Last year, Dr. Lee Boon Chye, the Deputy Health Minister of Malaysia, warned that over half of the adult population in the country had high cholesterol levels. He said diseases such as diabetes and hypertension are very high among Malaysians above the age of 18.

To add to the woes, the doctors and nurses in Malaysia are overburdened and are in desperate need of more workforces to reduce burnout.

So, what can healthcare providers do to overcome these challenges? How do they ensure that chronically ill patients receive timely treatment? How can they ensure that today’s low-risk patients do not become tomorrow’s high-risk patients?

A practical solution that I can foresee for this challenge is to capitalize on population health management (PHM).

What is population health management, and how is it beneficial?

Population Health Management is a holistic method of providing care and managing healthcare risks of the local population. The population is segmented based on their health status, access to clinical care, quality of care, and socio-economic background. This data enables the healthcare providers to segment the population as high-risk patients who need timely interventions or as low-risk patients who will benefit from early interventions that can stop the progression of chronic diseases.

Population Health Management has multiple benefits to healthcare providers –

  • It reduces costs: Healthcare providers can reduce the financial burden by identifying the right services for each segment of patients.
  • Provide value-based care: It arms healthcare providers with insightful data, which they can use to provide better care to their patients. It enables them to transition from a clinical-based approach to a more value-based patient care approach.
  • Mitigates risks: The data generated can help healthcare providers to profile the patients based on their age, gender, lifestyle, medical history, etc., so they can create a customized plan to mitigate patient risks.

How Can Technology Improve Population Health Management?

To implement population health management successfully, healthcare organizations need to rely on technology.

Here are a few ways to leverage technology to improve population health management:

Improve chronic disease management

Electronic Health Records enable healthcare professionals to manage chronic patients effectively. However, according to the KLAS report, only 6% of clinicians had access to the EHR data held in different systems. This makes it difficult for healthcare professionals to take a population health management approach to treat patients with chronic diseases.

How can technology help? EHR data is mostly unstructured, making it difficult for stakeholders to analyze. An optimized EHR with all the data related to patients with chronic symptoms will help healthcare professionals to identify high-risk patients and offer them more customized care.

Provide preventive care

Chronic patients require regular screenings and checkups to stay healthy. Sometimes a patient who is not chronic might face the risk of falling into the high-risk zone if they are not monitored regularly. Regular checkups and medications could help these patients to avoid getting into the chronic zone.

How can technology help? Healthcare professionals can use big data analytics and predictive modeling to ensure that the patient does not fall into the high-risk bracket. Philips, for example, provides hospitals with analytics, so they can identify high-risk patients who require immediate medical care. It offers clinical decision support tools and predictive models to help the care managers and the ICU staff to prioritize care and provide timely treatment to critical patients. It also offers hospitals with outpatient analytics, so healthcare providers can determine what level of care the patient needs. This reduces the burden of healthcare providers and also saves the patient’s cost.

Healthcare providers can also assign a health risk score for each patient. The higher the risk score, the more attention the patient would receive from professionals. This would mean more regular follow-ups and more support from the hospital. The objective is to prevent future health crises and emergency hospitalization. However, to ensure that the data is updated regularly, doctors and nurses should design a workflow to identify high-risk patients and offer preventive care proactively.

Introduce meaningful engagement with patients

Once healthcare providers identify the high-risk and low-risk patients, they can tailor the engagement with each of them accordingly. Sometimes chronically ill patients may require more complex and integrated care from different specialists. Healthcare professionals will have to proactively identify such patients and develop an ecosystem to provide more personalized care to patients.

How can technology help? Big data analytics play a crucial role in creating meaningful engagement with patients. For example, each patient may have their preferences for interacting with healthcare professionals. Some may prefer direct phone calls, or some may prefer to be contacted through email. Some patients may prefer to be engaged through their primary physician. Recording these data will help in creating tailor-made engagement with patients and provide integrated care.

Secure patient data

Patient data is vulnerable to cybersecurity threats. It can cost the healthcare industry $5.6 billion every year. In 2019, over 20 million patient data records were affected by the AMCA healthcare data breach. Not just patient data, even healthcare devices can be tampered easily. FDA has warned that connected insulin pumps are vulnerable to cyber-attacks. Attackers can also change insulin delivery systems from hypoglycemia to hyperglycemia and put a patient’s life at risk.

How can technology help? The first step is to implement a cybersecurity plan in the healthcare organization. Hospitals should install a firewall, install and maintain anti-virus software frequently, have a contingency plan in place in case of a data breach, train every member to identify potential cyber threats and follow the best practices to protect patient data. Most importantly, healthcare providers should be careful about the connected medical devices they prescribe to patients. Those devices should be trustworthy.

Improve the rate of vaccinations

Vaccinations are crucial in population health management. It helps to curb the pandemic diseases from spreading wide.

How can technology help? Healthcare providers can use big data to identify patients who have not received vaccinations as a high-risk population and find ways to engage with them. They can also determine the vulnerable group and plan a patient engagement model to create awareness about the vaccines and encourage them to take it to avoid future infections.


As Malaysia moves towards the fourth industrial revolution and adopts the 5G technology, it’s time for a healthcare organization to embrace technology to make population health management effective. It will help hospitals to transition from volume to value and provide better care to patients. Most importantly, it will reduce the burden of healthcare providers and save them from burnout.