Digital transformation is well and underway in Vietnam’s healthcare sector, following a series of directives from the Ministry of Health (MOH) around deploying IT in healthcare services, including a mandate to implement electronic medical records (EMR) in all medical facilities.

Assoc. Prof. Dr. Tran Quy Tuong

How is the progress so far, and what are the challenges and next steps ahead? Assoc. Prof. Dr. Tran Quy Tuong, Chairman of the Vietnam Medical Informatics Association – which works with the state agencies, community, providers and other associations to promote digital healthcare transformation – shares his views in this interview.

 

1. How has Vietnam progressed in its plans for digital transformation and implementation of EMR?

The application of IT to improve people’s health and the implementation of EMR at medical examination and treatment facilities in Vietnam has gradually developed and achieved some very encouraging initial results.

Some initial achievements include a regulatory framework built by the MOH around the application of IT, EMR, and electronic prescriptions. There is now sufficient legal basis for implementing EMR and EMR has the same legal value as paper medical records.

There is also better awareness of IT, digital healthcare and EMR amongst healthcare professionals . Every year, MOH and its agencies have organised conferences and training courses on IT, inspiring staff and doctors in the industry. Many localities and units have actively and proactively mobilised and arranged resources for digital transformation of healthcare and EMR implementation, such as Phu Tho Department of Health, Quang Ninh Department of Health, Hanoi Department of Health, etc.

In terms of IT infrastructure, most facilities now have server rooms and dedicated servers, and free Wifi for patients and their families.

All facilities nationwide (including public and private hospitals) have deployed IT applications with hospital information management software (HIS). On average, each facility has 3.15 full-time IT staff. 46.5% have deployed online appointment booking, and 61.1% have deployed electronic queue numbers. 99.5% have connected their HIS with the Vietnam Social Security Agency to perform electronic health insurance appraisal. So far, a total of 94 facilities have have deployed EMR – 32 Grade 1 Hospitals, 44 Grade 2 and 3 Hospitals, 4 Clinics, and 14 Private Hospitals.

A network has been formed with many Vietnamese companies and enterprises that research, deploy and have good products supporting the digital transformation of healthcare, with the capacity to provide quality EMR products.

There has also been significant progress in electronic hospital fee payment, since MOH issued a directive on this five years ago. Currently, 71% of hospitals apply electronic payment.

2. What are the key challenges in adopting EMR in Vietnam? In your view, what can be done to overcome these challenges?

In my opinion, some of the main challenges in applying EMR in Vietnam are:

1. IT infrastructure in Vietnamese healthcare sector is still in its infancy, with the necessary conditions for applying EMR already an initial barrier to adoption. This has resulted in a large overall cost to deploy EMR, a crucial factor that needs to be seriously considered in terms of “Readiness” (including: policy, IT infrastructure, human resources & finance) in implementing EMR.
2. There is a lack of leadership buy-in at some hospitals, where leaders do not clearly see the benefits and significance of implementing EMR, and so have not proactively implemented EMR.
3. Shifting to EMR requires a change in habits, routines, and working processes of the entire hospital, which in turn requires strong direction from leaders at all levels and active participation of all hospital staff.
4. In Vietnam, public health care accounts for the majority of care. Hence, MOH must have regulations on financial mechanisms so that public hospitals have funds to implement EMR. Currently, there are no specific financial guidelines for the application of medical IT in general or implementation of EMR specifically; hospitals mainly use the unit’s development investment fund to apply IT, which affects other hospital activities.
5. The IT level of medical staff is still lacking and weak, uneven across facilities nationwide.

To overcome the above challenges, MOH must synchronously deploy solutions. For one, MOH departments and bureaus should get more closely involved, proactively advising and proposing to the Ministry’s leaders policies and solutions to implement digital healthcare transformation. In particular, it is necessary to pay special attention to the synchronous implementation of platforms, application systems and specialised databases as a foundation to promote EMR. There needs to be continued development and refinement of mechanisms, policies, legal documents, and specialised documents (in this area).

We need urgent regulations on pricing of medical examination and treatment services according to the latest legal provisions, which stipulates the prices including IT costs, so that facilities have funds to carry out digital transformation.

MOH should implement sanctions for units and localities that do not implement EMR according to the prescribed roadmap. At the same time, it should pay more attention to promoting successful models, promptly encouraging and rewarding localities and units that do well, thereby helping to spread and create a model of effective study and experience sharing.

There should be strengthened coordination between the state management agency of health with professional associations, enterprises, localities, and related experts to create a unified and effective implementation of EMR nationwide. Seminars, training courses should be held to enhance awareness and IT skills of medical staff.

3. Besides EMR, what are some other areas of digital healthcare transformation that are being implemented in Vietnam? Are there areas with great potential that have not yet been explored?

In the immediate future, some areas that need to prioritised in healthcare’s digital transformation are as follows:

a) Digital transformation in Vietnam healthcare and disease prevention  

• Build and deploy a national electronic health record for each citizen with updated health information.
• Develop applications to monitor epidemics through collecting data from all sources including people, businesses, medical facilities, social networks, investigation programs and forecasting outbreaks through big data analysis technology and artificial intelligence (AI).
• Develop applications to provide citizens with healthcare knowledge, including prevention of infectious diseases, non-communicable diseases, nutritional information, and personal health declaration.
• Develop smart applications that allow the provision of remote monitoring and healthcare services, connecting patients, health monitoring devices, and medical staff virtually.
• Build and deploy health station management software for commune, ward and town health stations.

b) Digital transformation in hospitals

• Deploy HIS, LIS, RIS/PACS, EMR software systems in compliance with domestic and international standards to ensure the ability to connect, share, and integrate data, while connecting with all existing equipment (testing machines, diagnostic imaging machines, interactive screens, personal handheld devices) on the network to improve automation capabilities.
• Synchronise the Medical Identification Number (ID) nationwide, focusing on using VneID  (Vietnam’s digital identity and e-signature app).
• Build a “smart hospital”, based on MOH’s circular on developing a smart hospital roadmap.
• Deploy remote consultation and examination and treatment of some groups of diseases according to MOH regulations
• Develop AI applications in medical examination and treatment

c) Digital transformation in administration

• Build a digital system for shared health sector databases, which allows all units to reuse these data through API services, instead of current documents or excel files.
• Build and promulgate an EMR application framework with electronic forms. From there, agencies and businesses in need can reuse and further develop (open EMR framework).

Some areas have a lot of transformation potential but have not been well implemented. For example, building a core health data set as a foundation for developing databases and applications in the health sector, or a set of medical categories and terminology (Medical Terminologies) for nationwide use. Standards for connecting healthcare devices based on the principle of the Internet of Medical Things (IoMT) will be a foundation for systems that support clinical decision making.

In addition, (there is potential in) leveraging AI-driven clinical decision support system that is closely integrated and implemented in real-time with EMR; or in specialised fields such as diagnostic imaging, cardiovascular, respiratory, bone and joint, cancer, obstetrics and pediatrics, etc. AI could also be used to build big data systems with fast analytical algorithms to support clinical decision making, or in traditional medicine.

4. How will the Vietnam Medical Informatics Association support this digital healthcare transformation process over the next few years?

Vietnam Medical Informatics Association is committed to continue supporting relevant agencies and MOH units in promoting digital healthcare transformation and deploying EMR in healthcare facilities nationwide.

We act as a bridge between state agencies, society, and the community in applying and developing Healthcare IT. We support them in understanding the need to apply healthcare IT to better serve the people, and how they can access convenient and useful healthcare IT services. We promote training and coaching on medical IT, and application and development services for organisations and individuals, making medical IT closer to the people.

Digital transformation of healthcare is an inevitable development trend of the times, and it brings many benefits to the development of the healthcare sector, helping healthcare become smarter, better quality and more effective. The Association joins hands with agencies and units to successfully build smart healthcare with three main pillars: smart disease prevention, smart medical examination and treatment, and smart medical management.