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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application i
Concept Request for Proposal
GOVERNMENT OF MALAYSIA
Telemedicine Flagship Application

CONTINUING MEDICAL EDUCATION
Ministry of Health (MOH)
MALAYSIA, 25 July 1997

Multimedia Super Corridor
Copyright © 1997 Government of Malaysia 1
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application ii
Content 1. OVERVIEW................................................................................................................................................................ 1
1.1. INTRODUCTION TO THE MSC ....................................................................................................................................... 1 1.1.1. Overview and Objectives of MSC ..................................................................................................................... 1
1.1.2. MSC Flagship Applications ............................................................................................................................. 2 1.2. INTRODUCTION TO TELEMEDICINE ................................................................................................................................. 2
1.2.1. Objectives of Telemedicine............................................................................................................................... 2 1.2.2. Vision of Telemedicine..................................................................................................................................... 3
1.2.3. Approach to Achieving Telemedicine................................................................................................................ 3 1.2.4. Concept Request For Proposal........................................................................................................................ 4
1.2.5. Other Documents............................................................................................................................................. 4
2. OUTLINE OF CRFP................................................................................................................................................... 5
2.1. INTRODUCTION TO THE PILOT PROJECT........................................................................................................................... 5 2.1.1. Objectives of the Pilot Project.......................................................................................................................... 5

2.1.2. Background Information of the Pilot Project .................................................................................................... 5 2.1.3. Scope of the Pilot Project................................................................................................................................. 6
2.1.4. Timeline of the Pilot Project .......................................................................................................................... 10 2.1.5. Evaluation of the Pilot Project ....................................................................................................................... 11
2.2. FUNCTIONAL REQUIREMENTS..................................................................................................................................... 11 2.2.1. Operational Requirements ............................................................................................................................. 12
2.2.2. Maintenance and Support Requirements......................................................................................................... 13 2.2.3. Performance Requirements ............................................................................................................................ 14
2.3. TECHNICAL REQUIREMENTS....................................................................................................................................... 15 2.3.1. Standards ...................................................................................................................................................... 15
2.3.2. Technical Service Level Requirements............................................................................................................ 17 2.4. IMPLEMENTATION REQUIREMENTS .............................................................................................................................. 17
2.4.1. Project Management Methodology................................................................................................................. 17 2.4.2. Proposed Project Team Structure................................................................................................................... 18
2.4.3. Action Plans to Remove Implementation Obstacles......................................................................................... 18 2.4.4. Risk Management Requirements..................................................................................................................... 18
2.4.5. Training Programs ........................................................................................................................................ 18 2.4.6. User Acceptability ......................................................................................................................................... 19
2.4.7. Acceptance Test Plan.................................................................................................................................... 19 2.4.8. Change Management Programmes................................................................................................................. 19
2.4.9. Quality Assurance Plan ................................................................................................................................ 20 2.4.10. Technology Transfer Plan........................................................................................................................... 20
2.5. FINANCIAL REQUIREMENTS........................................................................................................................................ 20 2.5.1. Business Model Requirements........................................................................................................................ 20
2.5.2. Business Model............................................................................................................................................. 21 2.5.3. Financial Proposals ...................................................................................................................................... 23
2.6. CAPABILITIES OF THE RO.......................................................................................................................................... 24 2.6.1. Project Management Capabilities ................................................................................................................. 24
2.6.2. Training Capabilities.................................................................................................................................... 24 2.6.3. Support Capabilities ..................................................................................................................................... 24
2.6.4. Financial Capabilities .................................................................................................................................. 24 2.6.5. Technical Capabilities ................................................................................................................................... 25

3. ENVIRONMENT...................................................................................................................................................... 26
3.1. ORGANISATIONAL ENVIRONMENT ............................................................................................................................... 26 3.1.1. Mission and Objectives of the MOH ............................................................................................................... 26

3.1.2. Existing CME Programmes............................................................................................................................ 26 3.1.3. CME- Related Organisations .......................................................................................................................... 27
3.2. TECHNICAL ENVIRONMENT........................................................................................................................................ 27 3.3. FUTURE PLANS........................................................................................................................................................ 27

4. INSTRUCTIONS TO RESPONDING ORGANISATIONS ..................................................................................... 28
4.1. COMMUNICATION..................................................................................................................................................... 28
4.1.1. Responding Organisations Briefing ........................................................................................................... 28 4.2. SUBMISSION OF PROPOSAL......................................................................................................................................... 28

4.2.1. Time and Date.............................................................................................................................................. 28 4.2.2. Mode of Delivery and Address ....................................................................................................................... 29
4.2.3. Marking ....................................................................................................................................................... 29 4.2.4. Number of Copies and Separation of Sections of Proposals ............................................................................. 29
4.2.5. Deposit.......................................................................................................................................................... 29 4.2.6. Receipt of Proposal ....................................................................................................................................... 30 2
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application iii
4.2.7. Amendments ................................................................................................................................................. 30 4.2.8. Validity of the Proposal ................................................................................................................................ 30
4.2.9. Advertisement............................................................................................................................................... 30 4.2.10. Performance Bond....................................................................................................................................... 30
4.2.11. Letter of Undertaking................................................................................................................................... 31 4.2.12. Language .................................................................................................................................................... 31
4.2.13. Currency ..................................................................................................................................................... 31 4.2.14. Contents ...................................................................................................................................................... 31
4.3. SELECTION ............................................................................................................................................................. 32 4.3.1. Evaluation of Proposals and Short- list ........................................................................................................... 32
4.3.2. Multi- track Negotiations ................................................................................................................................ 32 4.3.3. Final Selection .............................................................................................................................................. 33
4.3.4. Implementation.............................................................................................................................................. 33 4.4. PROCESS TIMELINE .................................................................................................................................................. 33
4.5. MANDATORY REQUIREMENTS AND EVALUATION CRITERIA.............................................................................................. 33 4.5.1. Mandatory Requirements............................................................................................................................... 33
4.5.2. Evaluation Criteria........................................................................................................................................ 34 4.5.3. Responding to Specific Evaluation Criteria .................................................................................................... 34
4.6. RIGHTS OF THE GOVERNMENT .................................................................................................................................... 36 4.6.1. Amendments .................................................................................................................................................. 36
4.6.2. Acceptance of Proposals................................................................................................................................ 36 4.6.3. Cost of Proposal............................................................................................................................................ 36

4.6.4. RO s Responsibilities................................................................................................................................... 36 4.6.5. Non- liability .................................................................................................................................................. 36
4.6.6. Confidential Information ............................................................................................................................... 36 4.6.7. Failure of Negotiation ................................................................................................................................... 37
4.6.8. Discrepancy of Document.............................................................................................................................. 37 4.6.9. Withholding Tax ............................................................................................................................................ 37
4.6.10. Governing Law............................................................................................................................................ 37 APPENDIX 1 - MMC- CME GRADING SYSTEM........................................................................................................... 38
APPENDIX 2 - ANNUAL INTAKE CAPACITY OF TRAINING SCHOOLS BY TYPE OF TRAINEES, MALAYSIA, 1993 .................................. 39 APPENDIX 3 - HEALTH MANPOWER POPULATION RATIO BY CATEGORY OF MANPOWER, MALAYSIA IN 1993 .................................. 40
APPENDIX 4 - RESPONDING ORGANISATION`S UNDERTAKING FORM ........................................................................................ 41 APPENDIX 5 - BANK GUARANTEE DEPOSIT FORM ................................................................................................................ 42
APPENDIX 6 - QUANTUM OF DEPOSIT FOR RESPONDING ORGANISATIONS .................................................................................. 43 APPENDIX 7 - BANK GUARANTEE FORM FOR PERFORMANCE BOND ......................................................................................... 44
APPENDIX 8 - GLOSSARY................................................................................................................................................. 47 3
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 1
1. Overview
The purpose of this document is to enable organisations to respond to a ÒRequest For
ProposalÓ (RFP) for the procurement of Continuing Medical Education (CME) for the
Government of Malaysia.

1.1. Introduction to the MSC

1.1.1.Overview and Objectives of MSC
Malaysia s Multimedia Super Corridor (MSC) aims to revolutionise the way
business is conducted. Located at the hub of Asia s fastest growing markets,
the MSC will unlock multimedia s full potential by integrating ground
breaking cyberlaws and outstanding information infrastructure in an attractive
physical environment. The MSC will be a regional launch site for companies
developing or using leading multimedia technology, allowing these innovators
to harness Malaysia s unique competitive advantages that arise from its
multicultural links, committed leadership, and proven track record in
developing products and services for regional and global markets.

The MSC is a gift from the Malaysian Government to technology developers
and users seeking to expand their Asian presence, to Malaysians wanting their
country to prosper, and to neighbouring countries aspiring to partner with a
technology hub. The MSC is a 15- by- 50- kilometer zone extending south from
Malaysia s present national capital and business hub, Kuala Lumpur. The
nation is devoting this massive corridor to creating the perfect environment for
companies wanting to create, distribute and employ multimedia products and
services.

The MSC will bring together four key elements:
· Best possible physical infrastructure, including Kuala Lumpur City Centre, a new world class airport and an integrated logistics hub, rapid rail
links to Kuala Lumpur, a smart highway, and two intelligent garden cities.
· New laws, policies, and practices designed to enable and encourage electronic commerce, facilitate the development of multimedia
applications, and putting Malaysia as the regional leader in intellectual
property protection.

· High capacity global telecommunications infrastructure built on MSC s 2.5 gigabit to 10 gigabit digital optical fibre backbone using ATM

switches to provide fibre to the building. This network will have a 5
gigabit international gateway with direct links to US, Europe, and Japan,
as well as other nations in Southeast Asia. 4
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 2
· One- stop shop - the Multimedia Development Corporation (MDC) -created to manage and market the MSC. The MDC s mission is to create
the best environment in the world for private sector companies to pursue
multimedia and to facilitate their investment in the MSC. The MDC is a
high powered one- stop shop wholly focused on ensuring the success of
the MSC and the companies operating in it.

1.1.2. MSC Flagship Applications
To spearhead the MSC s evolution, the Malaysian Government has targeted
seven multimedia applications for rapid development. These flagship
applications are Electronic Government, Telemedicine, Smart Schools,
Multipurpose Card, R& D Clusters, Worldwide Manufacturing webs, and
Borderless Marketing Centres.

The objective of these flagship applications is to attract a critical mass of
world- class companies to develop leading edge applications, products, and
services in the MSC. Specifically, the flagship applications aim to increase the
productivity and competitiveness of Malaysia and also create a global test bed
for innovative solutions.

The flagships will improve Malaysia s productivity and competitiveness by
increasing the efficiency and effectiveness of technology transfer and creating
an environment that nurtures highly competitive webs of Malaysian and
international small and moderate enterprises. The flagships will also increase
foreign direct investment into high technology and will accelerate the
development of a vibrant and robust services sector.

The flagship applications also aim at creating a global test bed for innovation
by allowing consortia to pioneer new applications of multimedia in the public
and private sectors. The flagships will also build platforms for ongoing
innovation and create standards that allow growing reverse investment from
MSC consortia. The flagship will create the opportunity for the MSC to
develop a strong reputation in commercial R& D and will also strengthen
Malaysia s skill base in multimedia R& D.

1.2. Introduction to Telemedicine
1.2.1.Objectives of Telemedicine
Telemedicine is one of the flagship applications of the MSC. The Government
of Malaysia launched the Telemedicine initiative to lead the country s
healthcare system in the information age. In addition, Telemedicine will play
an essential role in catalysing the development of the MSC, as well as
furthering the economic development goals in Vision 2020. 5
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 3
1.2.2.Vision of Telemedicine
The vision of Telemedicine in Malaysia is to establish a healthcare system in
the information age which harnesses the power of information and multimedia
technologies to benefit the country and its people. Telemedicine, therefore
refers to the provision of healthcare and healthcare related services to all
players in the healthcare system using information and multimedia tools,
technologies and networks. Choosing a broad definition like this, the domain
of Telemedicine in the future is potentially unlimited. Through the seamless
and ubiquitous availability of virtual services, Telemedicine will dramatically
change the way the general public and healthcare professionals interact with
the healthcare system of the future.

In Malaysia, Telemedicine will enable the achievement of Malaysia s
healthcare vision and goals.

The national healthcare vision states:
Malaysia is to be a nation of healthy individuals, families and communities,
through a health system that is equitable, affordable, efficient, technologically
appropriate, environmentally adaptable and consumer friendly, with emphasis on quality, innovation, health promotion and respect for human dignity and

community participation towards an enhanced quality of life.
The alignment of Telemedicine with Malaysia s healthcare goals will ensure
the realisation of the vision. The goals define a future healthcare system which
is characterised by person and wellness focused services which empower and
encourage individuals to be well informed on health and to select lifestyle and
health management options that result in the highest possible state of health
throughout life. These services will be provided at home or close to home.
They will be seamless and continuous in nature and tailored to the individual s
and community s needs.

1.2.3.Approach to Achieving Telemedicine
The vision of Telemedicine will require a comprehensive development and
implementation program touching all aspects of health care. It will require
new processes, systems, structures, training to develop new skills and shared
values. A detailed description of the vision, the goals and the implementation
approach is provided in the ÒTelemedicine BlueprintÓ. The initial pilot
projects under Telemedicine flagship application are teleconsultation,
continuing medical education, mass customised/ personalised health
information and education and a life time health plan. 6
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 4
1.2.4. Concept Request For Proposal
This Concept Request For Proposal (CRFP) is a document designed to
describe the benefits the Ministry of Health (MOH) is seeking from
Continuing Medical Education (CME), being one of the four chosen pilot
projects, and to give companies responding to the CRFP the flexibility
required to innovate the best solutions to deliver the described benefits.
Specifically, this document will detail:

· solution requirements - functional, operational, technical, financial, and implementation. (Technical requirements are kept to a minimum to allow

responding organisation s room to respond with creative solutions. )
· required capabilities of the responding organisation (RO) such as organisational, financial and technical.

· existing environment both organisational and technical
· general terms and conditions of the document.
· instructions for the RO including timeline.

1.2.5.Other Documents
This CRFP shall be read together with the following documents :

· ÒMalaysia s Telemedicine BlueprintÓ This document describes how multimedia and information technology will be harnessed to realise the
future healthcare vision to Malaysia. It explains the goals of telemedicine
and outlines the implementation approach.

· ÒTelemedicine StandardsÓ This document provides an overview of each technology appropriate for Telemedicine and a list of current

standards that are required to be considered in designing new systems
solutions to ensure co- ordination and compatibility across all present and
future Telemedicine applications. 7
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 5
2. Outline of CRFP
2.1. Introduction to the Pilot Project
This project concerns the provision of appropriate multimedia solutions to further
enhance the delivery of CME through distance learning methods for healthcare
professionals in Malaysia.

2.1.1.Objectives of the Pilot Project
The ultimate goal of this pilot project is to harness IT and multimedia to
continuously upgrade knowledge skills and competence of healthcare
professionals in the country irrespective of geographic location. It is also
envisioned to help shorten the duration of certain postgraduate and postbasic
training programmes without sacrificing the quality of training. MOH also
intends to reduce the feeling of professional isolation among healthcare
professionals serving in remote areas by providing access to the latest
health/ medical knowledge. In more specific terms, the objectives of the pilot
project are:

· to enhance modular distant learning programmes for healthcare professionals to update and upgrade their knowledge.

· to improve formal distant education programmes to acquire postgraduate and postbasic qualifications.
· to provide access to virtual resources such as knowledge database and learning tools to healthcare professionals to support their work.

2.1.2.Background Information of the Pilot Project
Education and training in healthcare is an essential and continuous activity for
healthcare providers. In 1996 the MOH spent approximately RM 91.9 million
or 4.5% of the total operational budget for both basic and postbasic or
postgraduate training. CME is part of professional development for all
healthcare providers. After acquiring basic competencies from basic
qualification or degree, healthcare professionals are required to attain desired
increased levels of competencies for their profession. This attainment is
normally done through three main methods:

· reading such as books, journals, literature, audio- visual materials, Internet, CDs, correspondences.

· meetings such as lectures, ward rounds, research outcomes, discussions, interviews, seminars, congresses, conferences, bed- side teachings,
demonstrations, case presentations. 8
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 6
· courses such as training, attachments, classroom teachings, tutorials, workshops and post- graduate courses.
These activities are of varying duration from one hour to few years depending
upon the level of competencies (scope) and the place of activity.

Doctors or medical practitioners currently undergo voluntary CME grading
system which has been introduced since January 1995 (detailed information
relating to CME grading system is as shown in Appendix 1). Medical
practitioners attending such courses are awarded points as incentives which
aims to encourage medical practitioners in Malaysia to upgrade and update
their medical knowledge and skills. A CME secretariat at the Malaysian
Medical Association (MMA) provides administrative and secretarial
assistance to co- ordinate and collect credits points on behalf of the Malaysian
Medical Council (MMC). Every registered medical practitioner will be issued
annually an MMC- CME Certificate with total number of points.

CME today is an important complement to the existing educational system,
but has unresolved issues and problems such as the high cost involved in
establishing and maintaining facilities, difficulty in meeting changing
demands due to demographic changes and diseases trends alterations and staff
shortages in the deployment of knowledge workers, arising from the relatively
long duration in training and unattractiveness of rural settings.

2.1.3.Scope of the Pilot Project
The scope of the pilot project is as follows:

2.1.3.1. Categories of CME
The RO shall provide the following categories of CME services:

· modular distant learning programmes structured study programmes or learning modules to support updating and upgrading of knowledge and
skills which include the programmes for medical practitioners provided
by MMA.

· formal distant education programmes a programme which encompasses virtual higher education and which may shorten the learning
period for acquiring postbasic and postgraduate qualifications (detailed
information relating to training schools is as shown in Appendix 2).

· virtual resources a tool to access to the local and international
knowledge databases, publications, practice guidelines such as virtual
library and directory of services and activities such as locations, topics,
type of information. 9
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 7
2.1.3.2. Programme Areas
The RO shall provide programme areas which are comprehensive in nature. In
order to facilitate regular effective monitoring and evaluation, the topics to be
covered in the pilot project shall be based on epidemiological indicators such
as mortality and morbidity and the following criteria:

· disparity of outcome result from place to place (gap analysis) - wide difference in management and treatment of similar problems among
practitioners shall be highly regarded.
· good documentation or data record - topics with acceptable and sound databases shall be given priority.

· clinical drive - areas where professionals want to make changes in
management or treatment profiles will facilitate acceptance among the
target users or beneficiaries.

2.1.3.3. Content
The RO shall provide content for all the categories and programme areas
which may include:

· packaged information such as pattern of diseases, lifestyle activities, product features)

· training courses such as classroom teachings, hands- on- tutorial, bedside teachings, stepwise training.
· education materials such as case studies, basic practices, research work.
· outcome studies such as success rate, clinical trails.
· knowledge databases.
· full- text information from medical text books or articles on journals.
· clinical practice guidelines which are available both locally and internationally.

To achieve the objectives of the pilot project, the content shall meet certain
standards. The RO shall propose a list of content as well as the quality level of
the content in light of the overall objectives of the pilot project.

The RO shall warrant that all items sold, licensed or rented to MOH singularly
or collectively do not infringe any patent, copyright, trade mark, design or any
other intellectual property rights. The RO shall be solely responsible for any
claims arising howsoever and wheresoever out of such infringement, and shall
hold the Government harmless against any claims or liabilities. 10
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 8
2.1.3.4. Target Users/ Beneficiaries
The potential target users of this pilot project are healthcare professionals
including medical practitioners, nurses, pharmacists, therapists, medical
assistants both in the public and the private sector (detailed information
relating to the healthcare personnel is as shown in Appendix 3). The RO may
conduct demand surveys and identify user groups with greater demand for
CME. The pilot project shall be easily accessible to the target users.

2.1.3.5. Delivery Channels
The RO shall make CME accessible both from healthcare facilities and home.

2.1.3.6. Deliverables
The RO shall provide the following deliverables:

· content development: RO shall develop content or identify appropriate information suppliers for modular distant learning programmes, formal
distant education programmes, and virtual resources. If the RO develops
content internally and shapes up the content so that the information will
be easy to read, understandable and easy to access, the role for the RO is
regarded as both Information Supplier (IS) and Information Developer
(ID). If the RO outsources content from outside parties, the RO s role is
only as Information Developer.

· maintenance and updating of content: RO shall maintain and update the content to accommodate changing demand and new research findings.

· system development: RO shall develop content database and application systems for information delivery and monitoring of usage.
· provision of CME through multiple delivery channels: RO shall deliver CME programmes through multiple delivery channels which will
provide linkage between providers and beneficiaries such as government
hospitals and clinics, private hospitals, general practitioners (GPs), non-governmental
organisations (NGO) and individuals at home. The role for
the RO in this aspect is regarded as Information Provider (IP).

· market the CME programmes to healthcare professionals: The RO shall market the CME programmes to healthcare professionals both in
public and private sector.
· measurement of the effectiveness of the pilot project: RO shall assist the MOH in evaluating the effectiveness of the pilot project through
provision of statistical data and other measures.
· overall management of the project. 11
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 9
The RO is not required to provide network infrastructure which will be
provided by local telecommunication carriers or the selected RO in the
Electronic Government. However the RO in this pilot project shall ensure that
its solution shall interface with the networks provided by the said entities.

Even though multiple parties could contribute in developing such a
comprehensive, effective and affordable CME programmes, there shall be one
co- ordinator in the RO who acts as one shop window to the MOH. To
guarantee the delivery of right information to healthcare professionals in
Malaysia, all the information shall be approved by the MOH before going out
to the targeted users.

The overview of the pilot project is as shown in Figure 1.

Channel Users /Beneficiary
Hospital

Homes

Delivery Source
Network
access

Service provider Content provider

°Content
database

°Delivery and
monitoring

Ministry of Health
Access
° Internet
° Telephone- line
° ISDN- line
° PC
° Phone
° Fax
° Others

° Medical
practitioners
° Nurses
° Pharmacists
° Therapists
° Medical
assistants etc.

Clinics/ GPs
°Hospital
°University
°Suppliers
(medical/ drugs)
°Professional
organizations
°Training
Institutions
°Others

Healthcare
Professionals

Training
Schools

Figure 1: Overview of the pilot project
2.1.3.7. Geographic Scope
The CME services shall be available to all targeted users throughout Malaysia.
However, there will be two focus areas for the purpose of monitoring and
evaluating the effectiveness of the pilot project.

The two initial focus areas are :
Site A: MSC Area and its vicinity
The selected focus area includes MSC area which covers a 15km by 50km
zone extending south from Kuala Lumpur and its vicinity including Wilayah
Persekutuan, Hulu Langat District, and Seremban District. 12
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 10
Site B: Non MSC Area - Kinta District
Kinta District which includes Ipoh has been identified as the initial non MSC
focus area for this pilot project.

The RO shall ensure that CME services are provided in these two focus areas.
In these areas, all health clinics and hospitals involved in Teleconsultation
CRFP will have video conferencing capabilities and those involved in the
Mass Customised/ Personalised Health Information and Education CRFP will
have computers with network capabilities such as Internet which can be used
for CME as well.

2.1.4.Timeline of the Pilot Project The duration of the pilot project is 5 years. During this period, RO shall extend
its CME programmes in terms of coverage of topics, target users and depth of
content. The RO in its submission to this CRFP shall information on specific
implementation schedule, key milestone dates, and key deliverables.

The RO shall start its first wave of CME programmes in 1998, after setting up
all the necessary systems, content and infrastructures. The RO shall expand
services over the pilot project period and increase options for users.

The implementation schedule for the pilot project is as shown in Figure 2.

Infrastructure/
system set up

Content creation

Delivery
Check points

Activity
1998

Hardware, software and processes in place
1999 2000 2001 2002

Regulatory/ accreditation body in place
°i Focus areas °j
Others

Postbasic & postgraduate programmes
Modular courses
Content database

Update, improve and add
content/ programmes

System and
content

Reach,
accessibility,

Nation- wide

Usage,
acceptance

Figure 2: The implementation schedule of the pilot project. 13
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 11
2.1.5.Evaluation of the Pilot Project
At the end of the pilot project, the project shall be able to demonstrate the
following benefits:

modular distant learning programmes:
· increased number of medical practitioners who voluntarily join the current CME grading system.

· able to support structured approach to accreditation and grading process.
formal distant education programmes:
· increased number of healthcare professionals to take postbasic and postgraduate courses.

virtual resources:
· equitable distribution of expert knowledge and skills.
· quicker and accurate delivery of knowledge.
And for overall:
· improved access to learning facilities.
· increased number of healthcare professionals to take CME programmes.
· increased communication among practitioners.
· reduced professional isolation.
· reduced opportunity cost incurred on the health professionals.
· better co- ordination of CME activities.
· improved consistency of practice (standards).
· optimised use of practice guidelines and treatment protocols.

2.2. Functional Requirements
The solutions provided by the RO shall satisfy functional requirements described in
this section. Functional requirements consist of three components: 14
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 12
· operational requirements.
· maintenance and support requirements.
· performance requirements.
For each component, requirements are described in three parts, namely:
· content creation and management.
· content and service delivery.
· receiving and viewing of content.

2.2.1. Operational Requirements
2.2.1.1. Content Creation and Management
· Content: Education content shall be based on high needs and high value to the targeted users. The RO shall conduct needs analysis in determining the

type of content to be offered.
· Content design: Content shall be designed to motivate the users to use the CME services. In order to achieve this, text shall be easy to read by
appropriate layout, diagrams and charts shall be inserted whenever
necessary to help clear understanding, and the content design allows users
to interact with virtual teachers in studying the material.

· Data storage: Data storage design shall make it possible to store structured and unstructured data in a distributed environment.

· Data back- up: Database shall be able to back up the content either manually or automatically at a suitable time frame.
· Data security: Database shall be highly secured from intrusions of unauthorised users.
· Database Engine: Database engine shall support relational and objects
models or a hybrid of the two.

2.2.1.2. Content and Service Delivery
· Physical access: Physical access shall be possible through various types of medium including telephone (PSTN), ISDN, leased circuits, microwave

and satellite. 15
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 13
· Access point/ gateway: User access shall be done through an access point/ gateway provided by the Electronic Government Flagship
Application or existing telecommunications carriers.
· Interactive: CME programmes shall be interactive so that users can ask and/ or respond to questions.

· Self assessment component: CME programmes shall be such that users can make self assessment of their knowledge if necessary.
· High availability: Service shall be available 24 hours a day.
2.2.1.3. Receiving and Viewing of Content
· Access through Internet: Users shall be allowed to access to the CME services through Internet.

· Search Engine: Existing web search engine shall be supported.
· E- mail: End- user application shall support e- mail function which allows different computer users to communicate through the network.

· Discussion groups: In areas where interactions among users are useful, the RO shall provide discussion groups.
· Bulletin Board: End- user application shall allow users to access to bulletin board on the network.
· Video- conferencing: Video conferencing capability is not a requirement. However, the RO may consider video- conferencing whenever it is
effective and not costly to users.
· End- user interface: End- user interface shall be user friendly with graphical user interface.

· Interactive: The CME programs shall be interactive.

2.2.2. Maintenance and Support Requirements
2.2.2.1. Content Creation and Management
· Regular update: Content shall be regularly updated to accommodate new findings and changing demand.

· Regular monitoring of usage: Usage of content shall be regularly monitored in order to meet demands. 16
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· New programs: New programs shall be offered every year.
· Back- up: List of records of all back- up modules shall be kept.
· Database security: The database system shall be secured with gateways or firewalls.

· Database management: The database shall be managed by a proven database management system.

2.2.2.2. Content and Service Delivery
· Maintenance: A hotline support number and dedicated personnel shall be provided to users.

2.2.2.3. Receiving and Viewing of Content
· Maintenance: A hotline support number and dedicated personnel shall be provided to users.

2.2.3. Performance Requirements
2.2.3.1. Content Creation and Management
· Reliability: The system shall be reliable. In case of system breakdown, the system shall be recovered quickly with minimal damage.

· Security: The system shall maintain sound security levels by the use of authentication capabilities, authorisation capabilities, audit controls and
other security measures.
· Multiple access: The system shall maintain sound service levels such as
response time, availability of services under the condition of multiple
access.

2.2.3.2. Content and Service Delivery
· Network capacity and transmission speed: Network capacity and transmission speed shall ensure that users can access to the information

and download the various types of data (text, images, audio etc.) within
reasonable time.

· Data integrity: Sound transmission protocol shall guarantee that transmitted data are identical with the source.

· Secured delivery: Security shall be provided at the level of transmission. 17
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· High availability: The system shall be available 24 hours a day.
2.3. Technical Requirements
2.3.1. Standards
Any technical solutions provided for this pilot project shall comply with
policies and standards described in Telemedicine Standards Document.

The RO shall study the document carefully and shall ensure that the proposed
solutions are in line with policies and standards set in the document.

The salient points on technical standards which are specifically related to this
pilot project is described in the following section.

2.3.1.1. Communication Standards
The communication shall facilitate the exchange of information among users
and applications. The model shall have an open architecture such as TCP/ IP
protocol . This allows service providers to develop a wide variety and choice
of delivery channels to provide CME services, thereby increasing public
access throughout the country.

2.3.1.2. User Interface Standards
Interfaces based on industry accepted standards must be built in order for the
systems to inter- operate. The interfaces shall guarantee:

· multiple delivery channels: CME shall be provided via multiple delivery channels such as telephone (PSTN), ISDN, leased circuits, microwave and
satellite.
· ease of use: graphical user interfaces (GUI) is necessary to enhance user interaction with the system.

· adaptability: User interface shall be flexible to adapt new technology introduced such as Multipurpose card.
2.3.1.3. Application Architecture
The proposed application architecture shall be designed to support:
· easy and consistent access from a single workstation for different levels of users.

· GUI to minimise typing and use point- and- click mode of data entry. 18
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· built in security to allow authorised users access to relevant information.
The overall architecture shall be modular in design to facilitate ease of future
expansion.

2.3.1.4. Security
RO shall describe the security features that are included in the proposed
system, including processor and disk security, software security, audits trail,
data encryption and any available approaches.

The RO is required to ensure all aspects of security are managed and enforced.
The security measures and enforcement must be designed, developed and
implemented by the RO. The security aspects include:

· preventing security breaches e. g. fraud, theft, hacking, sabotage, etc.
· detecting attempted security breaches.
· recovering from a breach.
· limiting damage caused by any event.
Networks shall be reliable and secured to ensure user confidence, system and
data integrity, and robust system operation. Several security measures include:

· user security controls for user access, group access, public access, and local and remote access.

· system and disaster controls recovery measures in the event of system failures.
· data backup procedures.
· firewalls and user passwords to restrict unauthorised access to the network.

2.3.1.5. Software
The RO shall be required to supply the latest proven release of the appropriate
operating system( s), compilers, communications software, utilities,
applications development tools, etc. in order to ensure the total and efficient
functionality of the central hardware.

2.3.1.6. Hardware
The RO is free to select any hardware solution that delivers the requirements
and complies with the appropriate functional and technical standards and 19
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policies as detailed in the Electronic Government Information Technology
Policy and Standards and Telemedicine Standards .

2.3.2. Technical Service Level Requirements
Technical service level requirements of the proposed concept solution are as
follows:

· portability - application systems shall operate on various platforms regardless of manufacturer or operating system.

· reliability - application systems, hardware, and software shall be reliable and shall provide minimal downtime.
· availability - application systems, hardware, and software shall be available at all times.
· scalability - application systems shall migrate as a client or server to platforms of greater or lesser power and capacity, depending upon
requirements, with little or no change to the underlying components.
· interoperability - applications and computers from different suppliers will have the capability to work together on a network and to connect to each
other, share data and processes.
· usability - application systems shall be user- friendly. They shall enhance and support rather than limit or restrict business processes. Human
interfaces need to be intuitive and consistent with other application
systems.

· manageability - applications, hardware, and software shall be capable of being managed and user- friendly.

· adaptability - an application shall have the capability to take advantage of new technologies and resources, and can be implemented in changing
environments.
The RO shall describe their strategies on how the proposed solution provides
the desired level of performance in each of the said aspects.

2.4. Implementation Requirements
2.4.1. Project Management Methodology
The RO shall describe the pilot project management methodology through the
use of appropriate disciplines, techniques, practices and tools. The project 20
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management methodology shall define, develop and implement measures for
the realisation of business results throughout the life of the pilot project. It
shall focus on:

· on time delivery of quality service.
· co- ordination and co- operation to avoid duplication of effort.
· good human resource management.
The RO shall ensure quality of the deliverables.

2.4.2. Proposed Project Team Structure
The team shall possess the right skills and capabilities to deliver the desired
results which shall include content creation, network access and content
delivery mechanisms.

2.4.3. Action Plans to Remove Implementation Obstacles
The RO shall identify the implementation obstacles of the pilot project and
shall consider the following:

· quality level of information content.
· administrative structure to ensure the quality.
· ownership of content.
· changes required in the attitudes, behaviours and beliefs of the users.
· underlying changes required in the organisation, information systems, and skills and capabilities of the users.

· incentives for users for improving the utilisation and effectiveness of CME.

2.4.4. Risk Management Requirements
The RO shall prepare a risk management plan describing the approach for risk
identification, analysis, management and mitigation.

2.4.5. Training Programs
The RO shall prepare training programs for different groups: 21
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· information suppliers such as university lecturers, pharmaceutical companies
· users (medical practitioners, nurses etc.).
· technical/ operational staff.

2.4.6. User Acceptability
The RO shall conduct tests, interviews or surveys or a combination of these to
access/ evaluate the acceptance of the systems to be implemented among the
users.

2.4.7. Acceptance Test Plan
The RO shall provide a comprehensive acceptance test plan which shall
include:

· goals of test plan at each level and stages of test.
· strategies.
· composition of the test team and quality assurance team.
· functional level testing and acceptance.
· consolidated/ integrated system level testing and acceptance.
· timings and performance.
· network and communications testing.
· operational procedures testing.
· system back- up, systems failure and recovery testing.
The RO shall correct any deficiencies disclosed by the acceptance testing
within a stipulated time frame. The RO shall also review all applications and
sub- application systems.

2.4.8.Change Management Programmes
The RO shall address issues of change management such as managing the
changes the people involved in the operations will experience including
business processes and technology. The RO shall describe the approach and
outcomes that the RO will use to help the end users manage this change effort. 22
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2.4.9. Quality Assurance Plan
The RO shall describe the quality assurance plan covering the procedures,
methodologies and policies that it shall adopt in order to ensure the quality of
the deliverables and services to be provided in the execution of the pilot
project.

2.4.10. Technology Transfer Plan
The RO shall describe the technology transfer programme to be implemented
in this pilot project such as the approach, processes and the methods for
ensuring technology transfer to local companies.

The RO shall describe their future plans regarding research and development.
The RO shall also outline any present and planned future involvement with the
MSC, and how they see this involvement with respect to their technology
transfer plan.

2.5. Financial Requirements
The RO shall propose innovative financing solutions that would benefit the
Government, the RO and the users of the pilot project. This might draw on new
approaches to pricing structure, payment schemes and business models.

2.5.1. Business Model Requirements
Considering the fact that many Telemedicine projects throughout world have
failed due to lack of financial sustainability, financial aspects are definitely
one of the most important factors for the successful implementation of the
pilot project.

For the pilot project to be a success, the business model shall meet the
following requirements:

· low expenses - charges for providing the services shall be minimal.
· equal access - services will be made equally accessible to all relevant parties.

· high usage - the solutions shall foster high usage and widespread adoption.
· smooth and timely roll- out - the solution shall provide for a smooth, timely, focused and comprehensive roll- out. 23
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2.5.2. Business Model
2.5.2.1. Assumptions

In developing the business model, the RO shall provide a comprehensive list
of assumptions in different areas which include:

· macro economic conditions - such as the estimated inflation rate, annual increase rate of various costs, annual increase rate of service fees, etc.

· market demand - such as estimated total market population, targeted percentage of total market population using the services over a certain
time period, etc.
· system development plan - such as the number and size of systems and/ or volume of content to be developed within a certain time period,
etc.
· revenue - revenue source such as from the users, MOH, other relevant parties or a combination of these, unit fees/ prices for different services,
payment structure such as outright purchase, leasing, service fees etc.,
cash collection timing, etc. In the revenue assumption, pricing/ charging
scheme shall be clearly presented and will include:

pricing model - the RO shall indicate how much the services will cost the
Government, the users, and other relevant parties.

payback model - the RO shall indicate the mechanism and time period for
the RO to begin charging for its services.

· cost and tax - such as unit development costs for services or systems, estimated selling, general and administrative cost, operations and
maintenance cost, contingency cost, corporate and other tax etc.
· financial structure and conditions - such as estimated amount of investment, project financing strategy, interest rate, debt duration and
repayment schedule, etc.
· timeline for business activity - such as length of the operating period,
starting date for development, operation, marketing, and scheduled major
deliverables.

2.5.2.2. Preferred Business Model
In developing business model assumptions, the RO shall examine the
following preferred business model.

In this preferred business model, the role for the RO is to build, operate, and
own (BOO) the CME system. 24
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Under this business model, four entities, i. e. the Government, the RO, users
(healthcare professionals) of CME services and other relevant parties have
been identified:

· Government - Government will formulate and regulate policies and guidelines for the pilot project and monitor the success. The role of the
Government in terms of financial aspects is minimal, as the Government
shall not take any financial role in developing and providing the CME
programmes. However, as the Government partially bears the costs for
existing CME programmes used by the Government healthcare personnel,
the Government may pay for new CME programmes provided by this
pilot project.

· The RO - the RO shall build, operate and own the CME system. This task can be sub- divided into 3 areas, namely Information Supplier (IS),
Information Developer (ID), and Information Provider (IP), as described
in section 2.1.3. The RO shall also be responsible for taking necessary
actions to enhance the usage of the system including marketing, training
and improvement of the system. The RO shall be further responsible for
the financial sustainability of the pilot project by demonstrating clear
financial benefits to the users. The RO will obtain fees from the users for
providing the CME services.

· Users - users will obtain the CME services and pay fees in return. For government users, the Government may bear the cost for basic services. If
the Government users require additional services from the RO, they will
pay the RO an additional fee.

· Other relevant parties - currently drug companies, pharmaceutical
companies and other healthcare industries financially support medical
practitioners to take CME programmes. The RO shall identify such
sponsors, in return for providing advertisement for these sponsors.
Certain guidelines for advertisement are set by the Government.

In case the RO intends to take a role only as information developer and
information provider, and outsource information supply to universities and
private colleges, such information suppliers may be another source of
funds. The RO could receive fees from the universities, private colleges or
other teaching institutions in return for providing additional delivery
channels of their education programmes.

In the preferred business model, there is no upfront investment from the MOH.
The MOH may bear a part of the cost only as a user. However, the MOH may
support the RO by encouraging healthcare professionals to undertake the CME
programmes and by linking the programmes to the formal grading system.

The preferred business model is as shown in figure 3. 25
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Service
Fee
RO

Sponsors ° Drug companies
° Pharmaceutical companies etc.

Build, Operate, Own (BOO)

No Government provision of funds upfront; Government may bear a part of the cost of services for
government users.

Government
(MOH)

Fee for
advertisement*

Information
Supplier °Universities

°Private colleges etc.

Fee for providing
delivery channels

Public sector
Private sector

* Guidelines for
advertisement shall be set

User
Regulations
/Pilocoes /Monitoring

Service

Fee

Advertisement Provide delivery channels

Figure 3: Preferred Business Model
2.5.2.3. Other Options
The RO shall consider other options of business models which would be
beneficial to this pilot project.

2.5.3.Financial Proposals
The RO shall provide the following information in applying for this pilot
project:

· entire business plan of the pilot project over 5 years -entire business model of the pilot project shall include three types of business plan:

· most likely scenario
· optimistic scenario
· pessimistic scenario
which consists of income statement, balance sheet and cash flow
statement. 26
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· alternative financing options for the Government -the RO shall include options for ownership of intellectual property on items which are newly
developed for this pilot project and the development of derivative
products.

· financial implications for the Government -the RO shall describe the financial implications for the Government in terms of types of services,
amount and timing of cash outlay over the pilot project period.

2.6. Capabilities of the RO
The RO shall provide the following capabilities of its organisation:

2.6.1. Project Management Capabilities
The RO shall provide information on its project management capabilities and
relevant previous project management experiences of its proposed project
managers who will be involved in this pilot project.

2.6.2. Training Capabilities
The RO shall provide its organisation s capabilities and experiences on
training programs for users.

2.6.3. Support Capabilities
The RO shall provide information on the level of support which would be
necessary to support the proposed solution which shall include the following:

· operation hours for support help desk.
· problem reporting process.
· problem escalation process.
· average problem resolution time.
· percentage of problems unresolved.

2.6.4. Financial Capabilities
The RO shall describe the financial position of the organisations. If its
organisation has traded over the past two years, then the financial statements
of the organisation shall be included. If the RO is a newly established 27
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consortium, then the members of the consortium shall present their financial
statements for the past two years if they have traded over that period.

The RO shall also provide information on any major projects which have been
awarded to its organisation if this would be beneficial in supporting its
proposal.

2.6.5.Technical Capabilities
The RO shall provide information on its technical capabilities which shall
include the following:

2.6.5.1. Technical Leadership
Where the RO is recognised as a leader in particular technologies or service,
the RO shall provide a description of its area of expertise. Where a consortium
exists all the areas of technical leadership shall be described.

2.6.5.2. Relevant Reference Sites
Relevant reference sites describing the installed solution, scope of the work,
number of project team members and contact information shall be provided to
enable the evaluation of the experience of the RO.

2.6.5.3. Other Unique Capabilities as Applicable
The RO shall provide any additional information which may assist in its
proposal. 28
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3. Environment The existing CME has evolved without co- ordination and integration between
programmes. CME, in this pilot project, is broadly defined including both formal
post- basic/ graduate training with 4 years for disciplinary specialisation, and informal
short day- course providing updates on new techniques or trends. The formal post-basic/
graduate training is university based and jointly organised by Ministry of Health
and Ministry of Education. As for other CME programmes, they are organised based
on demand and provided by hospitals, NGO s, Medical and Pharmaceutical suppliers
and individuals.

3.1. Organisational Environment
3.1.1. Mission and Objectives of the MOH
The objectives of MOH in respect of CME are:

· to organise and marshall the best professional skills available to provide quality healthcare.

· to ensure health care personnel are adequately trained in respect of job function.
· to embrace the philosophy where continuing education is an integral part of healthcare profession.

3.1.2. Existing CME Programmes
CME programmes conducted by MOH are basically jointly organised either
with the Ministry of Education, the Nursing Board or Private Organisations.
The existing programs are:

· A 4- year Family Medicine training which is university based and offered by three universities namely National University of Malaysia (UKM),
University of Malaya (UM) and University of Science Malaysia (USM).
· A 4- year Open System masters programme for hospital specialist training in various disciplines are also offered by the same universities.

· A Government nursing staff training program of 2- 3 years duration is
jointly organised by MOH s Training Division and the School of Nursing
affiliated to major government hospitals and clinics.

· Other CME activities are provided by professional organisations and individual hospitals on an ad- hoc basis. These programs are funded by the
respective hospitals or sponsored by medical/ pharmaceutical suppliers. 29
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The hospitals training fund is allocated by MOH annually and the types of
CME programs conducted are left to the respective hospitals to decide.
Currently the CME Point System is on a voluntary basis and only about
30% of the doctors have registered with this system. The development of
the programmes depends on the individual CME provider and is carried
out based on demands hence, there is no co- ordination in the content
development among the various CME providers.

3.1.3. CME- Related Organisations
· MOH s Training department is responsible for allocating the training budget and co- ordinating with relevant bodies such as WHO in running

CME programmes.
· The Malaysian Medical Council (MMC) has been responsible for setting guidelines on issues relating to medical practice such as allocation of CME

points on course content.
· The Nursing Board Malaysia is responsible for the education and training of nurses in the country.

3.2. Technical Environment
Most Government tertiary hospitals are disignated as CME centres and are
equipped with classroom/ lecture room with audio visual aids.

3.3. Future Plans
The Ministry of Health has and is currently embarking on a major IT adoption
into its service. This is documented in the Information Systems Strategic Plan
(ISSP). The implementation of this plan is done in phases. Apart from the
development of the infrastructure, training is also conducted to ensure that the
personnel will be able to use such technology- related equipment.

By year- end 1998, every Health Centre in the country will have a minimum of
one (1) desktop computer for general use. This is part of the implementation
process of the development of an integrated network for the health facilities
especially so, for the Primary Care Centres. Hospitals are also being provided
with multiple computers for the development of the IT network for the
Ministry of Health. 30
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4. Instructions to Responding Organisations
The Government of Malaysia invites proposals to this CRFP.
4.1. Communication
Enquiries regarding development of the proposals shall be submitted in writing by
mail, fax or e- mail to:

Ministry of Health,
Procurement and Privatisation Division,
8 th floor, Perkim Building, Ipoh Road,
51200 Kuala Lumpur,
Malaysia.

Fax: +( 603) 4431355
Phone: +( 603) 4421211
E- mail: telemed@ mohptm. gov. my

Written responses shall be compiled and answered appropriately. No questions,
written or verbal, shall be entertained after 3 October 1997.

4.1.1. Responding Organisations Briefing
There shall be a Responding Organisations Briefing on 5 September 1997 to
address questions raised by ROs. ROs who wish to participate in this forum
shall indicate their interest to the MOH Procurement and Privatisation
Division no later than two weeks before the date of the forum, that is by 22
August 1997.

4.2. Submission of Proposal
4.2.1. Time and Date
Proposals shall only be submitted during office hours after 27 October 1997,
but not later than 1200 hours Malaysian Time, 31 October 1997. Proposals
submitted after this time shall not be considered.

Office hours are:
Monday- Thursday 0800 1245, 1400 1615
Friday 0800 1215, 1445 1615
Saturday 0800 1245 31
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4.2.2.Mode of Delivery and Address
Proposals, together with the Letter of Undertaking as set out in Appendix 4
and the Deposit, shall be delivered by hand to:

Ministry of Health,
Procurement and Privatisation Division,
8 th floor, Perkim Building, Ipoh Road,
51200 Kuala Lumpur,
Malaysia.

Fax: +( 603) 4431355
Phone: +( 603) 4421211
E- mail: telemed@ mohptm. gov. my

4.2.3. Marking
Proposals shall be sealed and clearly marked:

Proposal - Telemedicine CME Pilot Project

4.2.4. Number of Copies and Separation of Sections of
Proposals

The RO shall deliver five copies of each proposal which shall be physically
separated, bound, sealed and labelled as:

· Technical and business proposal.
· Financial proposal. Proposals shall also include a cost- estimate for the overall project along with detailed cost- estimates for various discrete parts
of the project.
The Appendices and Attachments may be submitted as a separate section.

4.2.5.Deposit
The RO shall submit a deposit together with the proposal.

The deposit shall be in the form of a Bank Guarantee issued by a bank
operating in Malaysia. The Bank Guarantee shall be in the form as set out in
Appendix 5. The quantum of the deposit is as specified in Appendix 6. The
bank guarantee shall remain valid until 1August 1998 or until the RO is
notified in writing that its proposal is unsuccessful.

The Deposit shall be forfeited by the Government in the event the RO: 32
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· revokes its offer prior to being informed of the result the CRFP evaluation.
· failure to honour its obligations under this CRFP.
· refuses to enter into a contract with the Government on being informed of the award of contract.

The Government shall not be liable for any interest or any other claim arising
from this deposit.

4.2.6.Receipt of Proposal
An acknowledgement signed by the authorised representative of the MOH
Procurement and Privatisation Division shall be evidence of receipt of the
submission of the proposal.

4.2.7. Amendments
No amendment shall be made to the proposal after its submission.

4.2.8. Validity of the Proposal
All proposals and prices shall remain valid for a minimum period of twelve
(12) months from the closing date. However, the RO is encouraged to state a
longer period of validity for the proposal.

4.2.9. Advertisement
No advertisement or press release regarding this proposal shall be published in
any newspaper, magazine or any other form of media, electronic or otherwise
without prior written approval from the Government.

4.2.10. Performance Bond
The successful RO shall be required to deposit in the form of a Bank
Guarantee a Performance Bond upon the execution of the contract, a sum
equivalent to five percent (5%) of the whole contract value. This Bank
Guarantee shall be issued by a bank operating in Malaysia and shall be kept
valid from the date of issue until eighteen (18) months after all contractual
obligations are to have been fulfilled. The Performance Bond shall be forfeited
by the Government if the RO breaches any of its obligations under the
contract.

The Bank Guarantee for Performance Bond shall be substantially in the form
as set out in Appendix 7. 33
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4.2.11. Letter of Undertaking
The RO shall sign a Letter of Undertaking as set out in Appendix 4.

4.2.12. Language
All proposals including appendices shall be in English, or if not in English
shall include an English translation as an attachment.

4.2.13. Currency
All currency in the proposal shall be quoted in Ringgit Malaysia (RM).

4.2.14. Contents
Proposals shall contain specific and detailed replies to all requirements, terms
and conditions set out in the CRFP.

These replies shall be in the following structure:
Technical and business proposal:
DESCRIPTION OF FUNCTIONAL SOLUTION
Operational description
Maintenance and support description
Performance description

DESCRIPTION OF TECHNICAL SOLUTION
Communication
User interface
Application architecture
Security
Software
Hardware

DESCRIPTION OF TECHNICAL SERVICE LEVEL
APPROACH TO IMPLEMENTATION
Project Management Methodology
Proposed Project Team Structure
Action Plans to Remove Implementation Obstacles
Risk Management
Training Programs
User Acceptability
Acceptance Test Plan
Change Management Programmes
Quality Assurance Plan 34
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Technology Transfer Plan
Plan for Involvement with the MSC

DESCRIPTION OF THE RO
Organisation structure
Organisation capabilities
Project Management Capabilities
Training Capabilities
Support Capabilities
Financial Capabilities
Technical Capabilities
Technical leadership
Relevant reference sites
Other unique capabilities as applicable

ACCEPTANCE AND UNDERSTANDING OF TERMS
Scope of the pilot project
Timeline of the pilot project
Delivery on stated requirements
Acceptance of general terms and conditions
RFP instructions
Evaluation criteria
Compliance with technology policies and standards as stated in the
Telemedicine Standards

Financial Proposal:
Assumptions
Description of Business Model
Financial Proposals

4.3. Selection
4.3.1.Evaluation of Proposals and Short- list
The Government will review and evaluate the submitted proposals to develop
a short list of qualifying organisations. A RO that has been short- listed will be
notified in writing by the Government on or before 31 December 1997.

4.3.2.Multi- track Negotiations
The Government will negotiate with the short- listed ROs concurrently to
consider on terms, scope, capabilities and performance milestones of the
proposed solutions. Confidentiality of proposals shall be strictly maintained. 35
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4.3.3.Final Selection
The Government shall select the winning RO based upon the best and final
offer. The successful proposal and the winning RO shall be announced on or
before 1 February 1998. The Government shall sign a contract with the
winning RO. The terms and conditions of the contract shall be agreed upon
between the Government and the RO.

4.3.4.Implementation
The successful RO shall demonstrate implementation capabilities through a
proof of concept of initial pilot project implementation. The successful RO
shall then be responsible for the full execution of the proposed solution and
agreements will be signed with the successful RO.

4.4. Process Timeline
· Late July 1997: CRFPs are made available for distribution.

· Late July - 31 October 1997: ROs prepare their proposals.
· 12 p. m. 31 October 31 1997: Deadline by which ROs shall submit their proposals.

· November - December 1997: Government evaluates the proposals.
· On or before 31 December 1997: Short- listing of ROs.
· December - January 1998: Multi- track negotiations.
· 1 February 1998: Selection of proposal is complete and awards are finalised.

4.5. Mandatory Requirements and Evaluation Criteria
4.5.1. Mandatory Requirements
Proposals shall comply with the following mandatory requirements:

(i) Instructions to Responding Organisations; and
(ii) The specific requirements in this CRFP.
Proposals that do not comply with these mandatory requirements shall be
excluded from further evaluation. 36
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 34
4.5.2.Evaluation Criteria
Proposals that comply with the mandatory requirements stated in section 4.5.1
will then be evaluated against the following evaluation criteria:

· attractiveness of solution will include the proposed technical concept, business model, funding options and approach to implementation.

· calibre of the Responding Organisation such as its composition, capabilities, record of experience and the composition of the proposed
implementation team.
· attractiveness of model for technology transfer, including the level of co- operation with local companies, any special initiatives for technology
transfer and joint development efforts.
· involvement in the MSC. Weightage and priority will be given to companies which have gained MSC status or would qualify for MSC
status. The level of investment in the MSC will also be considered, with
emphasis on the investment in Research & Development. It is envisaged
that the successful Responding Organisation apply and obtain MSC status
before a contract is awarded. This requirement may be waived in the case
of Responding Organisations that do not fall within the definition of
multimedia business.

4.5.3.Responding to Specific Evaluation Criteria
This section requires the Responding Organisation to provide a proposal on
each of the following criteria, which are not explicitly covered in this CRFP.

4.5.3.1. Calibre of the Responding Organisation
Response: Proposals shall contain the following:
· name of all participants in the Responding Organisation (if more than one) including their scope of involvement;

· name of lead contractor or joint venture and the relationship between this entity and the other participants of the Responding Organisation, if
applicable
· experience of the Responding Organisation in similar projects, including references;

· examples of industry recognition, if any, for the Responding Organisation in the areas of technological leadership, innovation and implementation; 37
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 35
· examples, if any, where the Responding Organisation has worked together on similar projects with the same participants.
4.5.3.2. Attractiveness of the Model for Technology Transfer
Response: Proposals shall set out a plan for achieving the objective of
technology transfer to Malaysia. The description of the approach process and
methods for ensuring technology is being transferred to local companies shall
be described. This includes participation of Malaysian companies in the
Responding Organisation and plans to raise the technology skills of Malaysian
workers. The Responding Organisation is required to demonstrate its
commitment to the goals and aspirations of Malaysia and the MSC and outline
its plan for knowledge and technology transfer.

The Responding Organisation shall outline its plan to implement:
· details as to how knowledge is to be conveyed.
· the level of co- operation with local companies, universities and government agencies.

· training programs.
· joint development efforts.
4.5.3.3. Involvement in MSC
Response: Proposals shall contain the following:

· If the Responding Organisation has:
- obtained MSC status, the Responding Organisation shall show proof of
MSC status;

- applied for MSC status, the Responding Organisation shall show proof
of submission of the MSC status application and attach a copy of its
application form;

- not applied for MSC status yet, the Responding Organisation shall
detail its eligibility for MSC status, with specific reference to the criteria
for MSC status.

- not applied for MSC status, the Responding Organisation shall provide
reasons for not applying MSC status

· An outline of the actual or planned involvement of the Responding Organisation in the MSC, if any. 38
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 36
4.6. Rights of the Government
4.6.1. Amendments
The Government reserves the right to amend or delete any part of this CRFP
or any document forming part of this CRFP at any time without prior notice in
order to give effect to change in policy or to correct any error, omission,
ambiguity or inconsistency that may arise after the issue of this CRFP.

4.6.2.Acceptance of Proposals
The Government does not bind itself to accept the lowest or any proposal.

4.6.3.Cost of Proposal
The Government shall not be liable for any payment or costs incurred in the
preparation and submission of the proposal in response to the CRFP. All costs
and expenses incurred by the RO in providing the proposal shall be borne by
the RO.

4.6.4.RO s Responsibilities
It is the RO s responsibility to understand the CRFP, including the
requirements and to make all examinations necessary in order to ascertain all
factors, enquiries and questions which might affect the RO s proposal.

4.6.5.Non- liability
Whilst care is taken to ensure that the facts and information contained in this
CRFP are correct at the time it is presented, the Government hereby makes no
representation as to the accuracy or adequacy of the facts and information
contained in the CRFP. The Government shall not be held liable for any
inaccuracy or inadequacy of such facts and information.

4.6.6.Confidential Information
All information of a confidential nature whether generated in Malaysia or
overseas, shall be subject to Malaysian Laws and Regulations. Without
prejudice to the right of the Government under any law, a breach by the RO
may entitle the Government to terminate dealings with the organisation
without prior notice to the RO. 39
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 37
4.6.7.Failure of Negotiation
It shall be agreed and understood that in the event that the negotiation fails and
a contract is not signed, there shall be no cause of action against the
Government, nor shall it be possible to pursue a cause of action against the
Government for any action howsoever arising.

4.6.8.Discrepancy of Document
In the event that there exists any discrepancy between an electronic version of
this document (or a document printed or distributed using an electronic
version as a source) and the official printed hardcopy distributed by the
Government, addenda or corrections, then the information in the official
printed hardcopy, addenda, or corrections shall prevail.

4.6.9.Withholding Tax
The RO is hereby informed that the Government shall deduct tax, at the rate
prescribed under the withholding tax laws of Malaysia, from all payments for
services rendered by any RO who signs a contract with the Government.

4.6.10. Governing Law
This CRFP and any contract executed pursuant to this CRFP shall be governed
by and construed in accordance with the laws of Malaysia. The Government of
Malaysia and all ROs responding to this CRFP and parties to any contract
executed pursuant to this CRFP shall submit to the exclusive jurisdiction of
the Malaysian Courts. 40
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 38
Appendix 1 - MMC- CME GRADING SYSTEM
Category Activities A
MEDICAL CONGRESSES
(LOCAL/ INTERNATIONAL)

B SCIENTIFIC MEETING OF CHAPTERS OF ACADEMY/ UNIVERSITIES/
COLLE. G. ES/ ASSOCIATIONS/ PUBLICS & PRIVATE MEDICAL INSTITUTIONS
a Less than 2 hours
b 2- 4 hours (1/ 2 day)
c 5- 8 hours 9full day)
d 4 or more full days

C WORKSHOPS/ COURSES
a Full day
b More than one full day, but less than two full days
c 3 or more full days

For all activities in these categories, attendance lists or certificates of attendance
(overseas meeting) are to be submitted

D WARD ROUNDS/ LECTURES/ CLINIC ATTENDANCES
 By hour

E PUBLICATION OF ORIGINAL ARTICLES IN MEDICAL JOURNAL, CHAPTERS
IN BOOK
a Indexed Journal
i Principal Author
ii Others

b Non- Indexed Journal
i Principal Author
ii Others

b Chapters in Book
 each chapter
(up to a maximum of 10 points)

F PRESENTATION AT ACCREDITED MEETING
a Free Paper/ short paper/ poster
b Plenary lecture/ long paper
c Visiting lecture

G SELF- STUDY/ GROUP STUDY/ DISTANCE LEARNING
a Reading Scientific papers from Indexed Journals
b Audio- Visual
c Organised group discussion under accredited co- ordinator 41
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 39
Appendix 2 - Annual Intake Capacity of Training Schools by
Type of Trainees, Malaysia, 1993

Type No. of Training Schools Annual Intake Capacity
Doctors* 3 439
Nurse 19 1638
Medical Assistant 4 347
Pharmacist 1 76 (University of Science)
Health Inspector 1 85
Occupational Therapist 1 16
Physiotherapist 1 32
Dental Officer 1 65 (University Malaya)
Dental Nurse 1 109
Radiographer 2 78
Community Nurse 11 654
Rural Health Assistant** 4 160
Pharmacy Assistant 2 103
Health Education Officer** 1 7

* University of Malaya 168
* University Kebangsaan 146
* University of Science 125
** In- Service Courses 42
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 40
Appendix 3 - Health Manpower Population Ratio by
Category of Manpower, Malaysia in 1993
Type of Health Manpower PENINSULAR MALAYSIA SABAH SARAWAK MALAYSIA Total

Doctor : Public
Private
Total

3,447
4,065
7,512

156
196
352

207
208
415

3,810
4,469
8279
Pharmacist: Public
Private
Total

332
852
1,184

22
30
52

19
69
88

373
951
1,324
Nurse : Public
Private
Total

9,985
N. A.
N. A.

1,047
N. A.
N. A.

929
N. A.
N. A.

11,961
N. A.
N. A.
Assistant : Public
Nurse Private
Total

8,068
N. A.
N. A.

1,354
N. A.
N. A.

308
N. A.
N. A.

9,730
N. A.
N. A.
Medical : Public
Assistant Private
Total

2,690
N. A.
N. A.

516
N. A.
N. A.

522
N. A.
N. A.

3,728
N. A.
N. A.
Pharmacist : Public
Assistant Private
Total

1,406
N. A.
N. A.

138
N. A.
N. A.

134
N. A.
N. A.

1,678
N. A.
N. A.
Health : Public
Inspector Private
Total

879
N. A.
N. A.

124
N. A.
N. A.

116
N. A.
N. A.

1,119
N. A.
N. A.
Physio- : Public
Therapist Private
Total

158
N. A.
N. A.

14
N. A.
N. A.

18
N. A.
N. A.

190
N. A.
N. A.
Radiographer: Public
Private
Total

334
N. A.
N. A.

23
N. A.
N. A.

47
N. A.
N. A.

404
N. A.
N. A. 43
43 Page 44 45
CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 41
Appendix 4 - Responding Organisation`s Undertaking Form
Responding Organisation´s Undertaking Form
To:
Secretary General
Ministry of Health
Kuala Lumpur
MALAYSIA

Proposal for Telemedicine CME Pilot Project
The undersigned (hereinafter called the Responding Organisation ) hereby offers to*

_________________________________________________ to the extent which the Government may
determine in accepting the CRFP and at such time as may be demanded by the Government.

2 The Responding Organisation hereby agrees to the forfeiture of the Deposit (forwarded together with the
proposal) to the Government in the event of the Responding Organisation:
a revokes its offer prior to its being informed of the result of this CRFP;
b fails to honour its obligations under this proposal; or
c refuses to enter into a contract with the Government on being informed of the award.

2 The Responding Organisation further offers to lodge with the Government, if its proposal is accepted, a sum
equivalent to 5% of the Contract value in the form of a Bank Guarantee for the said sum as performance
bond for the due fulfilment of the contract and agrees that the Bank guarantee shall be retained by the
Government until eighteen (18) months after the end of the contract.
3 We enclose herewith the deposit in the form of a Bank Guarantee as follows:

Bank Guarantee No ________________________ Amount:___________________________
Name of Bank _________________________________________________________________
Name of Responding Organisation _________________________________________________
Address _______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Signed by for and on behalf of Responding Organisation_________________________________
Name & Designation _____________________________________________________________
* The RO shall specify the services or solutions or applications that are offered. 44
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 42
Appendix 5 - Bank Guarantee Deposit Form
Bank Guarantee
To:
Secretary General
Ministry of Health
Malaysia
Sir,
BANK GUARANTEE

As requested by the Responding Organisation ____________________________________________, we
hereby guarantee that the sum of RM______________ (Ringgit Malaysia _____________________)
being the amount of Deposit required to be deposited with the Government of Malaysia in
accordance with the conditions of the CRFP for ________________________________________ shall
become payable by us immediately on receipt of notices in writing given to us by the Government or
its authorised representative.

This Guarantee is effective from the date the CRFP document is submitted by the Responding
Organisation, and shall remain in force until 1 August 1998 or until the Responding Organisation is
notified in writing that its proposal is unsuccessful.

Signed _________________________
For an behalf of__________________
Name of Bank___________________
Address________________________ 45
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 43
Appendix 6 - Quantum of Deposit for Responding Organisations
1. For International Companies
Estimated Cost for the Government of the CRFP solution Amount of Deposit
(i) Not exceeding RM 5 million RM 62, 500.00

(ii) More than RM 5 million but
not exceeding RM 10 million
RM 187,500.00

(iii) More than RM 10 million but
not exceeding RM 20 million
RM 375,000.00

(iv) More than RM 20 million but
not exceeding RM 30 million
RM 625,000.00

(v) More than RM 30 million RM 1 million

2. For local companies not registered with the Ministry of Finance, Malaysia These companies are required to submit a deposit of RM 10,000.00.
3. For companies registered with the Ministry of Finance, Malaysia All companies registered with the Ministry of Finance are exempted from paying a deposit. 46
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 44
Appendix 7 - Bank Guarantee Form for Performance Bond
Bank Guarantee Form for Performance Bond

THIS AGREEMENT is made the ________ day of ____________________ 19__ BETWEEN
_______________________________ (insert name of Bank) of _______________________________
(insert principal address of business of Bank) (hereinafter called the Guarantor ) of the one Part and
the Government of Malaysia (hereinafter called the Government ) of the other Part.

WHEREAS
In consideration of the Government allowing _____________________ (hereinafter referred to as the
Contractor ) to supply and deliver/ provide articles/ services to the Government __________________
(hereinafter called the Articles/ Services ) for a contract sum of Ringgit
____________________________ (state the amount in words) (RM __________________), we, the
Guarantor at the request of the Contractor irrevocably undertake a guarantee to the Government to
guarantee the due performance of the Contract in the manner hereinafter appearing.

Now the Guarantor hereby agrees with the Government as follows:
1 On the Government s first written demand, the Guarantor shall forthwith pay to the Government
the amount specified in such demand notwithstanding any dispute or protest by the Contractor
or Guarantor or by any other third party and without proof or conditions. Provided always that
the total of all demands so made shall not exceed the sum of Ringgit _________________________
(state the amount in words) (RM____________) and the total amount recoverable against the
Guarantor under this Agreement shall not exceed the said sum.

2 The Government reserves the right to make any partial demands if it so desire and the total of all
such partial demands so made shall not exceed the sum of Ringgit________________________
(state the amount in words) (RM______) and the liability of the Guarantor to pay the Government 47
47 Page 48 49
CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 45
the aforesaid shall correspondingly be reduced proportionately to any payment of partial
demand having been made by the Guarantor.

3 The Guarantor shall not be discharged or released from this Guarantee by any arrangement
between the Contractor and the Government with or without the consent of the Guarantor or by
any alteration in the obligation undertaken by the Contractor or by any forbearance, whether as
to payment, time, performance or otherwise.

4 The Guarantee given by the Guarantor is a continuing guarantee. This Agreement shall be
irrevocable and shall initially remain in force and effect until ________________ (referred to as the
Expiry Date ). The Guarantor shall upon the request of the Government extend this guarantee
for a further period of_____________ (state the period) until ____________ in which case, the
maximum aggregate amount that the Government shall be entitled to shall not exceed the said
sum of Ringgit_________________________________ (state the amount of bond in words) (RM
_________________).

5 All obligations and liabilities of the Guarantor under this Agreement shall cease upon the
determination of this Agreement on the date or such extended date as specified in paragraph 4
above as the case may be save to the extent that the Government shall previously have called
upon the Guarantor in writing to pay specified moneys payable under the Contract then
remaining outstanding.

6 ALL CLAIMS, IF ANY, IN RESPECT OF THIS GUARANTEE SHALL BE RECEIVED BY THE
BANK DURING THE VALIDITY PERIOD OF THIS GUARANTEE OR WITHIN FOUR WEEKS
FROM THE EXPIRY DATE OF THIS GUARANTEE WHICHEVER IS THE LATER.

IN WITNESS WHEREOF the parties hereto have hereunto set their hands the day and year first
abovewritten.

Signed for and on behalf of the said
Guarantor in the presence of: 48
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CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 46
Name:___________________________________
Designation:______________________________
Bank

(Witness)
Name:___________________________________
Designation:_____________________________
Bank

Signed for and on behalf of the said
Government of Malaysia in the presence
of: Name:___________________________________

Designation:______________________________
Department's Chop

(Witness)
Name:___________________________________
Designation:_____________________________
Department s Chop 49
49 Page 50
CRFP - Continuing Medical Education
Malaysian Telemedicine Flagship Application 47
Appendix 8 - Glossary
Government Government shall mean the Government of Malaysia. 50

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