjoy this episode. Consider helping the show by leaving it a rating, review, or comment on your podcast app or social media channels. Those reviews and comments are one of the best ways to help me get this podcast to reach more listeners. And hopefully they can also benefit from all the contents in this podcast. So let’s get this episode started right after our sponsor message.

Introduction [00:03:14]

Henry Suryawirawan: [00:03:14] Welcome everyone to a new episode of the Tech Lead Journal. Today I have with me, Dr. Yong Chern Chet, who is the founding Chief Operating Officer of a Southeast Asian region digital health startup headquartered in Singapore, that has a simple mission, but very profound, which is to enable better healthcare for many people, if not for all. So today I’m very happy to see you Dr. Chet, and looking forward to have this conversation about digital health and healthcare in general.

Dr. Yong Chern Chet: [00:03:43] Hi, good morning, Henry. Thanks for having me. It’s a pleasure to be on your show and I’m looking forward to discuss some interesting ideas around technology, and obviously we’re going to talk about healthcare.

Career Journey [00:03:54]

Henry Suryawirawan: [00:03:54] So maybe Dr. Chet, in the beginning can you help to introduce yourself for the audience who are not familiar with you? And also maybe you can tell your highlights and turning points in your career.

Dr. Yong Chern Chet: [00:04:04] Oh, okay. This is going to be an interesting story. I started my career as a medical doctor. So I’m basically a clinician who’s trained in specialty in surgery and orthopedics. But then, after few years being in practice, I started what they call “the journey to the dark side” as what clinicians would like to refer to it. So, what it means is I started to move into different areas of practice within healthcare. From the public sector, I got the opportunity to join Raffles Medical group, which is one of the major private provider groups here in Singapore. It was an opportunity for me to actually start to transform myself from a professional sense. So what I did was I moved into emergency care, which gave me the freedom to work after office hours. Plus this was actually an opportunity for me to get involved in the management of the business. So I was very fortunate in Raffles, where I had great seniors and mentors that actually work closely with me, and I learned a lot from the beginning as a junior management personnel. Even got the chance to, in fact, have direct face time with Dr. Loo Choon Yong himself, who is the Chairman and CEO, as well as founder of Raffles Medical. I rotated through operations management, insurance, even got involved in some of the strategic development works of the business at that time. This was in middle 2000 onwards where expansion of healthcare was all the rage. So, got exposed to looking into different geographies around Southeast Asia, and of course into China market as well. So you can imagine from a purely clinician role, this was quite an eye opener.

With that said, I think I got my first taste of venturing out from the clinical area, and I was hooked. At that point, I mean, the option of doing, for example, MBA came up, but I was a bit more adventurous. I wanted something a bit more real. I was also then had the chance to actually take up a role with Deloitte, it’s basically a consulting, advisory business, and it’s a partnership that is a global footprint. I was able to join the Deloitte team in the Southeast Asia practice. It was headquartered in Singapore, but the clients that we had were all over Southeast Asia. Of course, being a global practice, I had the chance to also get involved in work that was very much international. So from America, from Japan, Korea, Asia, Pacific, all over. Basically again, I was still anchored in healthcare, so very much being the subject matter expert go-to within the practice. I was working closely with what we call the functional team. From audit to strategic consulting, technology, even risk management, which I was mainly based. In the end of almost five years with Deloitte, I ended up being the lead for life sciences and healthcare practice, and at that point got very heavily involved in innovation as well as future healthcare. This cumulated in a center of excellence construct that was actually a collaboration between Deloitte and Singapore EDB. So it was a bit of a think tank, a bit of a future foresight position at that point. That was basically where you can see that slowly I’m transitioning into a technology as well as a future foresight subject matter expert.

After five years, usually the option for senior positions in the firms such as a partnership track started to open up. But at that point, me being someone who likes to challenge myself, I wanted to see how I would do from a corporate side. I was actually approached by one of the senior leaders from the Parkway Pantai Group, and this is under the IHH umbrella. Parkway Pantai is the management of basically major hospitals in Singapore, Malaysia, and right now they have footprint in India in Europe, as well as in China. I was asked to go over to take over the running of the clinical laboratory division. It was a very interesting appointment because it was there I had the opportunity to bring digital transformation, and to apply a bit of business turnaround methodologies, basically to achieve the business targets and to improve the customer experience. So this was, I would say, the first time where I witnessed the power of digital, and how it can really make a difference in healthcare operations. The diagnostic division, being the clinical laboratory, was a field that was very rich in data, and it also has a very operational component. Basically, technology here is basically used to gain not only more insights, but it was used to actually standardize as well as to improve the customer experience. Customer experience here is basically, it meant the doctors were getting their service better. It also meant that their patients were getting their results more accurate and delivered to them in a more timely manner. So it was almost like what we call the triple dividend outcome. The wins on all sides.

After that, I think my career took an interesting turn where I had the good fortune of meeting Chanond Ruangkritya. He is basically the Chairman and CEO of Ananda Development. Ananda is basically one of the fastest growing real estate developers in Thailand. They specialize in high rise modern residential developments, mainly in Bangkok metropolitan area. So I would say again, going back to the theme that I have in my career, where I’ve been fortunate enough to actually have opportunity to (be) mentored (by) people who I think are very outstanding. So Chanond is, I would say, nothing short of Maverick keys. Basically, very worldly, in a sense. Him being a self-made businessman, built this company from scratch and being really very successful in a very young stage of life. He was a big fan of technology, I would say, and about exponential thinking. So it’s about how to apply technology not as a “what”, but it’s basically the new “how”. He wanted to think about his company, which is a real estate development company, as a technology company in the field of construction and residential real estate. We got connected. We began to share ideas and very soon we realized that we have common love for tech. I’ve never been a technical person, but I’ve always looked at technology as a way towards achieving good outcomes.

I was given the chance to go over and to lead innovation and transformation within this organization. It’s basically the Chief Innovation Officer role. Very much in this position, I led corporate innovation and transformation. But at the same time also, Ananda and Chanond himself was very much involved in creating and supporting the Thai startup ecosystem, and basically connecting the local startups as well as the community to the startup centers all over. I was in Bangkok for three years. We did the transformation road map. I was looking out towards what was the next stage that I could bring to the table. So happens, I would say again, be it by chance or by timing, I read about a joint venture between Ping An Good Doctor and Grab. Ping An Good Doctor is the largest digital health platform in China under the Ping An insurance group, a very established basically innovation leader in the field. And then Grab, probably most people would be familiar with Grab in Southeast Asia, the largest online, offline platform started out with transport services. But now, basically, considered like a super app. And I think Grab right now get a lot of exposure because they’re heading for reverse IPO. I actually shared this news with Chanond, and he was literally excited on my behalf. He said, “Hey, this sounds like something that you should be part of. Healthcare, digital transformation, opportunity to build something new. Literally stuff that you go crazy about.”

I would say, with his blessing, and I’m very thankful. I actually started to figure out how can I get involved and literally I didn’t have the inside channel to this. So what I did was I WhatsApp literally everyone on my contact list. That was quite a lot of people asking if anyone could help me to introduce myself to the people who were looking to put the JV together in terms of the operating team. So finally, I got myself through a couple of rounds, speaking to people at the Grab side. I still fondly remember having a walking interview with Tan Hooi Ling, which is the co-founder of Grab, and talking about the impact that we wanted to deliver to the region using digital via the Grab Joint Venture with Ping An, and trying to make sure that we can bring new ideas and new solutions for healthcare. That was how basically I got into this role. That was about almost two years already.

So that has been my journey so far. Thanks for listening. If I haven’t lost you, it was a pretty long one, but I just want to highlight basically the different roles I’ve been in different forms. But I think the core purpose is very much still within healthcare. And me, personally being a number one fan of technology, and how I find opportunities to always solve problems using this approach, or rather finding ways to create new things.

Current Challenges in Healthcare [00:13:14]

Henry Suryawirawan: [00:13:14] So thanks for sharing your story. I think it shows a lot of things from you, which is little bit of adventurous as well. You started from the traditional healthcare line, and then moving on to multiple places, got involved in technology, and also a lot of hustle as well. When you shared the story of getting connected with the people from Good Doctor Technology, I think that’s pretty interesting. Speaking of healthcare in the Southeast Asian region, what kind of problems out there that needs to be solved?

Dr. Yong Chern Chet: [00:13:40] Okay. I will say this is quite a fundamental pain point for the region. If I take a step back and describe the situation to you, you might be very familiar as well. Whenever you try to access medical services, let’s say even for minor condition, or if let’s say you have an elderly parent who needs to be treated for, let’s say a chronic condition or some of us, we either need an elective surgery, or we know someone who actually has to be attended to an urgent basis for healthcare. It doesn’t matter whether in Singapore, Indonesia, Thailand, Vietnam, Philippines, there’s a common process, if you think about it. You either have to get yourself to a clinic, or you need to rush to a hospital, or you need to, let’s say maybe take half a day off to turn up for appointment with the doctors. So very common scenario here. If you realize that the situation that most of us will always be in is there’s a lot of wait. So you go to a facility, a hospital, whatever, you register, and then you’re asked to wait. Then after that, you get a chance to see a doctor and this doctor is almost never not rushed, always very busy, very hectic and for good reasons, right? I mean, there’s people waiting to see him or her. He has to manage the clinic load. At the same time, for those in surgical specialties, they actually have to probably go off to theatre after that to clear their lists. If you’re on call, you have to be ready to receive emergency cases. So sometimes you might get a situation where you’re seeing the doctor halfway in the clinic and he or she has to excuse herself. Sometimes it’s not very pleasant for us who have waited for a long time.

The reason why I’m giving you this whole scenario here is because the healthcare system is only mostly available to most of us via a facility based set up. So it’s anchored on a clinic, a medical center, a hospital, it’s always facility based. And then you have limited talent within the healthcare field. When I say limited, meaning doctors and nurses are not exactly the most available type of manpower or talent in the region. In fact, there is a global shortage of medical personnel, literally. Not just in the world, but especially in Southeast Asia, which is even lesser in terms of their numbers. So in that sense, their time is very compressed, is very valuable. If you think about it, this is basically a concept that I refer to as the Iron Triangle of Healthcare. Because of this limitation or the fact that the system is bounded by these physical limitations, access, cost and quality is the three points of this Iron Triangle. So what it means is it’s very difficult to get access to healthcare services or talent at a reasonable cost while maintaining great standardized quality. Because you have to compromise in either one or even two in whatever the situation, for most of it. Of course, in very rare circumstances, very fortunate segments of society, they have great access, cost is not a problem, and the fact that the quality is great. But for the greater majority of us in the region, and this region has almost, I think, 600 million over people, the problems about this constraint is there.

Solving Healthcare Challenges [00:16:52]

Henry Suryawirawan: [00:16:52] That’s quite a number of challenges out there. Thanks for sharing it, Doctor. So how do you then solve this problem?

Dr. Yong Chern Chet: [00:16:59] So, if we can create the situation where we do not have the physical constraints, number one. Number two, can we have a better siting of care? So what it means is let’s say a surgical specialist should be allowed to do what he or she is best trained for in the most efficient manner, and not having to switch the roles or the function every now and then, in fact, a few times a day. I mean, if you think about it from a biological perspective, what the analogy is, you’re going up to the heart, and you say, “Hey, heart. You’re great at pumping blood, right? That’s what you do well, best. Uh, don’t mind, can you help me to take over the function of the stomach for a while? Because it’s very busy, we need to clear the stomach now. Can you go and help out?” And then after that, maybe, “Oh, can you stand in for the brain? Because the brain is not available, is caught up in an emergency.” And then suddenly you get caught back to your area of specialty, which is the heart to pump the blood, and say, “Okay, quickly now, faster, quickly pumping blood to clear the backlog.” I mean, it sounds so silly. It sounds so cartoonish, but this is what’s happening in the health system. That’s how our medical resources are allocated to different things at different times of the day, and they’re just all over the place. So, right site of care is something that we very welcome as health professionals. How can we achieve that?

And then I think the third thing here is something that I address with that very silly story about specialization, is that we have gone down the track of specialization and super specialization in terms of how we train our doctors for quite some time. But if you recall, long time ago, or rather in the origins of medicine, physicians or doctors have always been generalists. Because it was the study and understanding of the environment, as well as the human body, that was the genesis of modern medicine, as we know today. So the fact that, be it the combination of again, facilities based resources or call it our health policy or the payer system, which is how we’re funding our healthcare, these doctors have gone down specialization track. But then, when you look at how we evolve in terms of our disease conditions, a lot of us now having burdens of chronic disease. Chronic disease is potentially also linked to, I would say, there’s a big lifestyle factor, as well as a general health and wellness influence. So I think we are starting to see our health burden start to gravitate back towards generalist type of conditions or rather the preconditions before the disease happen.

If you take all these three, then you apply a digital lens, coming back to answer your question, it’s about basically focusing on creating better access to health services. So instead of getting people to go down to clinic or hospital, can they get the same doctor’s consultation service through their mobile phones, for example? We already have so much interactions over our mobile devices. We are on chat interfaces. We are on video calls. We are connected through so many ways. If you asked me how I view what the doctor’s consultation is, basically you are seeking access and you’re seeking advice from a professional. And this professional needs information or data to make a decision. So this data could be symptom data, for example, do you, or do you not have a headache? Or your stomach cramps. How often a day? Where are they located? What is data? Data could be your heart rate or the sound of your breath. So things like this can be translated from a physical world reading into a digital world capture of data. It either could be literally through the interface where you’re having the consult itself. Nowadays we have high definition cameras, as well as ability to transmit real life information during the interaction. Or it could be a prerecorded, historical reading of your heart rate or even oxygen saturation. I’m talking about data that can be readily available from just your regular smartwatch. You’d be surprised that nowadays, wearable technology has come quite a way, and you have such rich and advanced medical grade data available.

Previously, to get oxygen saturation reading, I hazard that you probably have to make yourself available at a hospital or even at the emergency department, or the ICU. It’s not even regularly available in the general wards. But nowadays you get like a day long kind of reading and hours worth of data from someone’s smartwatch, which he or she bought herself. So this is basically the democratization of technology here. What we are doing is we are saying, okay, how can we make use of all this tech that’s already out there with the public, and how can we bring it together to create a system? So I think this is very important. People think that you can just randomly take little bits of tech, and put it together. But I think it’s just an acknowledgement to the professionalism of the doctors is that we always do things in accordance to the best practices. In fact, we do not say that we are disrupting what the clinicians are doing, but we are actually trying to enhance and we’re trying to enable them. So that’s the approach that we have. So we create the connectivity functions. That means we link the user or the patient to the doctor over a distance. This will help to take away the access issue. To give you an example, if let’s say the doctors are all based in Jakarta, and if the user or patient is in Kalimantan, can you imagine previously without technology, what endeavor it would actually take to get that person to see a doctor. But today, indonesia, it is literally a press of a button on the smartphone. And likewise, the doctor can receive this patient over his or her personal device. So that’s the access part.

From a cost perspective, of course, if you take away the physical infrastructure, as well as the fact that if we can help to enhance the productivity of the doctor. The scenario here is for a doctor to see, let’s say, 10 patients physically. Because of a lot of the manual processes that the doctor also has to fulfill in order to actually turn around patient, the doctor would take probably about, let’s say, 20 minutes (each) end-to-end. If it’s online consultation, if it’s very focused, and if it’s assisted, that means before the patient even puts him or herself in front of the doctor, there’s a simple triage where the symptoms are presented, and data is already collected. For example, blood pressure, temperature, pulse, things like that. So the moment the person is in front of the doctor, he’s already got initial summary and a triage of what’s going on, plus the relevant information. The doctor then can focus on what we call clinical decision-making, which is the key function and the value of the clinician in terms of a medical consultation. It’s about focusing and it’s about removing the waste. So this doctor now, assuming it’s a simple, straightforward general practice case, can probably turn around a patient in 8 to 15 minutes. It’s not much, but the fact that if you can shave-off, let’s say five minutes from each patient that you see, or even more sometimes, you really actually get to see more patients within your eight-hour shift. I sound very tactical, but for those of us who have actually worked as doctors and run clinics before, you will really understand, you appreciate what I’m saying. In fact it could mean a difference between you being able to have your lunch or not that day, if you can shave-off five minutes of each of the patients that are literally sitting outside your waiting room and they’ve been waiting for you for, let’s say one to two hours already. In fact, there’s a saying in this part of the world is three hours wait for three minutes consult. By no means, I’m not trying to criticize our medical service, but it’s something that literally I hear from being out there in the streets.

And then coming back to the fact that we create this capability, where we connect patients, we enhance the doctors productivity. And if you notice, I talk about the triage process and the ability to channel the right patients to the right doctors. So everything’s done digitally. That means you don’t even need to travel from one clinic to another, or you don’t need to go to a GP and then you have to take another transport to the hospital and enter the hospital. They have to decide where to send you, meaning you arrive at A&E, they say, okay, is this a general surgery case? Or is this (an) obstetrics and gynecology situation? This literally happens every day in hospitals. Here, this process happens online. The doctors all sitting comfortably in the offices reviewing the information. The user is at home, at least while it is appropriate to be. From the moment that we detect that the patient needs to be seen in a more urgent manner. Of course, they will be asked to go to a hospital. I realized that this is more of a technology discussion we’re going to have. So, it’s really to nail down how technology can actually be so beneficial and helpful in the clinical context. I just want to maybe use this chance to make a statement to say that a lot of us in the clinical practice always thought of technology as a tool. A tool, meaning is it a device? Is it an electronic medical record? Or is it an X-ray, for example? But today, technology has become not just a “what”. But it’s become a “how”. That means literally how you practice medicine can be enabled through technology itself. And this is basically the power of digital and the whole cloud capability.

Digital Healthcare 5Cs [00:26:15]

Henry Suryawirawan: [00:26:16] That’s a very interesting way of looking at how technologies can help to overcome those challenges. And I know that you have a way of looking at all these, how they could interplay together, which you coin as 5Cs. Can you share further about it?

Dr. Yong Chern Chet: [00:26:31] So, the services that mainly, I think where digital health is going, and this is my view in terms of, from today going forward. I use a 5C analogy. So we’re talking about the consult capabilities, which is including tele-medicine, remote consultation, remote monitoring, wearables and all that. So that’s the consult function. You coupled that with the second C, which I refer to as a commerce function. But actually, probably the term is not appropriate, but what it means is after you get a diagnosis and recommendation from your consult experience, you need to get, let’s say, therapies or treatment. So it’s like online pharmacies. Access to medication and treatment can be technically done remotely as well. And I think everyone listening to this call today is ultimately familiar with e-commerce. But imagine with a proper safeguards and processes, as well as safety considerations. If we can get medicines literally prescribed and fulfilled and delivered to us. So that’s a second C. The third C to me is I call it content. Because I think overall, all of us are looking for a place where we can get access to trusted and relevant medical content, and this will help with our health and wellness awareness. I think the first three Cs actually come hand in hand. So consult, commerce, and content. And that’s the starting point. And in fact, if you look at what’s available today all around the world, most of them provide services in these three areas. In different forms, different business models, but the function that they serve to the user is described by these 3Cs.

Going forward, if we want to have a future view, I’ll add on two more Cs. So to me, the fourth C is the care component or rather C for chronic disease. As I said, the health burden that we will have going forward, a lot of us, or at least the people we know, will have one form or another of chronic disease. For example, diabetes, hypertension, cancer is even considered a chronic disease today. Because you technically can live with cancer or you go into remission then comes back, things like that. Sounds not so pleasant, but this is a reality that a lot of us will be living with cancer, and it needs to be managed. It needs to be monitored, and health needs to be maintained. In the care component, which is the fourth C, you’re talking about chronic disease management, close follow-up, and of course monitoring and maintenance.

Ultimately, if you talk about empowerment, which is something that I’m very big on, and I think we are still not there yet unfortunately, is the community. Meaning it is our own self action in terms of taking care of ourselves as well as coming together as a community. If you’re diabetic, the diet that you have, the fact that for type one, they have to inject themselves instantly throughout the day. So it’s a kind of a lifestyle and it’s something that will not go away. In terms of having the support, and knowing that there’s someone out there as well, who’s in a same situation, a very simple question that you have, “Oh, where can I find a place to have lunch today in Jakarta CBD that is healthy, and it doesn’t throw my sugar off?” So that’s the community part, right? So from this five Cs, I think this is the challenge as well as opportunity for digital health. Because if you think about it, if technology can solve the problems that are captured in these five areas, this is where the impact will be. I really honestly believe that even on a personal level, especially if you know someone with chronic disease, this will actually open up a lot of options and it actually makes life a lot easier.

Remember when we started this conversation, all systems, whenever you need any healthcare service or therapy, you only have one option, which is you have to bring yourself to a clinic, likely there’s going to be a queue or wait, and likely, the doctor’s going to be too busy to really give you a lot of his or her time. So imagine if now we have alternative way of delivering healthcare, where there’s allocation of resources and support via digital platform, you can check-in with your designated doctor or your diabetic coach, then you can get your diabetes managed and maintained, and you can get your regular treatments. We’re not having to go through that whole process, right? Please do not misunderstand, that process, it does serve a function. If you have an acute condition, or if you have a potential heart attack, you bring yourself to emergency department, no doubt. So it’s not about saying that one is better than the other. It’s about saying really where is the right place to seek medical care. I think for those of us in Singapore, there’s actually a big mis-siting of care where people with cough and colds turn up at emergency departments, and it takes up a slot, or it takes up the doctor’s time, no matter how small, but if you accumulate that up, you’re taking away probably 15 minutes that they could have used to attend to someone who’s having a heart attack, it needs to be resuscitated.

If you realize that up to now I’ve not even brought up the fact that we have COVID-19 in the region. Even for that very reason itself, you can see the usefulness of having this alternative system of healthcare. It makes a lot of sense because if you are not acutely ill, and you are just wanting to maintain your diabetic condition, you really don’t want to bring yourself down to a hospital clinic, unless it’s necessary. That’s basically how I think digital health plays a role, and I think there’re lots more downstream opportunities. All of us are very aware of our state of wellness and our state of health, I would say. So if there’s anything positive, I think there’s a heightened awareness about wellness and wellbeing.

Digital Healthcare Technologies [00:32:05]

Henry Suryawirawan: [00:32:05] In terms of some of the technologies that enabled all these digital healthcare, you have mentioned a couple of technologies out there. But you can probably summarize some of the big technologies that actually enabled all this, what would be those technologies?

Dr. Yong Chern Chet: [00:32:17] Okay. This is a very good question. If we now think back about what we talked about and how we frame the challenges in healthcare and the approaches. So I’m going to bucket certain technologies into how they can serve this use case. So I think the first technology I’ll go for, let’s say, we talk about the upcoming 5G space. This is basically connectivity infrastructure. It’s basically about low latency, high bandwidth transmission of data. The colloquial term I like to think about 5G is remote. That means it enables remote connections. It’s really fast, and it’s real time. This technology enables a better way to connect people over distances. It’s enabled to transmit a lot more information, a high resolution. So we’re talking about image information, or real-time dynamic information, let’s say the way the heart valve is beating, or how a person is literally doing an operation at a remote site, and how can an expert actually observe and guide the person? That’s about the real timeliness about the high definition information that needs to be transmitted.

And of course, responsiveness is very important. You don’t want to delay. So this actually enables very high-tech kind of treatments. I mean, you’ve heard of surgical robots, right? So literally it’s now even possible to operate a robot over long distances, that is actually at the site of the patient, but the operator is actually miles away. Sounds a bit like science fiction, but in terms of all these possibilities, it actually opens up a lot more options. So if let’s say that surgeon is only available in a city center medical center, but the patient is far away or even in another country, for example, I mean, this is the future scenario. You might be able to get this doctor to be part of the procedure. We’re talking about like neurosurgical procedures where very high expertise, the limit is the fact that we don’t have a neurosurgeon in every corner of the block. They’re hard to find. So this sort of scenarios. So again, it answers to the access, then the scarcity of resource kind of situation. So that’s 5G to me. Now, building on 5G, we have this concept of edge computing. So meaning instead of having to send that information to a centralized server for AI processing, for example, you can actually bring the processing capability nearer to the edge. So nearer to the edge means nearer to where you are actually needing the capability.

So now from 5G, I’ll move to cloud computing. And of course, what is the application of cloud is basically about running, let’s say, AI processes or AI functionalities. Okay. So what is AI? AI to me, machine learning is about having the ability to actually create learning systems. That means it can be trainable models. It can be capabilities that initially led by, let’s say, a human or a manual expertise or process, meaning a doctor or an expert is actually giving the interpretation of outcome. The AI system, or the machine learning algorithm, actually starts to learn from the process, and then eventually it starts to become an assistant to the process. Later on, it might be the primary party doing the interpretation where then the doctor just performs the role, the reviewer. So here from 5G to cloud computing, edge processing and machine learning, you are able to literally set up capabilities almost from an unlimited sense. So when I say unlimited, meaning you’ve already overcome distance. You’ve overcome a scarcity of resource. Because this AI can scale, not like how you can scale doctors and nurses, but we can scale from a digital perspective. It’s constantly learning. It’s informed by the best practices still because it doesn’t operate in isolation. In fact, it is trained to always follow the human interpretation.

How do we think about the use case? Imagine in the future where we can do, let’s say, a video based consultation. Previously we couldn’t do this because the bandwidth wasn’t high enough, and we didn’t have edge computing. So now let’s say, we do have all this, the AI can start to literally do analysis on to the direct video feed, and in real time when this patient is speaking or trying to do a certain action such as a physical examination scenario. This is my idea of how we overcome the fact that we cannot examine a patient remotely. But guess what? In the future, I have this idea where we can, because it’s about getting the right data. So, for example, we’re doing a neurological examination where doctors would get the patient to actually look into certain views of vision, to track the eye movements. Even get them to squint their eyes or show their teeth because it’s to test the facial muscles. So imagine when the patient is doing that, the AI actually is also analyzing together with a doctor, and is picking up signs to say, “Oh, this patient looks like there’s a bit of asymmetry in the facial muscles on the left.” Or the fact that when the patient is trying to do a particular hand movement, which again is part of the physical examination, the AI would say, “Oh, it looks like the range of movement for the left elbow is limited versus the right.” Things like this really help the doctor to pick up on signs faster, and it straight away captures the information of the physical examination automatically.

So this is a very futuristic way. But it’s a sense of when the doctor is paired with the AI assistant or AI capability, straight away the doctor becomes like a superhero, right? It’s like enhanced detection capability, enhanced knowledge, faster processing, more efficient. I like to use this term, we want to make the doctor like Tony Stark, which is Iron Man in Marvel. So Tony Stark the human, the doctor, has AI assistant called Jarvis, and Jarvis is always giving the doctor the relevant information and getting his schedule sorted and things like that. Basically, what it means is the doctor’s using a consult system where the outside world is interacting with a doctor through this suit of armor. So the consult system is the suit of armor, the Iron Man suit. The AI assistant for the doctor is the Jarvis in equivalent. So you can imagine, Tony Stark the human versus Tony Stark when he’s inside the Iron Man suit, the capability is much more advanced. So here, same kind of analogy where it’s building on 5G connectivity, cloud computing, and AI.

Now, let us go one more step further. Since I talked about Iron Man, let’s talk about robots. Robotics, at this point today, is still a bit in the less advanced stage. But to me in medicine, the robots that I’m most excited about are not the robots that look like human beings. There are roles for companion robots and physical assistant robots. But the robots that I’m most excited are the really tiny ones. The ones that potentially can go nanoscale. So we’re talking about interventional robots, that means robots or assisted tools that can go inside the body, they can visualize internal structures. They can provide extremely enhanced degree of articulation. So imagine if I’m trying to let’s say, operate on an intestine in the body. Last time, I literally need to make a decision where I need to get through the layers of skin, muscle and connective tissue, and I need to open up the abdomen itself for me to access the intestines. That’s called open surgery. Now we have laparoscopic surgery where we just make small incisions, and you put in probes. Imagine from this level the probes that you put in, they’re not static, but you put in articulatable robots. That means robots that go in, they can turn around 360 degrees, and they can bend over and go in between organs. That’s literally robotics there, but it’s robotic in a very like tentacle fashion. The weird analogy here is imagine the surgeon can become an octopus. An octopus (that) can operate on you because with the tentacles, it gives the doctor a way better capability of getting around the organs and the body to do the procedure. So that to me, I think it’s where robotics can be applied.

And of course, with a lot of interventional diagnostic. That means, instead of just doing X-rays, MRI from outside the body, imagine you can do imaging from inside the body. That means you can travel through the access, be it through a venous access, or be it through the digestive track. And then you can get the image from within the body. So you don’t have to expose the person to so much of the radiation, because you’re already much nearer to your targeted area, and you can do much more high resolution scans. If any of you remember how we have advanced in terms of our computer image, we used to have a CRT monitor, CGA, VGA. I’m talking about graphics here. And then now we literally have all the way to 4K monitors, OLED, 8K even higher definition. So imagine X-rays and MRIs have also gone through that process where we started out with lower resolutions, and we’re getting higher and higher resolution scans. In fact, nowadays we’re even using AI to build the image to create a higher resolution, and to overcome the areas where the data is actually not so refined. So imagine if then we can help this AI by getting even better resolution.

So it kind of offered five areas of technology where I think this can make a difference. And I’m not even going down the fact that machine learning, for example, can help doctors process huge amounts of information and medical data. Again, becoming the doctor’s assistant role, like Jarvis, just bringing up the relevant information, the right treatment recommendations, and the right time for the right scenario.

Digital Healthcare Adoption [00:42:11]

Henry Suryawirawan: [00:42:12] Related to adoption. So as we all know, healthcare is booming now. A lot of new technologies from wearables, telemedicine, and all that. But still there’s perception that if you are not healthy, you need to go to the doctor, and you know, be physically checked. I mean, it’s just probably the old mindset as all technologies. Like last time, for example, ATM. We didn’t go to ATM straight away because we thought it was insecure. But the same thing here probably applies to digital healthcare, right? How do you think some of the things that people should have in terms of the adoption to the traction in terms of digital healthcare, where people actually can trust, and see it as a new norm in the future?

Dr. Yong Chern Chet: [00:42:50] Okay. So adoption to me, I look at two areas. One is what is the overall level of acceptance of technology that we have. So I think the fact that we have gotten used to, for example, buying groceries online. Now what I realize is my wife literally orders groceries, and it gets delivered to the front door. So that’s to me, a change of behavior. That’s accepting that you can order groceries online and fruits and vegetables are still as fresh as what you think they would be, versus getting them yourself. So that is a very simple example of everyday acceptance of technology. That’s one thing.

The second thing is about, I think, from a need basis. A lot of times we are very reluctant to change. But if let’s say our environment changes and there is a need for us to adopt a new way of doing things, likely that will actually help the transition. I think COVID-19 has created a new need, and you can see that everyone is just having to respond. I mean, whether you like it or not. Sometimes some people will say not by choice, and of course a lot of us are for collective benefit, that all of us change our behavior because we need to collectively deal with this situation. We want to work together to get out of it better together. That collectivism, I think, does help adoption as well.

The third thing, which is in a little sense, maybe slightly controversial is that some people will say that the problem about change in healthcare is actually the people in healthcare themselves. We’re talking about the practicing community, and the fact that we might be a bit risk averse. I will say that actually, there’s a very good reason why people are risk averse in healthcare. I mean, no one wants to take unnecessary risks with anyone’s health. Rest assured that. So I think how we overcome that is for people who are in the seat of trying to drive change, and also for me actually personally, because I’m also a doctor, I sit on both sides, I feel that it’s very important that we are able to show the benefits very clearly, very professionally, and using data. So it’s not about hearsay. It’s not about because it’s trendy or anything like that, no. It’s really about, is it truly better for the patient? So, for example, what I’m trying to say is if a tele consult is not the best way to address the particular condition. For example, acute appendicitis. You can never treat acute appendicitis over a digital consult. That should be attended as per what it should be. But if let’s say, if it’s a condition that is a general mild illness that can be dealt with over a teleconsult, I will advocate for it.

When people say, okay, how is it that you can equivalate a remote consult with a face-to-face? I would say, the data that we used to analyze and to make a decision and to form a diagnosis, what is this data? It could be temperature. It could be pulse rate. It could be oxygen saturation. So whichever data that is used in a best practice clinical sense, if we can offer equivalent or if not even better. When I say even better, because normally in a normal GP consult, you don’t do oxygen saturation readings. But let’s say, for example, in this case, the person has a generation six Apple Watch that can read a SPO2 and is providing the information. So you can even create a scenario where the technology or the new alternative can even give you better data. And then I would offer that as a solution. So to me, we have to offer things that are better. It’s never about compromising. Like I said, unless there is an urgent need, for example, COVID-19, we need to create ability to access doctors for people to get their chronic disease medication, or maintenance medication, but they cannot go to a hospital or clinic. So that’s fair enough because that is driven by a need.

So if you think about, it’s always between these three factors. It’s about going in reverse. It’s about providing better solution. Of course, as good as is as good as, but it’s always better to be better. The third point is about getting the actual practicing community to buy in and to support Then the second one is very much asking about what is the prevalent level of acceptance? And of course at the very most fundamental basic, is there overriding need or urgent change in environment that caused a new solution to be found? Literally, it’s almost like what’s the priority here?

3 Tech Lead Wisdom [00:47:12]

Henry Suryawirawan: [00:47:13] Okay. So due to time, I think I’ll ask the last question which normally I ask for all my guests. It’s called the three technical leadership wisdom. So Dr. Chet, would you be able to share your three tech lead wisdom?

Dr. Yong Chern Chet: [00:47:24] Okay. So to be honest, I’m not sure whether it’s technical leadership wisdom, but I think in general, it’s how you approach things in life. So I feel that when it comes to trying to change for the better using technology, I think you always need to be curious about how things are. Always ask questions. Don’t be shy to do it. You need to be comfortable in creating new things. Because if you’re not able to create new things, technology will always remain a tool. We want nowadays technology to be a new " how", right? A way of doing things. You are never able to do it alone because I think tech is why things are happening everywhere all the time. So I think you need to be very collaborative. A personality trait that I will say that technology leaders should have, which is curious, to be able to create, and to be collaborative across all industries and specialties.

And I will say at the end of the day as well, look for good mentors. I’ve been very fortunate to be mentored by amazing people. I am who I am today because I managed to be exposed to their thinking, their aspirations and their vision. So I think that’s a very big thing. Mentors make all the difference.

Lastly, I really want to say that in this time, I think empathy is very important. Especially also relating back to how you design technology to be used by others. Nowadays, I think even more so, kindness and understanding is key. I think that translates into leadership as well. So that’s my three things.

Henry Suryawirawan: [00:48:53] Thanks for your time, Dr. Chet. I wish you good luck with all the digital healthcare venture.

Dr. Yong Chern Chet: [00:48:58] Thanks, Henry. I really enjoyed our conversation. I hope our listeners will find this beneficial as well. Thanks for having me.

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