Dr. Timothy Low - Chief Executive Officer and Board Member, Farrer Park Hospital, Singapore

EF: What made you return to an executive role in Farrer Park? 

TL: I set up the hospital from its inception in 2015, and till 2017 I operationalized what is the newest modern private hospital in Singapore. Together with my management team, I put all operations in place within that 2-year frame. I also participated in competitions with other hospitals in Singapore and the region; by the time I left -after 25 months- we had won 25 local and regional awards in various categories. We won awards including “Smart Hospital of the Year 2017” due to the infrastructure, clinical excellence, employee engagement, and business excellence. Once everything was in place, I left to work in biotech, in the rare disease area, as many pharma companies were looking into making rare diseases a part of their portfolios. Then I moved on to healthcare investment in Pavilion Capital, part of Temasek Holdings, Singapore's sovereign government health fund, looking at all the new areas of research and technology for healthcare. Now, I have been asked to return to Farrer Park to help move on to the next stage of growth and development and take it to the next level.

EF: I read the hospital was designed and built to deal with a pandemic quite a few years before the pandemic hit. Could you elaborate on your vision and planning for something that might never occur? 

TL: The hospital is only seven years old, but the planning started over ten years ago. The building has a five-star hotel, a multi-speciality hospital, and a specialist medical centre -three in one- all seamlessly integrated. They are not side by side but completely integrated, a unique model worldwide. I have not seen this seamless integration model of a hotel, hospital, and medical centre anywhere else. We did not know there would be a pandemic, but we did plan for the possibility.

 In a pandemic, isolation and quarantine are needed, with medical care close by, to quickly react to patients' medical conditions. This is why the hotel, hospital, and medical centre were integrated.

 When not in a pandemic, the hotel functions as a business hotel with a convention centre. Because of the integration, we can do live surgery in the hospital operating theatre and be seen from the convention centre by six hundred people for educational purposes. We planned for all this before we built, and live surgery in our operating theatre can be seen anywhere in the world. Caregivers of patients admitted to the hospital can stay in the hotel; they are in the same building as the patients and can get to the ward by way of an access card within two minutes. 

Singapore is small; we have medical tourism and patients coming in from the region due to Singapore's high medical standards; 50% of our patients are from South Asia and Southeast Asia, and the rest are locals. The patients stay in the hospital and their caregivers in the hotel, which is convenient. 

We built the complex with a multipurpose mindset to function normally in "peace times." But if there was a pandemic, we could quickly switch the hotel into a quarantine or isolation area. In a pandemic, borders are closed, and locals are the only patients, so it is ideal for isolation. If there is a problem, they can be in our emergency clinic in two minutes, 24/7. We have trained the hotel staff to monitor and swab people in isolation, permitting us to keep the hotel staff when there is no tourism. The hotel air and water are infrastructurally separated from the hospitals for infection control; we can adapt to the different circumstances with a design that ensures quality and control. The model adjusts based on current needs. During the pandemic, we repurposed two hotel floors for private dining purposes. The hotel cooked and supplied food for dinners for groups of 2, 4, or 5 people per room. Private dining is still being done today; it is popular for small business dinners when privacy is needed. 

EF: What are your insights on digitalization, and how are you using it in your interconnected building?

TL: We use a technology called VDI, Virtual Desktop Infrastructure, which contains all the patient’s information, and the doctors can access it from their mobile phones or tablets in real time. The data can be transmitted anywhere in the world. As the hospital patients' results come in, these go straight to the doctor's phones or tablets, whether at a conference, restaurant, or wherever. If they attend a forum in the US, they also have access to their patient's results. The same happens for monitoring results. The information is password protected and has security, and its real-time connectivity for patient care for the principal doctor and whoever else is taking care of that patient. There is a Smart tablet on each patient's nightstand, and patients can use them to order meals, choose from a menu of 200 choices, read digital newspapers, see the results the doctors show them, and play games. 

Staying at Farrer Park gives access to five-star meals; we don't have a hospital kitchen, but we have a hotel kitchen that covers both as part of our integrated system. The five-star hotel chef cooks for the patients, taking into account the patients' therapeutic needs. We provide unique value and experience to the patient and are an innovative example for Singapore and the world.

EF: How do you see the healthcare hospital facilities evolving in the future? Where is the trend going?

TL: Next for healthcare are AI and automation. AI is decision support for doctors and physicians. I have recently introduced an AI colonoscopy in Farrer Park. In Asia, colorectal cancer is one of the top killers, and nowadays, it is happening in younger patients; I have seen 35-year-old patients getting colorectal cancer. Colonoscopies are a screening tool to help healthcare reduce cases in terms of early detection of colorectal cancer. The difference in an AI colonoscopy is when the doctor introduces the scope; the AI will identify areas the surgeon may have missed, for example, flat polyps, which the AI can find in less than a second and warn the surgeon. It shows around 20 to 30% of missed polyps. Clinical diagnostics for clinical decision-making is an area where AI can help. 

It is very difficult to diagnose dementia, and there are more patients with dementia worldwide. It is important to pick up on dementia early to delay the process with medication or therapies. We have AI-assisted MRI, which helps identify early dementia. When the brain tissues shrink in the early stages, the patient is perhaps a little forgetful, but there is nothing to raise the alarm, but the test can be done for early detection of dementia. We also use AI for cognitive monitoring skills, with the patient taking 20 minutes to do a quiz; the answers go to the algorithm system, which will churn out a report for the doctor to see if the patient has any cognitive decline. The exercise can be followed up every year to monitor the general progress.

Robotics is another important area; knee and hip problems are common as the geriatric population grows. Previously the surgeon relied on his experience to align the hip or knee replacement, and the operation's success depended mainly on the doctor's capacity and expertise. Now we have robotic knee and hip replacement where the alignment is perfect.

Considering Singapore is one of the most innovative countries and very open to technology, how do you see the adoption of artificial intelligence by doctors in Singapore? 

TL: Doctors are generally conservative and cautious, so adopting new technologies in healthcare is slower than in the tech world. They have an inborn fear of wrong decisions or data they personally haven't construed that could affect their reputation. It could even raise medical and legal issues. They wait until somebody else adopts the technology, and if it works, they will also adopt it. Even in Singapore, this happens, and the region has similar behaviour. We need early adopters who like to ride on new health tech to make faster and more accurate decisions and are prepared to use AI. In hospitals in Singapore, RPA (robotic process automation) is adopted because we don't have enough human resources to do the repetitive stuff; therefore, we use software for that work. Adoption is easier in these areas because it doesn't involve decision-making for patients.

We have an educational infrastructure in place; we have the faculty –doctors and specialists- and those interested in continuing their training.

EF: In this digital world, data is becoming critical; how do you evaluate data protection and security? 

TL: Data security is a top concern within the IT structure. We have many cyber security measures in place for tracking anybody out of line, hackers, increased usage in certain areas, and any of the above are quickly flagged. We train our staff regularly to identify phishing or scams and then test them. My employees text me before acting on emails they receive where I am the sender, to confirm that I have written to them, which is good news regarding their learning to detect a scam.

EF: Singapore is known for its startup culture in the health tech area; if you had to create a new health sector startup in Singapore in 2023, what would it be and why? 

TL: I would look for unmet needs and areas where a large population would benefit. Two areas come to mind:

1. Home monitoring for chronic diseases, where the user can easily buy into and embrace the service. Hypertension and diabetes affect many people and especially elders who struggle with chronic illnesses. That is why home monitoring devices should have a simple design and remind them to take their medication, take their blood pressure, or test their urine or blood for sugar in the case of diabetics. Again, we need these systems to be simple in order to work for chronic disease management. It is like having a hospital at home, which is a trend now. 
2. Borderless healthcare: getting a second and third opinion or consult from wherever you are. A well-connected platform to access a second opinion from afar -making it borderless- to seek and decide where to be treated. It is more than telemedicine, offering healthcare beyond borders.

EF: When you look back at this period in your professional career, how would you like to be remembered considering you navigated difficult times? 

TL: Leadership is about building new leaders within the organization. There are leaders at every level, and individuals should be leaders of their own lives and areas of influence. I want to be of significance; by this, I mean touching and improving the lives of others. That would be my contribution and my satisfaction. 

EF: Is there a final message you would like to share? 

TL: Being green and sustainable is important nowadays. Our entire building is green, and we have been certified "Green Mark Platinum," the highest accolade given to a facility that saves energy. ESG is our top priority; we save 30% on energy annually to maintain this certification while helping the environment and being sustainable, and we work on the staff having the same mindset. There are fifteen gardens within our complex. We aim to be green and to heal; bringing the patients closer to nature has a healing component. Biophilic architecture brings nature closer to people and is part of healing. Finally, art can also help to relax people; hospitals can make people anxious, and we have more than seven hundred pieces of art within the complex. The art is uniquely curated and, in a few cases, drawn for the building. We support regional artists; each piece has the artist's name and the reason the work was created. The art helps patients and caregivers release anxiety and stress. Art and nature are part of the healing process in Farrer Park.