IR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAM

IR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAMIR 4.0: OPPORTUNITIES FOR HEALTHCARE SECTOR IN VIET NAM

APPLICATIONS OF INDUSTRY 4.0INHEALTHCARE

The fourthindustrial revolution

The Fourth Industrial revolution, like the others before, was born in manufacturing connecting everything to the internet, generating data across the whole process, and using advanced analytics to support completely new products and servicemodels

Focusing first on a Smart Factory, the initial premise was to create a better connected production line and generate decision support to workers to keep the line running at maximum efficiency, removing waste, and minimizing costs Over time the quality and configuration of products could be changed more flexibly Connectivity then expanded outside of the factory to other factories to optimize stock levels and ordering Industry 4.0 now includes full value chain monitoring, including how the product is used, delivered, and maintained, creating a feedback loop to design and build and target products better in the future, keeping businesses competitive in a fast-evolving marketplace This revolution must meet needs at a massive industrial scale andisprojected to be worth $214 billionby 2023. The Industry 4.0 toolset includes :

• Cyber Physical System (CPS)—a connected, automated device, capable of learning from and effecting the physical environment, that is intelligent and responsive and can act independently (e.g., self-diagnosing problems) or interdependently with humans or other CPSs to achieve efficiencies or resolve issues.

• Internet of Things (IOT)—the network over which CPSs can connect to the internet and to each other in a secure, auditablemanner.

• Internet of Services (IOS)—when devices are networked over the IOT, new servicesfocusingonlogistics,intelligence,automationandpredictionarepossible.

• Smart Factory—the combination of cyber-physical systems and humans,connected through the internet of things with support from the internet of services,monitorproductionprocesses,andmakede-centralizeddecisionsaspartofan interdependent network The factory management is orchestrated via smart enterprise resource planning (SERP) systems and supported by human and virtual agents to develop product that is responsive in real time to demand, market conditions, and value chain (e.g., logistics)feedback.

The toolset applied within the context of manufacturing and provides a baseline capability map for an overarching ‘4.0’ toolset which can be applied to different sectors and delivery models Subsequent sections will consider other applications of this toolset in emerging next generation models of health and social care For these discussions the ‘smart factory’ has been jointly labelled a ‘virtual agent’ to allow the concept to better cross sectors The largely automated intelligent oversight of an interconnected system is a ‘smart factory’ in a manufacturing context, but in a care setting it is more likely to be a virtual assistant that translates between the system and the people within it, wherever theya r e Since the World Economic Forum’s action on Industry 4.0, many people have attempted to respond to the early challenge and opportunity The concept is still maturing,with discussion around the difficulty of defining this complex web of technologies and principles Contributors instead characterize Industry 4.0 through several different lenses.For example, arguing that it can only be fully characterized by the changing the way organizations, business models and markets work to optimize the benefits from the technology A second characterization looks at how the relationships between actors differs from previous revolutions—with the first and second revolutions operating as a centralized network, the third revolution as a decentralized network with multiple, powerful hubs, while the fourth revolution will constitute a distributed network made up of interconnected nodes with equal power The implications are that given the way the connected value chain reaches well beyond the physical confines of a factory, these technologies will change how society organizes itself, with power and assets redistributed (though not necessarily for societalgood).

Countries all around the world are now standing on the brink of h technological revolution, commonly called the Industrial Revolution (IR) 4.0 Asia & Pacific region is the case in point, and most particularly Viet Nam, where rapid technology innovation and adoption at the workplace are diffusing faster than ever before, with some variations across sectors This policy briefs introduces some of the opportunities and challenges for the world ofw o r k

Previous industrial revolutions have been characterised by the adoption of various techniques for production “The First Industrial Revolution used water and steam power to mechanize production The Second used electric power to create mass production The Third used electronics and information technology to automate production Now a Fourth Industrial Revolution is building on the Third with the digital revolution occurring since the middle of the last century It is characterized by a fusion of technologies that is blurring the lines between the physical, digital, and biological spheres In its broad definition, IR 4.0 is characterised by rapid technological advancement through increased use of mobile communication and interconnectivity (‘internet of things’), big data, artificial intelligence, robotics, autonomous vehicles, 3D printing, Nano and biotechnology, quantum computing etc What could be the impacts of IR 4.0 in the world of work in Viet Nam? With the transformation of entire systems of production, management and governance, the IR 4.0 offers a wide spectrum of opportunities and challenges in the world of work, with direct and indirect impacts on sectors across the economy (agriculture, industry and services) as well as categories of workers including the most vulnerable groups (youth, womene t c )

Technology as creator and transformer ofjobs

Technological advances can support structural transformation of the economy (shift away from the agriculture to the manufacturing and services sectors) by facilitating labour mobility of workers across sectors and occupations and/ or easing work by lifting up workers from cumbersometasks.

In the agriculture sector, the adoption of mechanisation is key for labour productivity increases and the diversification of the rural economy With two thirds of the labour force in rural areas, employment in agriculture, forestry and fishery sector is widespread, accounting for roughly 40 percent of total employment in 2017 While the sector’s growth has slowed down over the last decades, there is still some great untapped GSO potential in off-farm activities and diversification in the non-agriculture sector in rural areas with productivity gains arising from mechanisation” For example, the expansion of e-agriculture5 has the potential to enhance agriculture, forestry and fishery outputs and foster rural development through the emergence of “green jobs”6 Within the manufacturing sector, adoption of technology advancements has the potential to shift workers to higher skilled occupations with higher productivity The ILO report “ASEAN in transformation: How technology is changing jobs and enterprises transformation” indicates that majority of total employment in the manufacturing sector, particularly in the textiles, clothing and footwear (TCF) and electronic and electric (E&E) sectors, will be impacted by IR 4.0 While high-tech has not yet completely entered the industries, there are some signs of penetration in industries. Trade, foreign direct investment and associated technology have all contributed to productivity growth In those industries, significant changes in the medium to long term are most likely to occur due to disruptive technologies, for example in 3D printing technology, industrial robots, Internet of Things (iv) computeraid designs, and body scanners etc.7 In turn, subsectors in engineering, transport and infrastructure will likely boost demand for jobs The digital revolution has the potential to shift workers to more customeroriented jobs in the service sector Technology advancement also leads to a rise of the “gig economy” where a number of jobs are increasing being performed through online platforms (Uber, Grab, e-commerce) Ultimately, the adoption of new technology innovations could improve workplace safety, increase productivity, wages and stimulate aggregate demand, combined with anticipated increase of FDI inflow and easier access to major export markets arising from FTAs, particularly CPTPPandEU-VietNamFTA,onceratified.Asproductivityincreaseandworking conditions improve, this can further lead to a reduction of working hours and creation of more leisure services and products Ensuring workers’ protection and decent work in the context of the IR4.0 Technology per se is neither good nor bad as technology cannot automate all tasks that require for example perception and manipulation, creative intelligence and social intelligence Therefore, supporting workers and their protection in this process of rapid changes remains crucial In particular, the importance of the informal economy together with the rise of casualization and nonstandard forms of employment put concerns on workers’ protection and the quality of employment as the employment relationship (employer/employee) becomes moreblurry.

How to maximize the use of IR 4.0? Some examples

Technological advancement has been used in multiple ways in the agriculture sector in developed economies through increased use of technology and mechanisation in production to increase agricultural productivity (direct contribution) or through the use of ICT as a tool to empower farmers to take informed decisions (indirect contribution) Specific examples of using ICT include the use of smartphone mobile apps in agriculture, the use of Geographic Information Systems (GIS) for farming and fishing or satellite technologies and other agronomy sciences that increased significantly agriculture and fishing outputs Consumers and producers are also increasingly aware and conscious of ecological matters, fair trade and the importance of agricultural biological products with their specific characteristics as opposed to chemical products and mass production The use of ICT to promote these biological and organic products is often used to sale and promote quality products together with a range of strategies including packaging, sizing andpricing.

The use of high-tech technologies is most commonly found in industries In industrialised economies, technologies have been used in multiple ways in order to boost efficiency (both quality and quantity) and raise productivity As examples, successful Asian economies like Singapore, South Korea, Taiwan and Malaysia have achieved their economic miracles with strong industrial development policies that placed a strategic focus on specific export-oriented sectors In all cases, education and training policies have prepared the labour force for entry into targeted industries, by helping to absorb the know- how and technology from the rest of the world and to diversify into new and more sophisticated products In Singapore, for example, the share of high-skill and technology- intensive manufacturing exports represents almost 50% of theworkforce.

The use of mobiles devices and increased widespread access to internet has fundamentally changed the world of work The rise of the gig economy, digital platform, freelancing and ecommerce, bring up new forms of work that can be performed remotely (or partly) They also significantly contributed to expand markets beyond borders by connecting an increasing number of people On-line learning is increasingly used to foster skills’ development throughout the life cycle For example, the use of online courses such as MOOCs (Massive Online Open Course) expand opportunities for youth to learn and share knowledge at a minimal cost on a variety of topics What could be the priority areas of action for Viet Nam’s labour market? The 4th Industrial Revolution is here and cannot be avoided, yet the extent to which it penetrates different sectors of the economy varies While the impacts on the jobs are difficult to predict, some ingredients are critical to carefully manage the process of transformation In doing so, barriers to occupational, geographical and sectoral mobility need to be removed Moving up the skills ladderHaving the right skills to increase the ability to adapt to the need of the labour market and drive the process of technological advancement forward is critical A combination of both technical skills (such as STEM) and core skills (creativity, critical thinking, communication, teamwork etc.) are needed to best equip the labour force and foster resilience to the evolving labour markets Training,

(multi)skilling,reskilling, lifelonglearning throughout thelifecycleareallcritica l in and out of the job Education and training systems must be prepared to develop skills for the future In particular, partnership between policymakers, business and training providers are required to ensure adequate supply with demand in the labour market Sectoral approach to employmentcreation (incl industrial policies) As Viet Nam will increasingly witness the impact of technological change at the workplace, the effects will vary considerably across sectors An effective development strategy calls for expanding sectors that generate more value-added and employment, with large multiplier effects and upstream and downstream linkages to the domestic economy The importance of industrial and other sectoral strategies for structural transformation could be reasserted in light of the national,regional, and global developments The new growth model would need to be, in order to be inclusive and sustainable, built around higher technological value-added and productive sectors that nurture quality employment and other qualitative dimensions of the domestic economy The importance of labour marketgovernance Viet Nam could increasingly compete in global markets based on higher productivity and better working conditions But translating productivity growth into better wages and higher living standards requires effective labour market institutions, which include effective legal protection of workers’ rights in various forms of employment, representation of workers’ voice, and collective bargaining Effective industrial relations is a key for stability, productivity and equity,which will ensure sustainable and inclusive development Active labour market policy andsocial protection With accelerated changes under IR.4.0, workers who are more frequently moving from one job to another will need to be supported Effective ‘active labour market policies’ that help to connect people with jobs are important to constantly help workers to develop new skills; ensure smooth transition from one job to another;provide skill training and unemployment insurance during the gaps between the jobs Only with proper social protection, including unemployment insurance, workers’ move from lower to higher productivity sectors and jobs will befacilitated.

Healthcare4.0

“In a complex world that is advancing rapidly at an exponential pace where nearly every sphere of human existence seemingly finds the internet indispensable, therein lies profound benefits to be gained at the convergence of virtual reality, simulations, big data analytics and Artificial Intelligence Healthcare is no exception Sophysicians, health economists and healthcare administrators of this generation and beyond ultimately have to thrive in such a technological environment to remain relevant in the medical profession which provides care for the population in the modern age ofdigitalisation.

Robots are used to perform surgery and provide improved performance, movement and control Now, surgery can be per-formed through computer control It reduces/eliminates tissue trauma in open heart surgery case It can also work in an environment that is felt dangerous forsurgeons.

Holography is a noncontact 3D imaging that can be seen by anaked eye It provides details of the human anatomy, tissue, bones and activity of an internal organ of the body with high resolution Doctors can now see the patient in a holographic image without the physical presence of the patient It is an excellent tool for con-tactless study which is used to measure the internal and external fracture Holography has excellent potential to addresses the challenge of storing the complex issue of 3D image storing of thepatient.

Sensors provide information about temperature, blood pressure and other conditions of the patient Different types of sensors are used as per the requirement of the medicalfield.

IoT has opened up a world of possibilities in medicine It connects the Internet and medical devices and collects valuable in-formation to provide control over patients' lives and treatment It is helpful in monitoring, treatment and testing to provide satisfaction to the patient.

In health care, big data provides life-saving outcomes By the digitisation, it referred to vast quantities of information and analysed it Doctors required an understanding of patients' past for their best treatment, so this technology is helpful to provide valuable information regarding patients such as the sign of illness It also provides relevant critical insights into better care and fastert r e a t m e n t s

In medical field, AI is used to analyse complex medical data It is an essential technology that is programmed and controlled by machines with the help of the computer It has the ability to gain information and well-defined output to doctors and patients AI provides prevention and treatment technique to improve patient outcome It is helpful in personalised medicine, diagnosis processes, disease level, drug development and patient monitoring.6 Different capabilities of Industry 4.0 in the medical field Industry 4.0 could provide exciting capabilities and new opportunities for patient care It individualises products with the precise manufacturing of patient-specific devices, which creates ahigh- quality result It also positively impacts thehospital

Figure 1.1: Capabilities of Industry 4.0 in the medical field IoT,

Internet of things Source:Industry 4.0 applications in medical field: A brief review

- The customisation is the primary requirement of the medical field because data of every patient- specific implants and devices ared i f f e r e n t

- Industry 4.0 is famous because of the manufacturing of the customised product, so it can quickly create highquality implants and devicesin lesser time and cost

2 Digital hospital - Industry 4.0 provides better information management in medical by the application ofIo T

- Helpful in keeping medical record,p h y s i c i a n , sample and laboratory identification

- By the applications of digital technologies used in Industry 4.0, symptoms and cause of diseases are easily identified

3 Smart implants - Efficient manufacturing of smart medical components and the same can communicate with monitoring systems and remotephysicians

- It evolves in the part of the internet of service and opens a new era of opportunities in the medical field

- By the applications of smart material,implants can change the shape with increase in temperature concerning time as per requirement

4 Designing andmanufacturing of surgical toolsanddevices

- Industry 4.0 can play a useful role in the design and production of implants, surgical tools, biomodels and all other medical devices and models in lessertime

- Also used for upgradation of tools and devices by the application of additivemanufacturing

- Implants manufactured by smartmanufacturing technology fit the patients comfortably

- During unusual circumstances such as critical illness or unavailability of any family members, technologies are reliable to easily identify previous medical history of the patient such as name, age, blood group,etc.

- Provide more time for treatment by speedy admission procedure

- Provides 3G video equipment in an ambulance byw h i c h do ct or s c a n alsoi m a g e t h e c o n d i t i o n o f the patient before admitting

6 Provides implants in lesser time

- Build a customised model in lesser time with required mechanical strength

- Helpful to create a conceptual model for medical applications

- By the applications of different advance designing and manufacturing technologies, implants and other medical devices are createdin lesser time

7 Cost-effective for the hospitals

- Produces any medical devices, instruments or implants at a lower cost

- Digitally controls all the system in the hospital and provides excellent service to thepatient

- Highly reliable for manufacturing of acustomised product which correctly fits thepatient

- A customised implanta s p e r p a t i e n t d a t a r e d u c e s risk and surgery time

8 Improved accuracy as per patient match

- Models/parts manufactured by smart manufacturing technology have good accuracy and surface finish

- Using good-quality material accuracy is improved

9 Multimaterial implants, tools and devices with excellent strength

- Smart manufacturing technology uses multimaterials as input material

- Multimaterial-printed implants provide exact information such as defects in the bone of the patient

- These multimaterial medical models helpt h e surgeon for a better understanding of the patient- specific problem before surgery

10 Provide flexibility - Industry 4.0 provides excellent flexibility during a complicated surgery

- Traces the cause of diseases by predicting data of different patients

- Flexibility to create industrial parts,m e d i c a l models, cultural artefacts and also other dental models

- Industry 4.0 provides essential direction for the researchanddevelopment of personalisedprostheses and other implants/ devices.

- Industry 4.0 helpstoefficiently manufacture a prototype, and thisp r o t o t y p e i s t o b e t e s t e d a n d used for research & development purposes

12 Precise for surgeons- Medical parts and components manufactured by this process performed precise surgery because smart manufacturing system produces an exact fitmodel.

- Easy handling of different complex cases

- Medical model manufactured by smart manufacturing systems can improve the communication between doctor/surgeon and patient.

- Doctors and surgeons can better understand the treatment outcomes and provide appropriate information to the patient

- Industry 4.0 uses sensors and innovative manufacturing technology which has the potential to reduce the surgery risk

- Quickly identifies the problems for complicated cases

- Performs surgery efficiently which increasesthe success rate of operatio

- Industry 4.0 is famous because of the customisation, which can manufacture any shape implant

- Reduces inventory cost because implants are produced as per the individual demand

- By the use of digitisation, it also reduces the paperwork because patient data are stored digitally

16 Identifies the level of diseases

- By the use of different scanning process and technique, patient data are usedefficiently

- Helpful to identify different diseases and their causesbytakingdatafromvariouspatients

- Also helpful to identify the level of diseases

17 Holography - Industry 4.0 uses holography to display medical data of the whole patient in a three-dimensional tomographic image

- Doctors can see patient data in multiangular view without the presence of the patient

- Holography is an emerging and powerful tool for medical applications used inor th op ae di cs , pathology,tissue,d e n t i s t r y , o p h t h a l m o l o g y , o t o l o g y , u r o l o g y and cardiology

18 Virtual reality - In medical, virtual reality canp r o v i d e needfulinformation to doctors and patients

- Provides a 3D view of the patient'sd a t a

- Improves the quality of surgicalp l a n n i n g

- Reduces planning time ofcomplicated surgery

- Provides surgical skills to surgeons using simulation and investigates each organ ofthe human body in a better way

- Easily monitors the whole treatment process of the patient by recording alldata

- Helps to monitor and avoid public health problem with the help of different medical devices and technologies

- Increases the quality of medicaltreatment with optimised management cost

Management system with the help of innovative technologies.1,11Inmedical field, this revolution will become a new reality to create aninnovative concept and stay competitive It successfully changes the whole process of the medical field by the applications of new technologies Fig 1 shows the different significant capabilities of Industry 4.0 in the medical field Industry 4.0 provides innovative services to patients by analysing the data of the patient with the help of sensors and IoT It provides accurate information using upcoming medical imaging techniques and helps perform precise surgery It helps to easily handle different complicated cases with the help of a digitally controlled service to the patient This revolution will readily undertake new research and development in the medical field One of the excellent capabilities of this is the recycling of medical waste in the hospital that saves our environment The new capabilities are well incorporated by Industry 4.0 in the medical field and help create excellent services to patientsand doctors.

Journals and associated academic sources have published articles on ‘Industry 4.0 in the medical field’, such as communications in computer and information science journal and lecture notes in computer science including subseries lecture notes in AI and lecture notes in bioinformatics published as two articles each Rest other sources and other journals published one article each in this field Article source includes Advances in Intelligent Systems and Computing; Advances in Production Engineering and Management; Chinese Journal of Mechanical Engineering (English Edition); Future Generation Computer Systems; IEEE Internet of Things Journal; IEEE Journal of Biomedical and Health Informatics; IFIP Advances in Information and Communication Technology; Journal of Industrial Infor-mation Integration; Journal of Network and Computer Applications; Manufacturing Chemist; Technological Forecasting and Social Change; Manufacturing Letters and Wireless Communications and Mobile Computing In area-wise research on Industry 4.0 in medical, we observed that the computer science area provides the maximum contribution of 31% in total research publications However, the overall engineering field contributes 25%; decision sciences and mathematics contributing 11% each; business, management and ac- counting 6%; materials science 4%; biochemistry, genetics and molecular biology 2% and other fields 10%, which includes energy, health professions, pharmacology, toxicology and pharmaceutics, physics and astronomy, psychology and social sciences From Scopus data, we have analysed that research on Industry4.0 in the medical field is increasing and research and development are progressing towards providing commercially viable and acceptable solutions for the medicalfield.

In the medical field, Industry 4.0 focuses on the design and manufacturing and helps perform different cases precisely It isused for manufacturing of customised medical implants, tools and other devices to meet the varied requirement of the individual patient It can efficiently solve the problem by the application of its various components which helps to meet the requirements of the medical field Industry 4.0 provides extensive contributions in the medical field with the help of innovative designing and smart manufacturing system.

It efficientlymanufactures complex shape medical implants with a wide variety of materials that make surgeon job easier with minimum risk Surgeons and doctors can convert a need/idea into reality which provides a comprehensive opportunity for the manufacturing of modified medical implant asper requirement of the patient To save cost and time of surgery, it enhances the opportunities to create a new innovative medical product which can also be helpful for research &development purposes Industry 4.0 provides excellent flexibility to create smart industrial and medical models which help to improve communication between doctors and patients It uses the innovative concept of holography and virtual reality It reduces risk and analyses the data of the patient to increase the overall performance Industry 4.0uses different innovative devices that can quickly detect the glucose, sugar and cholesterol level of the patient.10 Future scope In future, Industry 4.0 will show opportunities for innovation using integrated innovative design, manufacturing and services During research and development, it will play a significant role to achieve the requirement of medical In future, Industry 4.0 will move towards mass production systems and adapt to the world-class manufacturing system It enables to create smarter medical products in lesser time and cost. This revolution will change all management and treatment system of the patient With the help of smart manufacturing technologies, medical students can be well trained to detect problems and correlate them to take future action With the help of smart technologies, data from different patients are collected and analysed Industry 4.0 offers new opportunities that create innovations by bringing new tools, devices and implants as per patient match. Different challenges regarding price, speed and complexity can be easily solved The hospital will also change its way to purchase different tools and devices By the use of the different device, it can monitor calorific intake It can become a new path that helps to treat an illness such as diabetes, asthma anda r t h r i t i s

Industry 4.0 strongly encourages smart manufacturing andi n - f o r m a t i o n system by which medical field can take significant advantage of this new revolution It produces high-quality medical devices and components using advanced manufacturingtechniquest o me et thedemandofeachpatient Inthemedical field, it can help to increase overall performance by providing a digitally controlled management system to the patients It effectively adopts mass customisation which fulfils the primary requirements This revolution has a better impact on the environment by reducing wastage of material and human efforts with the help of various advanced manufacturing facilities It provides precise surgery to the patient by the applications of additive manufacturing,sensors, holography, robots, AI, big data and IoT devices There are various unique requirements for fulfilled Industry 4.0, such as bringing upon innovation with the help of holography and visual reality Doctors and surgeons can take advantages of this revolution for research, development and excellent service to the patient In the upcoming years, it will provide disruptive innovations to the medicalfield.

Overview of healthcare systemi n Vietnam

Vietnam health care system comprises by four administrative levels of health establishments: central level, provincial level, district level and commune level Outline of the Vietnamese health system, there have been 21health facilities in central level including the Ministry of Health, 64 provincial departments of health, 622district departments and10,917 commune health centers (CHCs).The Ministry of Health of Vietnam, the govern- mental agency and the leading organization in central level, is responsible for the care and protection of people’s health including issuing law and other legal documents for health care and protection This organization also has duties in making long-term plans and strategies for the further development of the health sectors Provincial, district and commune health facilities are under the competence management of the Ministry of Health and responsible for the implementation and development of health care services in corresponding level In these levels, the people’s committee is responsible for allocating finance and human resource, while provincial or district health department is responsible for professional the supervising and monitoring of Ministry of Health Provincial and district health department also have duties in supporting people’s committee in corresponding level in term of health care and protection for people Commune health centers provided a range of basic services,such as: mother andchild health care, family planning, treatment for acute respiratory infections, immunization and treatment of common ailments About thirty years after the establishment oft he health care system, an extensive network of commune health center has been structured throughout the country, based on population distribution and geo- graphical condition Although mountainous and remote areas are allowed more CHCs, some areas still lack of health care services, not only because of their difficulties in geographic issues, but also because of their lack of attractiveness for health workers Although public health system in communes is well established with health workers available in100% of health facilities most of out-patients has chosen private health sectors and self-treatment rather than public health facilities Result from a previous study showed that even service quality of public health sector is better than that of private health sector however, people more often choose private health sector because the easier accessibility derived from the higher number of private health facilities in commune level Low quality of health service in private health facilities revealed that there are needs of comprehensive and consensus management system in health care quality monitoring, especially in private health sector, in order to assure the equality for people who have accessed to health care services Health management information system, a powerful tool for managing, organizing and planning of the health care system in multiple levels,isnecessary for the development of a health care system At the present, reports of the health care system in Viet Nam are mostly paper-based and manually created There-fore, it is difficult for managers and policy makers to analyze and receive the accurate data about the healthcare system In such an inefficient system, health workers in lower levels have manually created or summarized monthly reports to higherlevels;thisprocesssoftentakestimeandsometimesbecomeirrelevant.Thus, there is a certain need of a computerized, universal and comprehensivehealth management information system for all health facilities in all levels for the better administering and planning the health care system.

OPPORTUNITIES OF INDUSTRY 4.O FOR HEALTHCARE SECTORINVIETNAM

Vietnam underIndustry4.0

The country’s big potential in IT and large smart phone penetration are the key enablers for Vietnam to develop its digital economy However, a national strategy for 4.0 and sturdy policies in favour of the business community to apply IT solutions is in an urgent need. Opening Viet Nam up to industry 4.0 Vietnam’s Industry 4.0 strategy will need a completed legal framework One of the biggest questions raised was whether Vietnam is now lagging behind the global digital economic waves created by Industry 4.0 “How will the country seize the vast opportunities given by Industry 4.0 to develop its digital economy to reach into its own immense potential?” Over the past few years there have been almost no specific policies and actions for developing a digital economy in Vietnam “For example, in the public administration, programmes on e-government, e-tourism or e-healthcare have failed to be implemented effectively “A legal framework on applying IT or developing smart solutions has not been implemented either There has been a gap between policy and action, and while the concept of 4.0 has been widely talked about, few actions have been made – even as the country is bursting with opportunities to develop a digital economy.” Digital economy refers to an economy that is based on digital computingte ch no lo gi e s. The digital economy is surging in Vietnam, creating major changes in business methods. Vietnam has great opportunities to develop a digital economy because it has immense potential Google and Singapore’s Temasek valuing Vietnam’s digital market at $3 billion in

2015 and $9 billionin2018, and estimated it to rise to $30 billion by 2025 Meanwhile, a recent study by Data 61, Australia’s data innovation network, showed that Vietnam’s GDP could rise by an additional $162 billion within 20 years if Vietnam succeeded in digital transformation According to the Asia Internet Coalition (AIC), with a population of nearly

100 million people, Vietnam is among the few nations in Southeast Asia with the highest speed of digitaltransformation.Currently,Vietnam hasmorethan136million mobilephone subscribers and 54.2 per cent of the population are connected to broad-band wire- based Internet Vietnam is also one of 17 nations in the world with the biggest number of Internet users The Vietnamese government aims to turn the country into oneofthe10largestnationsintheworldproducingsoftwareanddigitalcontent.

We think this target will be easily reached thanks to Vietnam’s strong telecommunications industry.

Vietnam’s online advertising market and e-commerce are also developing strongly. According to the Vietnam E-Commerce Association, the country’s e-commerce market is estimated to be over $5 billion now and can double over the next four years, The impact of the Internet on the economy is estimated to be equivalent to 2- 3 per cent of the GDP, which may increase to 40-50 per cent in thefuture.

At a recent workshop on unlocking the full potential of Vietnam’s digital economy in Hanoi, Quint Simon, head of Public Policy in Southeast Asia at Amazon Web Services (AWS), surprised hundreds of business leaders and experts by announcing that Vietnam is one of the nations with the fastest growth of 64 per cent per annum in spending on cloud computing AWS is a subsidiary of Amazon.com that provides on-demand cloud computing platforms to individuals, companies, and governments “I believe that in the near future Vietnam will develop a digital economy successfully Cloud computing is a favourite in Vietnam, with many enterprises using it,” Simon said, explaining that with the cloud, businesses can completely protect their information and prevent it from being stolen “For example, Amanotes, a fast-growing app publisher, currently has hundreds of millions of users Itistypical of Vietnamese businesses with cloud computing,” Simon continued “In another case, Masan is also using cloud to manage its stores in Vietnam It has been a big trend that many Vietnamese agencies and enterprises are seeking our support in cloudapplications.”

Deputy Minister Thang said that in order for Vietnam to seize opportunities and facilitate enterprises to benefit from Industry 4.0, the Ministry of Planning and

Investment (MPI) is compiling a national strategy on Industry 4.0, which will clarify what the digital economy means, with specific tasks for ministries and agencies The strategy’s prime targets are to grab opportunities arising from Industry 4.0, increase the country’s GDP and employment, and attract more high- quality foreign direct investment “With this strategy, Vietnam stands ready to receive new technologies However, the country will have to adapt many policies to Industry 4.0,” said Nguyen Thi Tue Anh, vice head of the MPI’s Central Institute for Economic Management (CIEM) whichisdrafting thes t r a t e g y

Under the CIEM’s study on the draft, Industry 4.0 would likely raise Vietnam’s GDP by

$28.5-62.1 billion, equivalent to a rise of 7-16 per cent, from now to 2030 “The benefits for Vietnam will be huge, far higher than those from the Comprehensive and Progressive Agreement for Trans-Pacific Partnership, which will increase Vietnam’s GDP by 1.32 per cent by 2035,” said Dang Quang Vinh, deputy chief of the CIEM’s Department of Business Environment and Competitiveness “Besides, Vietnam will be able to generate 1.3-3.1 million new jobs by 2030 thanks to Industry 4.0,” said Vinh, who is one of the drafters of the strategy “However, these benefits will only materialise if we have more sturdy policies in favour of the business community.” According to the CIEM, if medium- level technologies are applied, Vietnam’s Industry 4.0 strategy will likely enable the country to see strong growth in many key economic sectors by 2030 such as manufacturing (16 per cent), wholesale and retail (20 per cent or $9.5 billion), agro- forestry-fishery (12 per cent or

$6 billion), supply of electricity, gas, and air conditioning (23 per cent), and finance- banking-insurance (14 per cent or $3.5 billion) For example, the manufacturing sector will grow by an additional $7-14 billion based on new technology applications, while the communications and industry sector will climb 77 per cent, or an additional $2.5 billion compared to the scenario where the country fails to follow Industry 4.0 According to theCIEM, new industries arising from Industry 4.0 “will be the key growth propellants forVietnam, such as the Internet of Things and media They will also supportother sectors by raising their competitiveness, revenue, and developing new products and services.” The new industries will include e-commerce ($40 billion in revenue by 2030), Artificial Intelligence ($420 million), data analysis ($730 million), cloud computing ($2.2 billion), ride-hailing ($2.2 billion), and fintech ($1.5 billion) Currently, many nations have been developing their Fourth Industrial Revolution strategies, such as Made in China 2025; Japan Resuscitation Strategy; Malaysia’s My-i4.0; Singapore’s 23 plans on digital transformation; India’s Smart City Mission and Industry 4.0 Centre; Indonesia’s Making Indonesia 4.0; and Thailand 4.0 “Industry 4.0 offers great opportunities to Vietnam without which, the country will continue lagging behind other nations,” said the CIEM study.

“Taking advantage of Industry 4.0 is the shortest way for Vietnam to turn itself into a modern and affluent nation, and develop into a modern industrial nation in the shortest time. Thus, the country needs to mobilise all necessary resources to implement its Industry 4.0 strategy.”

At the Vietnam Private Sector Economic Forum 2019 last week, CIEM deputy director Nguyen Duc Hieu said that it would be difficult to develop a sturdy legal framework to regulate activities related to the digital economy “For example, if an unmanned car causes an accident, who will be largely responsible? Is it the car, the software owner, the car owner or even road designers? We will have to have suitable laws for such cases,” Hieu said. According to Minister of Information and Communications Nguyen Manh Hung, several key foundations need to be developed to create an effective digital economy in Vietnam.

“When we dare to accept new things, new technologies and global talent will come to Vietnam and new industries will appear,” Hung said “Then Vietnam will be abletocreate digital products that can be exported.” “However, if we dare to accept new things but only follow other nations, we will not be able to create many added-value products,” Hung continued According to him, the digital economy in Vietnam must be supportedb y a g o o d I C T i n f r a s t r u c t u r e c h a r a c t e r i s e d b y 5 G t e c h n o l o g y a n d e a c h person in the country owning a smartphone “Second, we need to have good policies to spur digital economy and technology Internet in Vietnam must be globally competitive so that Vietnamese people will not go overseas to establish their enterprises any longer and more foreign enterprises will come to Vietnam to do business,” he said “Third, the government needs to develop an initial market for IT enterprises by spending more on IT products and e-government,” Hung added “Finally, human resources training needs a boost in foreign languages and IT education in schools anduniversities.”

Healthcare digital technologyinVietnam

2.2.1 Vietnam proposes the route of making hospitalsintelligent

The Ministry of Health has unveiled a roadmap for digitising patients’ records at hospitals and setting up smart hospitals, a conference heard in HCM City on Wednesday Assoc Prof

Dr Pham Le Tuan, a former Deputy Minister of Health, said: “The smart hospital approach is an inevitable choice in Viet Nam to improve the quality of healthcare to achieve customer satisfaction and ensure security, safety and efficiency in hospital management.” The fourth industrial revolution has been changing the face of the world and the lives of people in all fields in positive and promising ways, he said “Healthcare is therefore also greatly affected by the application of new techniques and technologies such as AI, expert systems, the internet of things, and big data to create information management systems and powerful applications that effectively support the management in medical as well as professional work” Many hospitals in the country have adopted health information technology systems such as electronic medical records, e-Health and telemedicine, he said A system to share data on treatment covered by health insurance between health facilities around the country has been set up, he said Health data is a valuable asset, especially for medical science,with its complex characteristics and increasing volumes, and so there is need for a plan and strategy to manage and exploit it, he added Nguyen The Dung, vice chairman of the VietNam Health Economics Association (VHEA), said globally digitization has created great transformationinthehealthcareindustry,improvingitsquality andefficiency.“AI, internet of things, big data, block chain, cloud computing, and other digital technologies make hospitals smarter and smarter.” According to professor Vo Van Toi, head of the School of Biomedical Engineering at the International University under the Viet Nam National University HCM City, telemedicine is an appropriate way to develop smart healthcare, especially for low- and middle-income countries His school has developed the internet of things for healthcare including point-of- care devices that patients can use at home or anywhere else to measure their vital signs, websites and apps to record and notify family members and physicians to assist the latter in monitoring and immediately taking care of the patient if necessary, servers to stores data, and software for connecting the above devices and persons and analysing data, he said A clinical trial of the system was funded by the Binh Duong Province Department of Health and a medical centre for public servants in the province The 1st International Health Informatics Conference Towards Smart Hospital was held by VHEA and the School of Industrial Management affiliated to the University of Technology, and provided an opportunityforhospitalmanagerstodiscusshowtomaketheirhospitalssmarter

Each person will have a unique health ID HA NOI — Each Vietnamese citizen will be issued with a unique health ID card, which they will be able to use throughout their lives,according to the Ministry of Health The ID will be automatically generated through the general identification system of the ministry and used to identify individuals for healthcare services Each ID will have a series of characters, of which the first ten are unique to the holder The numbers are based on basic personal information including name, year of birth and place of birth According to the regulation issued by the health ministry on creating,using and managing health IDs, each healthcare facility will have an account to access the national health identification system If the facilities are not connected with the system,healthcare staff must access the website of the national health identification system and search for the details of each patient The ID cards will be able to create and connect health reports for patients nationwide Healthcare facilitiesare responsible for managing the IDs and have to ensure the security of personal information and the national system The health identifications are managed through the national health identification system located at the healthcare data centre at the Information Technology Department under the health ministry The database of the national health identification system will be linked with the database of households signing up for the social security scheme.

2.2.3 Digitalisation of healthcare feild, double-edgedsword

Digitisation of the healthcare sector is important to better serve patients, but hacking by cybercriminals is a grave risk, and great efforts are needed to keep patient information secure HCM CITY — The development of technologies such as 4G, 5G, internet of things and artificial intelligence has rapidly changed the healthcare sector’s landscape globally, including in Viet Nam, with more organisations adopting digitisation, according to experts The goal is to have multiple affiliated organisations sharing patients’ digitised medical records to provide more holistic healthcare Many healthcare institutions are also using smart equipment to carry out conventional tasks For example, various devices measuring vital signs today are directly connected to the hospital’s systems Once measurements are taken, the data is incorporated directly in the patient’s medical records without the need for manual intervention New technologies have enabled the healthcare industry to carry out remote operations For instance, earlier this year, a surgeon in China successfully carried out an operation remotely Digitisation across the healthcare industry has helped service providers improve the quality of care and accelerate medical breakthroughs for better patient outcomes and mitigate the rising cost of healthcare The Vietnamese Government is also supporting the digitalisation of healthcare, launching projects to encourage and enable digital health solutions to be adopted around the country. According to the Ministry of Health, all healthcare establishments will complete digitisation of medical records by 2030 According to the Australian Trade and Investment Commission(Austrade) Viet Nam, Viet Nam’s economic growth, health-conscious population and fast- developing 4G and 5G infrastructure provide the perfect environment fordigital health solutions There is strong interest in telemedicine and advanced technologies and systems that can improve decision making, improve operational efficiency and enhance patient care and experience, it said Yeo Siang Tiong, general manager of Kaspersky Lab Southeast Asia, said most hospitals were in the first stage of digital transformation, digitising simple data such as patient records, personal information, past diagnosis, and medicine But the digitization of the healthcare industry had led to a massive increase in the number of targeted attacks against the sector, he said “The healthcare sector tracks a person’s medical history, personal information, sometimes they also track who their parents are, and genetic conditions that pass down from parents to child “Some of this information is actually worth more than a bank card.” In addition, "the sectorisless protected than sectors such as banking and finance," he said In the healthcare industry, cyber security should not be taken slightly because any issue could be a matter of “life and death,” he warned “What would happen when you need to treat a patient in an emergency room, but the information is suddenly not available It is a life and death situation It is actually very dangerous.” At a recent conference on cybersecurity in the healthcare sector, experts said the consequences of a breach could be quite detrimental since healthcare records are highly personal and sensitive in nature If patients’ records were stolen, their private data could be traded on the dark web to be exploited by cybercriminals for scams and frauds, and worse still it could cause tremendous trauma to the patients, they said Yeo said to protect the healthcare industry from cybercrimes, it was very important to “raise security awareness not just among IT workers but also users of the equipment, doctors, nurses, and healthcare workers.”

"A lot of hospitals do not have chief security information officers," he said, suggesting that they should focus on developing human resources to ensure cyber security, he said The healthcare sector is a critical one, and therefore hospitals, public and private, should start drafting regulations to address the rising threats, according toYeo.

2.2.4 Affairs on high-teach healthcare complex beginning inHanoi

The first phase of a hi-tech healthcare complex, expected to cost more than 1 billion USD, kicked off in Hanoi’s outskirt Dong Anh district on October 14.

Hanoi (VNA) – The first phase of a hi-tech healthcare complex, expected to cost more than 1 billion USD, kicked off in Hanoi’s outskirt Dong Anh district on October 14 The 40ha complex, invested by TH Group, is divided into two stages with the first slated for completion in the second quarter of 2022, providing 300 beds The second stage is expected to be finished in 2025, raising the number of beds to 1,000 The TH Medical complex will include five main areas that are an e- prevention centre, an international hospital, a wellness and rehabilitation centre, an international R&D centre and a geriatric centre and nursing home Addressing the groundbreaking ceremony, Chairman of the Hanoi People’s Committee Nguyen Duc Chung highlighted the significance of the project in improving healthcare servicesforlocal residents, pledging that the city will support the implementation of the project During the ceremony, the TH Group and TH Medical signed a cooperation agreement with Keio University and Keio Hospital of Japan on collaboration in the project’s management, operation and personnel exchange Statistics from the Ministry of Health revealed that healthcare spending accounts for approximately 7 percent of the country’s annual GDP People’s spending on overseas medical treatment reached nearly 2 billionUSD.

Doctor Anywhere partners with ViettelPay, part of Vietnam's largest mobile network operator Viettel, to become the 1st telco and payment gateway to provide online healthcare services

HANOI, Vietnam, Oct 21, 2019 /PRNewswire/ Doctor Anywhere (DA) and ViettelPay, part of Vietnam's largest mobile carrier Viettel, have signed a strategic cooperation agreement to bring a full suite of online healthcare services to ViettelPay's more than 6 million registered users throughout Vietnam ViettelPay's customers will be able to directly connect to Doctor Anywhere's virtual clinic and consult a locally-registered doctor, as well as access a range of wellness services directly on the ViettelPay App Payment for doctor consultation, medication, and other services can be made easily using the App With this partnership with Doctor Anywhere, ViettelPay’s users will soon be able to have direct access to online video-consult with a locally registered doctor, and shop on the DA health and wellness Marketplace - all payments processed through ViettelPay’s digital payment gateway This unprecedented agreement is set to expand ViettelPay's reach and influence in the Vietnam market, as the first telco and payment gateway in Vietnam to be integrated with online healthcare services.

It is also a significant boost to Vietnam's healthcare ecosystem, as this partnership is set to make healthcare delivery even more seamless and convenient With Viettel's extensive network coverage throughout the country, this will mean that people who live in remote and rural locations will be abletoaccess high quality healthcare on their phones, and make payment easily using ViettelPay's paymentg a t e w a y

Mr Pham Trung Kien, General Director of ViettelPay expressed his optimism in this partnership, "This cooperation between ViettelPay and Doctor Anywhere will greatly improve the distribution of reliable healthcare in Vietnam ViettelPay's users can have direct access to a wide variety of healthcare services anytime, anywhere All they need is a smartphone connected to the internet." In a country of 96 million with a smartphone penetration rate of 84%, anyone with a smartphone can easily download the ViettelPay App and immediately access Doctor Anywhere's services This will help to ease the strain and improve efficiency of public healthcare in the country, and bring about better quality of care for the Vietnamese population This service is slated to go live on ViettelPay App in early 2020 Mr Lim Wai Mun, Founder and CEO of Doctor Anywhere, stated: "We are excited to go forward with this partnership with ViettelPay to bring digital healthcare services to more people in Vietnam I am confident that with this partnership, we can better achieve our vision of a more robust and sustainable healthcare ecosystem in the country and region." About Doctor Anywhere Doctor Anywhere is a regional tech-led healthcare company headquartered in Singapore With a strong network of established healthcare providers and experienced doctors,

DoctorAnywhere'sdigital platformenablesuserstomanage theirhealth easilyand effectively through the Doctor Anywhere mobile App Users can consult a doctor anytime,anywhere, and get medication delivered to them within 3 hours On the in- AppMarketplace, users can shop for a wide range of health and wellness products and services such as nutritional supplements, beauty treatments, physiotherapy sessions, and even book home-based healthcare services - all in one place In Vietnam, Doctor Anywhere operates a chain of medical clinics and pharmacies in strategic locations to best meet the healthcare needs of the people About ViettelPay ViettelPay is part of a vast digital ecosystem underVietnam's largest mobile network operator Viettel, that includes digital payment gateway,data services, insurance, and e-commerce It currently serves more than 6 million users throughout Vietnam.

Hospitaldigitalization

Digital Transformation in Healthcare Trends

Digital transformation in healthcare is the positive impact of technology in healthcare.Telemedicine, artificial intelligence (AI)-enabled medical devices, and blockchain electronic health records are just a few concrete examples of digital transformation in healthcare.Innovation is the name of the game here, with the main goal of streamlining physicians’ work, optimizing systems, improving patient outcomes, reducing human error, and lowering costs through amazing web and mobile experiences Unfortunately, the healthcare and pharmaceutical industries have lagged behind when it comes to implementing digital strategies In fact, in a recent survey, only seven percent of healthcare and pharmaceutical companies said they had gone digital, compared to 15 percent of companies in other industries Despite that, the U.S healthcare market is enormous; with the national health spending projected to reach $5.7 trillion by 2026 There’s still time for you to get well- versed in digital technology and use it to bring in more business But in order to transform your standard practice into a thriving, digital machine in 2020, you first need a comprehensive picture of the modern healthcare landscape Thanks to technology, patients get better treatment with virtual reality tools,wearable medical devices, telehealth, and 5G mobile technology Doctors, on the other hand, can streamline their workflows using artificial intelligence-powered systems Here’s a better look at the state of digital transformation in healthcare in 2020:

When you think of ‘on-demand,’ you think of consumers who want things at their own convenience, on their own time, and wherever they happen to be The healthcare industry is entering the era of digital innovation, as patients seek on- demand healthcare because of their busy schedules Mobile is especially important when considering content marketing. People have simply become far more mobile in the past decade Mobility is the name of the game, and recent statistics show that more than 50% of all web browsing in the world occurs on mobile devices as of 2018 (to be exact, 52%) One of the first rules of content marketingisthat you must identifyw h e r e y o u r t a r g e t e d c o n s u m e r s g a t h e r a n d r e a c h t h e m ont h o s e p l a t f o r m s , i.e mobile That’s not surprising given that 77 percent of U.S residents own a smartphone.

On top of that, the number of mobile phone usersinthe world is expected to pass the five billion mark by 2019 Factor in that more than four billion people globally are on the Internet and you can start to see the possibilities that digital transformation in healthcareoffer.

According to DMN3, consumers are going online to obtain medical information for the followingreasons:

But on-demand healthcare is also driven by the growth of the ‘gig’ economy, in which freelance professionals in various industries hire themselves out per job or ‘gig,’ instead of tethering themselves to one company Companies such as Nomad Health – an online marketplace that links doctors directly with medical facilities for short-term work – are making it easier for physicians to provide on-demand healthcare to clients in specific circumstances that match their talents, expertise, and schedule In other words, doctors themselves become on-demandh e a l t h c a r e providers to better meet the changing needs of their patients, another benefit of digital transformation in the healthcareindustry.

A dull and monotonous waiting hall, the long queues, desperation to get inside the doctor’s chamber, gloomy faces of ailing patients; this is the picture one would imagine maybe a decade ago while paying a visit to a hospital.

Now with the help of mobile apps, doctors or healthcare professionals are able to speedily cater to medical emergencies and offer enhanced patient services This way mobile apps have successfully brought in a digital revolution in the healthcare industry They are rapidly becoming an integral part of doctor’s practices Like, starting from medical prescriptions and viewing blood reports and x-ray to track and monitor symptoms and patient recovery, these e-prescription apps allow doctors to diagnose patients, treat & monitor them for many common diseases while being on the move Consumers have become accustomed to accessing their data through the use of various digital tools, where the use of mobile and tablet health apps has tripled from 13% in 2014 to 48% today. Catering to this growing market, British based start-up Babylon Health is making waves on a global scale Partnering with the National Health Service (NHS) and private health provider, Bupa, it has also cemented its presence across the flourishing Chinese market, with a membership base exceeding 1.4mn citizens across Europe, Asia and Africa By partnering with global juggernaut Tencent, Babylon’s artificial intelligence system has enabled both parties to interact directly with users, identify specific illnesses, deliver health status assessments, and triage necessary actions The mobile app is available to over a billion users and linked to more than 38,000 medical facilities in Chinaalone.

Voice is a huge healthcare marketing technique that’s been on the rise since smartphone and smart speaker were first released (with Amazon’s Echo first hitting the market back in 2014.) And, more importantly, it can be an effective tool in the industry.Voice search has become incredibly popular around the world and with 1 in6Americans n ow owning asmartspeakerand 40%ofadultsus i n g voicesearch once a day So how does voice search apply to the industry? Healthcare access is predominantly local In other words, most Americans look for healthcare options within the proximity of their place of employment or their residence Since 20% of Google searches are voice searches in 2018, voice has become one of the main health technologies healthcare marketers must invest in come 2019 If 1 in 5 are using voice to find out about healthcare options, it’s imperative that you’re not missing out on the potential customers. Bottomline: optimize your marketing campaigns & landing pages for voice With the rise in popularity of smart speakers and native voice search as a whole (Siri, Google Now, Cortana etc), voice presents some of the most amazing opportunities for healthcare executives in

Another trend of the digital transformation in healthcare is companies collecting their own health data from medical devices, including wearable technology In the past, most patients were satisfied with undergoing a physical once a year, and only checking in with their doctors when something went wrong But in the digital age, patients’ are focusing on prevention and maintenance, and demanding information about their health more frequently.

As a result, healthcare companies are being proactive by investing in wearable technology devices that can provide up-to-date monitoring of high-risk patients to determine the likelihood of a major healthevent.

Some of the most common of these devices include:

In 2018, a major breakthrough study showed that AI could detect skin cancer better than doctors This study, published in Annals of Oncology, acknowledged that the testing was not being done on actual patients, but instead dermoscopic images which could skew the physicians’ work However, the study is just the tipping point of how

AI can help detect, and prevent, life threatening diseases AI engines can reduce and mitigate risk of preventable medical scenarios in three critical ways:

• Automate reminders – Great for helping patients take medication within a specifictimeframe.

• Identify people at high risk – Discovering those in need of medical intervention and trigger medical staff alerts to create custom care plans IBM Watson currently testing this with opioid addictioni s s u e s

• Deliver personalized dosage recommendations – Based on each patient’s unique body chemistry and associated environmentalfactors.

The European Union is set to invest $24 into artificial intelligence (AI) by 2020 in a bid to catch up with Asia and the US, who have invested heavily in AI and cloud services. This year, Google revealed its plans to harness AI and machine learning across a multitude of consumer technologies, particularly in healthcare “If AI can shape healthcare, it has to work through the regulations of healthcare In fact, I see that as one of the biggest areas where the benefits will play out for the next 10-20 years,” Google CEO Sundar Pichai has previously stated The bottomline is simple: keep AI on the radar and utilize the concept as one of the main health technologies for you in 2019 There’s no signs of slowingd o w n

Artificial intelligence (AI) is more than just a digital transformation trend in healthcare AI represents the epitome of medical innovation and industry players are eager to invest millions in it For most patients,AIin medicine brings to mind Japanese nurse robots But now, there are plenty of American versions too, like Moxi, a friendly hospital droid designed to assist human nurses with routine tasks such as fetching and restocking supplies Chatbots and virtual health assistants are another AI-based technology that patients are becoming familiar with Chatbots can fill a multitude of roles from customer service representatives to diagnostic tools and even therapists Their versatility is being translated in heavy investments But therealpowerofAIcanbebestobservedinareaslikeprecisionmedicine,medical imaging, drug discovery, and genomics For instance, cancer patients used to receive cookie-cutter treatments with high failure rates Now, thanks to AI’s sophisticated pattern recognition, these patients have access to personalized therapies tailored to their genetic makeup and lifestyle What AI-powered computer programs do for oncology, in a nutshell, is analyze thousands of pathology images of various cancers to provide highly accurate diagnoses and predict the best possible anti-cancer drug combinations And, in medical imaging diagnostics, this technology helps radiologists spot details that escape the human eye What’s more, top pharmaceutical and biotechnology companies are using machine learning algorithms to shorten the drug development cycle In fact, recent findings show that

AI can slash early drug discovery timelines by four years against the industry average, and generate cost savings of 60percent.

Blockchain in healthcare isn’t just useful for the hype it’s ramped up with bitcoin and other cryptocurrencies Instead, what’s exciting about blockchain is the digital record- keeping that creates the ledger of transactions that isn’t only transparent, but impossible to tamper with As healthcare organizations further embrace digital, and specifically blockchain, there are many areas of opportunity, including claims processing from a payer perspective and improving the exchange of patient information and data from a provider view Blockchain is a definite way of the future when it comes to increasing productivity and operative ability across healthcare organizations Blockchain is here to stay with a variety of experts, some of whom are skeptical of bitcoin, claiming that the technology could fundamentally changethewaythathugesectorsoperate– includingdigitalhealthcaremarketing.

2.3.1.4.1 Blockchain and promise of better electronic healthr e c o r d

Blockchain has recently developed a bad reputation due to the burst of thecrypto currency bubble Now, the average person thinks of blockchain as of this vague, puzzling concept that doesn't have much of an impact on their life In reality, this technology will soon play an instrumental role in keeping their electronic health records accurate andsafe.

Opportunity of utilizing big datai n healthcare

Big data aggregates information about a business through formats such as social media, ecommerce, online transactions, and financial transactions, and identifies patterns and trends for futureuse.

For the healthcare industry, big data can provide several important benefits, including:

• Lower rate of medication errors – through patient record analysis, software can flag any inconsistencies between a patient’s health and drug prescriptions,alerting health professionals and patients when there is a potential risk of a medicationerror.

• Facilitating Preventive Care – a high volume of people stepping into emergency rooms are recurring patients also called "frequent flyers.” They can account for up to 28% of visits Big data analysis could identify these people and create preventive plans to keep them fromreturning.

• More Accurate Staffing – big data’s predictive analysis could help hospitals and clinics estimate future admission rates, which helps these facilities allocate the proper staff to deal with patients This saves money and reduces emergency room wait times when a facility isunderstaffed.

With these benefits in mind, healthcare and pharmaceutical companies should invest in organizing their data That requires an investment in analytics experts who can crunch the data to not only identify areas of weakness, but to also help companies better understand their market For example, if you’re in the pharmaceutical industry, you probably understand that marketing dynamics are constantly shifting In fact, drugmakers believe that the biggest advantage of big data is how it helps them understand the market And with that understanding, they can determine product iteration and product budgets based on existing and future demand With a better grasp of the market, your healthcare marketing and sales teams will have an easier time identifying your ideal consumer And a big part of that is creating acustomer persona, which compiles demographic information on whatyourprospectswantandneed,andtheplatformswhereyoucanreachthem

2.4.1 Benefits of Cloud computing forhealthcare

Every day, more and more organizations migrate their data to either the cloud or a hybrid server There are many benefits to doing this, particularly when it comes to the cost of operating and maintaining a data center By leveraging cloud systems, organizations can take advantage of big data and all it has to offer without incurring many of its expenses. While cloud computing has been around for some time, its widespread adoption is a recent trend The healthcare industry in particular is presently growing and evolving to incorporate more modern technologies The hands-off aspect of cloud computing is especially valuable in the field because it meansaserviceprovider—theowneroftheserversandhardware— isresponsible not just for maintaining the equipment and systems but securing them as well And it’s no secret that the security of healthcare information is of utmost importance But there are other benefits to cloud computing beyond those mentioned When it comes to healthcare and the medical industry, cloud computing has a lot to offer Here are the top six advantages.

The healthcare industry relies on huge stores of data, and the storage capacity needed to retain it all is substantial To make matters more complicated, the list of requirements continues to grow as the amount of data amassed increases exponentially over time The beauty of cloud computing solutions, however, is that the service provider must accommodate the growing requirements and not the business collecting the data In healthcare, this means a near-unlimited capacity is available to store all the necessary content and information.

In addition to allowing for nearly unlimited storage capacities, cloud computing affords unprecedented levels of scalability As with most industries, there are busy seasons and there are slow seasons in healthcare The former requires greater and more powerful computing systems, while the latter relaxes said requirements The subscription-based nature of cloud computing services means that healthcare providers can increase system usage and decrease it as necessary, with little to no stress on their operations There is no waiting period to scale up or scale down It happens instantly Simply put, cloud computing makes it possible to easily scale operations according to the necessities of market conditions, demand and seasonalrequirements.

When it comes to pulling data and digital content from the cloud, it’s accessible from anywhere and by multiple contacts simultaneously That makes for excellent collaboration and sharing experiences, which is crucial in the healthcare industry Doctors and healthcare professionals must be able to share patient information and records between one another while still preserving theirsecurity.

Analog methods rely on paper-based records which are not secure at all They’re also not conducive to collaboration, at least not in the same way that digital records are Cloud computing means that the data is easy to share with anyone that needs to see it, including patients and insuranceproviders.

It’s a common misconception that cloud computing is less secure than alternate methods There is always some risk involved, of course, but security is almost always stronger under the control of cloud providers This is because the service providers specialize in data management, meaning they not only have the understanding and experience but also the resources to fully lock down that content Cloud providers also have more resources to invest in local information security teams and tools, which translates to stronger levels ofp r o t e c t i o n

It’s difficult for human analysts and laborers to pour over such massive troves of digital content and information Fortunately, they don’t need to, as they have machine learning and artificial intelligence solutions The healthcare industry can benefit from access to these technologies, which are capable of mining collected data for new insights and details For example, a Seattle company called Kensci leverages machine learning to predict illness and treatment patterns Another company called Path AI leverages technology to aid pathologists in making quicker and more accuratediagnoses.

Because the data and computing power is all remote, the same systems are available to just about any platform with internet access, including mobile This extends support to a wide range of platforms, creating a greater number of remote care opportunities Doctors, nurses and health practitioners can monitor events and even provide care from around the world This not only presents new opportunities but also enables more accurate and far- reaching care Imagine an on-site Doctor being able to monitor all their patient’s vital signs, remotely, while tending to others.Or asp ec ia l is t that’s a b l e toc a r r y outa pr oc ed ur e f r o m halfwayacross t h e world using remote conferencing technologies This form of remote-care-meets- modern- technology is referred to as telehealth, and it’s becoming more and more prominent in the field Reap the Benefits at a Fraction of the Cost Cloud computing solutions allow organizations to reap the benefits of big data at just a fraction of the cost That’s because a service provider handles the hardware and software maintenance necessary to keep the systems operational Healthcare providers can access cloud computing solutions with a seamless experience, gaining all the benefits above and more That means unlimited storage capacity, unprecedented scalability and collaboration opportunities, improved security, remote care possibilities and machine learning and AI capabilities But increased uptime, streamlined IT services and support, and optimized accessibility during major disasters and events are all part of the deal too In short, cloud computing is revolutionizing the healthcare industry, and there’s no room for argument on that point.

2.4.1.7 Advantages of data orientation for medical insurance

One of the most transformative shifts emerging in healthcare is the rise of the

‘quantified self’, which probably needs no new explanation The digitization of products, services, and payment models is democratizing current healthcare systems and also represents a new era of healthcare consumerism This entails an evolving ecosystem of connected health technologies such as we arables, telehealth, artificial intelligence, virtual reality, and others that support targeted, personalized health and well-being services. Technology Adoption Laggards and Need for Change The adoption of digital solutions by the health insurance sector has been limited over the past decade There can be no denial that the health insurance policies available today are dated and often fail to meet the personalized needs of individuals As a result, global health insurance market growth rates have been declining, from 9% in 2014–2015 to 6–7% in subsequent years The industry needs consumer-centric insurance programs that incentivize individuals for adhering to healthy habits and lifestyles.

A Changing Paradigm: The Health Insurance Pioneers for Tech Adoption

Globally, progressive private insurance companies have already started to leverage the convergence of digital health solutions, such as we arables and health apps, to rejuvenate the health insurance market Technology adoption is driving them towards data-driven, incentive-based health policies that promise to provide a personalized experience for policy holders, while reducing costs from potential claims During 2018 alone, some of the leading private health insurance companies globally have launched new programs or expanded existing ones in order to remain at the forefront of this digital transformation journey. Examples from across the world include Prudential in Asia (with Babylon Health), Discovery Group in Africa (the Vitality program), Manulife (with Vitality) and Sun Life (Best Life Rewarded) in Canada, and United Health Group (Motion Program with

Where We Are Headed and Impact

Frost & Sullivan’s research suggests that lifestyle and health data-driven interactive health insurance plans will continue to gain popularity globally, as they enable insurance companies to personalize premiums by stratifying health risk and reward programs This would open up business opportunities for we arables, OEMs, mobile apps, and health data aggregators to collaborate with progressive private insurance participants and employer health programs in order to promote consumer- centric insurance programs that incentivize individuals for adhering to healthy habits and lifestyles Furthermore, policy changes toward reimbursement for digital health and wellness technologies are set to provide more flexibility for emerging digitally-led insurance models, especially in healthcare markets with a high spending level on lifestyle-driven chronic health conditions and relatively mature digital health initiatives (such as the United States, Western Europe, Japan, Australia, andSouthKorea).

Strengtheninghealthcaresocialli zation

Economic progress alone is not enough We want a vibrant society where everybody participates and feels they belong Health and wellbeing is fundamental to this Much of our improved health status is due to progress in the formal health sector.

A great deal of it is due also to actions and developments in other areas - clean air and water, better housing, safer roads, safer food, safer workplaces, actions to address poverty and inequality All have an impact and we want to make sure that all sectors appreciate that they have a role to play and that health and wellbeing is affected by a whole range of factors across the life course Equally, we are seeing different health problems emerging; frequently the cause is our modern lifestyle This trend is worrying and unless we make some significant changes, we are facing an unhealthy and costly future The health sector alone cannot address these problems; we must change ourapproach.

That is what Healthy Vietnam is about - taking some important steps towards making a healthier and more prosperous nation It is the Framework which will bring together people and organisations from the length and breadth of the country into a national movement with one aim: supporting all of us to enjoy the best possible health and wellbeing It is designed to include Government Departments, local authorities and public bodies, businesses and employers, sports and voluntary groups, communities andfamilies.

Through Healthy Vietnam, its goals and actions, and through working together, we will create a coherent policy and sustainable co-operative action for health and wellbeing.

An essential part of this is to develop by the end of this year the measurements to make sure we are making the progress that wew a n t

By publishing and implementing Healthy Vietnam, we as Government are committing to playing our part and leading the way We are in turn calling on leaders from every sector of society to join us, and to help us By getting involved, by working together, we can make real progress on making Vietnam a healthier nation.

The current health status of people living in Vietnam, lifestyle trends and inequalities in health outcomes are leading us toward a future that is dangerously unhealthy and very likely unaffordable The work that is underway to build a health service that is accessible and fair will only succeed if we build an environment that supports people and their families to lead healthier lifestyles Evidence and experience from around the world clearly shows that to create positive change in health and wellbeing, it takes the involvement of the whole community, the whole of Government, all of society working inunison.

Healthy Vietnam draws on existing policies, but proposes new arrangements to ensure effective co-operation and collaboration across Government, the health system and other relevant areas It is about each individual sector helping to improve health and wellbeing, multiplying both our efforts and our results Many people, organisations and Government Departments who contributed to the development of Healthy Vietnam Many people contributed through participating in the consultation process and working group. Others attended meetings in the development phase and undertook background research and analyses Others advised and commented on drafts of the Framework, and all provided freely of their expertise and commitment This participation and support reflects our shared vision to address the risks to the health of all our people and to work collaboratively and purposefully for a healthier and fairerVietnam.

Health is a personal, social and economic good, and the health and wellbeing of individuals, and of the population as a whole, is Vietnam’s most valuable resource A healthy population is essential to allow people to live their lives to their full potential, to create the right environment to sustain jobs, to help restore the economy and to look after the most vulnerable people in society A healthy population is a major asset for society, and improving the health and wellbeing of the nation is a priority for the Government and the whole of society This means that all sectors of society and the whole of Government need to be proactively involved in improving the health and wellbeing of the population When a person experiences health problems, suffers illness or has a disability, the loss of health and wellbeing affects every part of his or her life and those around them Similarly, adverse trends in the health of the community and the population impact on the whole of society.Mortality rates have decreased and life expectancy hasr i s e n

However, these improvements are at risk with increases in adverse population trends related to obesity, diabetes and physical activity Current adverse health trends in Ireland are similar to those causing concern in other developed countries They include projected significant increasesinlevels of chronic disease, exposure to health risks, growing health inequalities, and difficulty in accessing care when it is needed The projected growth in incidence of chronic diseases will undoubtedly lead Vietnam toward an unhealthy and extremely costly, if not unaffordable, future Action is required to create change and try to address these negative health trends before our problems grow larger Healthy Vietnam is a collective response to the risks that threaten Vietnam’s future health and wellbeing, as well as its economic recovery It is a newnational

Frameworkforaction to improve the health and wellbeing of the population of Vietnam over the coming generation It sets out four central goals for improved health and wellbeing, and outlines clear routes and strategies to achieve these goals, in which all people and all parts of society can participate The Healthy Vietnam Framework draws on existing policies but proposes new arrangements to ensure effective co-operation and collaboration and to implement evidence-based policies at government, sectoral, community and local levels It is about each individual sector helping to improve health and wellbeing, multiplying all efforts and delivering betterresults.

A Healthy Vietnam, where everyone can enjoy physical and mental health and wellbeing to their full potential, where wellbeing is valued and supported at every level of society and is everyone’s responsibility Healthy Vietnam is designed to bring about real, measurable change and is based on an understanding of the determinants of health Health and wellbeing are affected by all aspects of a person’s life; economic status, education, housing, the physical environment in which people live and work Health and wellbeing are also affected by policy decisions taken by Government, the individual choices people make about how they live,a n d t he p a r t i c i p a t i o n of people i n their c om mu ni t ie s T h i s u n d e r s t a n d i n g ca lls for a partnership approach in all of the actions set out in the Framework Healthy Vietnam is designed to harness the energy, creativity and expertise of everyone whose work promotes health and wellbeing, and encourages all sectors of society to get involved in making Vietnam a healthier place to live, work and play participation of people in their communities This understanding calls for a partnership approach in all of the actions set out in the Framework Healthy Vietnam is designed to harness the energy, creativity and expertise of everyone whose work promotes health and wellbeing, and encourages all sectors of society to get involved in making Vietnam a healthier place to live, work andplay. Goal 1: Increase the proportion of people who are healthy at all stages of life This means addressing risk factors and promoting protective factors at every stage of life – from pre-natal, through early childhood, adolescence, adulthood and into old age, to support lifelong health andwellbeing.

Health and wellbeing are not evenly distributed across Vietnam society This goal requires not only interventions to target particular health risks, but also a broad focus on addressing the wider social determinants of health – the circumstances in which people are born, grow, live, work and age – to create economic, social, cultural and physical environments that foster healthyl i v i n g

Goal 3: Protect the public from threats to health and wellbeing

Healthy Vietnam is designed to ensure effective strategies and interventions to protect the public from new and emerging threats to health and wellbeing are implemented Being prepared to prevent, respond to, and rapidly recover from public health threats through collaborative working is critical for protecting and securing the nation’shealth.

Goal 4: Create an environment where every individual and sector of society can play their part in achieving a healthyVietnam

It is beyond the capability of any one Government Department or organization to promote society wide health and wellbeing This can only be done through society-wide involvement in and engagement with health and wellbeing promotion and improvement activities - from individuals making positive lifestyle choices and projects run by community and local groups, to policy and legislative changes at the highest level of government.

Healthy Vietnam, whilst guided by a clear vision, is very much outcomes driven, with targeted actions grouped under six broad themes:

The Cabinet Committee on Social Policy will oversee the delivery of this Framework. The Health and Wellbeing Programme in the Department of Health has responsibility for strategic planning and co-ordination of the implementation of the Framework actions.

Detailed and more specific implementation plans for priority policy areas will also be developed Implementation plans will be subjectedtohigh levels of consultation across Government, health and other sectors Specifying direct responsible individuals for each action will be an important characteristic of Healthy Vietnam implementationplans.

EXPERRIENCES OF APPLYING INDUSTRY 4.0 IN

Hospital digitalizationinUS

A number of technologies can reduce overall costs for the prevention or management of chronic illnesses These include devices that constantly monitor health indicators, devices that auto-administer therapies, or devices that track real- time health data when a patient self-administers a therapy Because they have increased access to high-speed Internet and smartphones, many patients have started to use mobile applications (apps) to manage various health needs These devices and mobile apps are now increasingly used and integrated with telemedicine and telehealth via the medical Internet of Things (mIoT) This paper reviews mIoT and big data in healthcarefields. mIoT is a critical piece of the digital transformation of healthcare, as it allows new business models to emerge and enables changes in work processes, productivity improvements, cost containment and enhanced customere x p e r i e n c e s

Wearables and mobile apps today support fitness, health education, symptom tracking, and collaborative disease management and care coordination All those platform analytics can raise the relevancy of data interpretations, reducing the amount of time that end users spend piecing together data outputs Insights gained from big data analysis will drive the digital disruption of the healthcare world, business processes and real-timedecision- making.

A new category of "personalised preventative health coaches" (Digital Health Advisors) will emerge These workers will possess the skills and the ability to interpret and understand health and well-being data They will help their clients avoid chronic and diet- related illness, improve cognitive function, achieve improved mental health and achieve improved lifestyles overall As the global population ages, such roles will become increasinglyimportant.

The Internet of Things (IoT) is a network of physical devices and other items,embedded with electronics, software, sensors, and network connectivity, which enables these objects to collect and exchange data Its impact on medicine will be perhaps the most important, and personal, effect By 2020, 40% of IoT-related technology will be health-related, more than any other category, making up a $117 billion market The convergence of medicine and information technologies, such as medical informatics, will transform healthcare as we know it, curbing costs, reducing inefficiencies, and savinglives.

It sounds pretty basic, but the adoption of Electronic Health Records (EHRs) is a game changer In less than a decade, an ink-and-paper system of managing records that goes back thousands of years will be digitized and replaced The advantages are obvious and many Paper records, often written in questionable penmanship, can get stuffed away in filing cabinets, out of the reach of researchers or other healthcare providers Instead, by keeping all the important information in one place, and easily sharable, EHRs will eliminate many inefficiencies, and save lives.

One of the major challenges to implementing the IoT has to do with communication; although many devices now have sensors to collect data, they often talk with the server in their own language Manufacturers each have their own proprietary protocols, which means sensors by different makers can't necessarily speak with each other This fragmented software environment, coupled with privacy concerns and the bureaucratic tendencytohoard all collected information, frequently maroons valuable info on data islands, undermining the whole idea of the IoT.

Precision medicine, as it's called, is a term that will be frequently heard in coming years It begins with genomics and goes through the rest of the omics platforms, providing multiscale data for analysis and interpretation In 2015, Intel and the Oregon Health and Science University launched a joint project, the Collaborative Cancer Cloud: a high-performance analytics platform that collects and securely stores private medical data that can be used for cancer research Though the platform began with cancer, Intel intends to open up the federated cloud network to other institutions, including ones working on cures to diseases like Parkinson's.

Engineering simulation solutions are making medicine participatory, personalized, predictive and preventive (P4 medicine) via the medical Internet of Things (mIoT)

3.1.1 IoT concept involves digitalization of medical products and related careprocesses

Pharma companies long ago realized that just selling traditional medicines will not produce growth nor even sustain competitiveness This fundamental change, known as moving 'beyond the pill', typically arises from one or two realizations: (1) medicines alone are often not enough to achieve optimal clinical outcomes for patients, and (2) as pharmaceutical pipelines dry up, 'beyond-the-pill' businesses can be valuable new sources of revenues This has created growing interest in methods of utilizing the new technologies and business processes for development and patient care, leading to PharmaIoT.

The Pharma IoT concept involves digitalization of medical products and related care processes using smart connected medical devices and IT services (web, mobile, apps, etc.) during drug development, clinical trials and patient care The outcomes of Pharma IoT in development and clinical trials can employ combinations of advanced technologies and services to create totally new kinds of disease treatment possibilities (e.g., Treatment2.0).

In patient care, Pharma IoT will enable patients and healthcare professionals to use medicines with advanced sensor hardware, and craft personalized care services and processes (Product 2.0) Good examples of the Pharma IoT solutions are the connected sensor wearables for Parkinson's disease and multiple sclerosis patients, which provide medication management, improving the patient outcomes and the quality of life.

In addition, existing medical device products such as inhalers and insulin pens can be added to the sensor and connectivity technologies to collect data for further care analytics,and even personalized therapy All this will substantially improve personal medication and care processes, because patient care data provides new sources of innovation and competitiveness.

The transformation also involves some challenges: at the same time, pharma companies need to take into account the forthcoming European Union (EU) data protection and privacy legislation, which will give patients control of their care data For example, patients will be allowed to transfer their care and health data across multiple service providers, leading to the emergence of totally new kinds of service platforms and business models, e.g., datab r o k e r s

3.1.2 Mobile devices and applications intohelthcare

We are heading into the age of information, where knowledge and data will be key.

We are also entering the age of the customer, in which more than ever the customer is going to determine what they want MyTomorrows is one example of the changing look of business models, in this case, directly connecting customers andpharma.

In this new age, devices and apps will be used to create a "health selfie" For example:

• The Myo, originally a motion controller for games, is now being used in orthopedics for patients who need to exercise after a fracture With the aid of the Myo, patients can monitor their progress and doctors can measure the angle of movement.

• The Zio Patch measures heart rate and electrocardiogram (ECG) and is the

US Food and Drug Administrationapproved.

Where is pharma in all this turmoil? Interestingly, there are signs that pharma is reaching out from its traditional medicine-centric approach.

• Glaxo recently announced that it is investing in electroceuticals, bioelectrical drugs that work by micro-stimulation ofnerves.

• J&J has teamed up with Google to develop robotic surgery In addition, they arecollaboratingwithPhilipsonwearabledevicessuchasbloodpressuremonitors.

• Novartis is working with Google (again) on sensor technologies, such as the smart lens, and a wearable device to measure blood glucosel e v e l s

Sensors can provide a lot of information to support pharma development, but iti s p a r t i c u l a r l y i m p o r t a n t t o r e c r u i t t h e r i g h t p a t i e n t s f o r t h e r i g h t c l i n i c a l t r i a l s

Body sensors, once gadgets that were mainly used by athletes and runners, are now rapidly entering the general market, and consumers and pharma will soon have access to a wealth of information including not only pulse, blood pressure, ECG and respiratory rate, but also more advanced data, such as inflammation, sleep patterns, etc.

Integrated care model based on capacities of IR 4.0 in Westone u r o p e a n 7 8 1Care4.0

There is a well understood sustainability crisis affecting Western European health and care economies A range of issues contribute to this (e.g., the ever- increasing costs of treatment and medicine), however one of the critical trends is around the ageing population and an increasingly fragmented informal care dynamic caused in part by societal changes and the forces of globalization A significant part of the response to these challenges is the strengthening of community care which is common across Europe In Scotland, policy and strategy are driving towards more preventative, co-managed, integrated and community- based care, with digital technology seen as a key asset to deliver change at scale The Scottish mode of transformation reflected in the emerging digital health and care market is accelerating, valued at $86.4 billion in 2018 and projected to be valued at $504.4 billion by2025.

The Digital Health and Care Institute (DHI) is one of many innovation centers, incubators, think tanks, and accelerators which have been setup to support both health and care transformation and economic development DHI is distinct in its whole system approach, which is underpinned by co-design with those providing and using health and social care services The market has notably matured in the five years of DHI’s existence and is now on the cusp of a significant shift as service design and technology strategies look to develop whole system models based on existing large-scale deployment of digital capabilities in other sectors In parallel, consumerism is now escalating in a broader digital market economy By 2020, 90% of UK adults will use a smart phone and 50% will have an average of four online media subscription services People are becoming increasingly accustomed to choice and use of flexible, dynamic services that stay relevant and useful within a rapidly changingworld.

These two forces—(i) strategic, and systemic service redesign enabled by technology and (ii) the emerging digital consumer, have intersected during the early stages of the fourth industrial revolution (Industry 4.0) Industry 4.0 providest h e capability to connect everything to the internet, generating data across the whole process and using advanced analytics to support completely new products and service models This capability allows for decentralization and/or distribution of power and capability throughout the valuechain.

It is likely that Industry 4.0 capabilities (4.0 toolkit) will be initially applied to health and social care systems following the dominant organization-centric discourse This risks isolating the user as an independent consumer being managed by, and passively consuming from, a formal health or social care service Within this approach there may be the possibility of self-management by that person, but as a fixed part of the organization’s top- down deliverym o d e l

The market must be stimulated instead, to work towards emergent empowerment and co-management models targeted by government policy If people can be involved in co- producing their own, asset-based service models, this would allow the 4.0 toolkit to re- integrate communities and rebuild trust and interdependency among people This is what Nesta, a UK innovation foundation, calls for in its plea to ‘make the fourth industrial revolution good’, i.e., for civil society to shape the fourth industrial revolution to be more productive for society than previous revolutions—which displaced and disenfranchised millions and focused energy and resources on environmental consumption, profit, andwar. This paper provides an overview of trends in Scottish health and care policy alongside the key integrated and person-centered care themes emerging from the co- design and design research within DHI to date It goes on to summarize an emerging toolset from the Fourth Industrial Revolution (Industry 4.0) that is transforming other sectors and then demonstrates the use of this ‘4.0’ toolset for optimization of traditional healthcare provision (Health 4.0).

It then argues that Health 4.0 alone will not deliver the services targeted in policy and proposes a new paradigm, ‘Care 4.0’,toenable integrated, person-centered cares e r v i c e s

Across the UK, the practices and premise of health and social care are shifting toenableasystemthatsupportsintegratedandperson-centeredcare.Inrecent years, the Scottish health and social care policy context has been moving from a patriarchal medical model, with resources concentrated in hospitals, to an integrated, co-managed, and person-centered model based in the community This shift aligns with policies across Europe to strengthen the role of primary and community care in support of person-centered, sustainable services The British language of policy and practice is changing in tandem, shifting from terms like patient, health, medical, doctor; to person, living, care, ands u p p o r t

Health and care research, innovation, and investment expenditure are not yet shifting with policy, remaining primarily focused on optimizing medicine, treatment of disease, and modernizing hospital and tele-medicine models Interventions by the medical community, such as Realistic Medicine, have provided vision, but asyetthere are few examples of putting this into practice ats c a l e

Digital health and care is heralded as a way of supporting this shift whilst also creating a more sustainable system This expectation is predicated on improved data sharing, advanced analytics, and automation Scotland is investing in this through the Digital Health and Care Strategy to support the development of more personalized and predictiveservices. However, these benefits will not manifest if resources continue to focus on transactional relationships between citizens and health and social care systems This is because in order to personalize and predict, systems must be informed by the person’s own context Therefore, it is proposed that the digital health and social care toolset must help systems by understanding people’s lived experience This includes their current health and wellbeing activity, health, and social care interventions in a broader life and environmental context and any resulting holistic outcomes The toolset must be able to balance the system’s need for information with a personal need for trust and the ability to connect to informal care circles and communities It must be able to use any formal or informal assets to help sustain the engagement, care interactions, and experiences on a co-managedb as is

3.2.2.1 Academic merging co-design inScotland

Over the past five years, the academic design research team who are part of DHI have undertaken over 20 design-led projects involving people with lived experience, practitioners across a range of health, social care and third sector organizations, academic subject experts, and industry partners Core to these projects has been the practice of co-design which supports the involvement of end users in the design process by valuing people as ‘experts of their experience’ Co- design empowers people with diverse experiences to come together and conceptually explore, develop, and create their own ideas to respond to a situation or design task Within DHI, co-design practice is employed to support participants to explore and prototype person-centered digital solutions to health and social care challenges Projects have explored a range of challenges including data sharing across health and social care systems, reimagining outpatient services to support people with long term conditions, and public health topics such as promoting breastfeeding.

The outputs of co-design have resulted in a body of knowledge of the role of digital technology in health and social care in Scotland evident through the findings, insight, and concepts generated from these projects For the purposes of this paper, the following learnings are considered key to informing future developments in this area.

The Role of Digital Technology in Health and Care is Enabling

One of the key learnings across all projects is the way in which technology should enable person-centered care, whether thisisfrom the perspective of those providing or those receiving care and services Technology needs to enable the right care at the right time through providing access and ease of use for citizens to have control of interactions with systems and services, helping them to activate services on their own terms Supporting an asset-based rather than deficit model of care allows the wider system to be responsive and proactive, rather than reactive, by adapting to the changing needs of the person, providing flexible access and engagement with services Developing technology that ‘enables’ the provisionand receipt of care also alleviates fears that technology will replace human interaction where it is most valued and appropriate This has previously been described as creating a ‘community of care’ where technology is not a replacement of services but provides a way to facilitate connections, redressing the balance between this and the burden of time consuming, organization-centric, risk managementactivities.

A prominent recurring challenge across all areas of co-design has been the difficulty of sharing information across systems, services, and access to information for citizens In Scotland, there are twenty-one health boards and thirty-one health and social care partnerships within and across the different health boards Within each of these organizations are then further silos, for example the largely separate hospital and primary care systems, or the specialisms within the outpatients system This is further compounded by an additional layer of services such as community pharmacies and other high street National Health Service (NHS) contractors, as well as thousands of third sector organizations providing diverse, localized services All of these care providers have different systems for collecting data which leads to silos in terms of who has access to information Further, these systems do not communicate with each other which can lead to people interacting with services having to ‘tell their story’ repeatedly to the many different care providers In this regard, Scotland mirrors similar degrees of organizational complexity found in all health and care systems globally To resolve this challenge, it is proposed that the person themselves should be the point of integration, allowing people to activate services across health, social care, third sector and communities by sharing their information to enable seamless care interactions Enabling people to hold their own health and social care information would overcome the challenges of systems data sharing as well as reduce the amount of times people need to repeat information about their own ‘health story’ In addition, this would enable person-centered care by building services that respond to personal care needs rather than react to the results of unmet need This would allow people to have more meaningful dialogue with health and social care professionals supporting shared decision making, allow people to better navigate and activate health, social care, third sectorand community services that are most appropriate, and allow people to self-manage by understanding patterns in combinations of clinical and personal data.

3.2.2.2 Building faith in systems and in the wholep o p u l a t i o n

A key implication from the co-design learning is the need to further explore and understand how to build trust in the context of digital health and social care This is not only in relation to trust in systems and information (human–system) but also in relation to people having control of sharing information (human–human through system) The co- design research in DHI has not explicitly explored trust in the context of digital health and social care, however, indications from one project exploring the concept of a person-owned data store suggested that participants were in favour of pragmatic sharing of information where benefits outweighed risks in terms of gaining better outcomes through sharing information Placing control of health and social care information with the person (point of integration) supports agency and enables shared decision making However, given the wide- ranging interest and differing levels of health literacy, and given the scope for exploitation or error, there is a need to explore the way in which trust is built between people, data and systems from a range ofperspectives.

Introducing and deploying technology in the health and social care context involves several considerations for the way in which technology is implemented, adopted, and leads to change and impact The co-design learnings identified have implications for the wider system and workforce culture which are critical to ensuring technology is truly enabling.Supporting a culture of innovation across the system and workforce is key to ensuring that the system and workforce are ‘ready’ for change This emphasizes the need to ensure that technology is designed ‘with’ not ‘for’ in ordertounderstand the impacts on existing processes, services, and systems, as well as attitudes, behaviours, and ways of working.Involving people who are likely to be the ‘end-users’ of technology in the design process helpstofoster a culture of innovation by giving people permission and a safe space to generate ideas and critically reflect and evaluate potential solutions This alignst o the Scottish Digital Health and Social Care strategy which seeks to create a permissive culture in order to rebalance approaches to risk.

Increasing service pressures are now creating the demand for digital health and care capabilities to be deployed at a far larger scale This prompts analysis of global trends in the way technology supports new business and service model change atscale.

Socializing healthcarei n China

Given China's rising health care costs and inequities, this healthcare app is attempting to level the playing field by changing the very nature of personal care.

WeDoctor, formally We Doctor Holdings Limited, is a mobile application aspiring to make healthcare more approachable and accessible for the average individual This Hangzhou-based company has been recognized for introducing “China’s first internet-based hospital,” and its platform has been used by over 2,700 hospitals in mainland China and has

27 million monthly active users since its founding in 2010 Valued at $5.5 billion in 2018, WeDoctor’s pre-IPO efforts raised

$500 in investments There is massive potential to scale this platform both domestically, with healthcare spending projected to reach $1 trillion by 2020, and internationally.

While WeDoctor has many capabilities, it has four main businesses:

1 WeDoctor HealthCare composes of two disease diagnoses system for Western(RealDoctor) and Chinese medicine (Huatuo AI Doctor), both of which are facilitated by artificial intelligence (AI) The latter offer is reflectiveof the

100 continuing reliance on traditional medicine in Chinese society One of its more notable capability is detecting cervical cancer.

2 WeDoctor Insurance offers varying insurance options for users based on gender and concerns (cancer insurance, leukemia insurance, children’s insurance) at different pricepoints.

3 WeDoctor Cloud allows its partnering hospitals, clinics, government, and businesses to use tools such as data processing, record management, AI diagnosis, pension management, and remoteconsultation.

4 WeDoctor Pharma integrates its healthcare services to provide patients a “one- stop shop” to receive a virtual consultation and receive an electronic prescription that can be immediatelyfilled.

The we doctor interface allows users to select from a number of options and be able to access their health records real-time with a doctor.

WeDoctor’s success can be attributed to how it addresses the traditional pain points related to healthcare: time, distance, and money Its value also arises by helping doctors make earlier or more precise diagnosis, and by speeding up the overall experience. Collecting data real-time and cross-referencing a patient history with millions of other users can, for instance, predict a heart attack “with a high rate of precision,” says Dan Vahdat, chief executive of Medopad WeDoctor can become especially valuable for rural populations who often experience increased difficulty reaching critical health services In many ways, WeDoctor redefines the very notion of personal care that has been at the core of the patient-doctor relationship As the platform continues to grow, its treasure trove of data proliferates and be valuable to many interestgr ou ps.

Patients can select any available doctor from a partnering hospital for their consultation, have a video consultation, and immediately get ap r e s c r i p t i o n

As it continues to expand, it will face stiff competition from Ping An Good Doctor,another mobile healthcare application considered the “first health-tech Unicorn” in China after the company raised $1.1 billion IPO; however, its shares

101 dipped 11% on the second day of trading Ping An Good Doctor expanded to Southeast Asia and created a joint venture with popular Singapore-based ride- hailing app Grab in November 2018 Another major competition will be from Google’s DeepMind Health, though the firm recently encountered legal troubles in 2017 when the UK’s Information Commission found that it had broke UK privacy law.

WeDoctor has found success in a country burdened by rising inequalities, where patients have to wait in line for hours just to get an appointment or buy a time off scalpers.The company also launched a $600 Echo-like home device, called WeDoctor Tong, that can link to user’s wearables and acts as a “doctors’ hotline.” Eyeing the international market,WeDoctor acquired a majority stake in the Australian fertility treatment company Genea to focus on its newest platform, BBlink Given that inadequate and expensive medical treatment is not indigenous to China alone, is sky the limitforWeDoctor?

Source: China’s Healthcare Revolution: WeDoctor

The healthtech market in China’s healthcare sector is one of the largest in the World. According to research agency, Prospective Institute, the healthtech market has reached CNY49.1 billion in value, a 46.7 percent increase from the CNY33.5 billion value it had in2017.

According to Dr Neil Wang, greater China president at Frost & Sullivan, this growth can be attributed to recent reforms and internet growth in the country.Hetold International Finance “Healthtech service is able to solve inconvenience and unfair problems of medical service Benefiting from opportunities brought by healthcare reform in China and fast growth of internet technology, the Healthtech market in China has developed fast in recenty e a r s ”

Two prominent companies according to him included WeDoctor and Ping An Good Doctor Founded in 2010, WeDoctor provides seamless online and offline healthcare services as well as integrated of general practitioner and specialist doctor services. Meanwhile, Ping An Good Doctor, which was founded in 2014 strives to provide families with a family doctor, and each person with an ehealth profile a healthcare management plan. These companies, he said, were helping make healthcare in China more affordable. Explaining the latter’s business model, he said, Ping An GoodDoctor lowers the spending of medical services through its specific insurance plans “The specific insurance plans combine insurance, hospitals, and doctors Employees who are covered by the insurance plan can visit specific medical institutions and only need to pay a little as registration fee Under the insurance plan, patients are abletopay less out-of-pocketmoney.”

With regards to WeDoctor, he said, it was leveraging technology such as AI and big data along with the internet to provide solutions to both government and medical institutions This, Dr Wang said, helped realise reasonable allocation of medical resources on one hand and the optimisation of medical service processes on the other “For example,Cloud Patrol Vehicle developed by WeDoctor makes quality medical service available to rural people At present, WeDoctor is sparing no effort to create a new HMO (health maintenance organisation)model aimed at helping both patients and medical insurance funds save more money,” Dr Wang said. Songqi Zhang, director of public relations at WeDoctor said the biggest impact of healthtech occurs at the grass-root level and this, in turn, helps save a lot of costs which are not just medical in nature Zhang explained to International Finance that in the past, a person living in a remote area would have to visit cities such as Beijing and Shanghai, upon falling ill, to make use of the medical services However, now, he said, healthtech was allowing people to get treated even remotely, helping them to save a lot in accommodation and travel costs in addition to medical expenses “ with remote diagnosis and treatment, patients can get consultation services from well-known experts in Beijing and Shanghai at the grassroots level for just a few hundred yuan This significantly reduces the burden of medical care for patients,” hesaid.

When queried by International Finance on how his company in particular was making these grass root level changes, Zhang said, for WeDoctor, there were three stages of development The first stage, he said was the technology platform, which links hospitals and patients through a registered network “WeDoctor established the largest appointment registration platform in China, named ‘Guahao.com’, which has been helping 2,700 hospitals to realise online appointment, online follow-up, inspection and inspection report inquiry, online payment and other functions In March 2015, WeDoctor pioneered the expert team medical model, with more than 7,500 platform expert teams, which was later promoted by major hospitals in Beijing.”

The second stage he said was the medical platform, which connected doctors and patients through the creation of internet hospitals Thanks to the internet, they have upgraded several village clinics at the grass-root level, which originally lacked capabilities, to efficient inspection centres and medical service centres, making it no longer difficult for rural people to meet a doctor, he said.

At the third stage, WeDoctor was using technology such as AI and big data to help grassroots doctors improve their medical capacity In this regards, Zhang explained that his company had launched two major medical AI products – Ruiyi Intelligent Doctor and Huatuo Intelligent Doctor While the former had achieved key breakthroughs in more than ten specialised fields such as bone age detection and general assistant diagnosis, the latter takes “TCM syndrome differentiation and treatment as the core, and condenses the experience of famous doctors into a set of TCM artificial intelligence diagnosis and treatment applications,” he said before adding that these two products were set to act as a coach to the general base doctors and familydoctors.

So, while these three stages are already started making several changes at the grass- root level, Zhang said there are still some challenges to growth These, he said, included lack of standardisation and the need for innovation and introduction of more technologies to enter the medical industry, such as genetic testing and AI medicaldevices.

When queried, how these challenges can be tackled, Zhang said they were doing their bit With regards to standardisation, it had two solutions One, is a plan to build a national training base for general practitioners and a continuing education platformforgrassroots doctors and two, it had successively formulated 26 system management documents to standardise the diagnosis and treatment behaviour It would, going forward, always insist on innovation under these policy norms To tackle the second issue, Zhang said, WeDoctor has invested a lot of money in Centrillion Tech, the world’s leading biochip and sequencing company, to bring gene testing at the grassroots level and into thehomes.

Digitalisation of healthcare: digital health enablersinVietnam

Vietnam is well positioned to adopt digital health solutions More than 60 per cent of Vietnamese are aged under 54 years old.8 And this young population is rapidly embracing new communication technologies The number of people using Facebook in Vietnam hit 37 million in 2017 This is set to rise to 44 million in 2020, giving Vietnam the seventh highest number of Facebook users in the world – a good proxy for Vietnam’s adoption of online communications On average, Vietnamese spend seven hours a day online, with three of these on mobile devices Indeed, the country has high rates of penetration for both mobile phones (130 per cent) and smartphones (40 percent), with both segments continuing to grow rapidly Vietnam’s Government has issued policies to build up the country’s Information and Communication Technology (ICT) infrastructure and to support the development of ICT services As a result, internet access is widespread, with a penetration rate of 67 per cent and an annual growth rate of 28 per cent.9 This is among the highest in the region In addition, Vietnam has seen rapid development in mobile communications technologies, with 4G networks now covering over 95 per cent of households On current forecasts,5Gnetworks are set to follow in 2020, bringing with them the potential to enable further digital transformation The country’s technology infrastructure is also moving towards cloud-based services, creating opportunities to develop innovative and cost- effective solutions to deliver healthcare services Together, these enablers provide a good foundation for integrated healthcare services in Vietnam Challenges, however, remain One is the cost and complexity of implementing digital health information systems suchas hospital information systems (HIS) and electronic medical records (EMR) A second is the preference of doctors and other healthcare professionals for using old- fashioned paper documentation As with any market, the digitalisation of data and services also gives rise to issues of privacy and customert r u s t

Government support for digitalisation in healthcare services

Vietnam’s Ministry of Health (MOH)isdriving a national agenda for the digitalisation of healthcare, encouraging the adoption of digital health solutions in all hospitals across the country Projects and initiativesi n c l u d e :

Health information management systems: MOH’s E-health Administration is working with various organisations, including social and health insurance agencies, to facilitate the coordination and implementation of healthcare digitalisation MOH recently issued circular 54/2017/TT-BYT on the assessment criteria for information technology applications at healthcare facilities across Vietnam It is also working on a plan to develop smart healthcare during 2018–2025, with a vision towards 2030 This plan includes a national healthcare datacentre, smart healthcare systems (such as electronic health and medical records, and commune health station-management systems), e-Government initiatives including e-transactions, e-verification and online public services, and smart medicine managements y s t e m s

The application of advanced technology in medical examination and treatment: MOH recently issued Circular 47/2017 regulating telemedicine in Vietnam This circular, in effect since February 2018, allows doctors to offer telemedicine services to patients, subject to certain requirements including IT infrastructure and license Circular 47 provides guidelines for a range of telemedicine activities such as telemedicine consultation, teleradiology consultation, remote anatomy consultation, remote surgery consultation and telemedicine technology transfer training More broadly, MOH is encouraging the use of advanced technologies such as big data, analytics and artificial intelligence (AI) inhealthcare.

MOH is responsible for healthcare in Vietnam It manages a large number of public hospitals, research institutes, universities and colleges Other Government agencies, such as the Ministries of Labour, Invalids & Social Affairs, Transportation and Defence, also run a number of Vietnam’s hospitals and clinics Vietnam’s public healthcare system is organised into four levels: central, provincial, district and communal Central and provincial-level hospitals usually consist of general and specialised hospitals and medical centres District health centres and commune health stations offer primary care alongside some medical and preventative services Vietnam’s private healthcare sector is growing The number of private hospitals has increased from 133 in 2011 to 231 in 2016, a CAGR of 12 per cent.

Public hospitals in Vietnam are overcrowded and their services are oversubscribed. Therefore, digital solutions have the potential to reduce hospitalisation rates They also open up opportunities to provide care to an ageing and diverse population, particularly in remote or rural areas Digital solutions can further help national-level or specialist hospitals to deliver training, or to conduct examination and treatment activities with satellite or lower- level hospitals Vietnam’s key public hospitalsinclude:

Founded in 1911, Bach Mai Hospital is a leading comprehensive general hospital with spacious facilities, modern equipment and qualified staff, including some of Vietnam’s leading physicians Under the management of MOH – and with strong international relationships – the hospital provides high-quality medical services, conducts training and scientific research, and provides guidance to lower- level hospitals Bach Mai Hospital has more than 3,000 beds, three institutes, eight centres, 22 clinical departments, six para- clinical departments, 11 functional departments and a nursing college.

Established in 1983, the National Geriatric Hospital is the first national hospital for elderly people in Vietnam It is the top specialist hospital in Vietnam providing medical examination and treatment to older people It has over 100 doctors and 200 nurses, with more than 300 patient beds The hospital is renowned within Vietnam for its international linkages and collaborativer e s e a r c h

There is growing demand for more accessible, higher-quality healthcare This demand is expected to drive more affluent people in Vietnam toward private healthcare providers. The country’s growing middle class is also becoming more discerning about their own health and their experience when receiving medical treatment This is leading private hospitals to innovate in areas such as mobile health and digital services In doing so, they hope to attract customers who want to save time and receive better customerservice.

Vietnam’s leading private conglomerate, Vingroup, has ambitious aims to raise the standard of healthcare in the country In 2012, Vingroup launched the Vinmec Healthcare System to achieve this goal As of 2018,Vinmec had seven hospitals providing premium healthcare services, with three more hospitals expectedto be operational by 2020 Patient satisfaction rates withVinmec are over 90 per cent, and patient numbers are rising between 30–50 per cent ayear.

Hoan My Medical Corporation is one of Vietnam’s leading and largest private healthcare networks It includes more than 2,500 operating beds, and has a capacity of over3,400 beds Hoan My has 20 hospitals and clinics with six hospital development projects in the pipeline Over its 20-year history, Hoan My has built a strong brand with a reputation for delivering affordable and quality healthcare The network employs over 800 doctors and4,000 staff, and serves over 3.7million

110 patients every year.14 Hoan My was acquired by the Clermont Group, a Singapore- based international business group, in2013.

A number of organisations are delivering solutions in the digital healthcare space in Vietnam These organisations range from ICT services and solutions companies to medical device distributors, and from startups to established companies Over the past few years, Vietnam has seen a growing number of health startups who aim to use high-technology solutions to improve the quality of medical services.

Established in 1994, FPT Information System (FPT IS) is one of the leading system- integrators in Vietnam and the region FPT IS offers solutions for industries including the public sector, banking & finance, telecommunications, healthcare, transport and utilities.FPT IS is a member of FPT Corporation, which is the largest ICT company in the private sector in Vietnam It has more than 32,000 employees, including 13,695 technology experts,engineers and developers The company operates in 33 countries around the world FPT’s eHospital software suite has been used by more than 200 hospitals in Vietnam These include top-tier national hospitals such as Bach Mai, Cho Ray, Dong Nai General Hospital and others belonging to MOH including the National Children’s Hospital, Thanh HoaChildren’s Hospital and Ha Tinh General Hospital FPT recently signed a memorandum of understanding with MOH on the application and development of IT solutions for healthcare during 2018–2028 The agreement covers multiple aspects of healthcare software development, including: building an electronic medical structure preparing guidance on the application of IT in the medical industry implementing e-health regulations for various units undertaking training and research on e-health development providing training on data centre operations developing standard IT health regulations building a smart healthcare system,smart

111 hospitals and smart medical management developing integrated solutions for medicalactivities.

VNPT Software is the leading subsidiary of the Vietnam Posts and Telecommunications Group (VNPT) This is a state-owned limited liability company that sells, imports and exports post, telecommunications, multimedia and other digital products and services VNPT Software undertakes research and development in software solutions, and provides products and services for national organisations, ministries and enterprises. VNPT launched VNPT-Information Technology in 2018, employing thousands of IT engineers with a focus on developing state-of-the-art technologies such as AI, big data and blockchain VNPT-HIS (Hospital Information System) was launched in 2015 It has since been implemented in hospitals and healthcare centres at various levels in Vietnam VNPT is currently working with international partners to continually develop its products and solutions to meet the medical examination and treatment needs of provincial and national hospitals The company aims to develop an interconnected digital ecosystem Viettel Business Solutions State-owned Viettel (Viettel Telecom Corporation, which is one of the largest providers of mobile services in Vietnam) launched Viettel Business Solutions Corporation in 2018 The corporation implements projects and provides ICT solutions to government ministries and departments, localities, businesses and organisations – both domestic and international Viettel Business Solutions works in a range of sectors, including e- Government, smart healthcare, edtech, smart transportation, smart energy and smart cities Viettel’s Core Technology Center is the first unit to implement blockchain solutions to the management of citizens’ health records nationwide Vietnam’s Minister of Information and Communications granted Viettel permission to pilot 5G mobile technology for one year at 73 locations in Hanoi and Ho Chi Minh City in 2019

One promising area is in telemedicine, where innovative services can help reduce overcrowding in public hospitals and provide healthcare access to an ageing, diverse and geographically dispersed population Opportunities for telemedicine applications in Vietnam exist across a number of areas including remote patient diagnosis and prescriptions, remote patient monitoring and consultation, telemedicine in surgical care, and telecardiology Vietnam has also started to embrace the application of advanced technologies to enhance quality in preventative healthcare, medical diagnosis and treatment. Advanced technologies such as big data, analytics and AI have the potential to improve healthcare decision making through innovation such as clinical decision-support systems, predictive modelling and cognitive analytics Robotics technology has also been sought out by selected hospitals inVietnam.

Health information systems that help increase operational efficiencies and enable coordinated healthcare are needed in Vietnam Quality and localised health information software and solutions such as picture archiving and communication systems (PACS), laborator information systems (LIS), HIS and EMR are in shortage in Vietnam Other emerging areas include: operational management systems such as clinic management software and energy management systems medicine management systems such as drug supply chain management and pharmacy management cybersecurity solutions. Additionally, there are business opportunities in the creation and provision of technologies or applications that can improve the patient experience and access to care Examples include digital patient services such as appointment booking, doctor selection and bill payment, and mobile healthapplications.

INVESTMENT OPPORTUNITIES IN VIETNAM'S DIGITAL HEALTHCARE

Policy and management: Adjusting our society to change fast in the

The healthcare sector is best placed to benefit from the merging of physical, digital and biological systems, but it is among the least well prepared New innovations and technologies will accelerate the pace of change and create new opportunities Access and Affordability Access and affordability are key considerations as we think about the implementation and governance of emerging technologies Workforce 4.0 is a tag given to the current trend of automation and data exchange in manufacturing technologies It includes cyber-physical systems, the Internet of things, cloud computing and intellectualc o m p u t i n g

Policy-makers work to enact new governance Policy-makers must work together with other stakeholders, including industry frameworks As the collection and exchange of personal data become even more ubiquitous, it will be increasingly important to ensure that personal information is protected and secure Policy-makers can promote such efforts by enacting policies and more stringent requirements around privacy and data security The health sector is possibly the sector most in need of an adequate technological convergence of factors of the Fourth Industrial Revolution Health 4.0 can be understood as the set of technological procedures emerging from the physical, biological and digital worlds that seeks to improve the efficiency and effectiveness of health processes and professionals with guidelines for transforming data into useful and accessible information However, systematizing and qualitatively describing the contributions of industry 4.0 in the context of the health sector is a complex task Exploring technology-driven initiatives that make life easier for human beingswill be a research trend.Industry

4.0 technologies that present similarities in the use of the health sectorshould also develop new paradigms on occupational health and safety management,as safer equipment is needed to operate and work environments and practices withbetter control and management

Technological developments are happening at every corner And this is just the tip of the iceberg The speed that innovation has been happening is something that we need to be aware and be able toadjust.

But it is not up to innovation alone that will ensure that it will thrive A healthy regulatory environment, a business ecosystem supporting SMEs and a society that fosters creativity will all becrucial.

Incresasing many investments intoInformationtechnology

Workforce 4.0 is commonly referred to as the fourth industrial revolution of the era.

In health care sector, workforce 4.0 or "Hospital 4.0/ Life Sciences 4.0, taking place in the form of ICT & E-Health practices E-Health & ICT practices can bridge the health divide between the haves and the have net’s It will be impossible to successfully implement and adopt these costs without an effective workforce – one with the right skills and composition of professions to support the new directions of health and healthcare New advances and technologies have important workforce implications It is important to recognize that the nature of the workforce of the future will be different from the workforce of today How education will need to evolve for those entering the workforce as well as how to retrain the existing workforce to align with evolving technologies and labourt r e n d s

Hospital 4.0 is supported by five pillars: the IoT, artificial intelligence (AI), big data, 3D printing, mixed reality and virtual simulation Healthcare 4.0 allows to imagines a world where everyone are connected through wearables and every data point of patients is getting recorded no matter where they are Hence future would be a combination of Artificial Intelligence, Internet of Things (IoT), Genomics and Big Data Genomic proving to warn us about future risks, big data to make sense of the tons of data from wearables, artificial intelligence to help us make the right decisions about procedures & treatment are expected to become a part of our everyday life just like e-mails and social networking has become a part of every otherbusiness.

Components Of E Health / ICT: Clinical applications of e-Health include ElectronicHealth

Records, Tele-Consultations, Clinical Decision Making Support Systems, Vital Signs Monitoring Services, Tele-Homecare, Ambulatory E-Health—smart clothing, E-Wear, EClothing, E-Prescribing, E-Nursing, E-dissemination of personalised healthcare and professional Continuing Education using e-Learning tools: Health Information Systems, Lifetime Health Records/EMR, Pharmacy Information Systems, Electronic ClaimsSystems, Laboratory Information Systems, Interfacing with Diagnostic Equipment, ICT inHealth

Administration, and Identification and Tracking Solutions Benefits of ICT in the Health Care sector: Technology is providing constantly more ways of storing and processing Healthcare data The increasing processing power of portable devices in particular has led to the development and linking together of services that would have been inflexible to imagine few years back Many Health ICT investments can offer clear quantifiable benefits that produce a measurable financial impact on the sector Increasing quality in the patient assistance:Oneof the most important flaws of this sector is the fragmentation of the health care and the difficulties for efficiently transmitting the information ICT can help improve patient safety through the direct access to the medical case story, checking the treatments online, keeping track of the patients’ progress and anticipating possible medical errors In general terms, they are regarded as generally positive tools among professionals and users Since they provide a way to increase the patient safety, their use is being promoted in many countries Cutting down of the medical expenditure: Using ICT and Serious Games for Health help reduce these costs by reducing the time required to process data and manage paperwork The system for image transmission and storage is essential to promote the development of the electronic medical case story and telemedicine since it speeds up the tests and the gathering of results Decreasing administrative cost: Invoicing brings about many possibilities of saving due to the use of ICT and the new remote devices Although the evidence of these data, electronic invoicing is not widely used in most of the countriesyet.

Opportunity to carry on brand new health models: ICT have been defined as technology with a high transformative potential, since it introduces new ways to carry out medicine and develop health care They are definitely essential to renew primary health care since they contribute to a personalized following of chronic diseases; they improve the access to health care in rural populations; and they contribute to the optimizing data measuring ands u p e r v i s i o n

Policy and technology renovation challengesinhealthcare4.0

According to Bui Quang Ngoc, vice chairman of IT giant FPT Group, over the past few years there have been almost no specific policies and actions for developing a digital economy in Vietnam “For example, in the public administration, programmes on e- government, e-tourism or e-healthcare have failed to be implemented effectively,” Ngocsaid.

“A legal framework on applying IT or developing smart solutions has not been implemented either There has been a gap between policy and action, and while the concept of 4.0 has been widely talked about, few actions have been made

Deputy Minister Thang said that in order for Vietnam to seize opportunities and facilitate enterprises to benefit from Industry 4.0, the Ministry of Planning and Investment (MPI) is compiling a national strategy on Industry 4.0, which will clarify what the digital economy means, with specific tasks for ministries and agencies.

According to the CIEM, new industries arising from Industry 4.0 “will be the key growth propellants for Vietnam, such as the Internet of Things and media They will also support other sectors by raising their competitiveness, revenue, and developing new products and services.”

According to Minister of Information and Communications Nguyen Manh Hung, several key foundations need to be developed to create an effective digital economy in Vietnam.

“When we dare to accept new things, new technologies and global talent will come toVietnam and new industries will appear,” Hung said “Then Vietnam will be able to create digital products that can beexported.”

“However, if we dare to accept new things but only follow other nations, we will not be able to create many added-value products,” Hungc o n t i n u e d

According to him, the digital economy in Vietnam must be supported by a good ICT infrastructure characterised by 5G technology and each person in the country owning asmartphone.

“Second, we need to have good policies to spur digital economy and technology. Internet in Vietnam must be globally competitive so that Vietnamese people will not go overseas to establish their enterprises any longer and more foreign enterprises will come to Vietnam to do business,” hes a i d

“Third, the government needs to develop an initial market for IT enterprises by spending more on IT products and e-government,” Hung added “Finally, human resources training needs a boost in foreign languages and IT education in schools anduniversities.” Driven by networked Electronic Health Record (EHR) systems, Artificial Intelligence (AI), real-time data from wearable devices and improved analytics, a quiet revolution is afoot in the healthcare industry – both globally and in India Over the next few years it is likely to fundamentally change how healthcare is delivered and how the outcomes aremeasured.

If we look back, it was the decades between 1970-1990 that saw the emergence of modular IT systems in the healthcare industry This period could safely be called Health 1.0 Throughout the next decade and a half, health IT systems started getting networked and EHRs that were being generated started getting integrated with clinical imaging, giving doctors a better perspective This was Health2.0.

The decade from 2005 onwards saw the development of genomic information, emergence of wearables and implantables The integration of all this data along with networked EHR systems saw the emergence of Health 3.0.

What we are seeing today is the emergence of Health 4.0 It is the coming together of all these technologies coupled with real-time data collection, increased use of AI and an overlay of invisible user interfaces The focus on collaboration,coherence, and convergence will make healthcare more predictive and personalised.

It is not just the enhanced amount of data that is available to doctors, but the real critical factors here are the ability to extract insights from the data being captured and the portability of thisdata.

Data portability allows patients and their physicians to access it anytime anywhere and enhanced analytics allows for differential diagnosis and medical responses that can be predictive, timely and innovative Health 4.0 allows the value of data more consistently and effectively It can pinpoint areas of improvement and enable more informeddecisions. What it also does is help move the entire healthcare industry from a system that is reactive and focused on fee-for-service to a system that is value-based, which measures outcomes and ensures proactive prevention This has already started in the US, where the Department of Health has announced that 90% of Medicare would move to a value-based system by nextyear.

Some of the larger super-specialty chains are moving towards Health 4.0, but the bulk of the healthcare industry is stuck in legacys y s t e m s

First is the government Building a national IT backbone that will help in integrating EHRs and making them portable For the government, initiatives like this are the key to meeting its societal objectives of enhanced access to healthcare and achieving the Sustainable Development Goal of Health forA l l

The second factor driving change is enhanced penetration of health insurance The insurance companies, in a bid to weed out spurious claims, are increasingly demanding a level of data collection and analytics that is forcing healthcare providers tochange.

The third factor is the rise of an aspirational middle-class that is more informed and hence demands better service from its healthcare providers The healthcare providers themselves – diagnosticians, physicians, surgeons and hospitals as a whole – are also realising that with the increased use of Health4.0-