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A Million-Bed Hospital for Vietnam?

Not with Me, Says Digital Health.

· Digital Health,Childrens Hospital,Vietnam

“It would take a million-bed hospital to respond to the demand,” I found myself, with tongue in cheek, telling Dr. Hùng, the dynamic and affable director of the Children’s Hospital 1, as I saw hundreds of people in a waiting room overflowing into the courtyard. I felt from the sparkle in his eyes that he was up to the challenge.

During a genealogy-focused trip to Vietnam, the personal visit put me directly in front of the challenging state of health care in the country, despite the evident courage and dedication of the under-resourced and overworked medical staff there.

With nationwide public hospital bed occupancy rates at 120% or more, there's a strong likelihood that if you're admitted in a hospital, you will end up sharing your bed (not just your room) with another patient, who might be even sicker than you, sleeping with their bare feet next to your nose. Surprisingly, nosocomial infection rates here are now almost at par with some hospitals in the US, thanks to a comprehensive nosocomial infection control program in place for more than 10 years.

Vietnam is a country of 95M inhabitants with a GDP that has more than tripled in the past decade, on track to exceed $200B for 2016 and to jump from the 48th to the 35th largest economy in the world by 2020, comparable to Israel's current GDP rank (with a much smaller population). With such growth and rising life expectancy, health care issues are coming to the front, and addressing them is a high priority now.

Key questions started to rush in my digital health entrepreneur's head like motorbikes on a busy Hanoi street: What could be the role of technology in the country's quest to modernize its healthcare infrastructure? What are the roadblocks to adopting productivity-boosting innovations, such as telemedicine and remote monitoring?

I had come to visit the largest of only 2 Children's Hospitals in Ho Chi Minh City, with 1,500 beds, almost 3 times larger than the largest children’s hospital in the US (Texas). It delivers all services free of charge to any child under 6, or from poor families, and is specialized in pediatric cardiac services, with a 99% success rate in open heart surgery. Treating on average 5,500 outpatients per day, with up to 8,000 on busy days, the staff of 1,700 never turns down anyone. Some time ago, they even admitted two Cambodian children coming from afar with severe burns.

Bed occupancy rates here exceed 100%, but it’s not as much a deal with smaller patient sizes, and fortunately, much progress has been accomplished in recent years, with much more to come.

“That’s an old-school concept...” Dr. Hung replied, to my comment of needing a million beds. “We won’t need to! We have already started developing in-house solutions for our electronic medical records, and are using telemedicine for biweekly remote training of medical staff in provinces. For serious patient cases, city doctors can also join in remotely and advise the rural staff.”

One major reason why so many parents prefer to take the long trek to the city instead of checking in at the local clinic is their often justified perception of lack of local qualified staff. So improving training and support at the rural level is expected to curb the flow of rural patients compounding the overwhelmed hospital capacity issue.

Applying evidence-based medicine, implementing Integrated Management of Childhood Illness (IMCI) guidelines, achieving ER admission rates at a low 5%, combined with telephone appointments and consultations, the hospital is increasingly leveraging technology and best practices. Total Quality Management, using music and team exercises, enforces stringent hand washing rules, and with the One-Stop Clinic principle, patients get their medicine on the spot.

Most importantly, the brand new, 1,000 bed Children’s Hospital Ho Chi Minh City, opens mid January 2017, which should dramatically improve the situation here. At Children’s Hospital 1, there are already plans to build two new wings with dozen stories to expand capacity. All this will certainly enhance patient experience dramatically.

Building on all these great accomplishments, what are the key challenges ahead?

In partnership with the Polytechnic University HCM City, the hospital IT department is developing an in-house EMR system with the ultimate goal of interconnecting nationwide with other healthcare centers. Clearly, issues such as standardization, ease-of-use, reliability, scalability, and extensibility, will have to be addressed in due time to continue to benefit from the latest innovations in digital health.

This is where inspired collaboration with qualified universities and digital health experts in more advanced countries could help shorten time-to-release, improve quality, and facilitate early adoption of best practices to leverage the well-known opportunity to skip older generations of technology solutions when starting from scratch.

Funding and authorization issues are also part of the picture, but it is another story...

“Congratulations!” I encourage Dr. Hùng as we shake hands to depart. “All these impressive accomplishments and plans are living proof that digital health is off to a great start here!”

Implicitly, we both know it will still be a long road. As the saying goes, even a thousand mile journey starts with one step, so the question for now is, what is the right next step?

As a former management consultant at a think tank for major public and private organizations in Europe, I know we need to keep the conversation going to improve understanding of the local needs and the potential of digital health. Maybe an updated qualitative study of the information management situation at the three Children's Hospitals in the city would be a logical next step.

Along with the heavy investment of building new capacity, it would make sense to gather workflow facts from the field, to understand what already exists, where the weakest links are in the chain of services from the rural villages to the eventual hospital discharge, to identify the appropriate remedies, technological or otherwise, and prioritize how and where they might be most effectively deployed.

In the deeply touching musical Les Misérables, Cosette dreams away her misery in the song “Castle On a Cloud”:

"... I know a place where no one's lost,

I know a place where no one cries,

Crying at all is not allowed,
Not in my castle on a cloud."

This sounds like a better vision than a million bed Children’s Hospital...

Copyright © 2017 - Phac Le Tuan

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