Strategic actions for digital healthcare gain

Over the past three decades, Vietnam’s health sector has been adopting information communication technologies (ICTs) through three main periods: experimental, developing, and scaling-up periods. The establishment of an electronic health agency within the Ministry of Health (MoH) in 2012 marked the beginning of the latter, where the health sector strengthened the policy and institutional environment and mobilised resources for ICT adoption and digital transformation.

Le Minh Sang, senior health specialist at the World Bank Vietnam Office

The MoH has made remarkable achievements in adopting ICT for public health system administration such as the provision of administrative procedures through the public health service portal at the highest level, the national immunisation information management system, and the pharmaceutical database. Medical and pharmaceutical institutions have adopted ICTs widely to improve operational efficiency.

All public hospitals in Vietnam have installed and operated a hospital information system, and almost all (99.5 per cent) healthcare facilities nationwide have submitted electronic health insurance claims to Vietnam Social Security.

Struggling with delivery

Despite such efforts in ICT application, health facilities in Vietnam are still in the early stages of digital transformation. In 2019, 40.4 per cent of hospitals met Level 1, the lowest level in the MoH’s seven-level hierarchy of ICT advancement; 32.2 per cent met Level 2; and 21.4 per cent hit Level 3. As of 2024, only 94 out of 1,500 hospitals nationwide (accounting for 6 per cent) have deployed an electronic medical record, equivalent to Level 6 of ICT advancement.

At the primary healthcare level, the adoption of ICTs in commune health stations has made good progress but the deployment of electronic health records for patients lagged behind schedule, failing to achieve the respective targets outlined in the national master plan for building and developing the grassroots healthcare network.

The World Bank has recently reviewed the digital journey for Vietnamese patients at the primary healthcare level. Unfortunately, there are not many digital health applications available for patients with non-communicable diseases (NCDs), which account for 74 per cent of the disease burden. Online health information and social networks are the most common applications for patients with NCDs to manage their health.

Numerous smartphone apps enable patients to update information, evaluate symptoms, look for services, book appointments, consult health professionals, and purchase over-the-counter medications, but there are not many dedicated to NCDs. Even short-message service intervention for NCDs is uncommon and lacks strong evidence of efficacy and sustainability.

The World Bank’s studies also provided a greater understanding of the challenges facing innovators, patients, and primary healthcare providers that have hampered the digital transformation of healthcare services. Digital health innovators work in a challenging environment that constrains research and development of digital applications for NCD works.

The entrepreneurship ecosystem in Vietnam remains nascent, with a non-transparent system and a weak regulatory framework. Weak collaboration between the public and private sectors poses another challenge in health data exchange and innovation development. Connecting to the public information system is difficult, especially for enterprises with limited ICT resources. Public facilities express weak demand for adopting digital innovations from the private sector, while clinicians tend to be uncomfortable with new digital tools.

In the absence of government financial support, entrepreneurs typically rely on their network to find funding resources. The question is whether digital health innovators have sufficient financial capacity and passion to endure and overcome market education and adaptation phases.

Many digital health applications for patients are struggling to scale. The MoH launched the Depression mobile app in 2012 and the Vietnam Cardiovascular Health mobile app in 2019 but received little public response. More recently, it launched another smartphone application on elderly health through a mass communication campaign but recorded a relatively low uptake.

At present, the uptake of official electronic services remains low (except for online health information sources), attributed to a lack of trust, limited digital capacity among primary healthcare professionals, and low digital literacy in the general population. Uptake is not simply a matter of having a digital health tool but depends on user acceptance and engagement.

The sustainability of digital health applications remains a major concern. Many digital applications are operating as a siloed technology to overcome specific challenges in the public health system. Patient-facing applications are not connected to or embedded in the current systems deployed in health facilities, making it impossible to maintain a seamless flow of health information along patient journeys across different healthcare settings.

Information-blocking practices remain common, such as restricting patient access to e-records, developing products with limited interoperability, charging high fees for health data exchange, and making third-party access to standardised data difficult. Other barriers to integration include insufficient guidelines on health data governance and weak coordination among stakeholders participating in health data exchange, particularly at the subnational level.

Moreover, it is very challenging to finance digital health applications for patients. Public procurement agencies in Vietnam are struggling to innovate due to unclear guidelines, limited experience, and fear of making mistakes. As a result, digital health applications for patients are adopted mainly in the private health sector, where providers can charge fees and users pay out of pocket.

Photo Le Toan

Action areas to move forward

The World Bank’s studies identified three problematic areas and proposed strategic actions to foster digital health innovation, enhance user engagement and uptake, and sustain digital health applications for patients in Vietnam. The first strategic action area is fostering digital health innovations for patients with NCDs.

The central and provincial authorities should utilise existing resources to strengthen health innovation exchange and support entrepreneurship. It is pivotal to facilitate collaboration between the ICT industry, consumers, and the research sector.

Innovators can receive the support they need and use data to identify opportunities to work collaboratively on designing digital health solutions. The government should provide incentives for impactful digital health applications, such as those improving the prevention or early detection of NCDs, allowing providers to monitor patients with NCDs remotely, and prescription medicines as patients with chronic diseases regularly need refills. For small, capital-strapped businesses or those in the early stages of growth, incentives in the form of small grants would encourage health-tech startups to continue pursuing research and development.

As digital health is evolving rapidly, policymakers should prioritise establishing a regulatory framework that supports innovations in healthcare without compromising privacy, security, and intellectual property.

Moreover, a sandbox policy will help create appropriate regulations that balance privacy and security concerns with support for innovation. Enforcing strong intellectual property rules is another effective measure.

The second strategic action area is enhancing user engagement and the uptake of digital health applications for patients. Providing useful information and practical guidance is a popular way to build trust with patients, as they are likely to trust providers who can give reliable educational content online.

Policymakers may consider a training curriculum, revisiting staffing assignments, and proposing incentives to support this transformation at grassroots level. Simultaneously, the government should make an effort to address low digital literacy and the digital divide. Priority should be given to older people, given they are high users of healthcare services and less engaged with internet use. People with disabilities and ethnic minorities are also digitally disadvantaged groups.

Sustaining digital health applications for patients is another strategic action area. A priority action is advancing integration and interoperability across digital systems deployed at grassroots level. The implementation of health registries through e-ID for facilities, workers, and patients is a key enabler for integrated, interoperable digital health systems.

The MoH should continue the development of data and interoperability standards to support broader and deeper types of health information flows and, in the meantime, ensure broad adoption of standards by health ICT vendors.

While promoting the development and adoption of core ICT systems, health system managers should allow patient-facing digital applications to be integrated into these common platforms to make data available for patients and health professionals whenever it is needed.

It is also necessary to address information-blocking practices among providers and ICT vendors in the near term and build a data-sharing culture in the long term.

Establishing a national reimbursement system for digital health applications would ensure financial accessibility in the long run, but also requires tremendous efforts to accomplish this goal. A starting point for government agencies is to review financing mechanisms and consider business models applicable to the Vietnam context.

Public funds for core health ICT systems should be allocated through innovative financing mechanisms, such as pay-as-you-use models that make common digital health platforms more accessible for patients, providers, and other stakeholders.

The common goal among key stakeholders is for digital health services to be covered by payer organisations, either public or private insurance. Policymakers should consider establishing procedures for digital health technology assessment to ensure that digital health applications are adopted in a safe, ethical, and cost-effective manner.

Digital healthcare to create motivation for investment The healthcare sector is expected to see a new wave of business and investment ahead, as more opportunities are coming on the back of the government’s new strong moves to accelerate digital transformation.