1、 EMPOWERING TELEHEALTH SOLUTIONS IN APEC December 2021 Study on the Policy Landscape for Telehealth in the APEC Region TABLE OF CONTENTS ACRONYMS I EXECUTIVE SUMMARY 1 INTRODUCTION 1 METHODOLOGY 2 OVERVIEW OF KEY FINDINGS AND RECOMMENDATIONS 2 INTRODUCTION 4 WHAT IS TELEHEALTH?5 UNDERSTANDING TELEHE

2、ALTH 5 INNOVATION IN TELEHEALTH 7 TELEHEALTH POLICY CONSIDERATIONS AND RECOMMENDATIONS 10 MOVING APEC ECONOMIES TOWARDS GREATER USE OF DIGITAL HEALTH 14 CONCLUSION 15 ANNEX I:ECONOMY-LEVEL PROFILES ON TELEHEALTH 16 INTRODUCTION 16 AUSTRALIA 17 BRUNEI DARUSSALAM 19 CANADA 21 CHILE 24 PEOPLES REPUBLIC

3、 OF CHINA 25 HONG KONG,CHINA 28 INDONESIA 31 JAPAN 33 REPUBLIC OF KOREA 35 MALAYSIA 37 MEXICO 39 NEW ZEALAND 42 PAPUA NEW GUINEA 45 PERU 47 THE PHILIPPINES 49 RUSSIA 51 SINGAPORE 53 CHINESE TAIPEI 55 THAILAND 57 THE UNITED STATES 59 VIET NAM 63 ANNEX II:BIBLIOGRAPHY 66 ANNEX III:APEC ECONOMY LEVEL S

4、URVEY 81 LIST OF TABLES AND FIGURES Figure 1 Telehealth at a Glance.4 Figure 2 Types of Telehealth Approaches.6 Table 1 Private Industry Telehealth Advancements.8 Table 2 Open-Source Telehealth Tools.10 Table 3 Telehealth Enabling Policy Considerations and Recommendations.11 i|EMPOWERING TELEHEALTH

5、SOLUTIONS IN APEC USAID.GOV ACRONYMS AeHIN Asia eHealth Network AHIMA American Health Information Management Association AI Artificial Intelligence AIDS Acquired immunodeficiency syndrome APEC Asia-Pacific Economic Cooperation Bru-HIMS Brunei Health Information and Management System CDC Centers for

6、Disease Control and Prevention(United States)CENETEC-Salud National Center for Technological Excellence in Health(Mexico)CMS Centers for Medicare and Medicaid Services(United States)CRVs Civil registration and vital service systems CT Computed tomography DHB District Health Board(New Zealand)DHIS2 D

7、istrict Health Information System 2 EEG Electroencephalogram EHR Electronic Health Record eHRSS Electronic Health Record Sharing System(Hong Kong,China)FCC Federal Communications Commission(United States)GHN Golden Health Network(China)GP General practitioner HA Hospital Authority HHS Department of

8、Health and Human Services(United States)HIMSS Healthcare Information and Management Systems Society HIPAA Health Insurance Portability and Accountability Act HITMAP Health IT Master Plan(Singapore)HITO Health Informatics and Technology Office(Hong Kong,China)HIV Human Immunodeficiency Virus HL7 Heal

9、th Level Seven International HWG Health Working Group ICT Information and communications technology IHiS Integrated Health Information Systems IMNC International MedioNet of China IoT Internet of Things IT Information Technology KHNW Krankenhaus Nordwest(Germany)KKI Konsil Kedokteran Indonesia LHP L

10、ifetime health plan LHR Lifetime health record MBS Medical Benefits Schedule(Australia)MHLW Ministry of Health,Labor and Welfare(Japan)MOH Ministry of Health MSC Multimedia Super Corridor NASA National Aeronautic Space Administration(United States)NDOH National Department of Health(Papua New Guinea)

11、NHI National Health Insurance(Chinese Taipei)NHFPC National Health and Family Planning Commission of China NOM Norma Oficial Mexicana(Mexicos Standards)NTG National Telemedicine Guidelines(Singapore)OMP Other medical practitioners USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|ii ONC Office of th

12、e National Coordinator for Health Information Technology(United States)OpenHIE Open Health Information Exchange PAHO Pan American Health Organization PLA Peoples Liberation Army(China)PPE Personal protective equipment PNG Papua New Guinea SMC Singapore Medical Council SOP Standard operating procedur

13、e UMMC University Malaya Medical Center UN United Nations UNICEF United Nations Childrens Fund USAID United States Agency for International Development VA Department of Veterans Affairs(United States)VHA Veterans Health Administration(United States)WHO World Health Organization Note:The terms“nation

14、al”,“nation”used in the text are for purposes of this report and do not imply the“political status”of any APEC member economy.1 EXECUTIVE SUMMARY INTRODUCTION The past decade has seen significant transitions in global demographics,as aging populations,a higher prevalence of chronic illness demanding

15、 more personalized care,and the resulting increase in healthcare costs require an exploration of new approaches to healthcare service delivery.These same transitions have resulted in a global push towards embracing digital health solutions to provide innovative ways of delivering services in an equi

16、table and efficient manner.This also involves enhancing processes,increasing efficiencies,creating opportunities for collaboration between the private and public sectors,and ultimately improving health outcomes.Telehealth is a key component of this health transformation.The World Health Organization

17、(WHO)defines telehealth as“the delivery of health care services,where distance is a critical factor,by health care professionals using Information and Communication Technologies(ICT)for the exchange of valid information for diagnosis,treatment and prevention of disease and injuries,research and eval

18、uation,and for the continuing education of health care providers,all in the interests of advancing the health of individuals and their communities.”1 The WHO also notes that telehealth can improve patient access to quality,cost-effective,health services wherever they may be and can be particularly v

19、aluable for those in remote areas,vulnerable groups,and aging populations.2 A pan-Canadian study conducted in 2011 reveals that telehealth has also demonstrated significant benefits to both patients and clinicians by improving equitable access to specialist services for Canadians living in rural and

20、 remote communities;reducing travel for patients and clinicians;and reducing wait times for specialty care including dermatology and ophthalmology.3 Similarly,a study conducted in Australia4 reveals that telehealth approaches addressed both quality and equity considerations.Not only did patients ben

21、efit from lower costs which addressed equity issues,telehealth approaches also reduced inconveniences,improving access to specialist healthcare services while ensuring improvements in the quality of clinical services.Additionally,health professionals benefitted from access to continuing education an

22、d professional development as well as experiential learning,stronger networking,and better collaboration.Telehealth is a critical part of strengthening health systems,improving the quality of and access to health services and achieving the goals of universal health coverage in the Asia-Pacific regio

23、n.Against this landscape and as part of the Asia-Pacific Economic Cooperations broader efforts in promoting digital trade and more specifically the approach to improving health service delivery in the region,the United States launched the Empowering Telehealth Solutions in APEC project in 2020 under

24、 the APEC Health Working Group(HWG),with the aim of mapping the existing landscape of policies and regulatory frameworks across APEC economies that enable the adoption and use of telehealth services to address 1 World Health Organization Global Health Observatory,Telemedicine:Opportunities and Devel

25、opments in Member States:Report on the Second Global Survey on eHealth,Geneva:WHO(2009).2 World Health Organization Global Health Observatory,“Telehealth:Analysis of Third Global Survey on eHealth,2016,”webpage,https:/www.who.int/gho/goe/telehealth/en/.3 Praxia Information Intelligence and Gartner,T

26、elehealth Benefits and Adoption-Connecting People and Providers Across Canada,Canada Health Infoway(May 2011).4 J.Moffat and D.Eley,“The Reported Benefits of Telehealth for Rural Australians,“Australian Health Review(August 2010)34(3):276-81.doi:10.1071/AH09794.USAID.GOV EMPOWERING TELEHEALTH SOLUTI

27、ONS IN APEC|2 healthcare needs.The objective of this study is to increase APEC members understanding of the existing policy and regulatory landscape that support telehealth delivery,while highlighting best practices that can be adopted and replicated throughout the region.The analysis considers both

28、 a pre-COVID-19 context as well as policy changes implemented in direct response to healthcare requirements during the pandemic.METHODOLOGY The information outlined in this report was gathered by a telehealth expert through desk research of publicly available resources including those from key multi

29、lateral and regional organizations,such as the WHO,United Nations,World Bank,and Pan American Health Organization(PAHO);analysis of websites in APEC economies to source information on current health policies and regulations;and via interviews and surveys.A copy of the survey questionnaire is at Anne

30、x III.Representatives from four APEC economies responded to the survey these were from Canada;Chile;New Zealand and Chinese Taipei.In addition,digital health experts from Australia;the Philippines;Singapore,and the United States also offered additional insights.The telehealth and policy landscape ra

31、pidly evolved during the COVID-19 pandemic.Therefore,the analysis contained in this report also covers policy frameworks,processes and information that emerged during the course of the pandemic.OVERVIEW OF KEY FINDINGS AND RECOMMENDATIONS APEC economies have a well-defined telehealth blueprint or po

32、licy frameworks in place,complemented by specific initiatives aimed at increasing the adoption of telehealth services.The findings reveal a strong participation across all economies from both the public and private sectors in developing suitable policies and implementation mechanisms.The study also

33、reveals how APEC economies utilize a broad range of telehealth models,policies,and regulations However,there are limitations with the enabling environment and legislation as well as lack of investment which has led to the“uneven”adoption of telehealth solutions.Therefore,by surveying the existing po

34、licy frameworks this report provides a useful menu of policy levers that can be utilized to guide the implementation of telehealth solutions across the APEC region.The experience of the COVID-19 pandemic provides a compelling example of how,when pushed into crisis mode,policymakers can adjust existi

35、ng healthcare policies to fully take advantage of new treatment and delivery options.The pandemic required significant rethinking of patient care delivery models that could be accommodated by more widely adopting new technology modalities,while making modifications to reimbursement policy and organi

36、zational operations to improve efficiencies and ease of access.In doing so,the pandemic created a regulatory sandbox-like environment for policymakers to make incremental adjustments and assess impacts in a timely manner.For instance,during the pandemic telehealth solutions became one of the safest

37、and the most easily accessible ways to deliver mental health support and manage chronic and noncommunicable diseases in contexts that already had well developed digital infrastructure.In addition,patients requiring prescriptions were able to gain approval from their providers via telehealth consults

38、 and then be supplied with an e-prescription.In most contexts,policy changes that broadened telehealth delivery were made under the aegis of public health emergency directives.As a result,some policy changes have not been fully integrated into existing 3 health service delivery frameworks.However,as

39、 evidenced by rising consumer demand for such services,telehealth should be seen as synonymous with existing healthcare delivery systems,not separate or apart.The experience of the pandemic should motivate policymakers to officially integrate telehealth into healthcare delivery by making temporary m

40、easures that facilitate care permanent so that patients and providers have continued access to telehealth.Annex 1 of the report outlines specific details on economies policy frameworks including initiatives implemented in the COVID-19 context.In uncovering the rich and varying policy approaches to t

41、elehealth across all APEC economies,this report offers a suite of practical policy considerations that all economies could carefully consider when committing to delivering good quality,equitable,reliable and efficient healthcare services,in a post-COVID world.From reimbursement policy to digital inf

42、rastructure investments,this report seeks to spark conversations within and among public sector stakeholders in APEC economies about how best to make policy decisions that support the continued and expanded use of telehealth services.These policy considerations are not unique to telehealth services

43、but reflect issues that support and are relevant to ICT connectivity and digital reform.Appropriate policy considerations include the following:Develop integrated and interoperable information sharing platforms;Align health data standards for greater interoperability;Expand telecom infrastructure;Ad

44、dress and harmonize licensing and professional practice regulations;Expand payment and reimbursement;Coordinate across whole-of-government;Enhance data stewardship;Encourage innovation;and Leverage public-private partnerships.Most importantly,this report offers considerations for the APEC HWG;consid

45、erations,that if undertaken,would support a comprehensive,coordinated approach to promoting telehealth innovations across the region.It also provides ready-to-use telehealth resources and best practices for APEC economies.USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|4 INTRODUCTION Innovation of

46、ten occurs at the moments of greatest need.As a global community,2020 tested the limits of our healthcare systems and spurred necessary innovation across all aspects of healthcare.To meet current challenges,healthcare workers,innovators,and the public sector worked together to deploy innovative heal

47、th solutions with supportive policies.Telehealth,though available as a digital health tool for decades,answered a uniquely critical need during the pandemic to safely deliver healthcare to patients outside of typical settings,including home based settings Telehealth enables healthcare to extend beyo

48、nd traditional spheres,connecting medical providers with previously hard-to-reach demographic groups and remote communities.Telehealth reduces disruptions to the continuity of patients care and provides more equitable healthcare service delivery.Telehealth services increased exponentially following

49、the emergence of COVID-19,producing myriad benefits that should continue after the pandemic,including increased convenience,reduced costs,increased accessibility,and in some cases,improved quality of care.Until recently,telehealth faced considerable obstacles from policymakers,payors,users,and profe

50、ssional organizations concerned about patient safety.These obstacles included limited high-speed broadband,liability concerns,privacy and safety,whether health workers at remote sites had the appropriate medical credentials,and inadequate reimbursement.Although many of these restrictions had been ad

51、dressed in some economies before the COVID-19 crisis,as the pandemic sheds light on the benefits of safe,remote testing,monitoring and treatment,removing these obstacles is of even greater importance today.5 Enabling policy frameworks that guide the effective roll-out of telehealth solutions include

52、 aspects such as data privacy policies,patient privacy and confidentiality considerations,coverage and reimbursement issues,intellectual property and licensing concerns,broadband infrastructure,and cross-border conformance.These are foundational to successful telehealth implementation.Notably,privat

53、e industry activity and innovation have also accelerated during this time,but more progress needs 5 M.Mrazek and R,Shulka,“After Coronavirus,Telemedicine is Here to Stay,”Digital Development(blog),World Bank,July 2020,https:/blogs.worldbank.org/digital-development/after-coronavirus-telemedicine-here

54、-stay.Figure 1 Telehealth at a Glance 5 to be made to integrate best telehealth practices into regulatory,reimbursement and standards policies across the region.In 2020,APEC members endorsed the APEC project Empowering Telehealth Solutions in APEC to explore telehealth,map the landscape of policies

55、across APEC economies that enable greater use of telehealth services,and provide an overview of best policy practices for member economy consideration.The information in this report provides a sound understanding of the policy landscape in economies before the COVID-19 outbreak,as well as policy cha

56、nges made in response to the pandemic to increase use of telehealth solutions in the current pandemic environment.The goal of this project is to enable greater use of telehealth solutions as part of the overall efforts to improve healthcare delivery across APEC and to achieve the goals of the APEC H

57、WGs Strategic Plan(20212025)which seeks to encourage research,support digital health innovation,and promote translation of that research into practice in a way that improves both health outcomes and health systems,while addressing the current and future needs of all APEC member economies.In addition

58、,this work is aligned with efforts progressed under other APEC fora to promote innovation and digitalization,and to deliver against long term commitments articulated under APECs Putrajaya Vision 2040.As part of this undertaking,information on the policy landscape for telehealth in APEC was gathered

59、via a desk review,survey,and interviews of key stakeholders and relevant agencies.This report provides an overview of telehealth policy frameworks and features examples of telehealth innovations from private industry,including practices that emerged in response to healthcare needs during COVID-19.It

60、 also includes a brief overview of the barriers to telehealth adoption and deployment.Learning from the research undertaken for this report,a discussion of policy considerations and recommendations is provided to encourage the adoption of better enabling policies for increasing the deployment of tel

61、ehealth solutions for improved healthcare delivery in the Asia Pacific region.These recommendations draw upon several examples of best practices currently being implemented by APEC economies.Lastly,the report provides a series of recommendations for consideration by APEC economies to support expande

62、d use of telehealth in the region.WHAT IS TELEHEALTH?UNDERSTANDING TELEHEALTH To ground this report and future discussions in common terminology for use in the broader context of digital solutions to support effective service delivery,it is important that key,often interchangeably,used terms like te

63、lehealth,telemedicine,digital health,and eHealth are clearly defined at the outset.Given the need for consistent,cross-economy definitions,this study uses definitions for key terms from WHOs third global survey on eHealth(2016),the WHO Global Strategy on Digital Health,and a foundational American Te

64、lemedicine Associations white paper:Telehealth:The delivery of healthcare services,where patients and providers are separated by distance.Telehealth uses ICT to exchange information for the diagnosis and treatment of diseases and injuries,research and evaluation,and continuing education for health p

65、rofessionals.6 6 World Health Organization Global Health Observatory,“Analysis of Third Global Survey on eHealth.”USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|6 Telemedicine:The use of electronic communications and information technologies to provide clinical services when participants are at d

66、ifferent locations.Telemedicine is closely associated with the term telehealth.However,telehealth encompasses a broader application of technologies such as distance education,consumer outreach,and other applications wherein electronic communications and information technologies are used to support h

67、ealthcare services.7 eHealth:The cost-effective and secure use of information and communications technologies in support of health and health-related fields,including healthcare services;health surveillance;health literature;and health education,knowledge,and research.8 Digital health:The field of k

68、nowledge and practice associated with the development and use of digital technologies to improve health.Digital health expands beyond the concept of eHealth to also include digital consumers,with a wider range of smart-devices and connected equipment.It also encompasses other uses of digital technol

69、ogies for health such as the Internet of Things,big data,robotics,and Artificial Intelligence(AI).9 This report focuses on telehealth as defined above.Telehealth can be delivered both synchronously and asynchronously,an important distinction to bear in mind.Specifically,according to the American Tel

70、emedicine Association,the most common approaches in telehealth include:Figure 2 Types of Telehealth Approaches 7 American Telemedicine Association,Telemedicine,Telehealth and Health Information Technology,white paper,May 2006,https:/www.who.int/goe/policies/countries/usa_support_tele.pdf?ua=1.8 Worl

71、d Health Organization,Draft Global Strategy on Digital Health 20202025,p.20.https:/www.who.int/docs/default-source/documents/gs4dhdaa2a9f352b0445bafbc79ca799dce4d.pdf.9 World Health Organization,Draft Global Strategy on Digital Health 2020-2025,p.20.7 Telehealth comprises a diverse ecosystem which i

72、ncludes a variety of stakeholders.It is important for policymakers to consider the breadth and depth of this ecosystem and its stakeholders as they seek to create policies that increase access for patients to telehealth services.Delivery of telehealth services involves many stakeholders,including(bu

73、t not limited to)clinicians,patients,digital infrastructure utilities(e.g.,internet providers),insurance organizations,technology partners,developers,and information technology(IT)equipment manufacturers.Findings of the survey pointed to the complex nature of the overall telehealth ecosystem and pro

74、vide important lessons for how to engage across all stakeholders,coordinate efforts,and develop appropriate public-private partnerships for optimal outcomes.Promising examples of cooperation,collaboration,and innovation are highlighted in this study such as the following:Brunei Darussalam:An importa

75、nt public-private partnership has been established between the Brunei Darussalam Ministry of Health and DXC Technology to deliver the“one patient,one record”Brunei Health Information and Management System(Bru-HIMS).This serves 420,000 Bruneians,with advanced telehealth capabilities.Canada:The federa

76、l government of Canada funds a pan-Canadian electronic health record(EHR)system with telehealth at its core,through the nonprofit agency Canada Health Infoway.Chile:The Chilean Digital Hospital serves over 1 million citizens and is funded as a domestic center of excellence.It uses asynchronous telem

77、edicine approaches focused on medical specialties such as dermatology,nephrology,diabetology,and geriatrics.It deploys synchronic telemedicine to deliver health services in isolated rural regions of Chile.Indonesia:The Ministry of Health works with the Indonesian Medical Council,a unique body respon

78、sible for promulgating telehealth policy and regulation,as well as dealing with licensing,liability and provider related issues.The Philippines:The Asia eHealth Network is based in Manila,Philippines and works with the Philippines government to operate as a regional multi-stakeholder collaborative,w

79、ith an interoperability lab,engaged in a broad array of digital health and telehealth initiatives and training in the Asia-Pacific region.Peru:Private telehealth innovation such as Auna,a network of private hospitals and medical centers across Peru delivers critical telehealth oncology services.Some

80、 of these services were expanded during the COVID-19 pandemic.Singapore:The Singapore Ministry of Health uses a unique on-line regulatory sandbox approach to encourage telemedicine providers to develop innovative care models within well-defined patient safety and welfare parameters.INNOVATIONS IN TE

81、LEHEALTH While telehealth solutions have been available for more than 50 years,globally,recent technological innovations enable more diverse,tailored,and broadly applicable solutions for addressing healthcare issues across a wide variety of treatments.For example,todays technology of sophisticated c

82、hatbots,AI-enabled diagnostic tools,and interoperable electronic health records promise to fuel more detailed USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|8 and thorough telehealth interactions in the future.This study found that the private sector(both established firms and start-ups)has conti

83、nuously introduced innovative new telehealth tools(both before and during the pandemic)to address vital society and public health needs.However,the adoption,acceptance,and ultimate success of these technologies is dependent upon policymakers understanding the technologies,addressing policy bottlenec

84、ks,supporting the enabling environment,and listening to private sector perspectives regarding challenges and opportunities.The table below highlights a selection of innovative telehealth technologies at the forefront of telehealth in the Asia-Pacific region:Table 1 Private Industry Telehealth Advanc

85、ements DXC Technology(Brunei Darussalam):The company has created a“one patient,one record”Brunei Health Information and Management System in partnership with the Ministry of Health Brunei that serves over 420,000 citizens and has built-in telehealth capabilities.10 JD Health(Peoples Republic of Chin

86、a):JD Health,a subsidiary of JD.com(e-commerce),launched a“family doctor”telehealth/telemedicine service.JD Health launched its free online consultation platform to deal with COVID-19 in late January of 2020 and quickly expanded the scope of its free consultation services to cover all medical depart

87、ments and diseases.11 It has an average daily consultation volume of more than 120,000 people.12 Halodoc,Alodokter,and GrabHealth(Indonesia):Indonesia has a burgeoning health IT ecosystem,with companies such as Halodoc,Alodokter,and GrabHealth(a joint venture between Singapore-based Grab and Chinas

88、Good Doctor),providing private medical consultations through chat or video calls,as well as prescription medicine purchase and delivery through partnerships with pharmacies and ride-hailing apps.App customers can pay out-of-pocket,with private insurance from partner companies,or through the startups

89、 own insurance programs.13 Doc+(Russian Federation):Doc+combines telemedicine with digitally enabled house calls.The visits are currently available in Moscow and Saint Petersburg.Patients can use the Doc+capabilities via chat or by audio or visual means.For both in-person and remote care,a digital r

90、ecord of the patients visit is stored and accessible to the patient online.14 Teladoc Health(United States):Teladoc Health provides care including telehealth across numerous clinical specialties to address primary care,acute,chronic,and complex health needs.It 10 J.Henderson,“Inside Bruneis Cutting-

91、Edge Health System Built by DXC,”Channel Asia(July 19,2019),https:/www.channelasia.tech/article/663103/inside-brunei-cutting-edge-e-health-system-built-by-dxc/.11 D.Koh,“Chinas JD Health Launches Family Doctor Telehealth Service,”MobiHealthNews,HIMSS Media(August 19,2020),https:/ H.Zhang,“JD Health

92、Provides Free Consultation Targeting 60 Million Chinese Living Overseas,”JD.com Corporate Blog,JD.com(March 17,2020),https:/ U.Florene,“Indonesias Might Go Online First When Seeking Medical Help from Now On,”KrAsia(May 3,2020),https:/kr- J.Comstock,“Russian Digital Health Call,Telemedicine Company D

93、oc+Gets$5 Million,”MobiHealth News,HIMSS Media(June 6,2017),https:/ covers areas such as virtual basic care,mental health,specialty medical services,and integrated care.15 Teladoc Health Medical Group clinicians serve millions of patients across the globe over Teladoc Health Platforms.16 Programs su

94、ch Teladoc Healths Livongo Diabetes and Hypertension Programs with smart home monitoring and live telehealth coaches are having a notable impact on health,such as a greater likelihood of staying in the“safe zone”(being 21 percent less likely,on average,to have days with hypoglycemic readings after j

95、oining)and healthcare costs that are 28 percent lower than those with similar conditions not participating in the program.17 Jio Health and Earable(Viet Nam):Jio Health provides online booking of clinical services,manages personal health profiles.and shares patient medical data with healthcare provi

96、ders.Jio also offers specialty medical services,an online pharmacy,family healthcare plans,maternity care packages,and corporate checkups.18 Earable is a U.S.company with its engineering and development base in Ho Chi Minh City.It provides services in Viet Nam,including an in-ear device with biosens

97、ors and Machine Learning algorithms used to collect health data.19 In addition to innovative advancements made by private industry,there are equally innovative efforts being undertaken to use open-source tools to create and maintain economy-level health information systems and individual components

98、and services,such as telehealth.This has been particularly relevant during the pandemic,when economies are seeking cost-effective digital health solutions with a proven track record,as well as training and education services for new digital health and informatics tasks.Some benefits of open-source t

99、ools are lower implementation and maintenance costs,active training,user communities,and continuity.These products and modules are being deployed in larger economy efforts such as domestic-wide electronic health information systems,civil registration and vital statistic tracking,HIV-AIDS management,

100、and natural disaster response.These tools are relevant to APEC economies because they are being increasingly deployed on every continent across the globe for general healthcare,COVID-19,and other functions.Table 2 provides examples of such open-source health tools.15 Teladoc,“What We Do,”webpage,htt

101、ps:/ Teladoc,“Teladoc Medical Group,”webpage,https:/ Livongo,“Harris Health System Doubles Down on Diabetes and Hypertension Programs,”Livongo(posted online).https:/nebgh.org/wp-content/uploads/2020/09/Livongo.pdf.18 J.Russell,“Jio Health Combines On-Line and Off-Line Healthcare in Southeast Asia,St

102、aring with Vietnam,”Tech Crunch(April 1,2019),https:/ T.Van,“Passion The Mother of Invention,Says Vietnamese Scientist,”Viet Nam News(June 1,2020),https:/vietnamnews.vn/society/717520/passion-the-mother-of-invention-says-vietnamese-scientist.html.USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|10

103、Table 2 Open-Source Health Information Tools DHIS2:The District Health Information System 2(DHIS2)COVID-19 Digital Surveillance Package tracks suspected and confirmed cases and has been used to control the pandemic.DHIS2 is an open-source,web-based health management information system platform,used

104、in 73 countries.20 COVID-19 success stories can be found at:https:/www.dhis2.org/covid-success-stories.OpenMRS:OpenMRS is a frontline electronic health record(EHR)system in over 40 economies and plays a vital role in addressing HIV control and care improvement.OpenMRS has been adapted during the pan

105、demic for COVID-19 screening,treatment,and surveillance.21 Open Health Information Exchange(OpenHIE):OpenHIE is a global community of practice and peer exchange focused on enabling large-scale health information interoperability,and providing and collating information related to healthcare data stan

106、dards and exchange.OpenHIE has a COVID-19 response task force.22 TELEHEALTH POLICY CONSIDERATIONS AND RECOMMENDATIONS As mentioned in the section above,innovation will continue to expand with new healthcare delivery solutions and models being developed every day.Of critical importance to the ultimat

107、e deployment and adoption at scale of these technologies are the underlying policy and regulatory systems implemented by governments that set the guidelines for how telehealth services can and should be delivered.Also of importance is the dedication of appropriate resources for education,as well as

108、the allocation of funding for the deployment of necessary infrastructure,to incentivize the use of these new,ground-breaking solutions.The review of publications,the survey and the stakeholder consultations that provided the baseline information underpinning study findings,brought to light a multitu

109、de of policy decisions that are critical to appropriately enable telehealth solutions as part of the overall healthcare system in any economy.Careful consideration of these policies and coordination amongst the diverse set of stakeholders who guide the implementation of these policies are critical t

110、o ensuring a robust,well-functioning,enabling environment for telehealth.The report identifies and recommends policy practices that have proven to be most conducive to increasing access to and guiding the effective adoption of telehealth solutions.The analysis also includes several case studies from

111、 across APEC region of relevant policies in action.20 DHIS2,“About DHIS2,”webpage,https:/dhis2.org/about/.21 OpenMRS,“About OpenMRS,”webpage,https:/openmrs.org/about/.22 OpenHIE,“OpenHIE:Our Community,”webpage,https:/ohie.org/community/.11 Table 3 Telehealth Enabling Policy Considerations and Recomm

112、endations TELEHEALTH POLICY CONSIDERATION POLICY RECOMMENDATION SPOTLIGHT ON POLICY IN ACTION(see Annex I for details)Recognize Telehealth as Healthcare In all future healthcare regulatory conversations and decisions,recognize telehealth as integral to healthcare policy and reform.Thailands Notifica

113、tion of the Medical Council on Guideline in respect of Telemedicine and Online Clinics No.54/2563(“Telemedicine Guideline”)and effective as of October 20,2020 Create Integrated,Interoperable Information Sharing Platforms To the extent possible,create interoperable health information systems that all

114、ow for transmission of health information between providers and patients.Brunei Health Information and Management System(Bru-HIMS)Chinese Taipeis MediCloud and PharmaCloud Hong Kong,Chinas efforts to incorporate robotics,big data analytics,AI,and augmented reality into the Hospital Authoritys(HA)ser

115、vices Align Standards&Achieve Interoperability Adopt and/or align with internationally accepted health data standards and interoperability principles.New Zealands longitudinal electronic health record and integrated digital hospitals initiatives The United States Office of the National Coordinator f

116、or Health Information Technology(ONC)10-year vision to achieve an interoperable health IT infrastructure Asia eHealth Information Network(AeHIN)Expand Telecom Infrastructure Expand citizen access to connected networks through increased investment,construction,and deployment and upgrades of modern br

117、oadband infrastructure.Papua New Guineas Highlands fiber network Address Payment&Reimbursement Policy Challenges Review payment and reimbursement policies for telehealth and consider:-removing provisions in law that require a prior in-person relationship between practitioner and patient;-removing ge

118、ographic and originating site barriers;-allowing practitioners to determine appropriate standards of care for patients;-billing parity for telehealth services.Canadas expansion of billing codes for virtual care delivery in context of COVID-19 Australias December 9,2020 health alert on new telehealth

119、 COVID-19 policy and COVID-19 Medicare Benefits Schedule fact sheets United States COVID-19 Recovery Legislation modifications to Medicare,Medicaid and Childrens Health Insurance Program USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|12 23 The Health IT Policy Committee leads United States effort

120、s to have private-sector input to Health IT policymaking decisions.Note broad range of private sector stakeholders advising HHS.The committee webpage is available at:Health IT Policy Committee|HealthIT.gov.TELEHEALTH POLICY CONSIDERATION POLICY RECOMMENDATION SPOTLIGHT ON POLICY IN ACTION(see Annex

121、I for details)Coordinate Across Whole of Government Coordinate policy decision making process across whole of government to be inclusive of all stakeholders including health equities,digital infrastructure equities,digital policy equities,labor,and others for comprehensive policy outcomes.Chinese Ta

122、ipeis use of health card database and customs information for providers to send alerts about COVID-19 based on patient travel history Russias telehealth policy and digital economy working in concert Viet Nams Ministry of Information and Communications and the Ministry of Health working jointly to de

123、velop technology platforms and databases for healthcare and to complete a legal framework and develop technical standards Leverage Public-Private Partnerships Where appropriate,look to leverage and/or create public-private partnerships to stimulate adoption of new technologies.Chiles Digital Hospita

124、l Mexicos Salauno United StatesHealth IT Policy Committee23 Update Licensing,Liability,and Provider Professional Practices-Policies Update guidance for health care provider regulatory authorities on permitted modalities of care and cross-border licensure requirements:-Flexibility in delivering remot

125、e care across state/provincial borders;-Allowing initial visits between patients and providers to be conducted remotely so long as the provider can meet the standard of care for the presenting patient and condition.Indonesian Medical Council(Konsil Kedokteran Indonesia)(KKI)KKI Regulation No.74 of 2

126、020 on Clinical Authorities and Medical Treatment Through Telemedicine Japans temporary easing of restrictions on remote medical care,allowing doctors to conduct first-time visits online or by telephone and expanding the number of illnesses eligible for remote treatment The United States Center for

127、Medicaid and Medicare Services(CMS)published a 42-page fact sheet COVID-19 Blanket Waivers for Healthcare Providers Chinas National Health and Family Planning Commission of China(NHFPC)framework regulation of telemedicine(2014)and July 2018 Guidance for the Administration of Remote Medical Services

128、for Trial Implementation 13 TELEHEALTH POLICY CONSIDERATION POLICY RECOMMENDATION SPOTLIGHT ON POLICY IN ACTION(see Annex I for details)Expand Patient Access and Health Equity Leverage all forms of virtual services to deliver care to patients including both synchronous and asynchronous modalities.Co

129、nsider expanding existing health programs through incorporation of telehealth services.Design initiatives ensuring all individuals and communities,including the most disadvantaged,have access to and use of information and communication technologies(ICTs)and telehealth.Chiles Digital Hospital Philipp

130、ines&USAID ReachHealth Program New Zealands COVID-19 Telehealth Strategic Framework(principles of digital inclusion)Develop Workforce,Educate Public,and Build Capacity Provide training and education to medical providers and patients on telehealth tools and capabilities.Perus Directorate General of T

131、elehealth,Reference and Emergencies continuing education programs for healthcare workers Encourage Innovation Employ regulatory sandboxes to encourage creation of new care delivery models,leveraging private sector technology expertise.Singapore Ministry of Healths regulatory sandbox Koreas efforts t

132、o explore integration of AI,Internet of Things(IoT)tools and other advanced technology into its electronic medical records and telemedicine Enhance Data Stewardship Institute healthcare and privacy frameworks that balance personal privacy with the need be able to securely transmit health data for he

133、althcare purposes.The United States Health Insurance Portability and Accountability Act(HIPAA)Malaysian MyHEALTH Portal Facilitate Cross-Border Service Delivery Consider leveraging global consensus tools and frameworks to ease cross-border service delivery facilitation.WHO Regional Office for the We

134、stern Pacific publication:Implementing Telemedicine During COVID-19:Guiding Principles and Considerations for a Step-Wise Approach PAHO and Inter-American Development Bank publication:COVID-19 and Telemedicine Tool,Version 3.0 American Health Information Management Association(AHIMA)publication:Inte

135、rnational Telehealth Toolkit USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|14 MOVING APEC ECONOMIES TOWARDS GREATER USE OF DIGITAL HEALTH In addition to policy related best practices that economies could consider replicating in their own jurisdictions to enhance and promote access to and adoptio

136、n of telehealth services,the findings of this report also highlight potential areas for additional work the APEC members could consider.These recommendations could help the efforts of all members to increase telehealth adoption throughout the region and achieve the HWGs broader objectives of improvi

137、ng access to healthcare services in the region.Most importantly,adopting these recommendations would support APEC Leaders directions to foster an enabling environment that is supported by digital economy and innovation which would not only accelerate digital transformation to support health service

138、delivery,but also address efficiency and equity considerations.Firstly,under the HWG,economies could engage regional and global creators of innovative,globally accepted telehealth toolkits for use throughout the APEC region.Several international organizations such as WHO Western Pacific,PAHO,the Int

139、er-American Development Bank,and AHIMA International are able to provide guidance on telehealth that could be leveraged by APEC members to develop appropriate strategies to guide the successful implementation of telehealth solutions.These could be shared through targeted APEC-wide capacity building

140、workshops.Secondly,findings from this study highlight that telehealth implementation and policy are impacted by a broad array of stakeholders and are aligned with other cross-cutting themes progressing under other APEC fora.Fostering APEC cross-fora collaboration to develop a coherent,coordinated te

141、lehealth strategy across different sectors,while leveraging work undertaken in the past,could prove useful to broadening access to telehealth services.This could involve collaborative policy discussions between HWG,the Life Sciences Innovation Forum,the Digital Economy Steering Group,the Human Resou

142、rces Development Working Group,the Emergency Preparedness Working Group,the Sub-Committee on Standards and Conformance,and the Transportation Working Group where natural synergies exist-to facilitate the development of appropriate standards or regulations involving telehealth and related tools.For e

143、xample,the establishment of the Digital Health Sub-Working Group spearheaded by Chinese Taipei offers an established platform for APEC economies to coordinate and promote efforts within the region on digital health more broadly,with telehealth being a substantive component of the workstream.Further

144、to the above,this study is strongly aligned with HWGs broader policy directions and the forums Strategic Plan and reflects APECs approach to support improved service delivery as economies transition to post-pandemic recovery.Fora such as HWG and LSIF can deliver valuable insights into future APEC di

145、gital health activities.In addition,given the groups mandate,topics such as AI in healthcare and digital therapeutics would be areas for further exploration.This would also facilitate the timely sharing of lessons learned on digital and telehealth policy and implementation of best practices,to bette

146、r prepare APEC economies for a post-pandemic environment as well as help the region manage existing challenges such as rapidly aging populations,higher incidences of chronic illness demanding more personalized care,and increasing healthcare costs.The analysis undertaken for this study revealed that

147、major digital health interoperability initiatives are underway in numerous APEC economies such as Malaysia,New Zealand,Peru,and the United States.Moreover,key global organizations related to healthcare and standards development are exploring opportunities to partner meaningfully and provide needed t

148、raining and technical expertise where 15 appropriate.Given this,APEC members can seek to progress interoperability efforts by further exploring opportunities to foster sustainable and effective healthcare interoperability efforts with standards development organizations(SDOs)and other influential he

149、althcare stakeholders.Lastly,the HWG could work to improve multi-stakeholder engagement with a focus on improving digital inclusion and health equity in telehealth throughout the APEC region.Digital inclusion and health equity are highlighted in global health and health system sustainability efforts

150、.Research undertaken as part of this study revealed that APEC economies have begun to link telehealth initiatives to digital inclusion or health equity initiatives.CONCLUSION The analysis contained in this report provides a snapshot of the policy and regulatory landscape supporting telehealth soluti

151、ons across the Asia Pacific region.This information is expected to provide a sound basis upon which to further progress the conversation within APEC on adopting innovative ways of delivering health services in the region in an equitable and cost-efficient manner while enhancing efficiencies and deve

152、loping opportunities for collaboration between the private and public sectorsultimately achieving the overarching objectives of the HWG and the LSIF.The pandemic has served as a catalyst for economies in the region to develop appropriate policy frameworks and processes,and the analysis contained in

153、Annex 1 clearly indicates how it has accelerated technological,reimbursement,organizational,and patient-centered telehealth changes in several contexts.While telehealth remains an integral part of several APEC economies medical practices and healthcare policy frameworks offering easy,high quality,an

154、d equitable access to communities in the region there are still some regulatory issues and gaps that require further effort by the public sector to ensure the smooth adoption of telehealth services to achieve universal health care.The recommendations in this reportsuch as the development of teleheal

155、th toolkits,best practice sharing,cross-fora collaboration,will support a comprehensive,coordinated,equitable,interconnected,and sustainable approach to telehealth in the Asia-Pacific context.APEC will also become a global leader in cross-border telehealth learning and innovation at a critical junct

156、ure.USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|16 ANNEX I:ECONOMY-LEVEL PROFILES ON TELEHEALTH INTRODUCTION The following annex provides a snapshot of economy-level contexts involving eHealth and digital health service delivery in APEC economies,best practice examples of economies implementat

157、ion of the aforementioned policy considerations and recommendations,as well as relevant telehealth policy frameworks supporting health service delivery in the times of COVID-19,since 2020.This information guided the analysis and recommendations provided in the main body of the report and was gathere

158、d primarily via an in-depth desk assessment of existing,publicly available resources,and supplemented by interviews and information gathered via an APEC survey conducted as part of this study.Representatives from four APEC economies responded to the surveyCanada;Chile;Chinese Taipei;and New Zealandw

159、hile digital health experts from the four additional economies of Australia;the Philippines;Singapore;and the United States offered written,structured insights.This was used as primary research material for this study.As noted in the studys introduction,the telehealth and policy landscape has rapidl

160、y evolved,particularly during COVID-19.Therefore,sources such as current news,academic journals,technologies from industry and economies digital health and telehealth websites were reviewed and monitored for updates during the studys period.Relevant economy policies and regulatory developments were

161、also analyzed in depth to provide the most comprehensive and up-to-date information.The data contained in this annex are not exhaustive and represents a first step towards guiding a deeper dive into APEC economy-level policy frameworks and existing regulations,as well as the critical drivers,challen

162、ges,and opportunities to promote telehealth solutions across the APEC region.Links to policy documents,relevant sites,and publications are also provided.17 AUSTRALIA Digital Health Environment:The Australian Digital Health Agency(known as Digital Health)is the Australian governments statutory agency

163、 responsible for health technology and execution of My Health Record,Australias digital prescriptions and health referral system,as well as other eHealth programs under the economys National Digital Health Strategy.Australias National Digital Health Strategy and the Framework for Action(20182022),wh

164、ich support the delivery of digital health,contain seven principles or strategic priorities which are expected to form a sustainable ecosystem for the use of digital health technology.These include:1.Health information that is available whenever and wherever it is needed(which includes initiatives l

165、ike My Health Record);2.Health information that can be exchanged securely;3.High-quality data with a commonly understood meaning that can be used with confidence;4.Better availability and access to prescriptions and medicines information;5.Digitally-enabled models of care that drive improved accessi

166、bility,quality,safety,and efficiency;6.A workforce confidently using digital health technologies to deliver health and care;and 7.A thriving digital health industry delivering world-class innovation.24 The strategy adopts a staged approach to improving Australian digital health capabilities.The impl

167、ementation of the strategy is governed and managed by the federal as well as state and territory governments,in line with identified priority areas where digital health can be progressively extended to support health service delivery reforms in Australia.Telehealth Implementation and Relevant Policy

168、 Frameworks:For over 25 years,telehealth has been the focus of considerable research and discussion in Australia,given the urgent need to serve rural and remote parts of the economy that remain beyond the reach of traditional healthcare services.There have been many pilots and institutional-level us

169、es of telehealth through the years.The federal government,which subsidizes the provision of medical care by medical practitioners under the Australian Medicare System,recently approved telehealth as a mainstream means of delivering(and paying for)physician care.On April 19,2017,the Australian govern

170、ment introduced the Better Access Telehealth Initiative for Rural and Remote Areas,a new program designed to improve access to services for mental health treatment for individuals in rural and remote areas.Under these guidelines,the telehealth therapy services are offered via videoconferencing facil

171、ities between a patient and their health professional.25 Service providers who are registered with the Medicare system,including psychologists,social workers,and occupational therapists,can deliver relevant telehealth services.To be eligible,patients are required to have a Mental Health Treatment Pl

172、an and be located in a rural and remote area.As of September 2018,eligible patients in rural and remote areas have been able to access all of their sessions offered through the Better Access Telehealth Initiative via videoconferencing facilities.24 Australian Digital Health Agency,“National Digital

173、Health Strategy and Framework for Action,”webpage,https:/www.digitalhealth.gov.au/about-us/national-digital-health-strategy-and-framework-for-action.25 Australian Government Department of Health,“About the Better Access Initiative,”webpage,https:/www1.health.gov.au/internet/main/publishing.nsf/Conte

174、nt/mental-ba-telehealth.USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|18 Medicare rebates are available for up to 10 individual and group mental health therapy service sessions per calendar year to patients with a Mental Health Treatment Plan and referrals.This is designed to increase access,aff

175、ordability and choice of mental health providers.General practitioners(GPs),specialists,allied health providers,mental health professionals,and nurse practitioners are all eligible to provide telehealth services to patients.Telehealth Use During COVID-19:Like in other contexts in the APEC region and

176、 beyond,the adoption of digital health services in Australia has been dramatically accelerated by the COVID-19 pandemic.26 As a temporary measure during COVID-19,the Australian government adjusted the Medical Benefits Schedule(MBS)to accommodate telehealth services.On December 9,2020,the government

177、released a detailed alert on a telehealth COVID-19 policy along with a number of COVID-19 MBS fact sheets.This included a list of healthcare professionals that can provide telehealth services under the MBS scheme(using relevant MBS codes).Australia also included a number of temporary Medicare items

178、and payment changes to help healthcare practitioners deliver telehealth services via phone or videoconference.These measures were extended until June 30,2021.They include temporary GP and OMP(other medical practitioners)telehealth billing incentives for non-hospital patients who are vulnerable to CO

179、VID-19 and relaxing requirements that allow GPs and OMPs to perform telehealth or telephone care when there was an established relationship with the patient.27 Reference Links:Department of Health:https:/www.health.gov.au/Digital Health Department or Strategy:https:/www1.health.gov.au/internet/main/

180、publishing.nsf/Content/eHealth MBS and Telehealth:https:/www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/mbs-and-telehealth Telehealth During COVID-19:https:/www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-advice-fo

181、r-the-health-and-disability-sector/providing-health-care-remotely-during-covid-19 https:/ Telehealth Society:http:/www.aths.org.au/26 D.Koh,“An Overview of Australias Digital Health Landscape,”Healthcare IT(October 14,2020),https:/.au/article/overview-australias-digital-health-landscape.27 Australia

182、n Department of Health,“COVID-19 Temporary MBS Telehealth Services,”MBS Online(September 23,2020),http:/www.mbson-line.gov.au/internet/mbson-line/publishing.nsf/Content/Factsheet-TempBB.19 BRUNEI DARUSSALAM Digital Health Environment:The Brunei Ministry of Healths Office of Healthcare Technology lea

183、ds the charge for developing approaches to promote digital health services and modernizing healthcare.In 2008,the government of Brunei launched“Vision 2035”as an overarching policy framework to guide the transformation of Brunei into a dynamic and sustainable economy in the Southeast Asian region.Al

184、igned under this broad strategic framework,is the Ministry of Healths own“Vision 2035:Together towards a Healthy Nation,”designed as an integrated healthcare approach with community participation and inter-sectorial partnerships.While there is no current overarching policy framework to guide Bruneis

185、 efforts in supporting digital innovations,there are several notable initiatives underway that seek to provide better diagnosis,treatment and care to patients by improving and upgrading existing systems.An example of this is the comprehensive health information system Bru-HIMS-Bruneis Health Informa

186、tion and Management System,led by the Ministry of Health in partnership with DXC Technology.This initiative is an economy-wide,comprehensive health record database intended to enable real-time patient support and more effective data management.The database stores patient information of all citizens

187、and is made available to health practitioners for better medical data access and management.The system enables Bruneis four government hospitals and 60 health centers to automate and better manage patient referrals,heath related data,and treatment plans.Bru-HIMS transactions are fully synchronized a

188、cross multiple databases to allow for doctors and physicians to coordinate more effectively with pharmacy,laboratory,and radiology units.Telehealth Implementation and Policy Frameworks:Brunei is noted as one of the first economies in the Southeast Asian region to deploy telehealth to deliver healthc

189、are services.These services are integrated with Bru-HIMS.An example is the Jerudong Park Medical Centre where the Neuroscience Stroke and Rehabilitation Centre has been established in partnership with the North-West Hospital(KHNW)in Frankfurt,Germany.In this center,patients and doctors consult overs

190、eas specialists through satellite technology,video conferencing,and data transfer via phones and the internet.Twenty-four hour teleneurology services are offered.All neurological laboratories have been set up on site,covering procedures such as telecytology,teleelectrophysiology,electroencephalogram

191、s(EEGs),and ultrasound.28 Telehealth Use During COVID-19:Through a series of proactive health measures and strong leadership from both Bruneian Sultan Hassanal Bolkiah and Bruneis Health Ministry,the economy has been able to manage its response to COVID-19 effectively.Brunei has taken a comprehensiv

192、e whole-of-government approach to managing the impacts of the pandemic by crafting a four-stage de-escalation plan.In addition,the government facilitated enhanced digital connectivity and leveraged its Bru-HIMS health application for tracking and contact tracing and other outbreak and emergency func

193、tions.28 HIMSS Asia Pacific,“Bruneis SMART City Story,”posted online(June 2016),https:/www.himssasiapac.org/sites/default/files/HIMSSAP_ExclusiveArticles_BruneisSMARTCityStory.pdf.USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|20 Reference Links:Department of Health:http:/www.moh.gov.bn/Pages/Hom

194、e.aspx Digital Health Department or Strategy:http:/www.digitalstrategy.gov.bn/Themed/index.aspx Telehealth and Policy:https:/www.gov.bn/SitePages/Digital%20Government%20Strategic%20Plans%20and%20Legislation.aspx https:/www.himssasiapac.org/sites/default/files/HIMSSAP_ExclusiveArticles_BruneisSMARTCi

195、tyStory.pdf Telehealth During COVID-19:https:/ 21 CANADA Digital Health Environment:Much of Canadas digital health efforts are executed through Canada Health Infoway(Infoway),established in 2001 and funded by the federal government of Canada.Infoway is a not-for-profit organization that works to imp

196、rove the health of Canadians through increased development,uptake,and use of digital health solutions.29 A pan-Canadian electronic medical record,on-line patient health portals,and First Nations community-based digital health services,are some of the initiatives provided under the aegis of Infoway.3

197、0 Some of the key achievements under this program are:the availability of electronic health record data for 93.8 percent of all Canadians;core digital health systems established for immunizations,patient and provider registries,drug,lab and diagnostic systems and clinical reports;and cost-effective

198、service provision through digital access to specialized care(with savings measured in terms of more than$420 million in savings and a reduction of more than 280 million kilometers of travel).31 Improvements to existing programs are conducted by Infoway via“Healthy Dialogues”and customer surveys.32 I

199、nfoway also provides a wide range of multi-media information on digital health and innovation,including podcasts on breakthroughs and innovative practices.33 Telehealth Implementation and Policy Frameworks:While there is no overarching federal government-level policy framework,telehealth has been an

200、 integral part of the Canadian healthcare system for over a decade,with a range of programs implemented by provinces and territories.Since Infoways establishment in 2001 to 2019,almost US$77 million has been invested in telehealth and US$45 million in tele-homecare programs.Videoconferencing is the

201、most commonly used and relied on platform for achieving provider-to-patient care in rural and remote areas,and specialists employ tools like digital stethoscopes and cameras to conduct patient examinations with assistance from local clinicians.Telehealth can improve access to care for people with mo

202、bility issues or people unable to get time off work.34 Prior to COVID-19,Canada conducted a broad analysis on the benefits of telehealth care,including the examination of the reduction of carbon dioxide emissions resulting from telehealth services in place of in-person care.35 Telehealth Use During

203、COVID-19:A survey conducted by Infoway found that up to two-thirds of patient visits(approximately 7 in 10 people)involving primary care providers are undertaken on a virtual platform since the start of the pandemic.To guide the change to virtual care,Infoway is working with Health Canada and the pr

204、ovinces and territories,to rapidly develop and expand virtual 29 Canada Health Infoway,“About Canada Health Infoway,”webpage,https:/www.infoway-inforoute.ca/en/about-us.30 Canada Health Infoway,“Solutions:Indigenous Peoples,”webpage,https:/www.infoway-inforoute.ca/en/solutions/indigenous-peoples.31

205、Canada Health Infoway,“Progress in Canada,”webpage,https:/www.infoway-inforoute.ca/en/what-we-do/progress-in-canada.32 Canada Health Infoway,“Healthy Dialogue Report Highlights,”webpage,https:/access2022.ca/section/a-healthy-dialogue.33 Canada Health Infoway,“Digital Health InfoCast,”webpage,https:/

206、www.infoway-inforoute.ca/en/what-we-do/podcast-digital-health-infocast.34 Canada Health Infoway,“Telehealth,”webpage,https:/www.infoway-inforoute.ca/en/solutions/digital-health-foundation/telehealth.35 Canada Health Infoway,“Analysis of the Current and Potential Benefits of Virtual Care in Canada,”P

207、owerPoint presentation(March),https:/www.infoway-inforoute.ca/en/component/edocman/resources/reports/benefits-evaluation/3819-analysis-of-the-current-and-potential-benefits-of-virtual-care-in-canada?Itemid=10.USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|22 care solutions across the economy.36Th

208、e Canadian government introduced a variety of new and expanded telehealth measures during the COVID-19 pandemic.These include expanded billing codes and technology use,a patient portal for COVID lab results,and virtual mental health services,including childrens assistance resources.Examples of these

209、 initiatives include:Expanded billing codes for virtual care delivery in context of COVID-19:All provinces and territories,excluding the Northwest Territories(where physicians are largely salaried),have employed billing/fee codes to expand the use of virtual care.Use of telephone:While the adoption

210、of virtual care services was limited prior to the pandemic,all provinces and territories are now employing the use of the telephone to support patient consultations with healthcare providers,and it is by far the most widely used modality within and across jurisdictions.Use of video conferencing and

211、secure messaging:All provinces and territories are using a variety of regulated and unregulated video conferencing services and messaging services to virtually meet and communicate with patients during COVID-19,including primary care physicians.Prior to COVID-19,virtual care services were largely li

212、mited to specialist services and constituted a very small portion of practice.Online patient access to COVID-19 lab results:Online patient access to COVID-19 test results is in place in several provinces,but with varying levels of access.Some programs use a mix of web portals and in some cases an ap

213、p.Other jurisdictions are exploring providing patients online access to test results.For jurisdictions that currently do not provide patients online access to test results,results are communicated to patients via phone.In-home monitoring:Some jurisdictions have programs in place for in-home patient

214、monitoring;these programs vary in scale and purpose.Initiatives in Saskatchewan and Ontario focus on non-COVID-19 patients and the expansion of acute care services for patients outside of hospitals(e.g.vitals monitoring,surgical discharges).British Columbias program is focused on remote home monitor

215、ing of higher risk COVID-19 patients in self-isolation.Virtual mental health services for COVID-19:Several provinces and territories have COVID-19 specific online mental health resources available.Kids Help Phone provides bilingual services across Canada and its website has experienced steady growth

216、 in the number of visitors since the beginning of March.The online Wellness Together Canada resource also provides access to resources and services across Canada.Reference Links:Department of Health:https:/www.canada.ca/en/health-canada.html Digital Health Department or Strategy:https:/www.infoway-i

217、nforoute.ca/en/solutions/digital-health-foundation/telehealth Telehealth Implementation and Policy:https:/www.infoway-inforoute.ca/en/solutions/digital-health-foundation/telehealth Telehealth During COVID-19:36 Canada Health Infoway,“Digital Health Week,”webpage.https:/www.infoway-inforoute.ca/en/di

218、gital-health-week.23 https:/www.royalcollege.ca/rcsite/documents/about/covid-19-resources-telemedicine-virtual-care-e https:/www.bnnbloomberg.ca/canada-s-telehealth-boom-in-the-early-innings-as-covid-19-stokes-demand-1.1507993 USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|24 CHILE Digital Health

219、 Environment:The Ministry of Health of Chile(MINSAL)created the Department of Digital Health which supports all functions related to ICT tools and the implementation and management of the Digital Hospital as part of the economys approach to achieving an integrated system for all citizens.The Departm

220、ent of Digital Health oversees provision of digital health services to effectively deliver patient care starting from prevention to treatment and recovery.The Digital Hospital reaches over 1 million patients including those in isolated rural areas and deploys asynchronous telemedicine in a variety o

221、f medical specialty areas like dermatology and geriatrics.Distance diagnosis for mammographic services and diabetic retinopathy are also offered via telemedicine.Telehealth Implementation and Policy Frameworks:Telehealth is a critical component of Chiles digital health approach and reflects several

222、useful policy initiatives that support access and the quality of healthcare service delivery.Some of the Department of Digital Healths initiatives have focused on:Integrating digital health actions to mirror that of face-to-face benefits;Articulating telehealth networks in the overall Integrated Hea

223、lth Services Delivery Network design;and Developing strategies for disseminating telehealth benefits to citizens.Plans for future reforms include a document to initiate digital transformation on health services systems,an upgrade of the economy-wide telehealth program,and a Digital Health Law.Telehe

224、alth Use During COVID-19:The Chilean government has implemented a variety of telehealth-related measures during COVID-19.Key initiatives include:providing additional financial support for telehealth programs at the Digital Hospital;expanding telehealth service offerings in the areas of mental health

225、,urgency care,and general medical support for elderly healthcare and the prison system;and introducing a regulatory document regarding health technologies.Reference Links:Department of Health:https:/www.gob.cl/en/ministries/ministry-of-health/Digital Health Department or Strategy:https:/ Implementat

226、ion and Policy:https:/www.minsal.cl/wp-content/uploads/2018/03/Programa-Nacional-de-Telesalud.pdf Telehealth During COVID-19:https:/www.hospitaldigital.gob.cl/25 PEOPLES REPUBLIC OF CHINA Digital Health Environment:Chinas National Health and Family Planning Commission(NHFPC)oversees digital health,t

227、he“informatization”of healthcare,and telehealth.Both Chinas online services market and digital health efforts were prevalent well before the advent of the pandemic;telemedicine as part of Chinas overall healthcare system took hold in the mid-1980s.A study undertaken on early Chinese telemedicine act

228、ivities indicates37 that initiatives were mostly based on store-and-forward techniques as the telecommunication infrastructure that was required for real-time work was in its infancy at the time.In recent years however,telemedicine has seen a rapid uptake with the growth of telecommunication network

229、s.The availability of low-cost telemedicine services is needed to support health services delivery of Chinas rural population.A number of privately owned companies offer online medical consulting services to patients.Since 2018,China has passed several policies to support“internet and medical health

230、”and,most importantly,incorporated the online medical services into the existing domestic health reimbursement system in late 2019.However,many private insurers have not yet codified online care into reimbursable payments.Looking ahead,the Healthy China 2030 economic and social development blueprint

231、 holds promise,with its emphasis on advancing health science and technology innovation,promoting health in all policies and expanding the health sector.However,many private insurers have not yet codified online care into reimbursable payments.Looking ahead,the Healthy China 2030 economic and social

232、development blueprint holds promise,with its emphasis on advancing health science and technology innovation,promoting health in all policies and expanding the health sector.38 Telehealth Implementation and Policy Frameworks:In 2014,Chinas NHC issued a regulation framework for telemedicine.In July 20

233、18,NHC published the specification for telemedicine services management(for trial implementation)which included an emphasis on“healthcare matching platforms”and“direct coordination”between medical institutions.The guidance outlines a series of requirements that medical professionals,patients,and pla

234、tform providers are required to follow to ensure fair and transparent use of digital healthcare platforms for health service delivery.Under the guidance,medical institutions must clearly explain the medical services and associated fees and obtain each patients(or guardians or relatives)written conse

235、nt to receive the service.Patients must also provide consent when giving their personal information.The guidance also requires the medical institution to enter into a telemedicine cooperation agreement(enforceable by electronic signatures)with the healthcare platform provider.In addition,the Law on

236、the Promotion of Basic Medical and Health Care,which demonstrates the legal framework to address medical information exchange,telemedicine services,and safety systems,was approved by the National Peoples Congress and became effective June 1,2020.Telehealth Use During COVID-19:Enhanced efforts have b

237、een made in China to improve 37 Z.Wang and H.Gu“A Review of Telemedicine in China,”Journal of Telemedicine and Telecare(2009)15(1):237,doi:10.1258/jtt.2008.080508.38World Health Organization,“Healthy China 2030:From Vision to Action,”webpage,https:/www.who.int/healthpromotion/conferences/9gchp/healt

238、hy-china/en/.USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|26 connectivity and electronic information sharing among different regions and healthcare service providers to improve health service delivery during COVID-19.The government emphasized online screening and consultation for COVID-19 affec

239、ted patients within a few weeks.Some public hospitals also offered basic digital services via a WeChat public account(WeChat mini program)or with their own apps.Online prescriptions were also incorporated in on-line service offerings during COVID-19 if patients had previously received a prescription

240、 from a medical practitioner.In China,on-line consultations are governed by existing legislation and controls for:online diagnosis and treatment administration;online hospital administration;and long distance healthcare service administration.39 The benefits of online health service delivery have be

241、en clearly demonstrated during COVID-19,40 which,according to officials at the National Clinical Medicine Research Center of Geriatric Diseases in China,guided Chinas strategy in reducing infections among patients,especially the elderly.With a rapidly aging population,this demonstrates that more con

242、certed efforts are needed to integrate internet technologies and healthcare to cope with increasing demand for healthcare services.41 Looking to the future,China is leveraging big data to expand online telehealth services including remote follow-ups and healthcare advice and examining offline servic

243、es for those who have difficulty using digital technologies,such as the elderly,children,and the disabled.42 Chinas telecommunications infrastructure also proved resilient during COVID-19 despite a 22.61 percent increase in daily broadband network traffic.Normal activities and operations in some are

244、as of the healthcare sector have resumed but,large online platforms are still experiencing high volumes of traffic which continue since the pandemic.43 Reference Links:Department of Health:http:/ Health Department or Strategy:https:/news.itu.int/covid-19-chinas-digital-health-strategies-against-the-

245、global-pandemic/Telehealth Implementation and Policy:Guidance for the Administration of Remote Medical Services for Trial Implementation(2018)Background on Law on the Promotion of Basic Medical and Health Care(2020):https:/ Telehealth During COVID-19:https:/ 39 Lay Leng Tan,“Leveraging Digital Healt

246、h in Times of COVID-19 and Beyond,”Healthcare IT News(July 13,2020),https:/ Health Commission of the Peoples Republic of China,“Internet Playing a Bigger Role in Healthcare,”China Daily(December 14,2020),http:/ National Health Commission of the Peoples Republic of China,“Internet Playing a Bigger Ro

247、le in Healthcare.”42 National Health Commission of the Peoples Republic of China,“Internet Playing a Bigger Role in Healthcare.”43 International Telecommunications News,“COVID-19:Chinas Digital Health Strategies Against the Global Pandemic,”ITU News(April 15,2020),https:/news.itu.int/covid-19-chinas

248、-digital-health-strategies-against-the-global-pandemic/.27 USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|28 HONG KONG,CHINA Digital Health Environment:The Hospital Authority(HA)has been developing digital health capabilities since the early 1990s,starting with the in-house development of a compr

249、ehensive electronic medical records system called the Clinical Management System(CMS).By the early 2000s every patient possessed a single lifelong electronic patient record available to all clinicians who cared for them wherever they sought care in the HA.Today most major clinical processes have bee

250、n digitalized,and clinicians can access the patient record and make clinical orders from the bedside with their digital tablets.Patients can also access a variety of digital health services,including telemedicine,through the“HA Go”patient app.With these foundational digital health capabilities in pl

251、ace,HA has been nurturing an innovation culture to further integrate digital solutions.The IT Innovation Office was established in 2016,supported by four innovation labs(Data,Mobile,artificial intelligence(AI)and Geek)and has since developed and delivered many innovative solutions.Digital health is

252、a pillar for the long-term sustainability of HAs services,and the flagship Smart Hospital project is underway to develop and implement a wide range of new digital health capabilities,including:(a)Smart Care the fourth generation of Clinical Management System(CMS)is under active development,focusing

253、on the five pillars of“patient-centered”,“paperless”,“protocol-driven”,“closed-loop”and“personalized care”.The AI Lab allows exploration of HAs clinical data to develop useful AI models,and the AI delivery centre allows these models to be deployed at scale.Devices and connectivity are being deployed

254、 to monitor patient status and to provide alerts and insights to patients health status.Telehealth capabilities have been built into CMS and HA Go,allowing seamless access to telehealth services.(b)Smart Support robots and AI models are being tested and deployed in pharmacy,transportation,logistics

255、and security.(c)Smart Management the Hospital Command Centre consolidates data and improves operational intelligence via Command Centre“Hubs”to display key metrics and take actions in areas including bed management,logistics and clinical monitoring.(d)Smart Staff-Digital Workplace applications are d

256、igitalizing workflows to eliminate manual steps,providing tools to enhance collaboration and giving staff easy access to the resources they need.The Department of Health established the Health Informatics and Technology Office(HITO)in October 2019,with a mandate to undertake:Planning and management

257、of information technology projects;Health informatics enablement and management;Advocacy of government/departmental IT and innovation initiatives;Development and oversight of the Clinical Information Management System;IT capacity building,security and risk management for the Department;and Grade man

258、agement of IT staff in digital healthcare.29 Telehealth Implementation and Policy Frameworks:Telemedicine is part of the Hospital Authority(HA)informatics efforts and a strategy is in place for more agile integration of IT innovation into HAs services along with robotics,big data analytics,AI,and au

259、gmented reality.In 2016,Hong Kong,China launched the territory-wide Electronic Health Record Sharing System(eHRSS).This enables registered healthcare providers/practitioners in both the public and private sectors,to obtain informed consent and proper authorization from the registered patient to shar

260、e electronic health records for healthcare purposes.The sharable data include personal identification and demographic data;information on allergies and adverse drug reactions,diagnosis,procedures and medication,appointments;birth and immunization records;laboratory reports;and healthcare referrals.T

261、he list is updated regularly.Participation in the eHRSS is voluntary for both practitioners and patients.A wide range of telehealth services have been developed under HAs telehealth framework.These services include tele-consultation,tele-information,tele-reminders,and disease management.HA Go,the HA

262、s one-stop mobile app,is the key enabler and many of the telehealth services have also been integrated into the CMS,giving clinicians and patients easy and convenient access.New telehealth services are under continual development.In the private sector,there are advances in telemedicine,including:Doc

263、torNow is a telemedicine service provider offering remote healthcare services with video consultations for patients suffering from conditions including cough and fever,sore throat,and diarrhea.For other severe illnesses,a face-to-face consultation would be required.Pulse by Prudential is a digital h

264、ealth app offering various healthcare-related services including telemedicine,AI assessment,medicine delivery,and connecting registered users to nearby clinics.Quality HealthCare Patient Portal is an integrated online platform for digital ticketing and appointment booking as well as video consultati

265、on for telemedicine.Telehealth Use During COVID-19:With the advent of the COVID-19 pandemic,digital health implementation gained a significant level of prominence in Hong Kong,China,as in other contexts.Hong Kong,China and its Department of Health have established prompt and effective public health

266、measures,which are supported by a wide range of digital technology.These include case investigation,health declarations and port health measures,quarantine and camp management,territory-wide vaccination logistics and issuing of authenticated electronic vaccination certificates,community PCR testing,

267、contact tracing,venue-based exposure notification and law enforcement.Effective dissemination of COVID-19 information to the public is crucial to better inform the community of the risk to which they may be exposed,and staying away from possible sources of infection.An interactive map and dashboard

268、were developed with geographic information system(GIS)to facilitate the public more conveniently learning about the latest developments of the epidemic at a glance on their computers and smartphones.Through an interactive and user-friendly map layout,it presents statistics on COVID-19 infection,info

269、rmation on buildings where confirmed cases appeared,USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|30 places where confirmed patients have visited,as well as information on the community testing services,the quarantine centers,community vaccination services,etc.The adoption of telehealth has acce

270、lerated during the pandemic as HA has explored innovative models to sustain service in the“new normal”.Professional collaboration at the bedside has been made possible by clinical tablets supporting the HA videoconferencing platform.Tele-information services have been widely used.Telemedicine for ou

271、tpatient appointments has been deployed for suitable patients and telerehab adoption has increased greatly.During the COVID-19 pandemic,health benefits solutions provider StartUpCare partnered with a Hong Kong,China insurance company Generali to launch an all-in-one digital healthcare platform.This

272、platform offers patients a seamless,end-to-end insurance journey within an app.The app included an assessment of initial symptoms,a tool to find a clinic,and setting an appointment.The app also assisted with payment by offering e-claim services.This digital healthcare platform enables customers to b

273、ook virtual consultations with network doctors and receive medical consultations about prescribing medicine or being referred to specialists.By streamlining services and creating an option for virtual care using telehealth,this digital health platform proved to be a critical tool in combating the pa

274、ndemic.Reference Links:Department of Health:https:/www.dh.gov.hk/eindex.html Digital Health Department or Strategy:https:/www.dh.gov.hk/english/main/main_hito/main_hito.html Telehealth Implementation and Policy:https:/www.ourhkfoundation.org.hk/en/report/36/healthcare-and-ageing/enhanced-telemedicin

275、e-will-be-big-health-boon-residents Telehealth During COVID-19:https:/www.coronavirus.gov.hk/eng/index.html 31 INDONESIA Digital Health Environment:The Ministry of Health has responsibility for digital health in Indonesia.Digital health innovation is critical for reaching Indonesias citizens spread

276、across 17,000 islands,and digital health tools have been in use since 1985.The digital health ecosystem in Indonesia includes the use of mobile,app-based,and video-based digital health platforms.Well-established multi-economy companies such as Phillips Healthcare Solutions and many innovative local

277、companies are active in the sector.44 The Indonesian Minister of Health has encouraged local governments to deploy digital health in the midst of COVID-19.45 The economys digital health strategy is supported through an eHealth policy which was passed in 2002,Indonesias electronic civil registration

278、and vital service systems(CRVS),an established health privacy framework,initiatives addressing online strategies for provider training in information and communications technology(ICT),and policies improving the health of women and children.46 Telehealth Implementation and Policy Frameworks:Indonesi

279、a has a burgeoning health IT ecosystem including an active private sector with companies such as Halodoc,Alodokter,and GrabHealth(a joint venture between Singapore-based Grab and Chinas Good Doctor)providing private doctor consultations through chat or video calls.There are also partnerships between

280、 ride sharing apps and pharmacies to deliver prescription medications.Medigo Indonesia provides facilities such as hospitals and village clinics with outpatient management platforms to facilitate operations,including announcement of clinic line-ups,doctors availability,patient wait-times,and an appo

281、intment scheduling system for both staff and patients.Efforts are underway to improve the regulation of the telehealth and telemedicine sector.The Indonesian Medical Council plays a central role with developing and implementing telemedicine and telehealth guidelines.As part of the governments Indust

282、ry Revolution 4.0 agenda,the Ministry of Health is assigned with supporting the growth of telemedicine and encourages increased adoption of telemedicine models among healthcare service providers.47 Example of Best Practice in Telehealth:Licensing,Liability and Provider-related Policies:The Indonesia

283、n Medical Council approved Konsil Kedokteran Indonesia KKI Regulation No.74 of 2020 on Clinical Authorities and Medical Treatment through Telemedicine(more details below).Telehealth Use During COVID-19:During COVID-19,Indonesian President Joko Widodo and 44 P.Preesman,“Transitioning Indonesia to Dig

284、ital Healthcare,”Phillips Future Health Index,(June 8,2020),https:/.sg/a-w/about/news/archive/future-health-index/articles/20200608-transitioning-indonesia-to-digital-healthcare.html.45 S.Dharmaraj,“Indonesian Ministry of Health Urges Local Government to Adopt Digital Health,”OpenGov,(November 12,20

285、20),https:/ World Health Organization South-East Asia Regional Office,“eHealth and Innovation in Women and Childrens Health:2013,”Atlas of eHealth Country Profiles(online),https:/www.who.int/goe/publications/atlas/2013/idn.pdf?ua=1.47 C.Endahayu,R.Mokodompit,and C.Benjamin,“Indonesia:New Medical Cou

286、ncil Regulation on Telemedicine Services During COVID-19 Pandemic,”Lexology,(July 28,2020),https:/ EMPOWERING TELEHEALTH SOLUTIONS IN APEC|32 Minister of Health Terawan Agus Putranto encouraged citizens to seek medical help through online platforms and apps.In an effort to expedite adoption of such

287、tools and keep healthcare services accessible during the pandemic,Indonesias COVID-19 taskforce included links to 20 telemedicine services on its website and the government issued several new telemedicine regulations.On April 29,2020,the Indonesian Medical Council(Konsil Kedokteran Indonesia or KKI)

288、issued KKI Regulation No.74 of 2020 on Clinical Authorities and Medical Treatment Through Telemedicine During the COVID-19 Pandemic.KKI Regulation 74 allows doctors and dentists with an approved registration letter(Surat Tanda Registrasi)and practice permit(Surat Izin Praktik),to deliver telemedicin

289、e services,which are defined as teleconsultation in the form of writing,voice,and/or video.It also deals with licensure and liability issues.48 Future policy challenges include integration of these applications with Indonesias expanding universal health insurance system.Another key challenge for Ind

290、onesia to overcome is the digital divide as current internet penetration rates are only 64 percent49 and there are user data privacy issues that need to be addressed.50 Reference Links:Department of Health:http:/www.kemkes.go.id/https:/ Digital Health Department or Strategy:https:/.sg/a-w/about/news

291、/archive/future-health-index/articles/20200608-transitioning-indonesia-to-digital-healthcare.html Telehealth Implementation and Policy Minister of Health Regulation No.90 of 2015 concerning the Organization of Health Service Facilities in Remote Areas and Very Remote Areas(“MoH Reg.90/2015”)Minister

292、 of Health Regulation No.20 of 2019 concerning the Organization of Telemedicine Services between Health Service Facilities(“MoH Reg 20/2019”)to specifically regulate the organization of telemedicine Telehealth During COVID-19:KKI Regulation No.74 of 2020 on Clinical Authorities and Medical Treatment

293、:https:/ 48 C.Endahayu,R.Mokodompit,and C.Benjamin,“Indonesia:New Medical Council Regulation on Telemedicine Services During COVID-19 Pandemic.”49 S.Kemp,“Digital 2020:Indonesia,”DataReportal,webpage(February 18,2020),https:/ I.Yuriutomo,“Indonesia Data Protection Overview,”OneTrust DataGuidance(onl

294、ine)(December 2020),https:/ JAPAN Digital Health Environment:The Ministry of Health,Labour and Welfare(MHLW)has primary responsibility for digital health in Japan.As a result of Japans rapidly aging population,there is significant need for cutting-edge healthcare technology to better meet the popula

295、tions healthcare needs.Japans drive towards digital health stems from its long history in innovation and use of digital technology.At the October 2019 G20 Health Ministers meeting,the Okayama Declaration emphasized promoting the use of data and digital health technologies by developing and implement

296、ing policy measures and appropriate regulations to protect personal health data and strengthening the interoperability of digital health information systems as well as equitable access to digital health technology.51 It is also notable that as part of Japans growth strategy,the economy undertook a d

297、eregulation of the medical industry,fueling digital health.Telehealth Implementation and Policy Frameworks:Initiatives in telemedicine and online medical consultation first originated in 1997 as the Medical Examination using Telemedicine guideline from the MHLW,stating that telemedicine could be use

298、d if preceded by an initial in-person medical examination.This guideline was in place for 18 years until 2015,during which expansion of telemedicine became more prominent.Japan issued guidelines to enable the expansion of telemedicine,and the reimbursement schedule of medical fees was revised and pu

299、blished in 2018.52 ICT-based telehealth networks and tools are being implemented throughout Japan.These tools have been introduced to reduce the number of hospitals and to maintain an adequate healthcare infrastructure despite geographical distances between urban centers and mountainous and rural re

300、gions.At the cutting-edge of telehealth innovation,Sekisui House,one of Japans largest residential construction companies,recently developed a smart healthcare house with a monitoring sensor system,and an electronic and computer-controlled integrated system within the home,which includes a monitorin

301、g sensor network that enables daily health checks for residents.Telehealth Use COVID-19:As COVID-19 cases rose,Japan temporarily eased restrictions on remote medical care in April 2020,allowing doctors to conduct first-time visits online or by telephone and expanding the number of illnesses that cou

302、ld be treated remotely.Previously,Japanese doctors were only allowed to treat recurring patients virtually,and for a limited number of diseases.The MHLW has not decided whether to make the changes permanent.Toshio Nakagawa,the president of the Japanese Medical Association,has warned against using ex

303、periences with use of telemedicine in an emergency situation to inform how telemedicine should be used long-term.53 51 G20,“Okayama Declaration of the G20 Health Ministers,”(October 19-20,2019),available online at https:/www.mhlw.go.jp/seisakunitsuite/bunya/hokabunya/kokusai/g20/health/img/G20Okayam

304、a_HM_EN.pdf.52 Japanese Health Policy Now,“Latest Initiatives in Telemedicine and Online Medical Consultation,”Notes from roundtable webpage,Health and Global Policy Institute,http:/japanhpn.org/en/ict-4-2/.53 K.Kaneko and I.Nakagawa,“With Apps and Remote Medicine,Japan Offers Glimpse of Doctor Visi

305、ts in Post-Corona Era,”Reuters News(July 8,2020),https:/ EMPOWERING TELEHEALTH SOLUTIONS IN APEC|34 Companies such as Medley Inc.and MICIN Inc.,which offer application services for appointments,video consultations,and payments,have experienced increased demand due to COVID-19.Japans market for such

306、technology is set to grow by 60 percent in five years to nearly 20 billion yen(US$185 million)by March 2024.54 Nearly 15 percent of all Japanese medical institutions(excluding dentistry)offered remote medical services,including by telephone as of July 2020,compared to only 970 registered to offer on

307、line care In July 2018.55 Moving forward,an intergovernmental study group will consider which COVID-19 telehealth changes are to be made permanent.The Review of Guidelines for Proper Implementation of Online Medical Care Group,led by the Economic Affairs Division,Health Policy Bureau at MHLW,include

308、s participants from Japans Ministry of Economy,Trade and Industry,and the Ministry of Internal Affairs and Communications.The group has begun discussions about making online medical care permanent,including the first-time visit.Reference Links:Department of Health:https:/www.mhlw.go.jp/english/Digit

309、al Health Department or Strategy:https:/www.mhlw.go.jp/seisakunitsuite/bunya/hokabunya/shakaihoshou/hokeniryou2035/assets/file/healthcare2035_proposal_150703_slide_en.pdf Telehealth Implementation and Policy:Medical Practitioner Act(and related changes):http:/japanhpn.org/en/ict-4-2/Telehealth Durin

310、g COVID-19:https:/ 54 K.Kaneko and I.Nakagawa,“With Apps and Remote Medicine,Japan Offers Glimpse of Doctors Visit in Post Corona Era”Thomson Reuters,(July 8,2020),https:/ K.Kaneko and I.Nakagawa,“With Apps and Remote Medicine.”35 REPUBLIC OF KOREA Digital Health Environment:The Ministry of Health a

311、nd Welfare has primary responsibility for digital health in the Republic of Korea,with related bodies such as the Bureau of Advanced Technology Policy and the Division of Information Management also playing a role.While the provision of digital healthcare services needs further development,in terms

312、of general healthcare,Korea is a leader in the APEC region,with expertise in medical device manufacturing,remote medical treatment,and medical software driving innovation.Digital health is a key priority for Korea,with particular focus on the integration of smart technology,AI,and the Internet of Th

313、ings(IoT)into healthcare.These aid telehealth delivery,particularly in home care environments.Korea jumpstarted its digital health efforts decades ago with the introduction of electronic medical billing,physician order entry,and the wide use of electronic medical records.Telehealth Implementation an

314、d Policy Frameworks:Telehealth was introduced in Korea in 1988,and its Medical Service Act was revised in March 2002 to allow telemedicine among doctors and healthcare workers.Three pilot projects for patientdoctor telemedicine services have been introduced since 2006.Koreas Medical Service Act does

315、 not allow a full patientdoctor telemedicine experience but has partly allowed it in the form of pilot projects using ICT,in order to enhance accessibility of medical services and health management for people living in remote areas.The Ministry of Health and Welfare,the Ministry of National Defense,

316、the Ministry of Justice,and the Ministry of Oceans and Fisheries are providing telemedicine services centering on special areas such as military bases,correction facilities,deep-sea fishing vessels and places with lower accessibility to medical services.Also,through regulatory exceptions,demonstrati

317、on projects for the efficacy of telemedicine using new technologies such as wearable electrocardiograph and rehabilitation robots have been carried out since 2019.Eight pilot projects for home health care have also been implemented since 2019 for patients requiring continuous care due to hypertensio

318、n,diabetes and use of mechanical ventilation.Discussions on developing telemedicine to complement in-person medical services are underway with the participation of stakeholders including the medical community.The aim is to provide patients with better and safer medical service and improve accessibil

319、ity for people living in remote areas.Telehealth Use During COVID-19:In order to prevent infection of health care workers and patients during the COVID-19 pandemic,the Korean government started providing patientdoctor telemedicine services beginning on Feb.24,2020.This was authorized through a Minis

320、try of Health and Welfare notification after the Active Administration Support Committees decision.To provide clear legal grounds for the move,the Infectious Disease Control and Prevention Act was revised in Dec.15,2020.As of the first half of 2021,11,163 medical institutes have provided about 2.38

321、million telemedicine services.More than 75%of the 45 upper-grade general hospitals and about 15%of the 66,409 clinic-grade medical institutes in Korea are providing telemedicine services.Telemedicine is also being utilized for home treatment of pediatric COVID-19 patients with mild clinical symptoms

322、 and adult patients with children,so that they can safely go through the quarantine with emotional and psychological stability in a familiar environment.A decision on maintaining the changes on a permanent basis,after the COVID-19 alert is relaxed to a lower level,will require additional stakeholder

323、 consensus.USAID.GOV EMPOWERING TELEHEALTH SOLUTIONS IN APEC|36 Reference Links:Department of Health:https:/www.mohw.go.kr/eng/Digital Health Department or Strategy:https:/pubmed.ncbi.nlm.nih.gov/31496868/https:/pubmed.ncbi.nlm.nih.gov/31496868/Telehealth Implementation and Policy:https:/ https:/ Te

324、lehealth During COVID-19:https:/ 37 MALAYSIA Digital Health Environment:The Ministry of Health has responsibility for digital health in Malaysia.The Malaysian government is committed to the principle of universal access to high-quality healthcare,which the Ministry of Health provides through a netwo

325、rk of clinics,hospitals,and healthcare programs.Integral to this is the MyHEALTH Portal,a web-based health information service set up by the Ministry of Health in Malaysia.56 The Multimedia Super Corridor(MSC)Telehealth Flagship Application is a system that aims to make the Malaysian healthcare syst

326、em more integrated and designed to provide equitable,accessible,and high-quality healthcare services to all citizens.It is anticipated that this system will,upon completion,provide citizens with an electronic lifetime health record(LHR)and lifetime health plan(LHP)as well as a smart card that will c

327、ontain a subset of the data in the Lifetime Health Record.The MyHEALTH Portal can be viewed both through proprietary and open-source platforms.Additional security measures are in place through Malaysias Security Policy for ICT,which ensures that external access via smartphones is only possible if re

328、gistered with the server.57 Telehealth Implementation and Policy Frameworks:In accordance with Malaysias vision to revamp its healthcare system through IT,in 1997 the Ministry of Health introduced Malaysias Telemedicine Blueprint:Leading Healthcare into the Information Age,which outlines a comprehen

329、sive plan to guide all aspects of telehealth services.This involves implementation strategies,success factors,and workforce issues including change management issues,communication,training and development.The blueprint defines telemedicine as encompassing“any health,health-support or governance serv

330、ice that can be provided via a multimedia network and a range of network-based or network-linked information and multimedia tools and technologies used by people and health professionals to access,manage or deliver healthcare.:58 The blueprint also includes an approach for articulating the laws and

331、regulations to support telemedicine(e.g.,the Telemedicine Act,Digital Signature/Contract Act,Computer Crime Act,Multimedia Intellectual Property Act,and the Electronic Government Act).In 2007,after 20 years of implementation experience,the telemedicine structure in Malaysia was organized into five m

332、ajor components:lifetime health record and services;lifetime health plan;health online;teleconsultation;and continuing professional development.59 Telehealth Use During COVID-19:During COVID-19,several tech start-ups such as DoctorOnCall that offer virtual health advisory platforms and other capabil

333、ities came into existence,operationalizing Malaysias telehealth blueprint.Another tool used in the multi-agency effort against the pandemic was the MySejahtera app,which was developed by the Malaysian government to assist in 56 Ministry of Health(MOH)Malaysia,“MyHEALTH Portal,”webpage,http:/www.myhealth.gov.my/en/.57 J.Mohan and R Yaacob,“The Malaysia Telehealth Flagship Application:A National App