A Malaysian digital health startup is embarking on a journey to responsibly build a better health system with technology, aiming to reduce specialist consultation time and cost.

One upside of the COVID-19 outbreak is that it accelerated innovation in healthcare, leading to the emergence of promising new startups worldwide. Angsana Health was founded in Kuala Lumpur in 2022, in the aftermath of Malaysia’s two-year pandemic, with co-founders Dr. Swee Kheng Khor and Dr. Ginsky Chan recognising an opportunity to address gaps in the nation’s healthcare system and also in Southeast Asia.

What makes Angsana particularly noteworthy isn’t just their range of digital health services, from autism care to a virtual liver clinic; it’s also the support they provide to healthcare professionals venturing into digital health through the Angsana Academy. Angsana not only implements digital health solutions but also actively share their expertise in partnership with IMU University, Malaysia’s oldest private medical school. 

Dr. Khor and Dr. Ginsky shared their approach and ambitions with me over lattes at a tropical forest-inspired cafe, appropriately named Botanica Deli (Angsana is a hardwood tree in Southeast Asia), in KL’s vibrant commercial hub Bangsar South.

The two are both experienced physicians, which is not unusual for founders of digital health startups, with international backgrounds.

Based in Hong Kong, Dr. Khor has a 19 year career in clinical practice, pharma and global health, gained in Singapore, Shanghai, Paris, Hong Kong and Dubai, among other places. He also holds three postgraduate degrees: in Internal Medicine from the Royal College of Physicians of the UK, in Public Health from University of California, Berkeley and in Public Policy from Oxford University. 

Access Director Dr. Ginsky, with a career spanning five years, studied Medicine and practised in India. He returned to his native Malaysia to continue practising before pursuing his Masters in Public Health, majoring in health economics, at the London School of Hygiene and Tropical Medicine.

When the pandemic struck, the co-founders realised that healthcare services could be improved with the adoption of technology.

Angsana envisioned building a better health system that is more digital first, Dr. Khor explained, citing Kaiser Permanente, an American healthcare provider and not-for-profit health plan as a concept that provided inspiration for his business. “The pandemic helped by bringing digital health to the forefront of people’s minds,” he said.

Collaborating with experts

Leveraging their expertise and enthusiasm to enable better healthcare, Angsana focused on providing digital health services in the areas of autism, liver care, and senior health.

“The Angsana teams building these services have first-hand experience of having an elderly parent or family member with autism or a non-communicable disease,” Dr. Ginsky said. “We are passionate about these problems and believe they are something we need to address.”

“The world also needs solutions, and the problem needs to be big enough for us to venture as a business to solve it,” he continued, emphasising the team’s clinical expertise. ‘Half of us are doctors, with six specialists among us. Additionally, there are 34 Master’s and PhD graduates within our team.”

Angsana’s expertise also extends to external partners. “We can’t do everything alone,” he acknowledged. “For autism we partner with the National Autism Society of Malaysia, for example, and for our non-communicable diseases, we collaborate directly with the manufacturer of the FibroScan machine.”

Collaborating with the healthcare industry is something Dr. Khor knows a lot about, meanwhile: he is also a co-founder of the Malaysian Health Coalition (MHC). The coalition of Malaysian health professional societies, health professionals, and citizens was launched during the COVID-19 pandemic to speak with one voice in support of the country’s health system. Today, the MHC comprises 53 professional societies and over 20 individual members.

Affordable and accessible consultations

Venturing into digital health didn’t prove a barrier for Angsana’s co-founders. “We both belong to a generation more familiar with technology, so that really helped,” Dr. Khor smiled. 

“Angsana doesn’t always use cutting-edge technology, “ he continued. “The adoption curve is slow. Sometimes technology just needs to be sufficiently advanced so that it appeals to the user, without being so advanced that it scares the user.”

Adding to this, Dr. Ginsky underscored Angsana’s clinical background. “Our domain expertise is in healthcare and we are well positioned to address the most imminent challenges. We define the problem, determine the best approach, and bring in specialists. Technology may or may not solve the problem.”

It’s why the company is cautious about deploying cutting-edge technologies like generative AI. 

“Even if you deploy the most advanced artificial intelligence, patients might not trust it immediately, and payers might not understand and pay for it,” Dr. Khor said.

Dr. Ginsky agreed. “Simple tech may be enough, so long as the clinical protocols are strong enough that define what can and cannot happen in a virtual consultation. We would like to have a more stable, safe, and cost effective fundamentals, and maybe then can we deploy Gen AI.”

These clinical protocols include checklists and examinations to be performed prior to a virtual consultation, effectively task-shifting, so that patient-specialist interactions are well-used and not wasted through assuming tasks that can ordinarily be undertaken by a GP.

“Accessing specialist care is challenging,” explained Dr. Ginsky, citing long waiting times, cost considerations, and distance from a patient’s home as contributing factors.

Task-shifting not only streamlines specialist consultations but also lowers associated costs. In Malaysia, the average specialist consultation lasts 30 minutes with a fee of 200 ringgit. Reducing consultation times to 15 minutes could halve the cost.

Healthcare practitioners support the approach. “GPs can maintain patient care without necessarily referring them to a tertiary hospital,” explained Dr. Ginsky. “Reducing the average consultation time also allows specialists to see more patients.”

Dr. Khor added that GPs should ideally “co-manage” patients with specialists, emphasising that retaining patient care also ensures continued revenue for the GP.

Angsana’s co-founders emphasised that patients are also comfortable with virtual consultations, enabling them to access specialists affordably without the inconvenience of hospital visits and waiting times. 

Additionally, patients retain ownership of their data. “Data is sacred and belongs to the patient. We have no intention to collect or monetize patient data,” stated Dr. Khor firmly. “We do not aspire to become a data company in the traditional sense, that monetizes user data as their sole business model.”

Building digital health capabilities

The shift towards embracing digital health in Malaysia has been rapid, marking a significant departure from pre-pandemic times.

During the outbreak there wasn’t sufficient awareness of digital health among healthcare practitioners, according to the Angsana co-founders. Seeing a gap in the market, the company launched an academy to educate providers on how to apply digital health in clinical practice. 

“We introduced a six-week course teaching doctors the fundamentals, for example, ethics and regulations, and how to examine the patient through virtual consultation,” said Dr. Ginsky. “While there was a boom in virtual consultations at the time, no one was teaching healthcare practitioners the regulations involved.”

Upon completion of the course, attendees receive a micro-credential certificate from the IMU University, a health sciences university in KL.

Looking to the future, Angsana Health is seeking to expand its digital health offerings with a variety of new services. 

“We’re developing an exercise program to strengthen the muscles of elderly patients, and we will undertake a comprehensive hazard assessment to eliminate risks in the home and prevent falls,” said Dr. Ginsky, noting that as today’s tech-savvy generations age, more patients will embrace digital health. 

“Additionally, we’re launching a virtual brain exercise program for patients with mild to moderate dementia. We also have plans for interventions to guide children with autism towards better development.”

After initially offering digital services in key Malaysian cities such as Kuala Lumpur, Ipoh, and Penang, Angsana is now eyeing new markets, Dr. Khor revealed, prioritising the biggest countries in Southeast Asia over a 10-year period: Vietnam, the Philippines, Thailand, and Indonesia. “We think healthcare is very local,” he said.

Advancing digital health responsibly

While Southeast Asian countries have attracted significant investments from major tech companies recently (Google, Microsoft, and Bytedance among others have pledged billions of dollars), government regulations must keep pace with advancing technologies such as AI, Dr. Khor noted. 

He also pointed out the increasing presence of non-healthcare professionals entering the digital health industry in Southeast Asia, including investment bankers, private equity, and family-owned businesses. “I welcome this as they are strengthening the healthcare system because of new perspectives,” said Dr. Khor. “However this could also be challenging because of their limited knowledge of medical ethics and regulations, lack of direct patient experience, and because they believe they can apply industry or manufacturing practices to healthcare.”

Dr. Khor further cautioned that digital health claims that “promise the world” are “misleading and perhaps unsafe”, noting that digital solutions are not always warranted, such as in the cases of cataract surgeries or the insertion of a pacemaker.

The co-founder was keen to emphasise that all digital health companies must comply with local laws, clinical practice standards, guidelines, and professional expectations. Any unethical, unlawful, and immoral behaviour should be met with enforcement measures.

On its part, Angsana adheres strictly to its Code of Business Conduct and will soon introduce a Code of Artificial Intelligence Conduct. “Silicon Valley’s philosophies of ‘Move fast and break things’ and ‘Ask for forgiveness, not permission’ must not hold in healthcare,” Dr. Khor said.

As we wrapped up the interview, it was encouraging to learn how the digital health industry in Southeast Asia can grow responsibly, through transparency and enforcement, perhaps avoiding some of the bigger ethical transgressions seen from unscrupulous technology companies in recent years. Digital health that is robust and wide-spreading: analogous to the Angsana tree itself.