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Malaysia’s Ministry of Health has set an ambitious target: to fully digitalise all public hospitals by the end of 2028, with the long-term goal of “1 Person, 1 Record”, which is a single, interoperable digital health record for every person in Malaysia. On this episode of #ConsiderThis Melisa Idris speaks with Dr Mahesh Appannan, Director of the Digital Health Division at the Ministry of Health Malaysia, a division which was set up in March last year.
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00:00Hello and good evening. I'm Melissa Idris. Welcome to Consider This. This is the show
00:15where we want you to consider and reconsider what you know of the news of the day. Malaysia's
00:19Ministry of Health has set a very ambitious target to fully digitalise all public hospitals
00:27by the end of 2028 with a long-term goal of one person, one record which is a single interoperable
00:36digital health record for every Malaysian. Now joining us on the show today to tell us more
00:41about this vision, I have Dr Mahesh Arpanen who is the Director of the Digital Health Division
00:48of Ministry of Health Malaysia which is a division that was set up in March of last year. Well to
00:55Mahesh, thank you so much for being on the show with me today. I am very interested
00:59to learn more about this overarching vision of digital health for Malaysia, specifically
01:05the one person, one record initiative. I think Dr Zul has talked about that quite a lot, this
01:12idea of a single unified health record for every person. Talk to me about what it aims to solve
01:20because I want to know maybe as a patient what that patient experience would look like if this
01:26initiative is fully realised. Right, thanks for having me here Melissa. And when we talk about one
01:33person, one record as it says that we want to have all our patients, all persons to have their health
01:41information at their fingertips. Today as we speak when a patient moves from one healthcare facility to
01:47another, nothing is carried with them and lots of time taken to elicit history, getting all those
01:54patient information and whatnot. How now if the record follows the patient to another facility? So that
02:01says it all, one person, one record. Okay so because currently they don't right, so every time somebody
02:07moves up from one clinic kesehatan to another public hospital for instance, they don't have the information,
02:14the tests that were done, the diagnosis, all of that has to be redone. Correct, you have to redo back
02:19everything and back again. Okay, are we also talking about private-public or is it just focusing just on
02:26public healthcare first? Ultimately it's going to be private-public as well. So we want to treat the
02:32person, the patient as a whole. He might be visiting the private healthcare facility or from private healthcare
02:38facility. He'll be coming up to the government healthcare facility. How these records follow
02:44them. So eventually we want all to be interoperable. That is the vision. Yes. That is the vision. Where
02:50are we now? Right. Where are we currently at? Okay, so let's just talk about the public healthcare system.
02:55We have got close to about 150 hospitals. 22 of them are now having some sort of software, an electronic
03:03medical record. And all those are just digitized. And moving to public healthcare clinics, less than 0.1% of
03:11them are actually digital. Oh, less than 0.1%. Less than 0.1% because we have got close to about
03:18close to about 3,000 clinics available and 107 was previously digital. And now we are accelerating,
03:25trying to get all of them, the basic fundamental electronic medical records in place. Do you think you
03:31can hit the target of all being digitalized by 2028? Yes, I think it's important for us to have a vision.
03:39Okay. And what we are looking at right now is trying to get all our primary healthcare clinics,
03:45including rural healthcare clinics and community healthcare clinics, have electronic medical records by
03:51the end of 2026. Talk to me about what building blocks are needed to achieve that. So the ambition is
03:59there. You're right. Let's work towards something. But what are the building blocks that are needed to
04:05get there? Talk us through the thinking or essentially this is your division's job, right? This is the
04:10this is the raison d'etre for your division. Talk to us about that. Yeah, I think we've got an overarching objective
04:18to be very person-centric and for us to have a very sustainable digital health ecosystem. It's so
04:25important sometimes when we design systems, when we deploy systems, we fail to look at the most
04:32important puzzle, which is the person himself, our clients, our patients. How do we now have them
04:38within the entire planning of the ecosystem? I think that's something very, very important.
04:45Until and unless we don't have them within the loop, we cannot close the loop. I think that's something very,
04:51very important. So talk to me a little bit about that. What was it before if it wasn't person-centric?
04:56Okay, our previous thinking is that we need to have persons record when I see a patient. Now we want to
05:03empower every individual to also take charge of their health information. Every information of the patient
05:10should be at their fingertips. I think that's the ultimate goal. That's what one person, one record means.
05:16Okay. So where are we in terms of those building blocks? So you talked about how there's this vision
05:23and you gave us a current analysis of where we're at right now. How do we move forward? How do we
05:30accelerate this? Right. So one of it, we've got three different interventions here. The first thing is,
05:36how do we now leverage on our existing digital health infrastructure? We've started basically having
05:43digital systems in MOH since 1985. So it's now many, many years. And how do we, we've invested
05:50quite a bit. How do we leverage on all those existing good functioning digital health infrastructure?
05:57That's the first thing. How do we now structure them, standardize them and make use of all those
06:02health information? And we want to start pushing all those information to individuals. I think that's
06:08one thing that we have done. And of course, now one of the digital infrastructure, or we call it a
06:13digital public infrastructure that's available in Malaysia is Maesajatra. We've got huge adoption.
06:19We've got many people with that particular app. How do we make that as the digital health front door?
06:26Now, what I need to do is, what we need to do is try to push all those records to individuals. And we've
06:32achieved something really, really interesting in the past one year. We've made use of our existing
06:40softwares. And we've already gotten prescription records to close to about 6.5 million people.
06:47If you have updated your Maesajatra, you've now gotten your prescription records.
06:51What does that mean? How many millions of people have this already?
06:55So, if any of these people have visited any of our public government clinics or hospitals,
07:03their prescription records will be at their fingertips. So, you can access your prescription
07:08records. What medication that you have been discharged with. Those were the days where doctors
07:13would spend close to about 10 minutes eliciting history. What medication are you on if you're a
07:18hypertensive? But now, with all those at their palm, they can always share it with the doctor.
07:23Okay. So, that's the kind of pharmacy side, right? How do you link all the other current systems?
07:30So, you say they're good systems, but they're all operating independently of each other. And
07:34sometimes we talk about interoperability as the kind of holy grail of any system.
07:40Correct. I think that is so important. That's paramount. So, one important work that we do is to
07:48ensure standardization. When you ensure standardization, then things can be interoperable.
07:54Like, you know, speaking the same language in tech world. Right now, that is the thing that we did.
08:00And we not only managed to push prescription records. If anyone of you who have visited any of our dental
08:06health care facility, your dental health record would be with you already. So, we have close to about 1.5
08:13million individuals who visited our dental health clinics have got their encounter summary with you
08:19right now. That's amazing. So, we've got pharmacy, we've got dental. What's the next step?
08:23We've got screening records. You know, we've screened close to about 3 over million people. All
08:27those screening information is with individuals. And of course, now we're looking at all your health
08:33clinic visits, your hospital visits, all those summaries should be with the patient.
08:38Is that harder to implement? Definitely. Definitely. Because we're looking at all those
08:43old systems that we've been using did not follow standards. So, we've got to standardize them,
08:48then start moving. So, we do not want to just wait until we get things perfect. Whatever that we've
08:54done, we launch first. Whatever that we've already successfully standardized them, we will start
08:59pushing. So, one of the things that strike me is that in the 1.5 years that this division has been
09:07up and running, you've gotten a lot of things done. And it's almost like a quick rollout. Let's just
09:13figure this as we go. Has that been the... Definitely. Because we cannot waste any more time
09:19with what vision of not only our health care, health minister, but also the Honorable Prime Minister
09:27and all other ministries going digital. We need to ensure that we work really, really fast because
09:32we want good patient outcomes. At the end of the day, we are catering for the people of Malaysia,
09:39people living in Malaysia. How do we have that? We need to start thinking very innovatively.
09:48Often, when change comes very fast, it meets resistance. And that happens in every organization.
09:56So, have you encountered any resistance to this change that you've been pushing?
10:00Definitely. But we are pretty lucky. We are pretty lucky in the sense that all doctors,
10:06all health care workers want things to be easier. You know, managing just way too many patients.
10:12Nowadays, we need some sort of softwares to augment our daily work process. But being health care
10:19professionals, we want everything perfect. We want everything perfect. And for us to ensure that we
10:26push in a system, a software solution, we need to gain trust first. So, our change management mantra is,
10:33you see, you feel, then you change. So, we start deploying systems, showing them the benefits of that
10:40particular system. That's when they start moving towards, all right, let's have this in my facility.
10:44Can you give me an example? Have you seen that actually change somebody's opinion or somebody's
10:51approach to where they were? Of course. I mean, the entire philosophy of digitalization
10:57before this was building our own system. Way back in 2023, it all started in 2023, where, you know,
11:05the island of Theoman, we have got one huge clinic with four different rural clinics. How did we
11:12actually connect them? Because they were all renovated, but the doctors were still using pen and paper.
11:18So, at that point of time, management thought that, no, this cannot be the way. Let's go do away with
11:23papers. That's when we adopted, resorted to this new concept business model of not deploying something
11:30that we built, something a little bit more mature, subscribing to off the shelf electronic medical
11:38record system. And we deployed it in just less than a week. All five digital. And you don't need
11:45patients to take their speedboat to come to the main clinic. They can speak online and all their
11:50records are connected. The timeframe boggles my mind that you can deploy this within a week. Is that
11:58typical or was this, is this, is this something you intend, this kind of type, this timeline of talking
12:04about weeks and sometimes people talk about projects for years, months and years. This is in a matter of
12:10weeks that you've managed to do this. Is that typical? Is that, is that, is there an urgent, I feel the
12:15urgency behind it. Right. So, so, so basically it's an innovative way of deploying systems. Deployment is a
12:22science by itself. How my team set, figured out the best deployment method. Of course, it involves
12:30multiple, multiple different stakeholders. And if you plan it really well, and by having all those basic
12:37fundamental infrastructure in place, your connectivity in place, your hardware is in place, deploying a
12:44system would be as easy as... So you, you work out the steps and then you just put it into place. Correct.
12:50That cuts the timeframe. Correct. Correct. So short. Now you have social media, you have videos where doctors
12:56can watch, you know. Everyone is tech savvy these days. How do we utilise all those talent, all those
13:03champions who can drive this real quick. Okay. So, I think previously there was news that you had very quickly
13:14ramped up Malaysia's first cloud-based clinics. I think it was the first 50 and then
13:19the ball just got rolling from there. Where are we now? And at what point did you start to see that
13:26really snowball, that momentum grow? Right. You, you said it real, right? How did that snowball?
13:33It all started when we were given the mandate after Theoman. Oh, it's working really well. So let's do more.
13:39So at that point of time, we, we had limited budget. So we opened up to all my colleagues on the ground,
13:45all those clinics, which had ready connectivity and also hardware. And we deployed the system in 50
13:53clinics in just under eight weeks. And that was a turning point. And, and it was possible to be done.
14:00And today they're all enjoying, you know, we managed to cut down waiting time, patient waiting time
14:05to under 30 minutes for almost 70% of our patients. Wow. Yeah. That's just through having this
14:11digitalization in the clinic. Correct. I think, I think one important thing for us to note is
14:18the difference between digitizing something and digitalizing something. Yes. So we had this
14:22conversation before where I, I think, and I, many people as well, we interchange this word,
14:28not knowing the difference. Maybe you might want to explain this in the context of public healthcare. Right. So when
14:33you digitize something, you're basically, you know, having all those, what you write in the paper
14:38to the computer. But when you digitalize something, you're actually understanding the entire business
14:43process, the patient flow in the clinic, understanding all those different pain points
14:48and trying to automate them. So for example, you know, searching for patient record cards and sorting
14:55them into different consultation rooms, the machine can actually do it. So you cut short the time
15:01of segregating them and, and, and just putting them into different rooms. So things like that
15:07is so easy to be done when you use a system. Is it, are the challenges all the same across
15:13the board or are there unique circumstances that are particular to a certain setting, a certain clinic,
15:19a certain public hospital? Right. So a very, very good question, Melissa. We need to understand one
15:24thing. Uh, we believe in standardization. How different can one clinic be in Kuala Lumpur to
15:31another clinic in Ipoh? We need to standardize even patient workflow process. Patients should have the
15:38same experience when he goes from one healthcare facility to another. It is also important for us
15:43as healthcare workers. I need not give him a long, one week long duration of orientation, you know,
15:49getting to know my clinic and whatnot, because everything is standard, you know, it's the same
15:54workflow process. Wow. Okay. So this is interesting to have standardization across the board, but also
16:00understanding the, the entire process, the digitalization process. Um, I'm curious to know
16:07more about the shift in the thinking. So you talked to me a little bit earlier about how the Ministry of
16:15Health Health had for years built its own systems, good systems, but very siloed and each to each, um,
16:22not interoperable, right? Talk to me about shifting to a subscription-based model and what prompted this
16:29change in philosophy? Right. So, uh, uh, when you build something, you have to have that expertise,
16:38uh, and electronic medical records is a market-driven industry. It's a specialty by itself. It's a,
16:44uh, uh, uh, uh, software, a branch of technology, uh, health technology by itself.
16:50Because other countries use it, right? Yes, yes. And, and, and, and if you want to
16:54follow the trend of, you know, fast moving tech era, you need to have that team who can work like,
17:01you know, uh, how to quickly deploy and scale systems. We don't have that. I always remind ourselves
17:08that, uh, our focus is very different. In the Ministry of Health, we, uh, govern the, uh,
17:13health care system, and we provide health care service delivery. We are not system developers.
17:18So, we will leave them to the experts out there. And, uh, now, uh, when we subscribe,
17:25we will be assured that we have the best system in the market, which moves in, uh, as time goes,
17:33which, uh, have all sorts of advancements in built. So, we do not have to, like, you know,
17:39every single new technology which is available, we tend to, you know, uh, try to figure it out
17:45ourselves. Why didn't we adopt this approach previously?
17:48Uh, at that point of time, uh, our, our school of thought was different. You know, uh, uh, data
17:54security is, uh, uh, is something that to be, uh, uh, uh, always, uh, being, uh, looked onto, uh, privacy.
18:02But now, all systems that's available are by design, secured, and private, and confidential.
18:08And you get the best of the best when we start using those.
18:11So, would the concerns over, uh, say, sovereignty of these systems, right?
18:15Because I can imagine that the traditional government procurement methods would be thinking about
18:20how do we, um, safeguard our technology, our data, our systems, there's sovereignty to owning it.
18:27Yeah.
18:28Now, in this, um, subscription-based era, I mean, we all subscribe to things personally and in the workplace.
18:36Um, there is a question also of what happens to that system that we're, are we outsourcing?
18:43Are there questions about accountability, questions about quality, for instance?
18:47You talked about standardization a bit earlier. Yeah.
18:49How do we ensure that all of that comes into play?
18:52That goes by design. Hmm.
18:54Even before we, we get all those systems, we have to make sure that all the guard reels are in place.
19:00But you're buying off the shelf, right?
19:01Correct. So, you need to ensure that you have these specifications for you to, uh, uh, adhere to.
19:07For example, uh, all our data, all our health information should be sovereign and resident.
19:13So, uh, storage of, uh, information, we have to follow our guidelines.
19:17Our government has come up with beautiful guidelines for us to adhere to.
19:21So, whatever software that we subscribe, they have to adhere to our rules and regulations.
19:25They have to be, uh, in Malaysia.
19:28The data center should be in Malaysia.
19:31Uh, it has to be, you know, within our reach.
19:33It has to satisfy various different security protocols and things like that.
19:38Okay. So, so you are at the very start saying, these are our requirements.
19:44This is what we need.
19:45Correct.
19:46Um, you designed it, designed it as such.
19:48By design.
19:49Okay.
19:49Because we cannot compromise on security.
19:52So, that is already there, uh, from the start.
19:55Okay. Um, once this is all in place, talk to me a little bit about the digital health front door.
20:03As a way to kind of access all healthcare in Malaysia.
20:08Um, paint a picture of what it could be like and what needs to happen next for it to happen.
20:14Right. I mean, today, in this age and this era, you, you order food via Grab.
20:21You order, you, you book your hotels through, uh, you know, uh, technology.
20:26And, and why can't we do it in the healthcare, uh, sector?
20:31Right.
20:31I think people are hungry for a front door, for digital health.
20:34Today, if I would want to make an appointment to see a doctor, see a dentist, I can do it at my, uh, uh, convenience at any point of time.
20:43And, uh, that is the meaning of digital front door.
20:45Not only that, having my healthcare information at my fingertips, I think that's superbly important.
20:51Uh, and, uh, in this highly globalized era, people travel everywhere.
20:57How now, if I visit Brazil or America or India, how can I now, if I ever, I fall sick or would want to get second opinion,
21:06how can I share my information with healthcare practitioners, not in Malaysia?
21:11Well, you're thinking beyond even domestically, um, interoperable, but internationally interoperable.
21:18Correct. We, we cannot just be locally interoperable. We must be globally interoperable now.
21:24Are you concerned that all this, the, the kind of rush and the urgency to digitalize, we might leave some people behind?
21:32I, I'm thinking of older folks. I'm thinking of people from rural communities, underprivileged, who might not have this tech savviness that you desire Malaysians to have.
21:43Right, right. I love this question. And we get this a lot, actually. Uh, we need to understand that digital equity is important.
21:51Uh, while we have that in mind, we cannot, uh, uh, you know, uh, miss out on the bigger opportunity.
21:59You know, I always follow the 80-20 rule. 80% of the people actually, uh, already having, you know, some sort of digital tools with them, but leaving no one behind.
22:09I think that's very, very important. Uh, for example, how do I now take care of my elderly?
22:15For example, if you still remember, uh, during COVID, we've got managed dependence where your, your child can actually manage your, uh, your parents and things like that.
22:25Right. So booking, um, appoint vaccine appointments for them.
22:28Yeah. Correct. Correct. For, for people who are not digitally savvy. Not only that, do not forget the, uh, less privileged, uh, people who are blind, uh, and things like that.
22:38So we are engaging with all those societies, making tech really accessible. And, uh, you know, things move really fast.
22:46How do you build applications which are low tech? I think that's something very important for us to consider as well.
22:52And, uh, people who are not reachable, uh, recently, I don't know whether you've, uh, heard about this.
22:58We recently had a collaborative effort with, uh, uh, the Ministry of Communications, MCMC,
23:04on how we now utilize their NADI centers, which are located at, uh, communities, uh, you know, which we cannot reach.
23:13How do we now utilize telemedicine technology for us to speak to them?
23:17So, so technology is there. It's just a matter of how do we want to use it, uh, to the benefit of those people.
23:24That was a great bit of inter-government, um, cooperation. We rarely see ministries working together on that level,
23:32but that was a really wonderful bit of collaboration.
23:34I think it's really, really important. And, and it was shown during COVID how multi-agency, uh, cooperation really, uh, uh, works.
23:44And now it's, it's on to us. How are we collaborating with the finance ministry,
23:49Ministry of Economy, Ministry of Digital, and everyone else to make this a success.
23:53Since you brought up COVID and Maize Jatra, I do have to ask you, um, there, after the controversies around Maize Jatra,
24:00how do you feel the need that you have to rebuild trust amongst Malaysians, um, in terms of the handling of health data,
24:09in terms of digital tools and all of that?
24:11Definitely, definitely. Digital trust is very important. So we are, everyone is moving towards, uh, being digital.
24:17How do we now gain trust? I think having all those safeguards,
24:21following protocols is so important and we need to continuously educate people. Uh,
24:26if you can have your data secured in the financial industry, why, what not, uh, the health industry?
24:33Yeah, we, we always forget how quickly we've adopted online banking. Okay. So if we were to say years from now,
24:42look back at our efforts to push, uh, digitalization in healthcare, I'm just wondering what you would
24:49have hoped we achieve through this technology. And I'm asking what your philosophy of care is
24:54in the digital age, because there will be a trade, well, there will be trade-offs made, right? In terms of
25:00this push to digitalization. How do you think about that? As someone who's steeped in public health,
25:07steeped in thinking about, um, the whole experience of healthcare, how do you see that? If you were to look
25:13back years from now and you think, oh, these, these were the principles and values that guided our journey.
25:20Yeah, definitely. I think we have to be very technical in our minds, but human at heart.
25:25I think that's what I would say as, as, uh, being a doctor myself, how, how I, I have all these values
25:33inbuilt while we design systems. Be very technical in our minds, but human at heart, that would help.
25:39Because there is a human element of care, despite the digitalization. Definitely, definitely.
25:45I'm very excited for this vision that you've painted for us. And I look forward to the day
25:50where I have my healthcare records at my fingertips. So thank you so much for being on the show with me.
25:54I appreciate your time. Thank you very much for having me. That's all the time we have for you
25:58on this episode of Consider This. I'm Melissa Idris, signing off for the evening. Thank you so much for watching.
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