Healthcare innovation: AI-enhanced and enabled, but not AI-decided

Straits Times

2 days ago

How should the healthcare sector deal with the opportunities and risks that come with the tech revolution? Health Minister and Coordinating Minister for Social Policies Ong Ye Kung addressed the issue at the ninth CHI Innovate conference on July 10. The following is an edited text of his speech.
With the power of AI in our hands, healthcare institutions need to use it judiciously and deploy it thoughtfully, says Health Minister Ong Ye Kung.
The way healthcare uses AI is different from many other industries. We are not overwhelmed by it, in the way AI has disrupted the music, entertainment or transport sectors; or digitalisation has revamped the telecommunications, retail or financial services sector.
This is because healthcare is an essential public service that cannot be substituted. It is also highly regulated. This means the determined and heavy hand of clinical governance can possibly keep out disruptive technological changes. In Singapore, we are, of course, not going to do that.
On the other hand, healthcare systems around the world are disrupted by a separate force – not of technology, but of nature. And that is demography, and the progressive ageing of our population.
Hence, the healthcare sector is in a unique, and I would say, advantageous position. We are confronting the biggest challenge of our generation, which is ageing. We have AI technology on our side, which we are in a position to titrate, introducing it judiciously into our system to help tackle our challenge.
This also means healthcare leaders are in a special position to envision the future, mobilise people and synergise human skills and AI to benefit our patients. With that in mind, let me offer a few thoughts on what healthcare leaders need to do.
Strategy and Vision
First, we need to define and articulate our strategy – how are we serving customers differently? What is the big change?
I find the example of PSA Singapore inspiring. I used to oversee the PSA as the minister for transport. PSA has been doing very well over the past few years. Despite the Covid-19 pandemic, supply chain disruptions and a setback in global trade, container volumes are rising.
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PSA's ability to buck the trend can be partly attributed to a clear strategy. It is strengthening Singapore's position as a transshipment hub, by developing a network of ports around the world, so that they can offer shipping line alternatives during a supply chain disruption, and are able to plan routes around the world for maximum yield.
Their AI-driven IT system made this strategy possible. But technology serves the strategy, not the other way round.
Where PSA saw opportunity in global supply chain disruptions, we have to contend with changing patient mix due to ageing. More patients are older, with complex multiple conditions. They need preventive care that avoids triggering the conditions, and continual care after they are discharged from hospitals.
Both preventive and continual care should be delivered in the community. But today, too much healthcare is still accumulated at the acute hospitals, which is the most expensive, often too late in the course of disease progression, and not necessarily the best setting for patients.
The big change we need to bring about in healthcare today is to deliver as much care as possible, especially preventive and continuous care, through the community, by leveraging technology and manpower transformation.
If we can do that, healthcare becomes a life companion, which is all round us, and not just delivered in hospitals and clinics.
While in Saudi Arabia last year, my host showed me how a team of specialists was congregated in an operations room, attending via telehealth to patients in villages far across the desert. It is a model driven by geographical necessity.
In the Netherlands, the company Buurtzorg, which means 'neighbourhood care' in Dutch, is a dominant player in home nursing care. They are organised into small teams of nurses, each taking care of an entire neighbourhood.
The nurses are empowered to do many things – from assessing what the resident needs, to tailoring the care plans, to delivering the medical and support services. There are no long chains of command or complex governance frameworks to navigate.
When the resident needs help, these nurses respond quickly and effectively. But they are well-supported, with direct access to specialists and nurse coaches in the backend, and an IT system to enable sharing of information.
Singapore has demonstrated exciting possibilities to the world too. With Healthier SG, Age Well SG and Community Health Posts firmly in place, we have a springboard to build community care for the future, as a core shift in strategy.
Fears, Concerns, Hope and Confidence
Second, organisations need to recognise that change instils fear and concern amongst people, and these need to be addressed decisively.
For example, workers will immediately worry that technology will render their service redundant. In an industry disrupted by technology and facing an uncertain future, it is better to be honest and forthright with people. But as I mentioned earlier, this is not the scenario in healthcare. We are facing rising patient loads, and technology is a potential saviour.
I recall how several years ago, DBS Bank embarked on a major strategy to digitalise all its services. Workers were naturally worried, but the DBS leadership assured their staff that their jobs were safe, and they would instead train workers with new skills to adapt to the changes. In the ensuing years, DBS' share prices soared and at one point it was voted the best bank in the world.
Patients and the public may have concerns too. For healthcare to be delivered seamlessly across all settings, and especially in the community, a patient's data needs to be captured and shared amongst healthcare providers whom he sought care from.
There will be concerns about cybersecurity, which we are addressing by strengthening IT infrastructure.
There will be worries about data privacy. We are therefore enacting new legislation, namely the proposed Health Information Act. Under the Act, beyond various data protection measures, a patient can choose to restrict the sharing of his medical data amongst the healthcare providers he sought care from.
This is not an ideal arrangement and will undermine quality of care for the patient. However, by making this choice available, it addresses fears and instils confidence. Based on experience around the world, the number that eventually exercised the restriction has been very low.
When there is greater availability of genetic data, there will be public concerns about how the data is used, and whether technology will inadvertently push us across societal ethical lines.
The Ministry of Health (MOH) is therefore working on enhancing legislative protections on the use of genetic test information and will be conducting broad public consultation. This will provide greater clarity on what genetic information can be used for, such as for medical treatment, and what it cannot be used for, such as in deciding employment and insurance underwriting.
Beyond addressing the fears and concerns arising from technology, we can also usher in hope and confidence about the future.
Everyone can be empowered to participate in innovation and leverage technology to do a better job. DBS has managed to achieve this. 3M is also an inspiring example, where its leaders encourage ground-up innovation and allow employees to spend 15 per cent of their time on projects unrelated to their work. That positive culture has turned 3M from a mining company into a diverse manufacturer, including in electronics and healthcare.
The Human Core
Finally, organisations need to be careful not to devolve their core competencies to technology. As leaders, we also have a role in safeguarding humanity.
We welcomed machines that could replace human labour. We applauded when computer software could process reams of paperwork in a moment, substituting human toil. We appreciated technology and servers that multiplied human memory. We were amazed when miniaturisation of computing power revolutionised human communication and perception.
But with each advancement in technology, machines edge closer to the human core. We are happy to be relieved of labour, manual calculations, paperwork, even meeting face to face, but should we be happy when AI starts to replace human judgment, creativity, empathy and relationship?
We should bear in mind even in the early phases of technological advancement, that are regarded as unmitigated good now, there were profound unintended negative consequences.
When machines substituted human labour during the Industrial Revolution, it led to suppression of workers' rights, which in turn gave rise to socialism and nearly triggered World War III.
As digital technology revolutionises human communications, it might have also rewired the minds of a generation. The evidence is still being debated, but ask any psychologist or counsellor, and they will tell you stories of how smart devices, video games or social media addiction have inflicted pain on young minds.
There is no doubt AI will have a profound impact on society. We just don't know its full extent yet. We have heard warnings about the potential loss of creativity, independent thinking, ability to learn, and the resilience to seek answers to difficult problems.
Healthcare, beyond medical knowledge, is all about the qualities of being human. With the power of AI in our hands, healthcare institutions need to use it judiciously and deploy it thoughtfully.
Last year, I suggested a basic principle – make sure that healthcare is AI-enhanced and enabled, but not AI-decided. But this is only a general principle, which needs to be interpreted and implemented wisely in healthcare institutions.
There is a good example in NHG Health, in the way it uses AI to read X-rays. AI will sieve out the normal readings and close the loop with the patients quickly. Those with abnormal readings will still be attended to by clinicians. That way, healthcare professionals do not lose their core competence.
This is also why my current favourite AI use case in healthcare is the systemwide automation of clinical documentation – significant productivity gain, with negligible impact on our core competencies and humanity.
I am glad we are having this in-person conference to discuss AI in healthcare. We welcome more human connections and networking, locally and internationally, to figure out how best to seize this opportunity of a lifetime to improve healthcare.
To this end, MOH will be the first Asian country to join HealthAI's Global Regulatory Network as one of its Pioneer Countries. HealthAI is a non-profit organisation to help governments implement and strengthen the governance and regulation of AI in the healthcare sector. We will contribute to this effort.
Thank you for listening to this speech, written without any AI assistance.