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The future of healthcare in Singapore. How an integrated use of Industry 4.0

Technologies will radically redeﬁne the industry, ﬁrms' business models, and
the doctor-patient relat...
Article in SSRN Electronic Journal · November 2021

DOI: 10.2139/ssrn.3965115
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The future of healthcare in Singapore. How an integrated use of Industry 4.0 Technologies
will radically redefine the industry, firms' business models, and the doctor-patient
relationships.
Ow Jezon
Abstract
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Industry 4.0 in the pharmaceutical, medical devices, and healthcare sectors could have
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a significant impact as they can help maximize productivity by analyzing the data of patients.
This is helpful as different medical technologies can be used concurrently. For example, the
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digital storage of medical data, providing awareness about the next virus mutation or outbreak
of diseases, may increase the accuracy of data and analysis. It may also provide more
personalized therapeutic treatments and medications, better patient care and a significant
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improvement in time and cost-efficiency. The application of Industry 4.0 technologies to the
pharma, medical, and healthcare sectors may also play an important role in addressing and
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helping overcome the COVID-19 pandemic, thanks to the latest innovations in the space of
biopharma and biotech.

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This research will examine how likely medical industries will adopt the integration of
industry 4.0 technologies and the full integration of Artificial Intelligence, Blockchain, Internet
of Medical Things, Digital Health, and Telemedicine to elevate their competitiveness, to

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improve doctor-patient relationships, and to sustain innovation. This study will also examine
how receptive the public is to use these technologies; the integration of technologies into the
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healthcare industry, and the future of digital health. This research focuses on the Singapore
medical industry and on the opinions of Singaporeans and the predictions of industry experts.
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Using qualitative methodology, this research is exploratory in nature, given the early-
stage developments in the implementation of integrated 4.0 technologies in the digital health
space. In addition, this study aims to assess the future potential benefits of integrating these
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advanced technologies into the medical and biopharma industries for the healthcare system of
Singapore and its citizens.

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Finally, this study will seek to contribute to the existing literature in the fields of digital
health, Blockchain-based health devices, Internet of Medical Things (IoMT), and
This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=3965115
Telemedicine, and to the integrated use of these technologies to create new value innovation
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opportunities and business models in the rapidly expanding digital health space of Singapore.
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Key Words: Digital Health, IoMT, Internet of Medical Things, Singapore, Telemedicine,
innovation 4.0 technologies, Blockchain.
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Introduction
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Industry 4.0
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Schwab (2016) commented that the First Industrial Revolution mechanized production
via the use of water and steam power. The Second Industrial Revolution made mass production
possible through the application of electric power. Thirdly, automation was accomplished
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through the use of electronics and information technology. Now, the Fourth Industrial
Revolution is eroding the foundations of the Third, the digital revolution that began in the mid-
nineteenth century. It is defined by a confluence of technology that blurs the distinction
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between the physical, digital, and biological realms.
Therefore, the Fourth Industrial Revolution builds on the rapid flow of information
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enabled by the data-centric foundations of the Third Industrial Revolution’s digital
technologies, which were based on the Second Industrial Revolution’s electricity and
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telecommunications networks (Philbeck & Davis, 2018).
Schwab (2016) added that millions of people would be connected by mobile devices
with unprecedented processing power, storage capacity, and access to knowledge. New
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technology breakthroughs in fields such as artificial intelligence, robotics, the Internet of
Things, autonomous vehicles, 3-D printing, nanotechnology, biotechnology, materials science,

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energy storage.
Schwab (2016) added that recent years had seen impressive advancements in artificial
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intelligence, fueled by exponential improvements in computer power and the availability of
massive quantities of data, ranging from software used to identify new medications to
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algorithms used to anticipate our cultural preferences.
These technologies allow wireless communication in manufacturing and service
industries, thereby increasing automation. When Industry 4.0 is fully implemented, we will see
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the interconnections between technologies, and medical stakeholders will interact with one
another for manufacturing and use of the vaccine, healthcare equipment, and logistics, checkup,
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detection, monitoring, and decision making with lesser human physical intervention (Ienca &
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Vayena, 2020; Javaid & Haleem, 2019b).
Singapore
Since 2001, the worldwide pharmaceutical market has grown from US$390 Billion to
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US$1.25 Trillion in 2019 (Mikulic, 2020).
Figure 1 - 2001 to 2019 worldwide pharmaceutical market
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Source: Mikulic,2020
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Between 2019 and 2024, global prescription drug sales are predicted to increase at a
positive Compound Annual Growth Rate (CAGR) of 6.9 percent, reaching US$1.18 trillion.
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The global market for medical devices was worth US$425.5 billion in 2018 and is projected to
grow to US$612.7 billion by 2025. The demand for the A.I. market in drug discovery is
projected to increase from US$159.8 million in 2018 to US$2.9 billion in 2025 at a CAGR of
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52.9% (Reh, 2020).
Therefore, given these global trends, it is not surprising that the pharmaceutical and
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biopharmaceutical industries in Singapore produced USD 8.1 billion in exports in 2019 and
imports close to USD 3.19 billion (Subhani, 2020).

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According to market research firm Fitch Solutions, Singapore’s healthcare sector is
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predicted to increase to US$29 billion in 2020, a 9% growth over the previous year, and could
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more than double to US$67 billion by 2029 (Subhani, 2020). Singapore’s healthcare industry
is regarded as among the best in the world as a result of a combination of factors such as strong
regulatory governance, contributions from medical saving accounts, and a cost-sharing system
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between the private and public sectors.
Singapore is ranked 1st in the Global Competitiveness Report by the world economic
forum, ranking 1st in the health care component and 5th in I.C.T. adoption (Schwab, 2019).
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Singapore currently has more than 50 manufacturing facilities, with eight of the world’s ten
largest pharmaceutical firms having operations in the country. Abbott, GlaxoSmithKline,

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Novartis, and Pfizer are among the major players, accounting for more than 40 percent of
Singapore’s regional market (Subhani, 2020).

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In addition, over 60 multinational medical technology (MedTech) companies leverage
Singapore’s strong engineering capabilities and high standards of quality assurance to
manufacturing high-value products, ranging from life science instruments to contact lenses.
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Over the years, we have seen the increase of digital health, Internet of Medical things,
and Artificial intelligence in Singapore, boosted by the ICT infrastructure and the Smart Nation
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Initiatives (Appendix 1).
Changes in the pharmaceutical and biopharmaceutical sector

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Gautam & Pan (2016) stated that the pharmaceutical and biopharmaceutical sectors’
operating model and footprint had shifted significantly over the last couple of decades.
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Numerous studies have examined the industry’s declining productivity (Khanna, 2012), the
transitioning of commercial models (Kessel, 2011), and the emergence of emerging markets as
key revenue contributors.

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The current challenge for the pharmaceutical industry is how to transit to a leaner model
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while still dominating the key innovation bio-clusters while being fuelled by the rising revenue
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stream from specialty products and biologics through emerging markets. Kessel (2011) also
argued that the pharmaceutical industry would face more rigorous regulatory pathways for the
approval of new products and that there will be increased government scrutiny of the marking
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of existing drugs.
Gautam & Pan (2016) concluded that it is highly likely that the regulators will place a
greater emphasis on patient’s safety and benefits when new drugs are introduced to the market.
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Sugiyama et al. (2019) commented that there is a strong emphasis on pharmaceutical research
and development (R&D) in research, as the drug development cycle is seen as a critical factor
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in evaluating progress. Sugiyama et al. (2019) added that this industry-specific characteristic
is a result of R&D activities that include clinical trials and regulatory approval by the
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authorities, which require a lengthy timeline to complete.
According to Javaid and Haleem (2019b), Industry 4.0 executes a variety of functions
and can produce the highest income of any previous revolution since it addresses a variety of
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medical problems through an interdisciplinary approach. It is an ideal industrial revolution for
automation because it enables greater design and manufacturing versatility and allows digital
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control of the production system (Manogaran et al., 2017; Thuemmler & Bai, 2017).
Javaid & Haleem (2019b) added that as Industry 4.0 is implemented in the medical
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sector, it has the potential to perform the following functions: (1) maximize efficiency in
analyzing patient’s data, (2) digitally store medical data and provide awareness about the next
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level of diseases, (3) increase accuracy, decrease time and expenses and improve quality.
Javaid & Haleem (2019b) commented that Industry 4.0 decreases inventory by storing
patient data in the digital computer-aided design (CAD) file, which reduces paperwork and
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enhances material management and tooling management. Additionally, Javaid & Haleem
(2019b) stated that by leveraging Industry 4.0, it would be able to efficiently manufacture
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customized implants based on patient compatibility utilizing sensor-based smart components
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and implement the appropriate control processes for complex surgeries.
Javaid & Haleem (2019b) argued that by applying the sensor system and digital
technologies, it could automatically track new diseases and establish a centralized information
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system inside the hospital to identify patient data and assess what are the relative information
required for clinical monitoring. Javaid & Haleem (2019b) also added that Industry 4.0 could
boost medical innovation by meeting diverse requirements; by introducing new designs; by
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developing customized tools, and by offering various other support devices in less time with
increased cost optimization.

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Gautam & Pan (2016) commented that the integration of I.T. and healthcare is another
factor that will affect the big pharmaceutical paradigm over the coming years. Big data and
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mobile health are beginning to significantly transform healthcare and diagnostics, with recent
disruptors such as Apple and Google serving as increasingly disruptive catalysts (Reinhardt et
al., 2020).
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Medicines paired with companion diagnostics have proven to be an effective strategy
for breaking into new markets, with companies including AstraZeneca, Roche, Novartis, and
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Sanofi increasing their clinical portfolios with companion diagnostics by as much as 60%–80%
(Reinhardt et al., 2020). This approach will probably translate into medications complemented
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by applications or wearable devices that will assist patients in monitoring their key health
parameters and managing their diseases in this era of personalized and precision medicines.
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Other factors that will contribute to healthcare change are the global population’s
growth, increasing demands for effective treatments, and overall higher quality of life. As a
result of these demands, healthcare continues to be one of the most significant social and
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economic problems on a global scale, and science and technology are continually developing
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new and more innovative solutions (Aceto et al., 2020; Chiuchisan et al., 2014).
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Aceto et al. (2020) stated that, based on the evidence of rapid and pressing technological
evolution and on the increasing global government efforts to boost innovation, one can
reasonably conclude that the healthcare sector is already experiencing the impact of Industry
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4.0 revolution, effectively transitioning eHealth to Healthcare 4.0 (henceforth referred to as
“HC4.0”). Although Smart Health is often adopted with different levels of acceptance, it is
generally worth noting that the model the researcher defines in this work as Healthcare 4.0 has
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its peculiarities in terms of ICT-based healthcare solutions.
Indeed, the scientific literature contains numerous definitions for Smart Health,
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spanning from “the medical and public health practice supported by smart mobile devices (i.e.,
smart-phones)” (J. Lee, 2011; Pezzuto, 2019) or “the intelligent health management and
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medical service using information technology” (Park & Kim, 2013), to “the use of technologies
such as smart mobiles, smart cards, robots, sensors, and telehealth systems via the Internet on
a pay-per-use basis for best medical practices” (Bamiah et al., 2012). However, Aceto et al.
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(2019) argued that Healthcare 4.0 is different as it is instead deeply distinguished by the use of
three paradigms: the Internet of Things, Big Data, and Cloud Computing that together are
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revolutionizing eHealth and its whole ecosystem, like Industry 4.0 is doing for the
manufacturing sector.
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Purpose of the study
Firstly, this research’s core focus is to explore how medical industries in Singapore can
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utilize Artificial Intelligence, Blockchain, Digital health, Internet of Medical Things (IoMT),
and Telemedicine as part of the future of the digital health evolution.
Secondly, this research aims to provide practical examples of how these technologies
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are currently being implemented globally and explore how they are implemented in the
Singapore Medical industry. Thirdly, this research aims to gather feedback on experts’ views
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related to the likely introduction in Singapore of these technologies in order to innovate the
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industry, the firms’ business models, and the quality and experiential dimension of the health
services for the doctors and patients. Lastly, this research aims to gather feedback from the
industry experts and the general public on integrating industry 4.0 technologies and their
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perspectives on digital health evolution.
Significance of the study
This research is sited in Singapore; it can be said to be highly representative of the
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global industry and serves as an optimal singular location to determine the impact of 4.0
without any geopolitical or cultural confounding influences.

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Through an in-depth literature review on Industry 4.0, Pharma 4.0, and related topics,
the author was able to identify a dearth of comprehensive scholarly publications on the
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industry’s readiness to embrace 4.0 technologies and on the future of healthcare in Singapore.
By conducting a comprehensive industry survey and a public survey, this research
offers a novel insight into the adoption of the integration of Blockchain, Artificial intelligence,
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Telemedicine, digital health, and the IoMT by the Singapore medical industry and the public.
This research aims to bridge the gap in the literature regarding the integration of
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Blockchain, Artificial intelligence, Telemedicine, digital health, and the IoMT in real-life
applications in the medical industry and to explore the general public’s opinion regarding the
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implementation of these technologies. The key research questions aligned to the study’s goals
are located in the first section of the research methodology chapter.

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The exploratory research methodology applied in this study is supported by secondary
data gathered from websites’ materials, press articles, and scientific and academic journals,
with primary data gathered from an online survey.

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Yin (2018) indicated that using a single case study can be beneficial for exploring and
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gaining insight into novel, creative, and more complex issues in the real world by analyzing a
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small number of events or conditions through pattern matching rather than theory testing.
As such, a focus on a particular exploratory study was undertaken to provide in-depth
qualitative insights (in real-world contexts) on the research subject (the examined phenomena)
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and on its relevant research questions while taking into account environmental characteristics,
resource constraints, and the country’s economic and cultural characteristics.
Literature Review
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In the current chapter, the researcher will first provide the theoretical background of
industry 4.0 and explore the application and efficacy of the technologies in the healthcare
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industries, especially during this pandemic situation and for future applications.
Industry 4.0
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The term “Industry 4.0” is often used to refer to the fourth industrial revolution, which
comprises advanced manufacturing and information technologies that allow humans to meet
personalized requirements in a shorter amount of time (Javaid et al., 2020; Javaid & Haleem,
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2019b; Oztemel & Gursev, 2018).
Schwab (2016) explained that there are three factors that can explain why today’s
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developments are not simply a continuation of the Third Industrial Revolution but the start of
a Fourth and unique one: pace, scope, and systemic effect. The rate at which innovations are
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occurring is unprecedented in human history. The magnitude and scope of these shifts signal
the transformation of the whole production, management, and governance systems. It is

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upending nearly every industry in every country. Furthermore, it signals the start of the Fourth
Industrial Revolution.
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Schwab & Davis (2018) commented that emerging technologies have the potential to
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offer enormous advantages to business and society, but earlier industrial revolutions have
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shown us that in order to exploit them fully, the world must address three critical problems.
First, to ensure that the benefits of the Fourth Industrial Revolution are distributed
fairly. As people can be deprived of the benefits of systems for a variety of reasons, they can
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be unavailable, unaffordable, or irrelevant; biased in overt or subtle ways; or deprived of
benefits due to the operations of institutions that tend to privatize profits and concentrate wealth
and opportunities (Schwab & Davis, 2018).
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Second, to manage the externalities of the Fourth Industrial Revolution in terms of the
risks and harm that it causes. Schwab & Davis (2018) added that externalities and unintended
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consequences are a particular concern in light of the power of Fourth Industrial Revolution
technologies and the uncertainty surrounding their long-term effects on complex social and
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environmental systems.
Schwab & Davis (2018) cited some examples such as threats like a) geoengineering
initiatives that might result in irreparable harm to the biosphere, b)or the creation of an artificial
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general intelligence whose goal-seeking behavior conflicts with the various messiness of
human existence, c) or by rendering large swaths of present cryptographic techniques outdated,

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quantum computing may pose substantial dangers to the privacy and security of anybody with
access to new computing technologies in some circumstances.

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Lastly, to ensure that the Fourth Industrial Revolution is human-led and human-
centered. Schwab & Davis (2018) emphasized that Human values must be valued in and of
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themselves, not just in financial terms. Furthermore, being human-centered means
empowering, rather than defining, humans as significant agents in the world. Schwab & Davis
(2018) added that this is a crucial problem, given the ways in which Fourth Industrial
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Revolution technologies differ from those of earlier industrial revolutions.
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Four important principles
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Schwab & Davis (2018) also added that there are four important principles to keep in
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mind when thinking about how technologies can create impact.
Systems, not technologies.
It is tempting to focus just on technologies, yet what counts most are the systems that
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produce wellbeing. With sufficient political will, investment, and collaboration among
stakeholders, new technology can enable the implementation of more efficient systems;
without these, new technologies risk deteriorating current systems (Schwab & Davis, 2018).
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Philbeck & Davis (2018) added that while artificial intelligence and blockchain
continue to be hot issues, the critical debate is how to manage these technologies as components
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of larger systems, not as standalone capabilities. It needs both a basic grasp of complicated,
fast-moving issues and a willingness to investigate the high-level social and political
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consequences of future systems.
Empowering, not determining.
Schwab & Davis (2018) commented that it is alluring to believe that technology
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development is difficult to control or direct and that there is nothing we can do to prevent
technologies from influencing human behavior. Rather than that, we should focus on human
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decision-making and agency, creating systems that leverage new technology to empower
individuals with greater choice, opportunity, freedom, and control over their lives.
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It is especially true in light of the ways in which modern technologies promote the
potential of robots that can decide and act autonomously, influencing our behavior in both overt
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and subtle ways.
By design, not by default.
Given the complexity of social and political institutions, it is tempting to reject any
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endeavor to shape them as hubristic and bound to failure. However, we should not accept the
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inevitability of default selections. Design thinking—particularly when combined with the tools
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and philosophy of human-centered design and systems thinking approaches-may assist us in
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comprehending the world’s structures and appreciate how new technology might reconfigure
systems (Schwab & Davis, 2018).
Philbeck & Davis (2018) added that we are still in the early stages of the Fourth
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Industrial Revolution, which means that the norms, standards, infrastructure, legislation, and
business models that will define the future are still being developed. These consequential
decisions regarding the future of our economies, political institutions, and communities must
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be discussed and shared by a wide variety of responsible stakeholders, including governments,
companies, and interest groups.
Values as a feature, not a bug.

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Schwab & Davis (2018) commented that it is alluring to view technology as merely
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tools, capable of being employed for good or evil but intrinsically value-neutral. In truth, all
technologies implicitly include values from their conception through their development and
deployment. We should acknowledge this and discuss principles throughout the creative
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process, not only when they do harm to someone with a voice.
Philbeck & Davis (2018) added that technologies are not, and have never been, purely
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instrumental, and there is no such thing as a bias-free system because technologies impact both
implicitly and openly by the prejudices they embody. They exemplify their creators’ beliefs,
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and both reflect and restrict their consumers’ wants. Technology’s ethics must be examined at
every level of development and application. It should be viewed as a realistic, accessible, and
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necessary step in achieving the technology future we desire.
Impacts to business
Schwab (2016) added that the Fourth Industrial Revolution has four major impacts on
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business: consumer expectations, product enhancement, collaborative innovation, and
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organizational structures. The rise of global platforms and other new business models requires
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a rethinking of people, culture, and organization structures.
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Impacts to government
Schwab (2016) commented that given the Fourth Industrial Revolution’s quick rate of
change and vast implications, lawmakers and regulators face unprecedented challenges and,
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for the most part, are proven incapable of coping.
Therefore, by adopting an “agile” governance approach, similar to how the private
sector has increasingly embraced agile approaches to software development and company
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operations in general, it requires regulators to constantly adapt to a changing environment and
reinvent themselves in order to really comprehend what they are regulating. Governments and
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regulatory bodies will need to work closely with industry and civil society to accomplish this.
Impact on people
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Schwab (2016) commented that the Fourth Industrial Revolution would alter what we
do and who we are. It will have an impact on our identity and all of the issues that go along
with it: our sense of privacy, our concepts of ownership, our consumption patterns, the amount
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of time we devote to work and leisure, and how we develop our careers, cultivate our skills,
meet new people, and nurture relationships.

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Schwab (2016) added that “privacy” is one of the most significant individual issues that
modern information technology faces. Although we intuitively understand why it is critical,

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tracking and exchanging information about us is a critical component of the new connection.
Debates over basic problems such as the impact of the loss of control over our data on our inner
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life will only grow in the coming years.
Similarly, the biotechnology and artificial intelligence revolutions that are redefining
what it means to be human by pushing back the existing limits of life duration, health, intellect,
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and capability will drive us to reconsider our moral and ethical bounds (Schwab,2016).
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The researcher has discussed the definition of industry 4.0, the four important principles
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to keep in mind when thinking about how technologies can create impact, and industry 4.0’s
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impacts on business, government, and people. Next, the researcher will explore how industry
4.0 technologies and their application and efficacy are likely to impact the healthcare industry,
especially during the COVID-19 pandemic era.
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Internet of Medical Things (IoMT)
Chamola et al. (2020) characterized IoMT, also known as the healthcare IoT, as an
amalgamation of medical devices and software applications providing comprehensive
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healthcare services connected to the healthcare I.T. systems.
Chamola et al. (2020) commented that the increase in the number of potential
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applications is due to the fact that a growing number of mobile devices are now fitted with
Near Field Communication (N.F.C.) readers, which enable them to communicate with I.T.
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systems. IoMT applications encompass monitoring patients remotely, tracking prescription
orders, and transmitting health information to appropriate healthcare professionals through
wearables. The healthcare and the pharmaceutical sector have recognized the transformative
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potential of IoMT technologies due to their ability to efficiently capture, interpret, and
distribute health data (Hassija et al., 2019; Rodrigues et al., 2018).

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Wearables are gadgets that enhance connectivity by being worn on the body and linked
to an internet source. Wearables, which can track people’s physical health and stress levels, are
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an excellent technology for use in the healthcare field, since these devices, which can be
connected to the IoMT, can assist in the collection of critical data (Al-Turjman et al., 2020;
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Chamola et al., 2020; Ray et al., 2020).
This is seen in how recently the use of mobile applications and smart platforms have
emerged as a prominent technique in fighting the pandemic and to support a better

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understanding of drugs and medical devices’ efficiency. Numerous governments and private
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organizations worldwide have already built certain applications and platforms for COVID-19
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impact management.
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Telemedicine
Telemedicine, alternatively referred to as telehealth, enables physicians to assess,
diagnose, and treat patients without requiring physical interaction. Chamola et al. (2020) stated
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that the advantages of adopting telehealth systems have been twofold; it has alleviated the
pressure on the overworked hospital staff, and it has decreased the risk of transmitting the virus
from infectious individuals to the healthcare personnel. The medical professional can utilize
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Telemedicine for Teleconsultation, Teleexpertise, Telemonitoring, and Teleassistance.
Teleconsultation enables the medical practitioner to remotely consult the patient, which
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is advantageous during pandemic circumstances and when they could be located in a distanced
location or a rural area (A. Jnr. Bokolo, 2020; Pezzuto, 2019). Teleexpertise enables medical
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professionals to collaborate with one another regularly, pool their medical knowledge, and
build their mutual competence (Qazi et al., 2019). A medical professional can also utilize
Telemonitoring to monitor and supervise a patient remotely. Lastly, a medical practitioner can
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use Teleassistance to support another medical professional remotely during an intervention.
However, despite all these benefits, the true potential of Telemedicine can only be
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achieved when current telemedicine platforms are combined with other innovations such as
blockchain, smart wearables, and 5G cellular networks.

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Artificial Intelligence (A.I)
Since its inception, A.I. has established itself as a game-changing technological

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advancement. Firstly, A.I. is utilized for disease surveillance where timely detection and
forecast of diseases, especially those with the potential to destabilize the world, is crucial
(Chamola et al., 2020; Tayarani-N & M-H.,2020).

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Next, Chamola et al. (2020) stated that A.I. is utilized for Risk prediction, and it can be
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divided into three main categories: predicting the risk of infection, predicting the risk of
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experiencing serious symptoms once infected, and predicting the risk of treating an infected
person with a specific line of treatment. Medical diagnosis and screening are also supported by
AI with the use of technologies such as face scanners, medical imaging, voice recognition
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systems, and AI-powered medical diagnosis systems.
Additionally, A.I. can also be utilized for Curative research, such as using Machine
Learning for drug development and identifying existing drugs or components repurposed.
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Other areas A.I. can be used are Virus modeling and analysis.
Digital health
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Digital health is described as “the cultural change that occurs as a result of disruptive
technologies that make digital and objective data available to both caregivers and patients,
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resulting in an equitable doctor-patient relationship with shared decision-making and care
democratization” (B. Mesko, 2017).
It encompasses digital therapeutics, wearables, mobile applications, big data, clinical

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trials utilizing digital tools, health information management systems (HIMS), electronic
medical records, V.R. and A.R., Machine learning (ML). The consolidation of these
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technologies with existing digital platforms can enable a more dynamic healthcare ecosystem
where the pharmaceutical and medical device companies can collaborate during clinical trial
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research and provide better medical coverage.
Blockchain
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Blockchain technology allows individuals and organizations worldwide to become a
part of a single interconnected network that allows for the data to be shared securely. The
blockchain’s tamper-resistant nature makes it impervious to unauthorized changes, and the

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utilization of consensus algorithms and smart contracts reduces the possibility of disseminating
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fake data and fraudulent details (Chen et al., 2018; Farouk et al., 2020).
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Apart from securely storing test reports, blockchain-based distributed systems can also
serve as a viable option for documenting COVID-19 patient information. Its inherent properties
of being timeless and tamper-proof can instill a sense of protection in the patient. With current
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data on COVID-19 patients, this platform will aid in the analysis of the disease’s clinical
characteristics and assist all health centers in better understanding the disease’s growth pattern
(Chamola et al., 2020; D. Marbouh et al., 2020).
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Additionally, blockchain technology can be used to control the supply chain and to
avoid counterfeit medication and pillage. As an avenue of integration of IoMT devices,

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blockchain implementation may provide useful governance applications by allowing
traceability, documenting ownership, and incentivizing smart contracts that might prevent
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falsified information and unauthenticated products. Supply chain management systems can
also utilize blockchain technology to control hospitals’ inventories and regulate the buy-sell
process for all hard-medical assets (Ahmadi et al.,2020; Alblooshi et al., 2018).
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The study has reviewed the literature articles from 2017 onwards to ensure that we have
the most recent articles in our research. As shown in Table 1, the researcher further analyzed
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these technologies based on nine application areas, which include:
a) detection, diagnosis, prediction, prognosis, prevention, and treatment;

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b) medical imaging;
c) monitoring;
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d) medical education, research, and training;
e) pharmaceuticals, drug delivery, and discovery;
f) healthcare facility management and process optimization,

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g) surgery;
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g) Telemedicine and medical record;
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h) medical devices and equipment
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Technology Applications References
J. Lopes (2020)
F. Jiang et al. (2017)
Detection, diagnosis, prediction, J. Mason et al. (2018)
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prognosis, prevention and T. Davenport and R. Kalakot
treatment: prediction and treatment (2019)
of diseases such as stroke and cancer N. Noorbakhsh-sabet et al.
(2019)
V.Chamola et al. (2020)
re
J. Mason et al. (2018)
Medical imaging
Monitoring: adult care or wellbeing, T. Davenport and R. Kalakot
eye care, diabetes care, patient care
er (2019)
Medical education, research, and J. Mason et al. (2018)
training: virtual assistant for patients V.Chamola et al. (2020)
pe
T. Davenport and R. Kalakot
A.I. (2019)
K.K. Mak & M. R. Pichika (2019)
S. Khezr et al. (2019)
Tayarani-N & M-H.(2020)
ot
H.C.S Chan et al. (2019)

A. Zhavoronkov et al. (2018)
K-K.Mak & M.R.Pichika (2019)
tn
S. Ellahham et al. (2019)

Pharmaceuticals, drug delivery, and
L. Wang et al. (2019)
discovery: for the discovery of new
L. Zhang et al. (2017)
classes of diagnostics and treatment
A.L. Oliveira (2019)
rin
S.K. Saikin et al. (2019)

P. Hamet & J. Tremblay (2017)
P.Shah et al. (2019)
M.J. Lamberti et al. (2019)
ep
F. Zhong (2018)
G. Hessler & K-H Baringhaus
(2018)
B. Mesko (2017)
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Telemedicine and medical record:

Blockchain
electronic health records (E.H.R.s) M. Hölbl et al. (2018)
modification, medical data S. Tanwar (2020)
18
management (patient-centered), V. Pashkov & O. Soloviov
personal health records (PHRs), (2019)
d
medication regimen A. Siyal et al. (2019)
P. Zhang et al. (2018)
we
H. S. Chen et al. (2019)
C. Agbo et al. (2019)
K. A. Koshechkin et al. (2018)
T. Mackey et al. (2019a)
T. Mackey et al. (2019b)
vie
S-H.Han et al. (2019)
S. Badr et al. (2018)
A. Dubovitskaya et al. (2020)
T. Alladi et al. (2019)
re
M. Banerjee et al. (2018)
V. Chamola et al. (2020)
D. Ichikawa et al. (2017)
A. Reyna et al. (2018)
er L. Bell et al. (2018)
k. Salah et al. (2019)
N. Garg et al. (2020)
B. Shen et al. (2019)
Y. Chen et al. (2018)
pe
A. Tandon et al. (2020)
E. Gökalp et al. (2018)
D. Marbouh et al. (2020)
A. Farouk et al. (2020)
K.N. Griggs et al. (2018)
ot
M. R. Naqvi et al. (2020)

K.A. Clauson et al. (2018)
D. Dimitrov (2019)
N. Evangelatos (2020)
tn
M. Hölbl et al. (2018)

S. Tanwar (2020)
V. Pashkov & O. Soloviov
(2019)
rin
A. Siyal et al. (2019)

Healthcare facility management and
P. Zhang et al. (2018)
process optimization: control of
H. S. Chen et al. (2019)
contracts for healthcare service,
independent medical assessment,
C. Agbo et al. (2019)
ep
claim and billing management,

K. A. Koshechkin et al. (2018)
healthcare delivery, drug supply chain
T. Mackey et al. (2019a)
management, drug tracing, tracking,
T. Mackey et al. (2019b)
and verification,
S-H. Han et al. (2019)
Pr
S. Badr et al. (2018)

A. Dubovitskaya et al. (2020)
19
D. Ichikawa et al. (2017)
d
A. Reyna et al (2018)
L. Bell et al. (2018)
we
k. Salah et al. (2019)
N. Garg et al. (2020)
B. Shen et al. (2019)
Y. Chen et al. (2018)
vie
K.N. Griggs et al. (2018)
K.A. Clauson et al. (2018)
D. Dimitrov (2019)
re
N. Evangelatos (2020)
Medical education, research, and A. Siyal et al. (2019)
training: education of medical C. Agbo et al. (2019)
professionals, clinical and K. A. Koshechkin et al. (2018)
neuroscience research
er V. Chamola et al. (2020)
I. Mistry et al. (2020)
pe
P. Dong et al. (2020)
N. Dilawar et al. (2019)
Monitoring: Blockchain for 5G A. Farouk et al. (2020)
enabled -IoMT K.N. Griggs et al. (2018)
ot

M. Seliem & K. Elgazzar
(2019)
tn
Anitha Kumari et al. (2019)

rin

F. Chiacchio et al. (2020)
K. Yaeger et al. (2019)
L. Bell et al. (2018)
ep

E. Fernando et al. (2019)
classes of diagnostics and treatment,
R. Kumar & R. Tripathi (2019)
counterfeit drugs, clinical trial records
L. Nørfeldt et al. (2019)
Pr
I. Haq & O. Muselemu (2018)

P. Sylim et al. (2018)
K. Abbas et al. (2020)
K. Clauson et al. (2018)
20
R. Singh et al. (2020)
V. Pashkov & O. Soloviov
d
(2019)
we
Medical education, research, and A. Siyal et al. (2019)
training: education of medical C. Agbo et al. (2019)
professionals, clinical and K. A. Koshechkin et al. (2018)
neuroscience research V. Chamola et al. (2020)
vie
G. Aceto et al. (2020)
A. Papa et al. (2018)
D. Dziak et al. (2017)
P. A. Laplante et al. (2018)
re
Monitoring: homecare (IoT-based N. Mani et al. (2020)
information system) for caring and P. Singh (2018)
monitoring of patients, the wearable X. Huang et al. (2019)
Internet of things (WIoT), the Internet G. J. Joyia et al. (2017)
of Health Things (IoHT) F. Al-Turjman et al. (2020)
er C. da Costa et al. (2018)
P. Dong et al. (2020)
P.P. Ray et al. (2020)
pe
R.P. Singh et al. (2020a)
R.P. Singh et al. (2020b)
K. T. Kadhim et al. (2020)
H. Zakaria et al. (2019)
ot
IMoT
V. Ahmadi et al. (2020)
H. Ahmadi et al. (2018)
X. Huang et al. (2019)
tn
M. Anandarajan & S. Malik

Medical devices and equipment:
(2018)
R. Basatneh et al. (2018)
(IoT in implantable and wearable
G. J. Joyia et al. (2017)
devices)
F. Al-Turjman et al. (2020)
rin
Y. A. Qadri et al. (2019)

K. T. Kadhim et al. (2020)
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Detection, diagnosis, prediction, V. Chamola et al. (2020)
prognosis, prevention and G. Aceto et al. (2020)
treatment: Internet of Nano Things G. Aceto et al. (2019)
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(IoNT) (IoT in nanomedicine for S. Swayamsiddha & C.

chronic care disease management, Mohanty (2020)
diagnostics, preventive health, G. J. Joyia et al. (2017)
treatment, and follow-up care) F. Al-Turjman et al. (2020)
21
T. Yang et al. (2020)
d
Y. Ushimaru et al. (2019)
we
T. Aladwani (2019)
Z. Lou et al. (2020)
J. Ni et al. (2019)
R. P. Singh et al. (2020a)
vie
The wearable Internet of things
V. Ahmadi et al. (2020)
(WIoT), the Internet of mobile-health
H. Ahmadi et al. (2018)
Things (m-IoT) (remote monitoring of
Rubı’ & Gondim (2020)
patients),
R. Basatneh et al. (2018)
G. J. Joyia et al. (2017)
re
Z. Guan et al. (2019)
Pharmaceuticals, drug delivery, and B. Perry et al. (2018)
discovery: measurement of outcomes G. J. Joyia et al. (2017)
for clinical research
er V. Chamola et al. (2020)
Pezzuto (2019)
J. M. Portnoy et al. (2019)
pe
S. Omboni et al. (2020)
Teleconsultation, Teleexpertise,
S. Gupta et al. (2020)
Telemonitoring, and Teleassistance.
S. Qazi et al. (2019)
V. Puri et al. (2018)
A. Jnr. Bokolo (2020)
Telemedicine
ot
Medical devices and equipment:

J. M. Portnoy et al. (2020)
S. Omboni et al. (2020)
(IoT in implantable and wearable
S.K. Garg & C.G. Parkin (2019)
devices), remote monitoring of
tn
S. Vishnu et al. (2020)

patients, management of patients
Medical education, research, and
P. Chen et al. (2017)
training: education of medical
professionals, clinical and
S. Gupta et al. (2020)
rin
neuroscience research
S. Malwade et al. (2018)
C. Ernsting et al. (2017)
A. Cahn et al. (2017)
P. Tinschert et al. (2017)
ep
Medical devices and equipment: S.Y. Banerjee et al. (2017)

Digital Heath Internet of Medical Things (IoMT) D. Dias & J.Paulo Silva Cunha
(IoT in implantable and wearable (2018)
devices), application A. Tricoli et al. (2017)
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L.C. Kourtis et al. (2019)

F.P. Wieringa et al. (2017)
A. Kamišali’c et al. (2018)
A.H. Sodhro et al. (2018)
22
L.H. Segura Anaya et al. (2017)
S. Majumder et al. (2017)
d
J. Dunn et al. (2018)
J. M Pevnick et al. (2018)
we
I. Sim (2019)
R.R. Kroll et al. (2017)
G. Cappon et al. (2017)
X. Li et al. (2017)
S. Chakraborty et al. (2020)
G. Shin et al. (2019)
vie
A. K. Yetisen et al. (2018)
S. Malwade et al. (2018)
D.A. Heldman et al. (2017)
C. Ernsting et al. (2017)
re
Y. O’Connor et al. (2017)
P. Tinschert et al. (2017)
S.Y. Banerjee et al. (2017)
X. Li et al. (2017)
The wearable Internet of things
er
(WIoT), the Internet of mobile-health
Things (m-IoT) (remote monitoring of
patients)
S.A. Bini et al. (2020)
pe
I. Sim (2019)
K. Montgomery et al. (2018)
B.K. Ngwatu et al. (2018)
ot

S.A. Bini et al. (2020)
F.P. Wieringa et al. (2017)
S. Bian et al. (2020)
tn
D. Dias & J. Paulo Silva Cunha

Detection, diagnosis, prediction, (2018)
prognosis, prevention and A.H. Sodhro et al. (2018)
treatment: Internet of Medical Things L.C. Kourtis et al. (2019)
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(IoMT) for preventive health, X. Li et al. (2017)

diagnostics, chronic care disease J. Dunn et al. (2018)
management, treatment, and follow-up I. Sim (2019)
care) S. Majumder et al. (2017)
ep

C. Voss et al. (2019)
J. McWhorter et al. (2017)
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D. Dias & J. Paulo Silva Cunha
23
classes of diagnostics and treatment, (2018)
clinical trial records X. Li et al. (2017)
d
we
C.G.M. Perraudina et al. (2018)
E. S. Izmailova et al. (2018)
O. Sverdlov et al. (2018)
D. Dias & J.P.S. Cunha (2018)
vie
A.H. Sodhro et al. (2018)
Monitoring: wellness (adult care) R.R. Kroll et al. (2017)
re
I. Sim (2019)
B. Byrom et al. (2018)
erTable 1 – Literatures
The majority of the articles were on the application of technologies on Telemedicine
and medical records, medical device and equipment, detection, diagnosis, prediction,
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prognosis, prevention and treatment, healthcare facility management, process optimization and
pharmaceutical, drug delivery, and discovery, followed by monitoring, medical education,
research and training, surgery and medical imaging. There has also been a surge of research
ot
articles on the application of technologies for COVID over the past one year.
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Based on the literature review, there is little research done on how these various
technologies can be used together. Most of the literature is just focused on the implementation
of one or two technologies. Only one study by V. Chamola (2020) managed to cover numerous
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technologies mentioned such as IoMT, AI, Digital Health, Telemedicine, Blockchain.
This was the initial literature that kick-started our research topic as it provides some
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examples of how these technologies are implemented in different countries and how they might
change the future of digital health. The other gap in the literature is the lack of research on
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public and industry responses regarding the application of these technologies in Singapore’s
medical industries and what is the future outcome of digital health in Singapore.
24
Summary of chapter
d
In the current chapter, the researcher discussed the literature review about the
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theoretical background of industry 4.0 and the application of selected industry 4.0 technologies.
First, the researcher presented the theoretical background of industry 4.0. Next, the researcher
presented the different literature reviews regarding each of the chosen industry 4.0
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technologies. Next, the researcher presented how the literature articles were further analyzed
based on nine application areas. Lastly, the researcher identified the gaps in the literature.
In the following chapter, the researcher will discuss the key research questions and a
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comprehensive description of the research methodology.
Research Methodology
er
Qualitative research is often used where little, or no evidence about a phenomenon
exists, while quantitative research is used to determine the cause-and-effect relationship

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between variables in order to validate or refute a theory or hypothesis (Creswall, 2002; Feilzer,
2009; Teddlie & Tashakkori, 2012). In quantitative research, the researcher utilizes a semi-
structured questionnaire that allows the study to have both the numerical data and the
ot
participants’ subjective thoughts behind the question.
Therefore, this study will adopt an exploratory qualitative approach, utilizing survey
tn
data from both the public and the selected industry participants. The researcher will then
subsequently consolidate the responses and analyze the data to address the research questions.
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The research methodology utilized for this research is based on an exploratory
(qualitative) study, with the objective of providing answers to the following research questions
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that are aligned with the research goals. The research questions are separated into two different
buckets to cater to the different audiences of the research.

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25
Key Research questions
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General Public
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1) Are the existing technologies able to achieve the full potential of digital health,
Telemedicine, and remote patient monitoring and addressing the needs of digital health
patients?
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2) What are the innovative 4.0 digital health devices and MedTech technologies that the
public is aware of and known of?
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3) What are the likely combinations of innovative 4.0 technologies and digital health that
the public would expect to be introduced in the next three years in Singapore and that
would benefit them? er

Industry experts
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1) Are the existing technologies able to achieve the full potential of digital health,
Telemedicine, remote patient monitoring, patient data security, and to address the needs
of digital health patients?

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2) What are the likely combinations of innovative 4.0 technologies and digital health
solutions expected to be introduced in Singapore in the next three years?

tn
3) What are the industry experts’ views on the likely introduction in Singapore of
these technologies in order to innovate the industry; the firms’ business models, and the
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quality and the experiential dimension of the health services for the doctors and
patients?
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4) What will be the applications of the 4.0 innovative digital health devices and MedTech
technologies in the future?

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26
Data Management
d
This section discusses the sampling technique used to determine the number of respondents
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required to gather more information about the phenomenon. The data is subsequently analyzed.
Sampling Method
General public.
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Collis (2009) explained that there are numerous kinds of sampling methods that can be
utilized for deriving a specifically targeted sample from a population. This current study
utilizes simple random sampling to source for respondents to answer the survey. Simple
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random sampling is regarded as the most fundamental form of probability sampling. Under the
method, participants are drawn at random from the population, with all elements having an
equal probability of selection.

er
Industry Experts.
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Expert sampling is also beneficial where there is a lack of empirical evidence in an area
and high degrees of uncertainty and situations where it may take a long time before the research
findings can be uncovered. Therefore, this current study will also use expert contributions to
ot
acquire industry experts’ responses on forward-looking scenarios.
Questionnaire Survey
tn
Given the research’s explorative nature, a semi-structured online questionnaire has
been developed for this study on Survey Monkey, an online survey provider website.
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The collected data was then analyzed through Survey Monkey Statistical shareware for
descriptive analysis. The demographic section of the survey has been analyzed using
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descriptive statistics. The researcher performed the following steps: 1) a check of the
questionnaires’ responses completion, 2) a check of the dataset, 3) a cleaning of the data set,
4) a review the data, 5) an organization of the data, and 6) a completion of the data analysis.
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27
Preparing and organizing the data.
d
The researcher prepared and organized the data before analysis by separating the data
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collected from the industry experts survey from the one completed by the general public. Next,
the researcher further separated the surveys where the participants filled in both the closed-
ended and open-ended questions from those surveys where the participants only filled in the
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closed-ended questions and partially completed the open-ended questions. The researcher used
a classification code like IE to denote that the data were collected from industry experts and
PS to denote public survey data.
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Conducting data analysis.
For the analysis of the generated data derived from the survey’s closed-ended questions,
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categorical data will be used. Even though the data values are not able to be quantified
numerically, they can be classified into categories. The researcher can organize the data into
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more than two sets, which can be ranked. Saunders et al. (2019) added that descriptive data
could count the number of instances within each category of a variable in order to determine
which category has the most cases and how the cases are distributed.
ot
The researcher would utilize survey monkey and excel software to analyze the data,
visualize the research findings in the form of diagrams and tables to identify interdependences,
tn
and compare proportions, patterns, and conjunctions. The analysis process will focus on the
data distribution, specific values, and highest or lowest values as recommended by Saunders et
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al. (2019).
To analyze the data derived from the survey’s open-ended questions, the researcher first
ep
extracted the data into excel files. The researcher then interpreted the textual responses to open-
ended questions by working through question-by-question to identify the key themes that recur
across different respondents; then the researcher read the responses to a specific question,
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looking for any themes that recur in their responses to each question.
28
Rowley (2014) emphasized that this facilitates the collation of disparate feedback from
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different respondents but on the same subject, which serves as a foundation for highlighting
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the frequency of occurrence of themes, any differences in what people say about themes, and
identifying some interesting quotes for inclusion in the results write-up.
Summary of chapter
vie
In the next chapter, the researcher had discussed the key research questions and a
detailed explanation of the research methods and design, which includes the targeted sampling
size, the method of data collection, the timeline, and the method of data analysis.
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Presentation of results
This chapter also explained the main sections of this chapter, which comprised of (a) a
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description of the sample (participants), (b) the research methodology implemented to the data
analysis, (c) data results and analysis from the general public survey, and (d) data results and
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analysis from the industry experts survey.
Demographics of the survey participants
General Public
ot
For the purpose of data collection, the researcher reached out to close to 1,100
participants. 711 of the participants accepted the invitation to participate, but only 623 of the
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participants completed the survey. The researcher has achieved 56.6% in terms of response rate
for the survey. The graph below represents the participant demographics.
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Figure 2: Public survey participants demographics
Survey Participant demographics

300 213
203
ep Number of responders
200
105 102
100
0
18-25 26-35 36-45 46-55
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Age Group
Source: Online Survey on the Future of Healthcare in Singapore (General Public) (Ow Jezon)
29
d
The majority of the participants are from the 26-35 and 36-45 age groups and are
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working professionals or executives. Most of the drop-out rate came from the 18-25 age group,
who skipped several survey questions. The drop-out may be due to a lack of in-depth
understanding of the topic.
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Industry experts
For the purpose of data collection, the researcher has reached out to close to 150
participants, who were selected based on their professional expertise, related industry
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knowledge, and their profile’s good fit with the research questions’ topics. Close to 50
participants accepted the invitation to participate in the survey, but they requested that their
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identity be kept “anonymously” as this is still an exploratory study, and 33 of the participants
completed the survey. Therefore, circa 33% of the contacted experts agreed to participate in
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the survey, and that circa 22% completed the survey.
The table below presents a summary of the sample demographics.
Participant Role
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Participant 1 Executive in an insurance institution

Participant 2 Executive in a Medical Device company
Participant 3 Executive in a healthcare institution
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Participant 5 Executive in a digital health company
Participant 7 Executive in a technological consultancy firm
Participant 8 Medical Doctor
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Participant 10 Executive in a Pharmaceutical company
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30
d
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Table 2: Participants of the industry experts survey
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Research methodology applied to the data analysis
As mentioned in the previous chapter, the researcher utilized Survey Monkey and
Microsoft Excel software to analyze the data, visualize the research findings in the form of
er
figures and tables to determine interdependences and compare proportions, trends, and
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conjunctions. The analysis process also centered on the data distribution, specific values, and
highest or lowest values as recommended by Saunders et al. (2019).
Data analysis was broken into two phases due to some differences in the questionnaires
ot
and the level of depth of knowledge. The researcher first extracted the data from both sets of
surveys from SurveyMonkey and further split the findings between closed-ended and open-
tn
ended questions. The researcher then interpreted the textual responses to open-ended questions
by working through each question to identify the key themes that recur across the different
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respondents’ responses.
Presentation of Data and Results of the Analysis
Phase 1 – public survey

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Q1. To answer the research question of whether the existing technologies are able to
achieve the full potential of digital health, telemedicine, and remote patient monitoring and to
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address the needs of digital health patients, the researcher surveyed the participants with two
questions: (1) are existing technologies able to achieve the full potential of digital health,
31
Telemedicine, and remote monitoring? and (2) are existing Internet of Medical Things (IoMT)
d
devices and technology addressing the needs of digital health patients?
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Figure 3: Public opinions on existing technologies achieving the full potential of digital health.
In your opinion, are the existing technologies able to achieve the full potential of
digital health, Telemedicine, and remote patient monitoring?
No 402
vie
Yes 221
0 50 100 150 200 250 300 350 400 450
Number of responders
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Close to 64% of the participants answered “No,” and 36% answered “Yes,” which
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indicates that the majority of the participants felt that the existing technologies were not able
to achieve the full potential of digital health, Telemedicine, and remote monitoring. It can be
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inferred that the respondents think that there are more untapped opportunities to introduce this
combination of technologies to improve the capabilities.
Close to 50% of the participants who answered “No” cited a lack of public knowledge
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and technology advocacy. 40% of the participants who answered “No” cited the lack of medical
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data security, data leaks, and breaches. The remaining 10% mentioned that we are still in the
early stages of development and implementation; hence there are still rooms to improve and
enhance. One of the participants cited a lack of a high degree of adoption of IoMT, resulting in
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the absence of a robust pool of data for doctors to draw from for any one patient.
40% of the participants who answered “Yes” cited that we have the infrastructure in
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place but lacked advocacy, adoption, and data security, which are critical factors. 40% of the
participants who answered “Yes” cited that due to the COVID-19 pandemic, there has been a
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sharp increase in utilization, but it still lacks some enhancement. The remaining 20% indicated
32
that they expected that there would be more extensive services and capabilities implemented
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in the future with the advancement of 5G and other smart technologies.
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Figure 4: Public opinions on existing IoMT devices and technologies
In your opinion, are the existing Internet of Medical Things (IoMT) devices and
technology addressing the needs of digital health patients?
No 337
vie
Yes 246
0 50 100 150 200 250 300 350 400
re
61% of the participants indicated “No” while 39% indicated “Yes,” which stated the
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majority of the participants felt that the existing IoMT could not address all the needs of digital
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health patients.
50% of the participants who answered “No” indicated that we are still at the initial stage
of implementation and development where a person would usually only have one or two
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devices to measure basic health vital signs like ECG, heart rate, the oxygen level in the blood,
blood sugar level. 40% cited data security as one of the primary concerns of data sharing, and
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10% cited the lack of public education about this technology and how it can benefit the public.
60% of the participants who answered “Yes” indicated that the existing IoMT devices
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meet the patients’ and consumers’ basic needs, but more can be done to expand the capabilities.
20% cited that it has reduced healthcare professionals’ workload by constantly taking patients’
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vital signs, and the time can now be better spent on better patient care. The remaining 30% are
concerned about how the data will be utilized or shared without their consent for commercial
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usage.
33
Q2. To answer the research question of what are the innovative 4.0 digital health
d
devices and MedTech technologies that the public is aware of, the researcher surveyed the
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participants with two questions: (1) if they have owned or heard of Internet of Medical Things
Devices (IoMT) such as an Apple Watch, Fitbit, and other medical devices and (2) if they heard
of or utilized digital health services before.
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Figure 5: Public awareness of IoMT devices
Do you own or heard of Internet of Medical Things Devices (IoMT)? E.g.

Apple Watch, Galaxy Watch, Fitbit, and other devices?
re
No 68
Yes 557
0 100 200 300 400 500 600
er
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Close to 89% of the participants indicated that they have owned or heard of Internet of
Medical Things Devices (IoMT) such as an Apple Watch, Fitbit, and other medical devices,
whereas 11% of the participants indicated that they do not own or heard of Internet of Medical
ot
Things Devices (IoMT).

tn
Figure 6: Public awareness of digital health services

Have you heard of or utilized digital health services before? E.g. Doctor anywhere,
Speeddoc, mydoc, and myhealth connect.
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No 236
Yes 389
0 100 200 300 400 500
ep
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Close to 70% of the participants have heard of or utilized digital health services before,
whereas 30% of them are not aware of or did not utilize these services.
34
The survey results of these two questions indicated that a high percentage of the participants
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are aware of digital health devices and Medtech technologies such as the IoMT.
we
Q3. To answer the research question of what are the likely combinations of innovative
4.0 technologies and digital health that the public would expect to be introduced in the next
three years in Singapore and how we may benefit from them. The researcher first surveyed the
vie
participants with the question of, whether in their opinion, is the combination of the innovative
4.0 technologies and digital health expected to be introduced in Singapore within the next three
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years to gauge the public’s anticipation of the roll-out of the combination of new technologies.
Figure 7: Public opinion on the introduction of innovative 4.0 technologies and digital health
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ot
tn
Close to 86% of the participants (18% indicated “Very Likely” and 67% indicated
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“likely”) are optimistic that the combination of innovation 4.0 technologies and digital health
are expected to be introduced within the next three years. The researcher has provided examples
ep
of innovation 4.0 technologies in the survey, including Artificial intelligence, Blockchain,
Internet of Medical Things (IoMT), digital health, Telemedicine, virtual reality, augmented
reality, and wearables, for further explanation of what innovation 4.0 technologies include.
Pr
35
Out of the 86% of these participants, 60% cited the COVID-19 pandemic as the reason
d
for the acceleration of technology, especially with social distancing, work from home
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arrangements, global acceleration of digital health, and IoMT to reduce the massive workload
that the healthcare personnel is dealing with.
The remaining 40% cited Singapore as being a medical hub and a tech hub. In addition,
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with the constant push for digital advancement and technological innovations to become a
smart nation, the three years’ timeframe seems ideal and achievable. They also compared how,
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since countries like China are more advanced in the digital health space, Singapore needs to
quickly innovate and catch up so as to remain competitive and not fall behind.
The remaining 14% of the participants who selected “unlikely” or “neither likely nor
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unlikely” cited public trust in providing the data and the public not being receptive to change
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as the key reasons.
Phase 2 – Industry Expert survey
Figure 8: Demographics of the industry experts

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Industry Experts Participants

8 7
6 5 5
4 4 4 4
tn
4
2
0
Medical Doctor Executive in a Executive in a Executive in a Executive in a Executive in a Executive in a
Medical Device Pharmaceutical technological digital health insurance healthcare
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Firm Firm consultancy company insitution institution
Source: Online Survey on the Future of Healthcare in Singapore (Industry Expert) (Ow Jezon)
The industry expert participants are representatives from across different healthcare
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stakeholders, such as medical doctors, executives from medical device companies, executives
from pharmaceutical companies, executives from technological consultancy firms, executives

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from digital health companies, executives from insurance institutions, and executives from
healthcare institutions. They provide their inputs based on their industry expertise.
36
Q1. To answer the research question of whether the existing technologies can achieve
d
the full potential of digital health, telemedicine, remote patient monitoring, patient data
we
security, and addressing the needs of digital health patients. The researcher surveyed the
participants with two questions: 1) are existing technologies able to achieve the full potential
of digital health, telemedicine, and remote monitoring, and 2) are existing Internet of Medical
vie
Things (IoMT) devices and technology addressing the needs of digital health patients.
Figure 9: Industry experts’ opinion on existing technologies achieving the full potential of digital health.
In your professional opinion, are the existing technologies able to achieve the full
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potential of digital health, Telemedicine, and remote patient monitoring?
No 21
Yes 12
0 5 10 15 20 25
erNumber of responders
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Close to 64% of the participants answered “No,” and 36% answered “Yes,” which
indicated that the majority of the participants felt that the existing technologies are not able to
ot
achieve the full potential of digital health, telemedicine, and remote monitoring. These results
are similar to the results collected from the public survey. Therefore, it proves that both industry
tn
experts and the public feel that there are still more opportunities to introduce a combination of
technologies to improve the capabilities.

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Among 64% of the participants who selected “No,” participant 27, an executive at a
pharmaceutical company, commented that penetration is suboptimal for all three technologies
ep
mentioned. Among the three technologies, remote patient monitoring for the elderly in
Singapore could have the most potential and value to unlock (Ow,2021).
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Participant 9, an executive at a technological consultancy firm, added that we could do
a lot more to optimize the ecosystem, as currently, there were many roadblocks regarding the
37
sharing of data. There is no centralized repository that people can trust. Therefore, this resulted
d
in multiple databanks without interoperability. This gives patients a broken journey as they go
we
to different healthcare providers for consultation and treatment (Ow,2021).
Participant 28, an executive in a digital health company, cited significant
interoperability and predictive analytics issues as each hospital or healthcare institution still
vie
functions and stores our health information differently due to confidentiality issues (Ow,2021).
Participant 25, an executive in a healthcare institution, added that Singapore needs to break the
re
silos between different clusters and be ready to take chances and innovate with digital health
services. Currently, the information is disparate, and its ability to integrate is limited
(Ow,2021). er
Participant 14, an executive in a healthcare institution, added that public education and
pe
government advocacy are lacking, and the training and upskilling of the healthcare workforce
lack a robust collaborative ecosystem where the different stakeholders can work together to
build interoperability. He also added that access and affordability might be a challenge as not
ot
every patient can afford smart devices and computers to utilize the technologies (Ow,2021).
Participant 1, an executive in an insurance institution, commented that many patients

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still needed to fly overseas to access good medical treatment, which also meant that the current
technologies were not up to the capabilities to perform the "online" treatment or operations
rin
(Ow,2021).
Among the remaining 36% who selected “Yes,” participant 33, an executive in the
ep
medical device company, commented that she believed that the current adoption is more
significant in acute care, but there is potential to expand into chronic or longer-term care. With
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accumulated data points captured over a period of time via these means, it will allow for a more
holistic view of patient care and treatment strategies. She added that another area that needs to
38
be transformed to enable faster and greater adoption of these technologies is healthcare
d
institution policies and regulations that may be outdated if not reviewed. As such, these need
we
to be updated to provide for the ecosystem (Ow,2021).
Participant 19, a medical doctor, commented that we are moving into an age where
patients no longer have to go to the doctor to do medical checks or tests as they could be done
vie
using a doppler. The doctor could call for numerous clinical tests on the blood sample once she
received the doppler. She can also review the report via the digital health platform and perform
re
medical consultations through phone or video conferences with the patients (Ow,2021).
Participant 6, an executive at an insurance institution, commented that while the
infrastructure or systems are already in place, he believed that the security, software, and social
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aspects are not. Hence, the security part of IoMT must be addressed and enhanced to tap the
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full potential of these innovative 4.0 technologies (Ow,2021).
Figure 10: Industry experts’ opinion on existing IoMT devices and technologies
In your professional opinion, are the existing Internet of Medical Things (IoMT) devices
and technology addressing the needs of digital health patients?
ot
No 21
Yes 12
tn
0 5 10 15 20 25
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63% of the participants indicated “No” while 36% indicated “Yes,” which is similar to
the public results, which stated the majority of the participants felt that the existing IoMT could
ep
not address all the needs of digital health patients.
Among the 64% of the participants who indicated, “No,” participant 24, an executive
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in a medical device company, commented that digital health patients' current needs are still
39
basic. The existing devices and technology probably address these basic needs only, such as
d
heartbeat monitoring or steps counter. However, it would be good to have devices that track
we
blood sugar levels and cholesterol or any tracker that can predict heart attack/stroke (Ow,2021).
Participant 28, an executive in a digital health company, commented that none of the
existing IoMT devices and technologies looked at all aspects of a patient as most of the devices
vie
were focused on their niche areas. For example, heartbeat monitoring devices would only
measure the heartbeat, but there is no sharing of information with the other trackers to measure
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blood sugar or oxygen level concentration (Ow,2021).
Participant 29, an executive in a technological consultancy firm, commented that
currently, the masses are mainly using it to collect data that is, well essentially trivial for the
er
respective individual (i.e., heart rates, sleep patterns, weight, etc.) as this information are used
pe
just “for your information” kind of situation. He suggested that future enhancements could be
that once the heartbeat/heart rate becomes irregular or if the sugar level of that person suddenly
spikes, it will inform the person or inform an ambulance to pick up if someone is in medical
ot
danger. However, there is a thin red line between personal privacy versus medical emergencies
(Ow,2021).
tn
Among the 36% of the participants who indicated “Yes,” Participant 3, an executive in
a healthcare institution, commented that current wearable health devices help monitor patients'
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health remotely and notify relevant personnel if needed. However, more can be done to
improve the usage and effectiveness of digital health (Ow,2021).

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Participant 2, an executive in a medical device company, commented that the existing
devices could do some remote monitoring, and teleconsultation services are starting to be
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utilized more often (Ow,2021). Participant 7, an executive in a technological consultancy firm,
added that he would select both yes and no, as while we are seeing more utilization of
40
technologies and devices, which reduce the workload of the healthcare workers, there is still a
d
lot of innovation required to push our technology forward, gain more acceptance from the
we
public, and share the knowledge and benefits with the public (Ow,2021).
Q2. To answer the research question of what the likely combinations of innovative 4.0
technologies and digital health expected to be introduced in Singapore's next three years are,
vie
the researcher asked the participants a series of questions.
Firstly, the researcher asked the participants if they foresee the combination of the
re
innovative 4.0 technologies and digital health expected to be introduced in Singapore within
the next three years to gauge the participants’ sensing of the implementation of these new
technologies.
er
Figure 11: Industry experts’ opinion on the introduction of innovative 4.0 technologies and digital health
pe
ot
tn
rin
Closed to 88% of the participants (18% indicated “Very Likely” and 67% indicated
ep
“likely”) are optimistic that the combination of innovation 4.0 technologies and digital health
is expected to be introduced within the next three years. The researcher has provided examples
of innovation 4.0 technologies in the survey, including Artificial intelligence, Blockchain,

Pr
41
Internet of Medical Things (IoMT), digital health, telemedicine, virtual reality, augmented
d
reality, and wearables, for further explanation of what innovation 4.0 technologies include.
we
Participant 32, an executive at a technological consultancy firm, commented that the
Singapore government is very efficient in implementation. Therefore, if the government sees
opportunities in MedTech, which will bring jobs and business to Singapore, the government
vie
will definitely put in all the required resources to make it happen (Ow,2021).
Participant 30, an executive in a medical device company, added that we could already
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see that trend in Singapore with health care providers offering telemedicine as a standard
service and eye checks enabled by AI in other Asian markets. Also, diabetes wearables are
more accepted and used in Western markets, which have expanded into Asia and are now
er
expected to gain market share. He added that affordability and access would play a significant
pe
role in expanding into the mass market for some of the new innovations, and the innovations
also need to improve patients' quality of life and the efficiency of treatment (Ow,2021).
Participant 23, an executive in a healthcare institution, concluded that it depends on the

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type of technology being used as technologies like Telemedicine and digital health have already
seen widespread adoption due to COVID-19. However, more innovative solutions such as
tn
blockchain and AI will take a longer time to gain public acceptance (Ow,2021).
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unlikely” cited a lack of public trust in providing the data and the public not being receptive to
change as the key reasons. Participant 22, an executive in an insurance institution, commented
ep
that the public is still not so receptive to new technologies, and existing services have yet to
instill confidence in the public as they are still at the initial stage (Ow,2021).
Pr
Next, the researcher surveyed the participants with the question of which innovations
and combinations of innovative 4.0 technology, in their professional view, they think would
42
bring the best benefits to the industry, patients, and healthcare as a whole. The researcher
d
provided some examples of innovative 4.0 technologies, including Artificial intelligence,
we
Blockchain, Internet of Medical Things (IoMT), Digital health, telemedicine, Virtual reality,
Augmented reality, and wearables.
Figure 12: Industry experts’ opinion on the combinations of innovative 4.0 technologies
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Combination of Innovative 4.0 technologies
12 11
10
8
re
6
4 4 4 4
4 3
2
2
0
AI &
Blockchain
AI & Digital
health
er
AI & IoMT AI & Blockchain, Digital health
Blockchain & digitial health & IoMT
All of the
above
IoMT & IoMT
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Close to 47% of the participants indicated the combination of AI technologies with

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other innovative 4.0 technologies (13% indicated “AI & blockchain,” 13% indicated “AI &
digital health,” 13% indicated “AI & Blockchain & IoMT” and 9% indicated “AI & IoMT”
tn
would bring the best benefits to the industry, patients, and healthcare as a whole.
Participant 18, an executive in a medical device company, commented that there are
rin
just too many things that computers perform way better than humans, and we still have not
utilized them fully. For example, AI technology identifies eye conditions more accurately than
humans for diagnosis based on digital images like X-rays and CT scans. He suggested that
ep
institutions can also utilize AI for evidence-based diagnosis and treatment recommendations
(Ow,2021).
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43
Participant 26, a medical doctor, added that AI could help accelerate medical research
d
to aid drug development and therapeutic treatment development (Ow,2021). Participant 1, an
we
executive in an insurance institution, commented that the combination of AI and digital health
provides a good simulation of the insurance coverage a company needs to have (Ow,2021).
Participant 7, an executive in a technological consultancy firm, commented that AI and
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Blockchain facilitate more precision diagnosis and recommendations as it allows secured and
speedy transfer of information, and it also helps to reduce operational costs (Ow,2021).
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Close to 34% of the participants indicated that the combination of “digital health and
IoMT” would bring the best benefits for the industry, patients, and healthcare. Participant 5, an
executive in a digital health company, commented that IoMT allowed for easier remote
er
monitoring and gathering of data for medical trends and health trends. Participant 14, an
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executive in a medical institution, concurred with participant 5 and added that digital health
and IoMT allowed for easier remote monitoring and provided conveniences for the patients,
leading to reduced waiting time, reducing healthcare professionals' workloads, and allowing
ot
them to focus on delivering better patient care (Ow,2021).
Close to 13% of the participants indicated the combination of “Blockchain, digital

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health & IoMT” would bring the best benefits to the industry, patients, and healthcare.
Participant 17, an executive in a digital health company, commented that blockchain would
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help provide the data security required for the rest of the technologies to leverage (Ow,2021).
Participant 7, an executive in a technological consultancy firm, commented that with

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the combination of Blockchain, digital health & IoMT, patients could seek medical
consultation regardless of where they are. The doctors can access the patients' medical records
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via digital health, which is supported by blockchain technologies, and obtain vital health
44
measurements via IoMT to diagnose the patient and provide the appropriate medication and
d
treatment plan (Ow,2021).
we
Close to 6% of the participants indicated that “All of the above technologies” would
bring the best benefits to the industry, patients, and healthcare. Participant 9, an executive at a
technological consultancy firm, commented that all the mentioned technologies would benefit
vie
the industry, patients, and healthcare as they will become a complete ecosystem where other
technologies, like 3D printing, personalized medication, quantum computing, etc., can be
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integrated (Ow,2021). Participant 16, an executive in a pharmaceutical company, commented
that all of the technologies mentioned above play a role, but the question is how to integrate
and analyze coherent data (Ow,2021). er

Q3. To answer the research question about what industry experts' views are on the
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likely introduction in Singapore of these technologies in order to innovate the industry, the
firms' business models, and the quality and the experiential dimension of the health services
for the doctors and patients have been thoroughly analyzed.

ot
industry definitely needs a disrupter. Many HealthTech companies are working to address some
tn
of these inefficiencies right now. However, they are not getting enough traction or support from
the government, which results in a lack of talent in this space (Ow,2021).

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Participant 31, an executive in a pharmaceutical company, added that it required
behavior changes, for example, the cardless payment, which became very popular due to covid
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which before that, the government had a hard time pushing it across to hawkers and other small
businesses (Ow,2021).
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Participant 24, an executive in a medical device company, commented that the
Singapore government has been driving consistently new technologies across all industries
45
(e.g., autonomous driving, Covid tracing app and token, start-up) and their adoption (digital
d
education for seniors, digital payment at hawker centers). Therefore, it would be highly likely
we
that the government would push for the utilization of blockchain and other forms of data
security to ensure data privacy and integrity in order to resolve data breaches and improve
public confidence in medical data security. This will subsequently drive the adoption of the
vie
technologies due to their convenience. He added that it would also require several guidelines
and laws to be in place to ensure proper utilization of the technologies and data (Ow,2021).
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Participant 15, an executive in a digital health company, commented that it is definitely
in the cards and being evaluated and planned for by the Singapore government. Therefore, there
is a high chance of introducing these technologies to innovate the industry to reduce the
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healthcare budget and the burden of the aging population. He added that it would require a
significant push for innovation campaigns and awards to drive companies to innovate and
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collaborate and to propel public and industrial education of the technologies and media
exposure of the successful implementations (Ow,2021).

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Q4. To answer the research question of what the future applications of the 4.0
innovative digital health devices and MedTech technologies will be, the researcher has reported
tn
in the survey some of the potential applications for the participants to select.
Figure 13: Industry experts’ opinion on the application of innovative 4.0 technologies
rin
ep
Pr
46
d
36% of the participants selected “Remote monitoring and medical consultancy” as
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future applications of 4.0 innovative digital health devices and MedTech technologies.
Participant 26, a medical doctor, commented that it improved the efficiency and
healthcare resource allocation effectiveness spread across the population (Ow,2021).
vie
Participant 3, an executive in a healthcare institution, added that increased remote monitoring
would improve quality of care and health outcomes, resulting in higher mortality rates and
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longer life expectancy (Ow,2021). Participant 27, an executive in a pharmaceutical company,
suggested that this would lead to the gamification of self-reporting of health care metrics
(Ow,2021).
er
27% of the participants selected “IoMT and personalized health tracking” as
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applications of 4.0 innovative digital health devices and MedTech technologies in the future.
Participant 5, an executive in a digital health company, commented that it allowed patients to
understand their own health conditions, monitor their lifestyle, and allow medical professionals
ot
to do remote patient monitoring through the IoMT devices (Ow,2021).

tn
Participant 20, an executive in a healthcare institution, is interested in seeing the future
evolution of the current IoMT to make remote patient monitoring more convenient (Ow,2021).
Participant 29, an executive in a technological consultancy firm, commented that this space's
rin
potential is quite huge as there are still many opportunities and metrics we cannot measure;
companies like Alphabet, Apple, Tencent, and others are currently expanding their capabilities
ep
and expertise (Ow,2021).
24% of the participants selected “Personalized medication” as the application of 4.0

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innovative digital health devices and MedTech technologies in the future. Participant 15, an
executive in a digital health company, commented that patients and doctors faced multi-
47
medication challenges with growing age and multiple diseases. He added that adverse drug
d
interactions result from patients and doctors not always aware of the numerous medications a
we
patient is taking daily, and those unknown interactions could be better managed (Ow,2021).
9% of the participants selected “Blockchain security and contracts” as applications of
4.0 innovative digital health devices and MedTech technologies of the future. Participant 25,
vie
an executive in a pharmaceutical company, commented that smart contracts would drastically
optimize the value chain and remove many intermediaries, hopefully making the end-to-end
re
process more efficient. However, this may also have an impact on the economy when
intermediaries are removed. If done too quickly, there could be a negative impact on the
economy (Ow,2021). Participant 20, an executive in a healthcare institution, commented that

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blockchain security would significantly increase medical data security and increase public trust
in healthcare institutions to protect their medical data (Ow,2021).

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1% of the participants selected “Precision surgery and treatment” as applications of 4.0
innovative digital health devices and MedTech technologies of the future. Participant 4, an
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executive in an insurance institution, commented that while this application is still an initial
concept, it would be great if precision surgery and treatment were accurate and effective in
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treating patients (Ow,2021).
Summary
rin
This chapter offered a detailed presentation of the quantitative and qualitative data
collected from both the general public survey and the industry input survey. This exploratory
ep
study identified the factors that would answer the key research questions and the study's goal.
The researcher reported that the response rate for the general public survey was 56.6%,
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and the response rate for the industry experts survey was 22%. Also, the researcher reported
48
that due to the study's exploratory nature, most industry experts have requested that their
d
identities be kept anonymous.
we
In this chapter, the researcher summarized the study findings gathered from the 623
participants from the general public survey and 33 participants from the industry experts
survey.
vie
The researcher utilized survey monkey and Microsoft Excel software to analyze the
data, visualize the research findings in the form of diagrams and tables to identify
re
interdependences and compare proportions, trends, and conjunctions. The researcher has then
interpreted the textual responses to open-ended questions by working through each question to
identify the key themes that recur across the different respondents’ responses. Data analysis
er
was broken into two phases due to some differences in the questionnaires and the level of depth
pe
of knowledge.
In Phase One, the researcher analyzed and reported the data inputs collected from the
general public survey, which offers the public perspective on the key research questions. In
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Phase Two, the researcher analyzed and reported the data inputs collected from the industry
experts survey, which offers the industry experts’ perspectives on the key research questions.
tn
In order to answer the research questions, the researcher grouped several themes to provide a
better perspective and depth of the inputs to answer key research questions.
rin
In the next chapter, the researcher will answer each research question by discussing the
inputs from both public and industry experts and supported by external references from
ep
literature and external sources.
Discussion of Results
Pr
This section discusses and interprets the study's results. The results' interpretation was
based on the unique participants from both the general public survey and the industry experts.
49
The discussion would include comparing the results of both the general public surveys and
d
industry experts, including practical use cases from other countries and how they can be applied
we
to Singapore.
The researcher’s expertise and professional background also affected the interpretation
of the results; the researcher would utilize direct quotes to bolster the analysis of the results.
vie
The researcher answered each of the research questions by discussing the inputs from
both public and industry experts and supported by external references from literature and
external sources.
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Q1. Are the existing technologies able to achieve the full potential of digital health,
Telemedicine, and remote patient monitoring and to address the needs of digital health
patients?
er
As mentioned in the previous chapter, to understand the current state of where digital
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health, telemedicine, IoMT, and other advanced technologies are deployed in Singapore and
how both the general public and industry experts feel about these technologies, the researcher
has undertaken a survey targeting both groups of participants. Two specific questions have
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been proposed to the participants in order to gather their inputs and perspective on these topics.
This section is to understand the “as is” state of technologies in Singapore, including
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IoMT, telemedicine, digital health, blockchain technology, and A.I. Hence, in this section, the
researcher would discuss the perspectives of both groups of participants in both subsections to
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answer the research question 1.
1.1 Perspectives on existing technologies able to achieve the full potential of digital health,
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Telemedicine, and remote monitoring
The majority of both groups of participants felt that the existing technologies were not
able to achieve the full potential of digital health, Telemedicine, and remote monitoring. It can
Pr
50
be inferred that the respondents think that there are more untapped opportunities to introduce
d
this combination of technologies to improve the capabilities.
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Lack of public knowledge and technology advocacy
One of the main reasons cited by the general public was the lack of public knowledge
and technology advocacy. Participant 14, an executive in a healthcare institution, concurred
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with this perspective. He commented that public education and government advocacy are
lacking, and the training and upskilling of the healthcare workforce lack a robust collaborative
ecosystem where the different stakeholders can work together to build interoperability. He also
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added that access and affordability might be a challenge as not every patient can afford smart
devices and computers to utilize the technologies (Ow,2021).
Lack of medical data security

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The second reason cited by the general public was the lack of medical data security,
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resulting in data leaks and breaches. Participant 9, an executive at a technological consultancy
firm, concurred with this perspective, as he added that we could do a lot more to optimize the
ecosystem, as currently, there are many roadblocks regarding the sharing of data. There is no
ot
centralized repository that people can trust. Therefore, this results in multiple databanks
tn
without interoperability. This gives patients a broken journey as they go to different healthcare
providers for consultation and treatment (Ow,2021).

rin
Initial stages of development and implementation
The third reason cited by the general public was that Singapore is still in the early stages
of development and implementation; hence, there are still rooms to improve and enhance. One
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of the participants cited a lack of a high degree of adoption of IoMT, resulting in the absence
of a robust pool of data for doctors to draw for any one patient.
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51
This perspective is consistent with the inputs from industry experts. Participant 27, an
d
executive in a pharmaceutical company, commented that penetration is suboptimal for all three
we
technologies mentioned. Among the three technologies, remote patient monitoring for the
elderly in Singapore could unlock the most potential and value (Ow,2021).
Participant 1, an executive in an insurance institution, added that many patients still
vie
needed to fly overseas to access good medical treatment, which also meant that the current
technologies were not up to the capabilities to perform the "online" treatment or operations
(Ow,2021).
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Interoperability and data sharing
One of the other reasons mentioned by several industry experts was interoperability and
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data sharing.
Participant 28, an executive in a digital health company, cited significant

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interoperability and predictive analytics issues as each hospital or healthcare institution still
functions and stores our health information differently due to confidentiality issues (Ow,2021).
Participant 25, an executive in a healthcare institution, added that Singapore needs to break the
ot
silo between different clusters and be ready to take chances and innovate with digital health
tn
services. Currently, the information is disparate, and its ability to integrate is limited
(Ow,2021).
rin
These findings corroborate those from the Future Health Index 2020, which found that
83% of Singaporean healthcare professionals agree that interoperability across platforms
should be strengthened to maximize the use of healthcare data (Philips, 2020).

ep
36% of the participants from both groups felt that the existing technologies were able
to achieve the full potential of digital health, telemedicine, and remote monitoring but still felt
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there were rooms for improvement and enhancement.
52
Existing Infrastructure
d
One of the main reasons cited by the general public was that we had the infrastructure
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in place but lacked the advocacy, adoption, and data security, which are critical factors.
Participant 6, an executive at an insurance institution, commented that while the
infrastructure or systems are already in place, he believes that the security, software, and social
vie
aspect are not. Hence, the security part of IoMT must be addressed and enhanced to tap the full
potential of these innovative 4.0 technologies (Ow,2021).
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Increase of utilization due to COVID-19
The second reason mentioned was due to the COVID-19 pandemic, there was a sharp
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increase in utilization, but it still lacks some enhancement. Participant 19, a medical doctor,
further explained this perspective and commented that we are moving into an age where
pe
patients no longer have to go to the doctor to do medical checks or tests as they could be done
using a doppler. The doctor could call for numerous clinical tests on the blood sample once she
received the doppler. She can also review the report via the digital health platform and perform
ot
medical consultations through phone or video conferences with the patients (Ow,2021).
tn
Future advancement and enhancement
The third reason cited by the general participants was that, while they felt that the existing
rin
technologies were able to achieve the full potential of digital health, telemedicine, and remote
monitoring, they expected that there would be more extensive services and capabilities
implemented in the future with the advancement of 5G and other smart technologies.
ep
Participant 33, an executive in the medical device company, further expanded on this
perspective, stating that she believes that the current adoption is more significant in acute care,
Pr
but there is potential to expand into chronic or longer-term care. With accumulated data points
53
captured over a period of time via these means, it will allow for a more holistic view of patient
d
care and treatment strategies. She added that another area that needs to be transformed to enable
we
faster and greater adoption of these technologies relates to healthcare institution policies and
regulations that may be outdated if they are not reviewed. As such, these need to be updated to
provide for the ecosystem (Ow,2021).
vie
1.2 Perspectives on existing Internet of Medical Things (IoMT) devices and technology
addressing the needs of digital health patients
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The majority of both groups of participants felt that the existing IoMT could not address
all the needs of digital health patients.
Lack of advanced and comprehensive monitoring

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One of the main reasons cited by the participants was that we are still at the initial stage
of implementation and development where a person would usually only have one or two
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devices to measure basic health vital signs like ECG, heart rate, the oxygen level in the blood,
blood sugar level.
The industry expert group's results show a similar perspective; participant 24, an
ot
executive at a medical device company, commented that digital health patients' current needs
tn
are still basic. The existing devices and technology probably address these basic needs only,
such as heartbeat monitoring or steps counter. However, it would be good to have devices that
track blood sugar levels and cholesterol or any tracker that can predict heart attack/stroke
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(Ow,2021).
Participant 28, an executive in a digital health company, added that none of the existing
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IoMT devices and technologies looked at all aspects of a patient as most of the devices were
focused on their niche areas. For example, heartbeat monitoring devices would only measure
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the heartbeat, but there is no sharing of information with the other trackers to measure blood
sugar or oxygen level concentration (Ow,2021).
54
Data security and Lack of Public education
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The two other reasons cited by the general public were data security as one of the
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primary concerns of data sharing and a lack of public education about this technology and how
it can benefit the public. The results were consistent with the results collected from the industry
expert group.
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Participant 29, an executive in a technological consultancy firm, commented that
currently, the masses are mainly using it to collect data that is, well essentially trivial for the
respective individual (i.e., heart rates, sleep patterns, weight, etc.) as this information is used
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just “for your information” kind of situation. He suggested that future enhancements could be
that once the heartbeat/heart rate becomes irregular or if the sugar level of that person suddenly
er
spikes, it will inform the person or inform an ambulance to pick up if someone is in medical
danger. However, there is a thin red line between personal privacy versus medical emergencies
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(Ow,2021).
Participant 7, an executive in a technological consultancy firm, added that he would
select both yes and no, as while we are seeing more utilization of technologies and devices,
ot
which reduce the workload of healthcare workers, he added that there is still a lot of innovation
required to push our technology forward, gain more acceptance from the public, and share the
tn
knowledge and benefits with the public (Ow,2021).
Close to 40% of the participants from both groups felt that the existing IoMT devices
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met patients’ and consumers’ basic needs and helped with the reduction of workload for
healthcare professionals.
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Met patient basic needs
The majority of the participants cited the first reason as the existing IoMT devices meet
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the patients’ and consumers’ basic needs, but more can be done to expand their capabilities.
55
Participant 24, an executive in a medical device company, commented that digital
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health patients' current needs are still basic. The existing devices and technology probably
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address these basic needs only, such as heartbeat monitoring or steps counter. However, it
would be good to have devices that track blood sugar levels and cholesterol or any tracker that
can predict heart attack/stroke (Ow,2021).
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Reduction of medical resource workload
The second reason cited by participants was that it has reduced healthcare
professionals’ workload by taking the patients’ vital signs constantly, and the time can now be
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better spent on better patient care. Participant 3, an executive in a healthcare institution,
commented that current wearable health devices help monitor patients' health remotely and
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notify relevant personnel if needed. However, more can be done to improve the usage and
effectiveness of digital health (Ow,2021).

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Data utilization versus convenience
Participant 2, an executive in a medical device company, commented that the existing

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devices could do some remote monitoring, and teleconsultation services are starting to be
utilized more often (Ow,2021). Despite the convenience that the technologies bring, the third
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reason cited by the public participants was that they were concerned about how the data would
be utilized or shared without their consent for commercial usage.

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Summary
The majority of the responders from both groups felt that the existing technologies were
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not able to achieve the full potential of digital health, telemedicine, and remote monitoring,
citing several reasons, such as a) lack of public knowledge and technology advocacy, b) lack
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of medical data security, which resulted in data leaks and breaches and c) Singapore is in the
initial stages of development and implementation.
56
The majority of the responders from both groups felt that the existing IoMT could not
d
address all the needs of digital health patients, citing reasons such as a) lack of advanced and
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comprehensive monitoring, b) data security, and public education on IoMT and how it would
benefit the public.
Therefore, in this section, key research question one allows the researcher to understand
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the perspective of how the general public and industry experts feel about the current state of
digital health, telemedicine, IoMT, and existing technology in Singapore, and how both the
general public and industry feel that the existing technologies are able to address the needs of
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digital health patients.
Q2. Innovative 4.0 digital health devices and MedTech technologies that the public is
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aware of and known of
In this section, the researcher would discuss the innovative digital health devices and
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Medtech technologies that the general public are aware of or have utilized before, which might
influence their perspective on question 1 and answer research question 2. Hence, the researcher
surveyed the general public on two focused technologies: IoMT devices and digital health
ot
services.
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2.1 Internet of Medical Things Devices (IoMT)
Close to 89% of the participants indicated that they have owned or hear of Internet of
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Medical Things Devices (IoMT) such as an Apple Watch, Fitbit, and other medical devices,
whereas 11% of the participants indicated that they do not own or heard of Internet of Medical
Things Devices (IoMT).

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This level of high awareness of standardized IoMT wearables which was due to the
public utilization to monitor their health and government push for healthy lifestyles such as the
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national steps challenges. It started from Health Promotion Board (HPB) with the healthy365
57
application and insurance companies like AIA with the AIA Vitality application to encourage
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the public to walk 10,000 steps per day to partnering with apple health to create the Lumihealth
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application and program to encourage the public to clock their steps in exchange for points to
redeem vouchers or discounts at restaurants or stores (AIA, 2012; Smart Nation, 2020b; Tan,
2020).
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National Steps Challenge
As part of the Health Insights Singapore survey, nearly 3,000 Singaporeans wear a
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smartwatch linked to an app that transmits real-time data about their heart rate, sleep patterns,
and physical activity to the HPB (hiSG). According to Terence Ng, Director of HPB's Policy
& Technology Innovation Office, the study collects lifestyle data from participants aged 17 to
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74 using FitBit Ionic smartwatches and the hiSG mobile application (Tay & Lim, 2020).
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With the National Steps Challenge, HPB aimed to make tracking one's steps with
wearables and mobile apps easy and appealing to Singaporeans. Participants can monitor their
progress anytime and everywhere using a steps tracker, wearable devices, and a smartphone
ot
application as they work toward their personal goals.

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HPB had distributed new fitness trackers with a heart rate tracking feature to encourage
adoption by allowing participants to be more conscious of their physical activity level. The
new trackers will even nudge participants to move around if they have been sedentary for an
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extended period of time in order to maintain their fitness levels.
Mr. Ng went on to say that gamification and bonuses are being used to encourage
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Singaporeans to take part in the challenge. The challenge has improved over time to pique and
maintain participant interest, such as the recent inclusion of a new physical activity category
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for those physically capable of participating in more intense exercise.
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Mr. Ng also mentioned that the National Steps Challenge has risen in popularity from
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156,000 participants in the first season to 800,000 in the fourth season (Tay & Lim, 2020).
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2.2 Digital Health Services
Close to 70% of the participants have heard of or utilized digital health services before,
whereas 30% of them are not aware of or did not utilize these services.
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Due to COVID-19, there has been a surge in the utilization of digital health services
such as Doctor Anywhere, Miya Health, SpeedDoc. Insurance companies started to cover
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digital health services with partnerships with digital health services like whitecoat.
Private healthcare institutions like Raffles medical group also create their own digital
health services to allow patients to do telehealth consultations to do medical reviews and

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appointment bookings and preclinical measurements like temperature taking to reduce the time
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needed to queue at the clinic.
By October 2020, 24,227 patients sought medical help through video consultation.
However, by January 2021, it increased to at least 36,000. Citing the IHIs data, in January
ot
2020, there were only 53 public healthcare institutions that held 407 video consultations.
However, in January 2021, it increased to 125 public healthcare institutions that held 7,500
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video consultations (Teo, 2021).
In this section, the survey results of these two questions indicate that a high percentage
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of the participants are aware of digital health devices and Medtech technologies such as the
IoMT, which allow the researcher to have a better understanding of the current stage of
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innovation 4.0 technologies and digital health in Singapore and the adoption level of these
technologies. In the following section, the researcher would discuss the likely combination of
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innovative 4.0 technologies and digital health, which are expected to be introduced in
59
Singapore in the next three years. The upcoming section aims to provide a future perspective
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on innovation 4.0 technologies and digital health and their likely impact on Singapore.
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Q3. What are the likely combinations of innovative 4.0 technologies and digital health
expected to be introduced in Singapore's next three years?
In this section, the researcher would discuss the results collected from both groups of
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participants to answer the research question of what are the likely combination of innovative
4.0 technologies and digital health technologies expected to be introduced in Singapore's next
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three years.
The researcher decided to gather:

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a) the industry experts’ view on the likely introduction in Singapore of
these technologies in order to innovate the industry, the firms' business models, and the quality
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and the experiential dimension of the health services for the doctors and patients;
b) the perspective of both groups of participants on the likely combination of the

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innovative 4.0 technologies and digital health expected to be introduced in Singapore within
the next three years;

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c) the industry expert’s perspective of future applications of the 4.0 innovative digital
health devices and MedTech technologies;

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d) and the industry perspective on the combinations of innovative 4.0 technologies that
might bring optimization benefits and value creation for the industry, the patients, and the
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healthcare system as a whole.
The researcher aims to address how each subsection correlates with answering the 3rd
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research question.
60
3.1 Industry experts' views on the likely introduction in Singapore of these technologies
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in order to innovate the industry, the firms' business models, and the quality and the
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experiential dimension of the health services for the doctors and patients.
The researcher surveyed industry experts on their views on the likely introduction in
Singapore of these technologies in order to innovate the industry, the firms' business models,
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and the quality and experiential dimension of the health services for doctors and patients.
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industry definitely needs a disrupter. Many HealthTech companies are working to address some
of these inefficiencies right now. However, they are not getting enough traction or support from
the government, which results in a lack of talent in this space (Ow,2021).

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Participant 31, an executive in a pharmaceutical company, added that it required
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behavior changes, for example, cardless payments, which became very popular due to covid-
19 and which, prior to the pandemic outbreak, the government had a hard time pushing the
adoption of technologies among hawkers and small businesses (Ow,2021).

ot
Participant 24, an executive in a medical device company, commented that the

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Singapore government has been driving consistently new technologies across all industries
(e.g., autonomous driving, Covid tracing app and token, start-up) and their adoption (digital
education for seniors, digital payment at hawker centers). Therefore, it would be highly likely
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that the government would push for the utilization of blockchain and other forms of data
security to ensure data privacy and integrity to resolve data breaches and improve public
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confidence in medical data security. This will subsequently, drive the adoption of the
technologies due to their convenience. He added that it would also require several guidelines
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and laws to be in place to ensure proper utilization of the technologies and data (Ow,2021).
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Participant 15, an executive in a digital health company, commented that it is definitely
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in the cards and being evaluated and planned for by the Singapore government. Therefore, there
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is a high chance of introducing these technologies to innovate the industry and to reduce the
healthcare budget and the burden of the aging population. He added that it would require a
significant push for innovation campaigns and awards to drive companies to innovate and
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collaborate and propel public and industrial education of the technologies and media exposure
of the successful implementations (Ow,2021).
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Summary
Overall, the responders from the industry expert group are positive in their view of the
likely introduction in Singapore of these technologies in order to innovate the industry, the
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firms' business models, and the quality and the experiential dimension of the health services
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for doctors and patients.
These perspectives were further supported by the results of the survey of young
healthcare professionals in the Future Health Index 2020, which indicated an optimistic outlook
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for digital technology’s potential to transform healthcare. As currently, in Singapore, the
healthcare system has advanced the use of digital health records and is ready to move on to
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implementing AI for integrating diagnostics, predicting outcomes, and optimizing operational
efficiency and, instead of removing the human element from healthcare, they advocate
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technology’s benefits to improve both professional satisfaction and patient experience (Philips,
2020).
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After understanding the industry experts’ perspective on the likely introduction to
Singapore of these technologies in order to innovate the industry, the firms' business models,
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and the quality and experiential dimension of the health services for doctors and patients, which
is a more long-term perspective. The researcher also surveyed both groups of participants on
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their view on the likelihood of the introduction in Singapore of a combination of innovative
d
4.0 technologies and digital health within the next three years (shorter-term perspective).
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3.2. Likelihood of combination of the innovative 4.0 technologies and digital health
expected to be introduced in Singapore within the next three years
The majority of both the general public and industry experts are optimistic that the
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combination of innovation 4.0 technologies and digital health are expected to be introduced
within the next three years.
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The researcher has provided examples and further explanations in the survey of what
innovation 4.0 technologies include such as, Artificial Intelligence, Blockchain, Internet of
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Medical Things (IoMT), digital health, Telemedicine, virtual reality, augmented reality, and
wearables.
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Covid-19 Pandemic
Out of the 86% of these participants, 60% cited the COVID-19 pandemic as the reason
ot
for the acceleration of the technology, especially with social distancing, work from home
arrangements, global acceleration of digital health, and IoMT to reduce the massive workload
tn
that healthcare personnel are dealing with.
Participant 23, an executive in a healthcare institution, concluded that it depends on

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what kind of technology is used as Telemedicine and digital health have already seen
widespread adoption due to COVID-19. However, more innovative solutions such as
blockchain and AI will take a longer time to gain public acceptance (Ow,2021).
ep
As cited from numerous published sources, the surge in digital health utilization was
due to the COVID-19 pandemic. Firstly, Speeddoc’s revenue surged to nearly 400% in 2020
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63
compared to 2019 due to the pandemic, with plenty of patients keen to keep a distance (Ang,
d
2021a).
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Next, Kahn et al. (2020) reported a 70% surge in the number of video consultations
provided by Doctor Anywhere from the beginning of the pandemic to mid-February and a 41%
surge in sign-ups to utilize video consultation services provided by Doctor Anywhere from
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January to March 2020. Kahn et al. (2020) also reported that there was a 25% weekly surge in
usage of WhiteCoat, a Singapore-based telemedicine provider since the pandemic began (Khan
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et al., 2020).
Finally, Ted Tan, ESG's deputy chief executive, stated that the COVID-19 pandemic
has put the global healthcare system to the test and accelerated the need for Singapore's
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healthcare sector to transform and meet contemporary demands. Teleconsultation is gaining
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popularity as patients seek treatment online (Tan, 2021).
Smart Nation
The remaining 40% cited Singapore as being a medical hub and a tech hub. In addition,
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with the constant push for digital advancement and technological innovations to become a
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smart nation, the three years’ timeframe seems ideal and achievable. They also compared how,
since countries like China are more advanced in the digital health space, Singapore needs to
quickly innovate and catch up so as to remain competitive and not fall behind.
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Singapore government is very efficient in implementation. Therefore, if the government sees

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opportunities in MedTech, which will bring jobs and business to Singapore, the government
will definitely put in all the required resources to make it happen (Ow,2021).
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Participant 30, an executive in a medical device company, added that we could already
see that trend in Singapore with health care providers offering telemedicine as a standard
64
service and eyesight checks enabled by AI in other Asian markets. Also, diabetes wearables
d
are more accepted and used in Western markets, which have expanded into Asia and are now
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expected to gain market share. He added that affordability and access would play a significant
role in expanding into the mass market for some of the new innovations, and the innovations
also need to improve patients' quality of life and the efficiency of treatment (Ow,2021).
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Singapore launched its Smart Nation Initiatives in 2014 to leverage the Fourth
Industrial Revolution's technologies and implement them on a national scale (Ng, 2019). The
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Smart Nation Initiative was launched to boost total factor productivity, improve Singaporeans'
lives, retain and attract local and international talent.
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The Smart Nation initiatives are based on three key pillars: 1) Digital Economy, 2) Digital
Government, and 3) Digital Society (Civil Service College, 2019).
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Figure 14: Three key pillars of smart nation initiatives
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tn
rin
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Source: Lau & Cheong, 2020
As to date, the Smart Nation initiatives are targeted at transforming five main domains -
transport, urban living, finance, education, and health, as reflected in the figure below.
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65
Figure 15: Targeted Five domains
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Source: Lau & Cheong, 2020
Under the health domain, the two main initiatives are HealthHub and TeleHealth.
HealthHub
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It is a web portal and mobile application that is intended to serve as Singapore's first
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one-stop-shop for online health information and services. It serves as every citizen's digital
healthcare companion by arming them with the information, knowledge, resources, and
services necessary to take greater ownership of their own health and wellness.
ot
Additionally, it is a milestone project under the Ministry of Health's (MOH) Health
Information Technology Masterplan (HITMAP); healthcare institutions are now connected to

tn
one another to ensure patient continuity of care (Smart Nation, 2020a).
With a SingPass login, parents have access to their children's hospital records, lab test
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results (chronic diseases), and future medical appointments with various public healthcare
institutions; they also have access to their children's immunization records, dental health
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records, medical appointments, medication details, and known side effects, as well as referral
letters.
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66
Patients can grant caregivers access to their personal health and medical records, as
d
well as medical appointments, when HealthHub is used in conjunction with the Caregiver
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Access Module (Smart Nation, 2020a).
Additionally, it provides access to a comprehensive directory of healthcare and lifestyle
facilities and services available throughout the island, including polyclinic locations, healthier
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dining options, and sports facilities. Finally, users will be able to earn and collect Healthpoints
that can be redeemed for rewards such as NTUC LinkPoints by sharing HealthHub articles or
events on social media platforms (Smart Nation, 2020a).
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Telehealth
To help shift care away from hospitals and into the community, Singapore is gradually
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rolling out national Telehealth pilots. The initiatives will evaluate the technology's efficacy in
a variety of use cases, with the goal of increasing patient convenience, improving patient access
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to healthcare services, enabling proactive monitoring, and optimizing manpower and resource
utilization. Smart Health Video Consultation, Smart Health TeleRehab, and Smart Health Vital
ot
Signs Monitoring are three of these Telehealth initiatives (IHis, 2020a).
These initiatives allow patients to receive treatment in locations that are convenient for
tn
them. Additionally, patients can obtain more prompt advice and intervention to help them
control their conditions. Additionally, it has the potential to alleviate caregiver burden and
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motivate individuals to take an active role in their own health. IHiS, Singapore's health
technology agency, has established national IT platforms and collaborates with various public
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and private healthcare institutions to pilot telehealth platforms and services (IHis, 2020a).
Smart Health Video Consultation (VC) for Healthcare.

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Smart Health Video consultation was launched in April 2017; VC enables patients to
communicate with their care team remotely via video conferencing technology. When patients
67
require care, the system provides an immediate response, as in-person visits are not possible.
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The platform will be utilized at other institutions to offer follow-up services for pediatric
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eczema pharmacy consultations, pediatric home care services, lactation consultations, and
speech therapy for patients, as well as post-stroke, communicable disease, and cancer patient
care.
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The following institutions and 31 community care partners have implemented the Smart
Health Video Consultation platform: (Smart Nation,2020c).
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Smart Health TeleRehab.
Through wearable monitors and remote supervision by a therapist, the Smart Health
TeleRehab allows patients to perform rehabilitation exercises at a time and place of their
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choosing (Smart Nation,2020c). Because data is transmitted wirelessly to therapists via
wearable motion sensors attached to patients' limbs, clinicians can perform rehabilitation and
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therapy sessions remotely for patients in their homes.
Remote support from healthcare professionals can also be provided to patients and
ot
caregivers via an Internet-based video conferencing service that is compatible with consumer
devices and supports one-to-one and multi-user interactions. The solution is appropriate for
tn
patients recovering from a stroke, fractures, lower limb joint replacements, or amputations, as
well as deconditioning and musculoskeletal conditions.

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Smart Health Vital Signs Monitoring.
Smart Health Vital Signs Monitoring (VSM) will allow remote monitoring of patients'
vital signs such as blood pressure, blood glucose, or weight who have hypertension, diabetes,
ep
or cardiovascular or pulmonary diseases (IHis, 2020a). As a result, patients can obtain more
prompt advice and intervention to control their conditions, resulting in fewer unscheduled visits
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to Specialist Outpatient Clinics and Emergency Departments. In aggregate, the use of VSM
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enables more frequent monitoring, enhances patient management, and decreases hospital visits
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and readmissions.
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Primary Tech- Enhanced Care (PTEC).
The Primary Tech-Enhanced Care (PTEC) program is one such example. It is a
collaborative effort between the Ministry of Health's Office for Healthcare Transformation
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(MOHT) and the three Polyclinic Clusters - National Healthcare Group Polyclinics (NHGP),
National University Polyclinics (NUP), and SingHealth Polyclinics (SHP), and is supported by
IHiS. PTEC's mission is to offer care support to patients with chronic diseases through the
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utilization of simple-to-use technologies (e.g., VSM devices, chatbots) that allow them to better
self-manage their condition and enhance their well-being from home while minimizing
polyclinic visits (IHis, 2021a).

er
PTEC will benefit patients who wish to improve their management of chronic
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conditions but lead busy lives and are less mobile. These patients can utilize PTEC to self-
manage their conditions in order to avoid disease progression and complications. PTEC will
ot
carry out the first program, the Home Blood Pressure Monitoring Programme, through the three
polyclinic clusters (NHGP, NUP, and SHP) in August 2020, based on the promising and
tn
optimistic results of the one-year pilot.
PTEC's long-term goal is to evaluate additional solutions and to offer a comprehensive

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range of support for patients with a variety of chronic care needs. PTEC will proceed as
follows: (1) expanding to other chronic conditions such as diabetes in the future through e-
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coaching and home HbA1c tests, and (2) expanding to additional primary care partners to
benefit more patients (IHis, 2020a).

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69
On the other hand, the remaining percentile is less optimistic that the combination of
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innovation 4.0 technologies and digital health is expected to be introduced within the next three
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years.
Lack of public trust and Not receptive to change
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unlikely” cited public trust in providing the data and the public not being receptive to change
as the key reasons.
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unlikely” cited a lack of public trust in providing the data and the public not being receptive to
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change as the key reasons. Participant 22, an executive in an insurance institution, commented
that the public is still not so receptive to new technologies, and existing services have yet to
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instill confidence in the public as they are still at the initial stage (Ow,2021).
The following two use cases further support how the lack of public trust and not being
receptive to change led to the slow adoption of technology.

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Slow Adoption of TraceTogether

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According to the TraceTogether website, only 25% of the population had downloaded
the app since its March 2020 launch, far short of the 75% required for effective implementation
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(Today, 2020). The government needed to engage the public directly by stationing Smart
Nation Ambassadors at TraceTogether education booths located throughout Singapore's
shopping malls. The ambassadors assist members of the public during these roadshows by
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assisting them in setting up the app, walking them through the registration process and its
features. Additionally, they assist those who are experiencing technical difficulties in
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troubleshooting.
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By 14th December 2020, despite months of public education, government advocacy,
d
and indications that 70% of the population must adopt in order to move forward with phase 3
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of the economy's reopening, the adoption rate was only in the low 60% (Chew, 2020).
In April 2020, several initial key concerns were raised, including privacy, battery drain,
and standalone application. In terms of privacy, Singapore-based polling firm Blackbox
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Research discovered that 45% of respondents did not download TraceTogether despite being
aware of the app, with the primary reason being that they did not want the government tracking
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their movements (SingCERT, 2020).
However, privacy concerns have waned in importance, according to the most recent
survey in December; only 28% cited them as a concern, down from 45% in April. Concerning
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battery drainage, which continues to be a major reason for the app's slow adoption, SNDGG
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stated that it is constantly refining and updating the app, including fine-tuning it to be as power-
efficient as possible (Chew, 2020).
SafeEntry with TraceTogether only combines two distinct systems: TraceTogether,

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which identifies those in close proximity with COVID-19 patients; and SafeEntry, which
digitally checks in visitors at most locations, which identifies which coronavirus-infected

tn
individuals have visited premises.
Once the integrated TraceTogether-only SafeEntry system is fully implemented,

rin
visitors will be not able to enter higher-risk locations such as restaurants, cinemas, schools,
workplaces, or shopping malls by scanning the SafeEntry QR code with their mobile phone
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camera or the SingPass mobile app as these modes of SafeEntry check-in will be discontinued.
(Tham, 2020b).
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By 23 December 2020, TraceTogether's adoption rate had finally surpassed 70%, one
of the requirements for moving to Phase 3 of the reopening of its economy (Tang, 2020).
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Slow Adoption of cashless payment
d
Singapore's government has been promoting the use of cashless payment methods
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across a variety of sectors and industries, including the food and beverage (F&B) industry.
Numerous mobile payment platforms, such as NETsPay, GrabPay, LiquidPay, DBS PayLah!,
PayNow, Google Pay, Apple Pay, and Samsung Pay, have also been introduced by various
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providers (Ha & Lin, 2018).
Despite numerous initiatives to promote cashless transactions, usage rates remain
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persistently low when compared to cash payments, particularly in small business
establishments, small food and beverage outlets, and hawker centers. According to a 2016
KPMG study, nine out of ten consumers still prefer to pay in cash at Singapore's wet markets
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and hawker centers. Cash transactions accounted for approximately 90% of transactions in the
wet market and hawker centers (Ha & Lin, 2018).

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According to a survey conducted in September 2018 for a Singapore University of
Social Sciences student project, this preference for cash has remained consistent, and more
ot
needs to be done to remove barriers faced by hawkers. Only 39.8 percent of 236 hawkers polled
across Singapore's hawker centers adopted mobile payments, while the remaining 142 had yet
tn
to adopt mobile payments (Ha & Lin, 2018).
Apart from these factors, hawkers' reluctance to adopt mobile payment can be attributed
rin
to four impediments: cost barriers, tradition barriers, usage barriers, and value impediments.
Cost barriers refer to the additional expenses associated with mobile payment services
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adoption, such as the cost of acquiring a smartphone and the payment of transaction fees.
Tradition barriers happen when innovation disrupts users' established routines, whereas usage
barriers refer to resistance to using mobile payments due to factors such as inconvenience and
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the speed with which mobile payments are processed.
72
Value barriers refer to the monetary value associated with customers’ reluctance to
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improve their task performance unless the innovation is significantly less expensive than its
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alternatives. When the return on investment in mobile payments is unknown, the initial
investment creates a value barrier to adoption (Ha & Lin, 2018).
However, the COVID-19 pandemic in 2021 has accelerated electronic payments
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adoption, but Singapore does not intend to become a cashless society, according to the
Monetary Authority of Singapore (MAS) board member Ong Ye Kung. He reported that
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PayNow registrations rose by 1.6 million last year, taking the total to 4.9 million. PayNow
Corporate registrations, meanwhile, have nearly doubled to roughly 245,000. This means that
according to Mr. Ong, who is also the Transport Minister, 80 percent of residents and
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companies are now PayNow users (Ang, 2021b).
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Money transacted through the service more than doubled year over year to $5 billion in
December, and growth is expected to continue as users now have the option of sending and
receiving money through PayNow using non-bank e-wallets such as GrabPay and Singtel Dash
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(Ang, 2021b).
In this subsection, the researcher discussed the participants' perspective on the

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likelihood of the combination of the innovative 4.0 technologies and digital health expected to
be introduced in Singapore within the next three years, which is a shorter-term perspective
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compared to the previous subsection.
In the following subsection, the researcher surveyed the general public group of
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participants on what they would utilize or have utilized digital health services to understand
how they are utilizing the existing digital health services and future enhancements of digital
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health services.
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3.3. Future applications of the 4.0 innovative digital health devices and MedTech
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technologies
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The researcher surveyed industry experts on what they think the future applications of
the 4.0 innovative digital health devices and MedTech technologies are and how industry
experts envision these technologies being utilized to redefine the industry, firms’ business
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models, and doctor-patients relationships.
Remote monitoring and medical consultancy
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The majority of the responders selected remote monitoring and medical consultancy as
the number “one” future applications of 4.0 innovative digital health devices and Medtech
technology.
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Participant 26, a medical doctor, commented that it improved the efficiency and
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healthcare resource allocation effectiveness spread across the population (Ow,2021).
Participant 3, an executive in a healthcare institution, added that increased remote monitoring
would improve quality of care and health outcomes, resulting in higher mortality rates and
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longer life expectancy (Ow,2021). Participant 27, an executive in a pharmaceutical company,

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suggested that this would lead to the gamification of self-reporting of health care metrics
(Ow,2021).
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Use Cases.
The following implementation use cases highlight how some countries utilize remote
monitoring tools. First, the Singapore-based Smart Health-Assist program developed at-home
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sensors to track patients, and researchers are investigating ways to combine sensor data with
other types of medical, economic, geographic, or personal identification information (FINN

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Asia,2021).
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Following that, Mola et al. (2020) announced that Philips is accelerating the
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development of its crucial VitalWatch eICU Program, which enables remote monitoring of
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intensive care units from a central location, allowing hospitals to address the current clinician
shortage in this region. Finally, Mola et al. (2020) noted that VivaLNK, a Chinese medical
technology provider, implemented a remote patient monitoring platform to automate
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temperature taking at the Shanghai Public Health Clinic Centre, a primary care center for
COVID-19 patients (Mola et al., 2020).
IoMT and personalized health tracking
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IoMT and personalized health tracking was ranked second as future applications of 4.0
innovative digital health devices and Medtech technology.

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Participant 5, an executive in a digital health company, commented that it allowed
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patients to understand their own health conditions, monitor their lifestyle, and allow medical
professionals to do remote patient monitoring through the IoMT devices (Ow,2021).
Participant 20, an executive in a healthcare institution, is interested in seeing the future

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evolution of the current IoMT to make remote patient monitoring more convenient (Ow,2021).
Participant 29, an executive in a technological consultancy firm, commented that this space's
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potential is quite huge as there are still many opportunities and metrics we can not measure;
companies like Alphabet, Apple, Tencent, and others are currently expanding their capabilities
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and expertise (Ow,2021).
Use Cases.
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The following use case demonstrates how IoMT and digital health can be utilized for
personalized health tracking and remote monitoring. KAHA, an IoMT solutions provider, has
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partnered with Easy Care International to launch iDOC Remote monitoring solutions, which
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include iDOCWATCH, iDOC East Track, and iDOC remote monitoring Dashboard. The
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solutions are powered by KaHa's proprietary IoT platform, COVE® (AsiaOne,2020).
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Individuals will be able to use the iDOCWATCH in conjunction with the mobile app
iDOC Easy Track to allow continuous tracking of their health. This will be accomplished by
gathering and analyzing vital health data from the user and sending it to the iDOC Remote
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Monitoring Dashboard, which aims to enhance users' health and fitness. Additionally, the app
offers a detailed visual representation of the user's health markers and other vital details,
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enabling users to track their own health from virtually anywhere (AsiaOne,2020).
The iDOC Remote Monitoring Dashboard provides a health or fitness counselor with
essential details about a user's health, such as activity level, sleep quality, blood pressure, and
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heart rate. Individual users will have specific health criteria and thresholds set, and the health
or fitness counselor will receive reminders and updates when a user reaches a predefined
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threshold, such as a custom-set blood pressure level for the chosen user (AsiaOne,2020).
Personalized medication
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Personalized medication was ranked third as the future application of 4.0 innovative
digital health devices and Medtech technology.

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Participant 15, an executive in a digital health company, commented that patients and
doctors faced a challenge related to multi-medication with growing age and multiple diseases.
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He added that adverse drug interactions may result from patients and doctors not being always
aware of the numerous medications a patient is taking daily. Participant 15 also added that
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these unknown interactions could be better managed (Ow,2021).

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Use Cases.
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The following use cases highlight how Personalized Health Records can be utilized for
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digital health, and innovative 4.0 technology can aid the patients in terms of personalized
medication and detailed patient history.
In 2019, the Korean government launched the voluntary program "MyData," which
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provides users with improved access to their data stored on portable electronic devices such as
smartphones (Choi et al., 2020). This program represents a paradigm shift in the storage and
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management of personal data, propelling the existing institution-centric approach toward a
person-centric system, which has already been implemented in various countries' medical
fields.
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The MyData software has been implemented in a variety of sectors, including the
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insurance sector, and allows individuals to more actively and efficiently monitor their own
health data. This PHR application was created to enable patients to own their medical records,
not hospitals, and to empower patients to share that information with healthcare providers when
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necessary.
Blockchain security and contracts

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Blockchain security and contracts were ranked fourth as promising future applications
of 4.0 innovative digital health devices and Medtech technology.

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Participant 25, an executive in a pharmaceutical company, commented that smart
contracts would drastically optimize the value chain and remove many intermediaries,
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therefore hopefully making the end-to-end process more efficient. However, this may also have
an impact on the economy when intermediaries are removed. If done too quickly, there could
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be a negative impact on the economy (Ow,2021). Participant 20, an executive in a healthcare
institution, commented that blockchain security would significantly increase medical data
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security and increase public trust in healthcare institutions to protect their medical data
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(Ow,2021).
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Use Cases.
The following use cases highlight how blockchain security and Smart contracts can be
utilized for digital health and innovative 4.0 technology. They are Accredify, a digital health
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passport containing the COVID-19 swab results and vaccination records, Tracktogether, a
contact tracking application and device developed by the Singapore government for COVID-
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19, and several other smart contracts applications such as Mediledger, FarmaTrust, Chronicled,
and Curisium.
Accredify.
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Accredify has launched a mobile app for digital health that uses blockchain technology
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to build tamper-proof COVID-19 medical records. The contents of a health record are used to
create a specific fingerprint called a "hash," an alphanumerical sequence of characters that is
then uploaded and stored in the blockchain (Accredify, 2021).

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By storing only the fingerprint of a record on the blockchain, it is impossible to decrypt

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or access an individual's personal and medical details, guaranteeing a high level of data privacy
and protection. Additionally, the Digital Health Passport contains medical records provided by
Accredify's affiliate hospitals, including a secure portable archive for individuals to retrieve
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their COVID-19 swab results and vaccine records (Accredify, 2021).
To confirm an individual is COVID-19 compliant, authorities can immediately verify

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the validity of the individual's health record by scanning the document's specific QR code in
the Accredify Digital Health Passport, enabling employers and immigration authorities to
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conduct an effective on-site COVID-19 health screening procedure (Accredify, 2021).
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IBM and Accredify, a Singapore-based company, announced today plans to collaborate
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in February 2021 to help facilitate overseas travel and return to work, as well as the
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management of vaccination roll-out in a verifiable and privacy-preserving manner. IBM Digital
Health Pass will integrate with Accredify's Digital Health Passport as part of this offering. IBM
and Accredify intend to collaborate in order to assist governments and organizations in making
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data-driven decisions in order to reduce risk and interact effectively (SGInnovate,2021).
TraceTogether.
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The Singapore government released the TraceTogether app in March 2020 as part of its
efforts to contain the spread of the COVID-19 virus (Today, 2020). Approximately 90% of
residents, or approximately 4.7 million people, have downloaded the TraceTogether app or
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accumulated TraceTogether tokens (Chee, 2021).
On Tuesday, SNDGO announced that over three million people had received their
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TraceTogether tokens (Chee, 2021). By utilizing TraceTogether to access a site, authorities can
ensure that near contacts in those locations are notified if a COVID-19 case is detected. With
the TraceTogether and SafeEntry systems, authorities will now classify and quarantine near
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contacts of COVID-19 patients in 112 days or less, down from an average of four days
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previously (Chee, 2021).
Smart Contract.
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Here are some of the use cases where blockchain can be utilized in healthcare in the
context of the supply chain, compliance, and medical insurance.

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First, MediLedger is a leading example of a blockchain protocol that allows companies
in the prescription drug supply chain to validate the validity and expiration dates of
medications, as well as other critical details (MediLedger, 2019). Following that, FarmaTrust's
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blockchain-based system notifies law enforcement automatically when it detects a compliance
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problem (STL Partners, 2017).
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Following that, companies such as Chronicled and Curisium offer blockchain-based
systems in which various stakeholders in the healthcare sector, including pharmaceutical
companies, medical device OEMs, wholesalers, insurers, and healthcare providers, can
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authenticate their organizational identities, record contract details, and monitor transactions of
goods and services, as well as payment settlement details for those goods and services. Beyond
supply chain management, this environment allows trading partners and insurers in the
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healthcare industry to operate completely digitally and, in certain situations, automatically
(STL Partners, 2017).

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By establishing mutual digital contracts between manufacturers, distributors, and
healthcare organizations and storing them on a blockchain ledger, rather than letting each
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player maintain their own version of the contract, they will greatly minimize conflicts over
payment chargeback claims for prescription drugs and other products. According to
Chronicled, since pricing structures frequently shift, over one million chargeback claims were
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filed annually between these players, with more than 5% being challenged, necessitating
lengthy manual resolution (STL Partners, 2017).

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Similarly, mutual smart contracts can be utilized to handle patient medical insurance
contracts, where 10% of claims are challenged, according to Curisium. As with other use cases,
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once this data is digitized and readily available, insurers can leverage increasingly sophisticated
analytics to improve patient outcomes and costs (STL Partners, 2017).

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Precision surgery and treatment
Precision surgery and treatment were ranked lowest as future applications of 4.0
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innovative digital health devices and Medtech technology.
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Participant 4, an executive in an insurance institution, commented that while this
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application is still an initial concept, it would be great if precision surgery and treatment were
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accurate and effective in treating patients (Ow,2021).
Use Cases.
Accuray's CyberKnife System utilizes robotic arms to operate on cancerous tumors in
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the body accurately. Doctors and surgeons were able to operate on only infected areas rather
than the entire body by using the robot's real-time tumor monitoring capabilities. Accuray
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CyberKnife robot utilizes six-dimensional motion sensing to aggressively monitor and attack
cancerous tumors while sparing healthy tissue (Accuary,2021).
Accenture evaluated artificial intelligence technologies in healthcare in terms of

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projected annual benefits by technology by 2026; robot-assisted surgery was ranked first. As a
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result, this demonstrated the ability for highly precise care and surgery (Forbes Insights, 2019)
Figure 16: AI application in terms of healthcare

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Source: Forbes Insights, 2019

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In this subsection, the researcher discussed what industry experts think the future
applications of the 4.0 innovative digital health devices and MedTech technologies are. The
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researcher also shared use cases of implementation of the different applications and how they
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can be applied to Singapore to redefine the industry, firms’ business models, and doctor-patient
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relationships.
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In the following subsection, the researcher will discuss what innovations and the
combination of innovative 4.0 technologies industry experts think would bring the best benefits
to the industry, patients, and healthcare as a whole.
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3.4. Innovations and combinations of innovative 4.0 technology do industry experts think
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Artificial Intelligence (AI)
Close to 47% of the participants indicated the combination of AI technologies with

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other innovative 4.0 technologies (13% indicated “AI & blockchain,” 13% indicated “AI &
digital health,” 13% indicated “AI & Blockchain & IoMT” and 9% indicated “AI & IoMT”
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Participant 18, an executive in a medical device company, commented that there are
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just too many things that computers perform way better than humans, and we still have not
utilized them fully. For example, AI technology identifies eye conditions more accurately than
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humans for diagnosis based on digital images like X-rays and CT scans. He suggested that
institutions can also utilize AI for evidence-based diagnosis and treatment recommendations
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(Ow,2021).
Participant 26, a medical doctor, added that AI could help accelerate medical research
to aid drug development and therapeutic treatment development (Ow,2021). Participant 1, an

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executive in an insurance institution, commented that the combination of AI and digital health
provides a good simulation of the insurance coverage a company needs to have (Ow,2021).
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Participant 7, an executive in a technological consultancy firm, commented that AI and
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Blockchain facilitate more precision diagnosis and recommendations as it allows secured and
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speedy transfer of information, and it also helps to reduce operational costs (Ow,2021).
The following implemented use case shows how AI, Blockchain, digital health, and
IoMT can help to reduce workload and increase operational efficiency, which could be
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implemented in Singapore.
Health systems such as Health First in Brevard County, Florida, are benefiting from
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data-driven organizational decisions enabled by technology solutions (Siemens Healthineers,
2020). Operational decision support encompasses asset and fleet management (for example,
enterprise-wide usage, policy, and image management) as well as staff and workflow
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management (for example, workload balancing and aggregated scheduling systems) as well as
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hospital and enterprise performance management, enabling unified control for comprehensive
patient journey management.
Since introducing an initiative that merged IT solutions and lean management concepts,
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Health First has seen a 300 percent rise in adult transfers and a 37% reduction in the time
between emergency department admission and hospital bed occupancy (Siemens Healthineers,
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2020).
Digital Health and IoMT

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Close to 34% of the participants indicated that the combination of “digital health and
IoMT” would bring the best benefits for the industry, patients, and healthcare. Participant 5, an
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executive in a digital health company, commented that IoMT allowed for easier remote
monitoring and gathering of data for medical trends and health trends. Participant 14, an
executive in a medical institution, concurred with Participant 5 and added that digital health
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and IoMT allowed for easier remote monitoring and provided conveniences for patients,
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leading to reduced waiting time, reducing healthcare professionals' workloads, and allowing
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them to focus on delivering better patient care (Ow,2021).
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The following use case shows how the combination of digital health and IoMT can
better improve the quality of patient care, which could be implemented in the Singapore
context.
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Dr. Ellis stated that the advanced technology makes treatment simpler for patients and
that she has seen an increase in patient participation since the program began (Lovett, 2021).
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She cited the example of a patient who saw a general cardiologist and was diagnosed with
arrhythmia; rather than sending them to an electrophysiologist and leaving the patient to seek
treatment on their own, the clinician should assist in establishing the link.
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The VA has partnered with technology giant Samsung and health technology company
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LIVMOR to launch a remote patient monitoring initiative focusing on cardiology (Lovett,
2021). The program, which launched in April 2020, was created to assist clinicians in collecting
patient data through digital tools such as smartwatches, tablets, and smartphones, as well as in
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coordinating and planning treatment.
The software was developed on Samsung hardware and incorporated Samsung's data
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protection tool, Knocks, which ensures HIPAA-compliant system security. From there,
LIVMOR was able to integrate its remote monitoring software, collaborate with the VA, and
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develop customized solutions (Lovett, 2021).
According to Ken Persen, CEO of LIVMOR, it is a comprehensive remote monitoring
device that consists of a Samsung wearable and a Samsung tablet, as well as a cellular-enabled
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tablet operating in a specific mode and using the Knocks network (Lovett, 2021). Additionally,
it provides additional medical peripherals that can be tailored to the patient's chronic condition,
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such as a blood pressure cuff and weight scale, as well as a glucometer, spirometer, or optical
stethoscope.
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Ken Persen added that they are specifically using the sensors on the Gear S2 system to
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collect pulse rhythm data and action, which they then wirelessly transmit via the tablet and
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upload to the cloud for analysis by Dr. Ellis and her team, as well as the patients (Lovett, 2021).
Blockchain, Digital health & IoMT
Close to 13% of the participants indicated the combination of “Blockchain, digital
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health & IoMT” would bring the best benefits to the industry, patients, and healthcare.
Participant 17, an executive in a digital health company, commented that blockchain would
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help provide the data security required for the rest of the technologies to leverage (Ow,2021).
Participant 7, an executive in a technological consultancy firm, commented that with
the combination of Blockchain, digital health & IoMT, patients could seek medical
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consultation regardless of where they are. The doctors can access the patients' medical records
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via digital health, which are supported by blockchain technologies, and obtain vital health
measurements via IoMT to diagnose the patient and provide the appropriate medication and
treatment plan (Ow,2021).

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The following use case shows how the combination of Blockchain, digital health, and
IoMT can bring the best benefits to industry, patients, and healthcare which could be
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implemented in the Singapore context.
Medicalchain is an industry leader in collaborating with healthcare providers to

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introduce blockchain-enabled electronic medical records (EMRs) (Medicalchain,2018). They
enable patients to monitor changes to their medical records and to have informed consent when
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sharing with healthcare providers or others. Additionally, patients can opt to share their medical
records or portions of their medical records with researchers and restrict the amount of time a
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third party can have access to their medical history.
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Medical insurers may obtain instant, certified confirmation of healthcare services
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directly from patients, eliminating the need for an intermediary and saving time and money.
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Apart from developing blockchain-based medical records, Medicalchain is also building a
platform for third-party developers to create digital health solutions (Medicalchain,2018).
Additionally, the platform offers virtual consultation services and a medical data
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exchange, where patients can trade their anonymized medical data in exchange for Medtokens,
which can be used to fund the advancement of digital health applications such as population-
level analytics solutions (Medicalchain,2018).
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Ecosystem
Close to 6% of the participants indicated that “All of the above technologies” would
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bring the best benefits to the industry, patients, and healthcare. Participant 9, an executive at a
technological consultancy firm, commented that all the mentioned technologies would benefit
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the industry, patients, and healthcare as they will become a complete ecosystem where other
technologies, like 3D printing, personalized medication, quantum computing, etc., can be
integrated (Ow,2021). Participant 16, an executive in a pharmaceutical company, commented

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that all of the technologies mentioned above play a role, but the question is how to integrate
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and analyze coherent data (Ow,2021).
Figure 17. Ecosystem to enhance telemedicine

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Source: Chamola (2020)

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Although telemedicine and digital health on their own have merits, Chamola (2020)
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noted that combining these innovations with established telehealth systems will enable a more
dynamic healthcare ecosystem capable of remote surveillance and clinical treatment for
patients with mild cases of COVID-19.
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The following use case shows how an ecosystem of technologies such as digital health,
insurance tech, and IoMT can provide an end-to-end patient journey from making a medical
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appointment, teleconsultation, prescription of medication, to receiving the medicine at the
doorstep, which could be applied to Singapore.
On 19 April 2021, DOC2US, a provider of electronic prescription (e-prescription)

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telemedicine, announced a strategic partnership with AIA Malaysia (Insurance firms) to offer
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virtual health services and wellness programs to the insurer's individual and corporate
customers (Murugiah, 2021).
Tung Hsiao Ley, chief executive officer of AIA Health Services, stated that the
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collaboration is a significant step in the company's foray into digital health services as it
strengthens and extends its Total Health Solution ecosystem (Murugiah, 2021).
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According to Murugiah (2021), DOC2US is the only virtual health advisory network
integrated with the MySejahtera app, in addition to the in-app integration with My AIA.
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Additionally, DOC2US has incorporated its telemedicine platform into the MiCare MyMed
app, allowing clients and workers to consult physicians remotely and have medication
delivered directly to their homes.

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Murugiah (2021) added that DOC2US has also partnered with private laboratory
network Gribbles Pathology to streamline the lab e-request process and real-time online
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reviews with doctors for patients and customers. Additionally, it has partnered with Alpro
Pharmacy, Malaysia's largest chain of prescription pharmacies, to process and dispense e-

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prescriptions, as well as with GDEX, a leading domestic and foreign express delivery service
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provider, to provide patients with last-mile drug delivery.
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Thus, users can digitally consult preferred healthcare professionals through text
messages or video calls via the My AIA app's simple and intuitive interface, without the hassle
of physically seeing a doctor. Following that, after patients obtain an e-prescription from
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doctors at DOC2US, the prescription will be filled by a partner pharmacy. Patients who want
doorstep delivery will have their barcoded prescription shipments handled by riders who have
been trained in secure medication delivery (Murugiah, 2021).
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In this subsection, the researcher discussed what innovations and combinations of
innovative 4.0 technologies industry experts think would bring the best benefits to the industry,
er
patients, and healthcare as a whole. The researcher also shared use cases of implementation of
the different innovations and the combination of innovative 4.0 technologies and how they can
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be applied to Singapore to redefine the industry, firms’ business models, and the doctor-patient
relationship.
Summary of the section

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This section provides us with what the likely combinations of innovative 4.0
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technologies and digital health expected to be introduced in Singapore's next three years are.
The researcher started with the discussion of the industry experts’ view on the
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likely introduction to Singapore of these technologies in order to innovate the industry, the
firms' business models, and the quality and experiential dimension of the health services for
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doctors and patients, which provides a long-term perspective on the macro view.
The researcher continues with the discussion on the perspective of both groups of
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participants on the likelihood of introduction of the combined use of innovative 4.0
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technologies and digital health technologies in Singapore within the next three years. The
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author provides a shorter-term perspective on the macro view.
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Lastly, the researcher summarized the innovative 4.0 technology and digital health
envisioned future state and how it could radically refine the industry, firms ’business models,
and doctor-patient relationships by discussing two subsections. The researcher addressed the
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industry expert’s perspective on future applications of 4.0 innovative digital health devices and
MedTech technologies, and the industry experts’ view of the innovations and combinations of
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innovative 4.0 technologies that they think would bring the best benefits to the industry,
patients, and healthcare as a whole.
After answering research question 3 on what the likely combinations of innovative 4.0
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technologies and digital health expected to be introduced in Singapore's next three years are. It
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provided the researcher with a perspective of the intended future state of innovation 4.0
technologies and digital health from both groups of participants. One of the participants' key
concerns in the previous sections was data security, medical data integrity, and data sharing.
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Conclusion based on the results
As the researcher mentioned in the literature review chapter, based on the literature
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review, there was little research done on how these various technologies can be used together,
as most of the literature was just focused on the implementation of one or two technologies.
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Only one study by V. Chamola (2020) managed to cover numerous technologies mentioning
for example, IoMT, AI, Digital Health, Telemedicine, Blockchain, and their applications
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worldwide during COVID-19.
Next, in the literature review chapter, the researcher also mentioned that this initial gap
in the literature kick-started the research topic as it provides some examples of how these
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technologies are implemented in different countries and how they might change the future of
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digital health. The other gap in the literature is the lack of research on the public and industry
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responses regarding the application of these technologies in Singapore’s medical industries, as
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well as an outlook on the future digital health in Singapore.
In the research methodology chapter, therefore, the researcher set out seven key
research questions each for both groups of participants to understand the “as-is” state of
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technology in Singapore, such as IoMT blockchain, AI, Digital health, telemedicine, the future
trends for these technologies and their applications in Singapore.
Therefore, for the key research question number one, the majority of the responders
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from both groups felt that the existing technologies were not able to achieve the full potential
of digital health, telemedicine, and remote monitoring, and the existing IoMT devices and
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technology could not address all the needs of digital health patients.
The common reasons cited were lack of public knowledge and technology advocacy,
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lack of medical data security, interoperability, and data sharing. They are still in the initial
stages of development and implementation, and lack of advanced and comprehensive
monitoring.
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Regarding the key research question number two, the majority of the responders from
both groups owned or heard of IoMT devices and heard or utilized digital health services
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before, which indicated a high level of awareness and adoption level of digital health devices,
Medtech Technologies, and digital health services that provide the researcher with a better
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understanding of the current stages of innovation 4.0 technologies and digital health in
Singapore. The researcher also discussed the reasons behind this high level of awareness and
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adoption in the section.
Regarding the key research question number three, the researcher started by discussing
the industry experts’ view on the likely introduction in Singapore of these innovation 4.0
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technologies in order to innovate the industry, the firms’ business models, and the quality and
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experiential dimensions of health services for both doctors and patients. Based on the survey’s
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research findings, the majority of the responders reported a positive opinion about this research
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question.
Next, the researcher discussed the perspectives of both groups about the potential
benefits of combined and integrated use of innovative 4.0 technologies and digital health
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devices in Singapore in the next three years. As stated, the majority of the responders from
both groups reported being optimistic about this integrated configuration of the new
technologies and their likely exponential growth in Singapore in the coming three years, driven
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by an acceleration in adoption rate caused by the COVID-19 pandemic and by the Smart Nation
initiatives.
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Next, the researcher also discussed what future applications of innovative 4.0 digital
health devices and MedTech technologies could be utilized to redefine the industry, firms’
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business models, and doctor-patient relationships. The majority of the responders selected
remote monitoring and medical consultancy. The researcher also shared some use cases that
are being implemented in Singapore and overseas related to these specific applications.
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The researcher also discussed the use cases for each of the other future applications,
such as IoMT and personalized health tracking, personalized medication, blockchain security
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and contracts, and precision surgery and treatment.
Lastly, the researcher also discussed the innovations and combinations of innovative
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4.0 technology that the industry experts think would bring the best benefits to the industry,
patients, and healthcare as a whole. The majority of the responder selected the combination of
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AI technologies such as AI & Blockchain, AI & Digital health, AI & Blockchain & IoMT, and
AI & IoMT as the combination innovative 4.0 technologies that they think would bring the best
benefits to the industry, patients, and healthcare as a whole.

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Therefore, the researcher answered all the key research questions mentioned in the
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research methodology chapter and closed the gaps indicated in the literature review chapter.
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The first gap was the lack of research on public and industry responses regarding the
application of these technologies in Singapore’s medical industries.
The second gap was what is the future outcome of digital health in Singapore, provide
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examples of how these technologies are implemented in different countries and how they might
change the future of digital health, and also some of the upcoming innovations and applications
which are in progress of being implemented or in the pipeline.
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Limitations of the study
This exploratory qualitative study may suffer from several limitations, notwithstanding
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the efforts to make this study analytically defendable. Firstly, one potential limitation could be
the composition of the research sample size. Although the researcher tried to recruit industry
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expert participants from all the relevant industries, most of the participants were from
healthcare institutions, pharmaceutical, and medical device manufacturers, insurance firms,
digital health, and technology consultancy firms.

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It would have better if the researcher had also included participants from government,
statutory boards, and financial institutions. The researcher used purposive snowball sampling
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to gather participant knowledge about the topic. Although the sample size of the general public
is relatively sizeable and feasible, it would have probably been better to have a larger sample
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size if the researcher did not have resource limitations. Hence, the lack of representativeness
of the sample was a limitation in this research.

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Next, the second limitation was that as the researcher was basing the study on Singapore
alone due to due to limited resources, which has a small population pool compared to countries
like China and Malaysia, and the United States. One possible avenue of future research would
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be to carry out studies in these countries in order to have a more comprehensive and
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comparative dataset for the study.
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Expected Outcomes, Results, and Contributions of the research
This study aims to contribute to the existing literature by exploring the integrated
applications of Artificial Intelligence, Blockchain, Digital Health, IoMT, and Telemedicine in
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Singapore by providing the perspectives of the responders on the current state of the
technologies in Singapore, the future state of the technologies in Singapore.
Next, this study aims to contribute to the existing literature by providing future
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exploratory ideas to accelerate the rate of digital health utilization in Singapore.
Implications for Practice and Recommendations for Future Research

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The adoption of digital health and innovation 4.0 technologies are on the acceleration
due to COVID-19 as they provide convenience, efficiency, and speedy treatment and
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consultation time which increase access to medical care. The data that it generated could help
to improve process efficiency, drugs, and medical device efficacy, develop new medicines and
therapy breakthroughs, and improve health care standards and access to medical care.
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Healthcare institutions, digital health companies, insurance firms, pharmaceutical, and
medical devices, and technological consultancy can utilize the results of this research to
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implement digital health and innovation 4.0 technology that may increase the adoption of
general public users. Organizations can also use the results to engage other stakeholders in the
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healthcare industry to build the ecosystem to drive adoption and provide an end-to-end patient
journey.
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This study offers a direction for further research into the future of health care in
Singapore and other countries. The future researcher could replicate the current study in other
countries like Malaysia, China, and the other Asia Pacific countries, the USA and UK, utilizing
Pr
a similar research study approach to innovation 4.0 technologies or inclusive 4.0 technologies
93
in those countries. The results could offer a way to compare similarities and differences in
d
sample demographics.
we
The future researcher could also include industry 5.0 technologies and how countries
are gearing up to prepare for them to be implemented in the healthcare industries.
Conclusion
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The purpose of this exploratory qualitative study was to explore the general public and
industry responses regarding the application of these innovation 4.0 technologies in
Singapore’s healthcare industry, as well as, to explore what is expected to be the future outlook
re
of digital health in Singapore, and how the integrated use of AI, IoMT, blockchain, digital
health, telemedicine are likely to radically redefine the industry, firms’ business models, and
er
the doctor-patient relationship. The researcher also discussed the use cases of how they are
being implemented in other countries and how they could be implemented in Singapore.
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The researcher collected data from 623 general public participants and 33 industry
experts via questionnaires using closed-ended and open-ended survey questions.
The researcher utilized survey monkey and Microsoft excel software to analyze the
ot
data, visualize the research findings in the form of diagrams and tables to identify
interdependences, and compare proportions, trends, and conjunctions. The analysis process
tn
will focus on the data distribution, specific values, and highest or lowest values as
recommended by Saunders et al. (2019).

rin
The researcher first extracted the data derived from the survey’s open-ended questions
with the support of excel files for the open-ended questions. The researcher then interpreted
ep
the textual responses to open-ended questions by working through question-by-question to
identify the key themes that recur across different respondents; then the researcher read the
responses to a specific question, looking for any themes that recur in their responses to each
Pr
question.
94
In the presentation of the result chapter, the researcher then presented the data collected
d
in two separate phases; phase one focusing on the data collected from the general public survey
we
and phase two focusing on the data collected from industry experts. The researcher correlated
the data back to the key research questions that were set out in the research methodology
chapter.
vie
Next, the researcher discussed the inputs from the responders from both groups, how
they answered the key questions, highlighting the themes of the results, and incorporating use
cases from secondary sources such as journals and articles from consultancy firms and news
re
articles. The researcher also discussed some of the recommendations for the concerns that the
responders raised. The combination of perspectives from the general public and industry
er
experts allows the study to compare the similarities and differences in the viewpoints on the
same questions.
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The results of this research could help organizations implement an integrated digital
health and innovation 4.0 technology architecture and operating model that may lead to
significant improvements in the adoption rate of these innovative technologies by the general
ot
public in the years to come; to becoming a more efficient, cost-effective, and inclusive health
system in Singapore, and to support the consolidation of Singapore’s global leadership position
tn
as an innovation hub.
rin
ep
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95
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Appendices
A.1: Applications for digital health in Singapore.
d
Name Primary Type Description Country Links
we
Function
HealthHub Access to Web and Access to health Singapore https://play.googl
SG Services mobile app records, schedule e.com/
medical store/apps/details?
appointments, check id=sg.gov.hpb.hea
personal health records, lthhub
manage healthcare.
vie
Carer Access to Web and Patients with chronic Singapore https://www.carer
Services mobile app illnesses and caregivers .com.sg/index
of the elderly
(including dementia
patients) can use the
app to monitor and
re
manage medical
appointments and
medications, receive
relevant caregiving tips
and support from an
online community of
erhealthcare
professionals,
and hire qualified local
nurses.
pe
Homage Access to Web and Provides on-demand Singapore https://www.homa
Services mobile elderly caregiving and ge.sg/
platform nursing services,
including specialized
care for dementia,
Parkinson's, and stroke
patients.
ot
Caregiver Access to Web and Platform that connects Singapore, https://www.careg

Asia Services mobile patients with freelance Malaysia iverasia.com/?loc
platform caregivers, provides ale=en-SG
caregiver training, and
tn
has special services for

dementia patients.
Jaga-me Access to Web and Provides access to Singapore https://www.jaga
Services mobile trained caregivers, me.com/
platform and nurses, and medical
app escorts on demand for
rin
elderly patients. Users

can book, track and
manage healthcare
delivery over mobile
app.
ep
Mydoc Access to Platform, web Patient-centric digital Singapore, https://www.myd

Services and mobile health platform that Malaysia oc.com/
app provides users with a
B2B healthcare network,
including doctors,
nurses, nutritionists and
Pr
pharmacists. It also
connects to insurers,
clinics, and hospitals
within the one
128
platform. Available by
subscription through
d
employers.
BookDoc Access to Platform, web Integrated online Malaysia, https://www.book
Services and mobile ecosystem to seek Singapore, doc.com/
we
app health services Indonesia,
throughout the region, Thailand,
with partnerships to Hong
facilitate transportation Kong
and accommodation.
Also includes an active
lifestyle app that
vie
synchronizes with your
personal fitness tracker
and provides
incentives/rewards
when you achieve your
goals.
re
Doctor Access to Telemedicine, Telemedicine through Singapore https://doctorany
Anywhere Services Platform, web video consultation with where.com/
and mobile doctors and includes
app optional home delivery
of prescriptions.
Access to Platform, A virtual network of Singapore, https://www.docd
DocDoc
Services Artificial
Intelligence
er physicians that are
vetted by expertise and
Indonesia,
Hong
oc.com.sg/
connect to patients Kong,

through their insurance Philippines
pe
company. Artificial
intelligence is used to
find the best match
between patient and
doctor.
Speedoc Access to Telemedicine, Portal that provides on- Singapore, https://speedoc.co
Services web and demand access to Malaysia m/sg/
ot
mobile app doctors and nurses for

home visits, with a
special focus on elderly
patients. The on-site
tn
team also performs

holistic assessments of
living conditions for
elderly patients to help
reduce falls and
encourage better health
rin
at home.
Health Access to Web and Health videos and tips, Singapore https://www.singh
Buddy services mobile app articles about common ealth.com.sg/patie
medical ailments and ntcare/patient-
treatments, find a GP visitorinfo/
ep
service, find a health-buddy-app

specialist service, find
a hospital/centre
service.
Silver Behaviour Mobile app SilverActivities Singapore https://silveractivi
change and web, develops products and ties.com/
Pr
Activities
. devices applications, such as
activity sheets games,
and specialized tablets
for elderly to enable
129
increased
independence, avoid
d
social isolation and
stay engaged
Healthy 365 Behaviour Mobile and Track daily steps count Singapore https://play.googl
we
change web app and calculate the e.com/store/apps/
corresponding calories details?id=s
burned. Also, a health
and diet tracking
mobile application.
EyeDEA Behaviour Wearable Small wearable device Singapore https://agelessonli
vie
Change device for elderly patients ne.net/a-solution-
with glaucoma without to-helpwith-
smartphones to remind compliance/
them to take their eye
drops. (Pilot, still
developing)
NUH Behaviour Mobile app Helps patients and their Singapore https://www.healt
re
Mymeds Change caregivers manage hhub.sg/apps/34/n
medication times, as uhmymeds
well as arrange for
pick-up or delivery of
prescriptions.
Behaviour Mobile app Eye exercise app for Singapore https://www.healt
MyEyeGym
change
erpeople with certain
types of squints that are
hhub.sg/apps/14/a
pp_myeye
due to the absence or gym
limited binocular
pe
vision.
SugoSure Behaviour Mobile app, App with three Singapore https://www.conn
change Platform, interfaces: patient, health.com/sugos
Cloud doctor, and health ure_overvie
coach that enables w/
management of Type 2
diabetes. Patients
ot
record data and receive

feedback from coaches
and doctors to assist
them in managing their
tn
condition.
GlycoLeap Behaviour Mobile app Diabetes control and Singapore, https://glycoleap.c
Change prevention through an Malaysia om/
online app that
connects type 2
rin
diabetes patients with

healthcare coaches to
monitor food, glucose,
activity, and weight.
Coaches provide real-
time feedback to make
ep
a tailored program for

patients.
Match-a- Community Platform A platform that Singapore https://www.ihis.c
nurse Support connects patients from om.sg/Latest_Ne
pilot Singapore‘s General ws/News_Ar
Pr
Hospital` to nurses ticle/Pages/'Bid'_t

living in their area to o_care_under_Ma
assist with care at home tch-ANurse.aspx
after discharge.
130
My Community Mobile app Crowdsources first Singapore https://play.googl
Responder Support responders within 400 e.com/store/apps/
d
meters of a cardiac details?id=s
emergency to render g.gov.scdf.Rescue
assistance until rApp&hl=en_SG
we
ambulances arrive.
E-care Community Mobile app Helping seniors find Singapore https://www.aic.s
Locator Support services near their g/resources/e-
location. care-locator
Singapore Community Website One-stop portal by Singapore Silverpages.sg
Silver pages Support Agency for Integrated
vie
Care (AIC). The
website gives
caregivers, seniors, and
Community Care
partners resources on
senior outreach and
engagement,
re
community-based care,
healthcare, community
mental health, financial
support, and
caregiving.
Monitoring Wearable Heart Rate Monitor, Singapore http://omgsolution
OMG
Elderly
GPS Watch
device
er Pedometer, Blood
Pressure
and
Indonesia
s.com/gpstracker/
elderlyhealthmoni
measurements, fall toring-gps-
detection, SOS button, trackerwatch-
pe
and two-way calling. gps027/
SOS Buddy Monitoring Wearable GPS tracking device to Singapore https://www.sosb
technology locate seniors with uddy.sg/
dementia, includes fall
detection, SOS button,
2-way conversation,
and an alert system that
ot
is activated when a safe

zone is exceeded.
UCARE.AI Monitoring AI, predictive Uses AI and health data Singapore https://www.ucare
analytics analytics to predict and .ai/
tn
prevent the onset and

development of disease
using patient profiles to
prevent hospitalization
and reduce healthcare
costs.
rin
SHINE Monitoring IOT, A project by the SMU- Singapore https://icity.smu.e

Seniors monitoring TCS iCity Lab. Sensor- du.sg/
devices enabled smart homes https://www.tcs.c
and personalized home om/helping-
care for the elderly. seniors-shine-on
ep
Monitors physical
environment (such as
air quality, noise level,
temperature, and
humidity) and daily
living patterns (such as
Pr
their mobility patterns

at home, medication
adherence, and sleep
quality). (Pilot)
131
BPro by Monitoring Wearable Wearable watch that Singapore https://www.healt
Healthstats devices provides continuous hstats.com
d
blood pressure
monitoring at 10-
second intervals.
we
Smart Monitoring Wearable and Enables patients to Singapore https://www.ihis.c
Health monitoring undergo rehabilitation om.sg/telerehab
TeleRehab devices exercises from the
comfort of their homes.
This is done through
wearable sensors and
remote monitoring.
vie
Table 3: Applications for digital health in Singapore
re
er
pe
ot
tn
rin
ep
Pr ns
tat
s
132
tio
ca
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ew
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The future of healthcare in Singapore. How an integrated use of Industry 4.0

Article in SSRN Electronic Journal · November 2021

The user has requested enhancement of the downloaded file.

biopharma and biotech.

of Medical Things, Digital Health, and Telemedicine to elevate their competitiveness, to

Singapore and its citizens.

health, Blockchain-based health devices, Internet of Medical Things (IoMT), and

nineteenth century. It is defined by a confluence of technology that blurs the distinction

technology breakthroughs in fields such as artificial intelligence, robotics, the Internet of

Things, autonomous vehicles, 3-D printing, nanotechnology, biotechnology, materials science,

intelligence, fueled by exponential improvements in computer power and the availability of

algorithms used to anticipate our cultural preferences.

These technologies allow wireless communication in manufacturing and service

Figure 1 - 2001 to 2019 worldwide pharmaceutical market

52.9% (Reh, 2020).

imports close to USD 3.19 billion (Subhani, 2020).

largest pharmaceutical firms having operations in the country. Abbott, GlaxoSmithKline,

Singapore’s regional market (Subhani, 2020).

Singapore’s strong engineering capabilities and high standards of quality assurance to

Initiatives (Appendix 1).

Changes in the pharmaceutical and biopharmaceutical sector

key revenue contributors.

medical problems through an interdisciplinary approach. It is an ideal industrial revolution for

boost medical innovation by meeting diverse requirements; by introducing new designs; by

increased cost optimization.

Medicines paired with companion diagnostics have proven to be an effective strategy

Purpose of the study

and Telemedicine as part of the future of the digital health evolution.

Significance of the study

This research is sited in Singapore; it can be said to be highly representative of the

without any geopolitical or cultural confounding influences.

By conducting a comprehensive industry survey and a public survey, this research

are located in the first section of the research methodology chapter.

The exploratory research methodology applied in this study is supported by secondary

with primary data gathered from an online survey.

As such, a focus on a particular exploratory study was undertaken to provide in-depth

resource constraints, and the country’s economic and cultural characteristics.

2019b; Oztemel & Gursev, 2018).

the transformation of the whole production, management, and governance systems. It is

and opportunities (Schwab & Davis, 2018).

human existence, c) or by rendering large swaths of present cryptographic techniques outdated,

access to new computing technologies in some circumstances.

themselves, not just in financial terms. Furthermore, being human-centered means

Revolution technologies differ from those of earlier industrial revolutions.

Systems, not technologies.

Empowering, not determining.

and subtle ways.

By design, not by default.

systems (Schwab & Davis, 2018).

companies, and interest groups.

Values as a feature, not a bug.

process, not only when they do harm to someone with a voice.

necessary step in achieving the technology future we desire.

business: consumer expectations, product enhancement, collaborative innovation, and

Therefore, by adopting an “agile” governance approach, similar to how the private

meet new people, and nurture relationships.

modern information technology faces. Although we intuitively understand why it is critical,

life will only grow in the coming years.

especially during the COVID-19 pandemic era.

amalgamation of medical devices and software applications providing comprehensive

orders, and transmitting health information to appropriate healthcare professionals through