Amongst the North African countries, Egypt formulates the biggest demand in healthcare development. The Egyptian healthcare market continues to grow, due to demand from the continuous increase in general population (expected to reach 151 million by 2050), and, specifically, due to a gradual increase in the elderly population (from the current level of 7.8 per cent to 15.3 per cent by 2050), as well as increase in health insurance coverage.

Keeping in mind this need for growth, Informa Exhibitions, the organisers of Arab Health Exhibition & Congress, have launched North Africa Health, which is set to take place from April 6 to 8, at the Egyptian International Exhibition Center (EIEC), situated in New Cairo.

The full-scale exhibition will gather decision makers and professionals in the medical field from various regions under one roof and will be complemented by a diverse range of educational content.

The 12th edition of North Africa Health (previously Mediconex) will expand its visitor audience to include key buyers, dealers, distributors and healthcare professionals from the whole North African region. The expo will host over 3,000+ attendees, 150+ leading international and local companies from 20 countries showcasing the latest in medical device technologies and healthcare services, 154 product categories, and three Continuing Medical Education (CME) accredited conferences that will provide insights into the latest clinical and non-clinical healthcare trends in the market. These accredited conferences and hands-on-training workshops will provide the opportunity for growth in multiple fields.

Visiting North Africa Health is sure to be a beneficial experience for all dealer and distributor job functions – from senior management of larger organisations that are looking to connect with key industry players, sales and business development professionals tasked with expanding their product portfolios and entrepreneurs hoping to source the next ‘big product’ to supply in their country. With 20 manufacturing countries to choose from, choice is one thing that will not be lacking at the show.

Furthermore, professionals who are tasked with purchasing and procurement responsibilities, educational providers and medical specialty associations, can use North Africa Health as a way of starting each new year efficiently. Using the show as an opportunity to get ahead of the upcoming year’s product needs, they can scope the full variety of options available and take part in detailed discussions.

Exploring latest trends

As a leader in the industry that emphasises the importance of innovation, North Africa Health will ensure that several avenues are available for healthcare professionals to foster connections.

The CME conferences will take place across all three days and cover different disciplines. The Egyptian Society for Radiology and Nuclear Medicine (ESRNM) will be hosting their 55th annual conference during the show. With the opportunity to network with a range of professionals in the field of radiology, the delegates will receive a holistic educational experience achieved through live education, debates and discussions. In turn, this meeting will fast-track advances in radiology that will benefit the healthcare community.

Plus, as part of the Laboratory Medicine Conference, the Egyptian Society of Laboratory Medicine (ESLM) will also be hosting their 30th annual edition of the ESLM conference. It is one of the biggest yearly events for medical laboratory professionals in Egypt, as well as across Africa. Spanning over three days, with two parallel sessions, the programme will showcase a multitude of topics featuring international and local speakers. The theme of the conference is ‘Breakthrough to Excellence’ and will feature scientific lectures examining the latest findings in lab medicine, allowing for ample time to discuss new developments with experts. The event will also host poster sessions situated throughout the exhibition hall.

Furthermore, joining North Africa Health for the first time is the American College of Surgeons – Egypt Chapter who will be hosting their annual conference and will feature a mix of surgical sessions.

The first day will focus on ‘Women in Surgery in Africa’, highlighting the work achieved, and run by women exclusively. This session will feature an expert from the American College of Surgeons, as well as members from the Women in Surgery Africa (WiSA) association. The other sessions will cover a variety of topics ranging from gastric to endocrine surgery.

For more info visit www.northafricahealthexpo.com.

The healthcare sector often struggles to keep up with the increase in patients needing care as we enter the winter season.

It’s not just the flu. This is reflective of a wider endemic, with the global healthcare industry facing a number of challenges – from aging populations and staff shortages to rising costs.

Research shows intense winter festive periods such as New Year bring a huge spike in pressure for healthcare staff.

In the UK, the seasonal challenge is well recognised; more than half of doctors surveyed in a 2017 research said hospital delays due to winter pressures led to avoidable emergency admissions among their patients.

Healthcare’s technological resolution

The global increase of pressure on institutions, doctors, workers, patients and communities has led to higher demand for services and support that is not sustainable with existing resources and methods.

Hospitals are increasingly turning to technology and clinical mobility to reduce the strain on an already fragile system. For them to combat these pain points, they need to tackle the winter period head on and the best way to do so is to address where improvements in efficiencies can be made. This needs to start with patients.

Every single birth generates a patient record, which forms the bedrock of future diagnosis and treatment. Then, with every subsequent visit, no matter what age or complaint, these records are updated and maintained to give doctors the most current information.

Historically these records have been compiled manually, using paper and pen and stored in huge filing archives, meaning any updates and cross referencing was dependent on humans. While these records hold crucial information, paper and pen can lead to missed diagnosis or complications, errors and missed opportunities. Moving from paper and pen to a modern positive patient identity management solution can and will help institutions create a more reliable digital chain of custody.

This digital chain of custody does not allow for these types of human error. By using barcodes and affixing them to medical records, doctors and nurses can use mobile scanners and mobile computer devices to interpret records more efficiently and effectively. Taking this a step further, by affixing barcodes to medication removes the need to write on a cylinder, ensuring correct treatments are administered while wrong ones are flagged immediately.

Nurses see the benefits, too. Zebra’s 2022 Hospital Vision Study shows that 61 per cent of nurses reported reduced medication administration errors when using mobile medical devices. And 97 per cent of nurses say they plan to have a mobile device at the bedside by 2022, an increase of 38 per cent than currently do. Patients are also happy to see technological improvements. Of those surveyed, 77 per cent of patients said they are feeling positive about clinicians using mobile devices for care.

Here in the region, Mediclinic Middle East, one of the UAE’s largest private healthcare groups, has also partnered with Zebra to provide a full range of healthcare solutions for its new Parkview Hospital in Dubai. This package includes solutions to improve patient identification and increase visibility of medication and clinical mobility allowing them to focus on patient care.

The solutions don’t just need to focus on patients. By opening up solutions to staff, equipment and management, hospitals can build a database and in return, get a single ‘pane of glass’ view over their entire estate.

Hospital staff would be provided with a clearer vision of availability over staff and equipment, allowing them greater insights into internal operations and helping to better plan resourcing and deliverables without impacting patient care. Hospitals would also be able to keep a much more detailed eye over equipment such as magnetic resonance imaging (MRI) machines or wheelchairs, ensuring there aren’t lengthy waiting times for either.

Finally, hospital management can better use the database and analytics to manage the facility as a whole. This includes having insight over the minutiae of utility bills and rotations to understanding longer term resourcing issues and, with the help of Artificial Intelligence (AI), predicting spikes and dips in activity as well as likely hotspots for issues. This would not only improve patient care and conditions for staff but also improve the bottom line.

Creating better healthcare

The winter weather, celebrations and yearlong pressure can build up and as November, December and January approach, healthcare institutions can be hit with a variety of pain points. However, just like paper and pen, this can be a thing of the past. Hospitals and healthcare institutions around the world are already adopting solutions that can make the festive period and the winter challenges more manageable, less stressful and cost effective. Combine this with providing better patient care, and medical institutions have found an antidote to the winter doldrums.

Colo-rectal cancer (CRC) is a major healthcare problem in the industrialised world. It accounts for 13 per cent of all cases of adult cancer in Europe annually with an estimated number of around 215,000 CRC-related deaths per year, about one death every three minutes. CRC has no gender preference, since it is currently the second leading cause of cancer-related deaths both in males and females.

Despite those threatening evidences, CRC is one of the most favourable cancers for being prevented. In fact, in at least 75 per cent of the cases, colon cancer develops from a benign precursor, an adenomatous polyp. This carcinogenetic pathway, known as adenoma-carcinoma sequence, lasts for five to 10 years.  

This offers a time window wide enough to allow the detection of either an already developed cancer, but at an early stage, or, in the best scenario, its benign precursor, the adenomatous polyp. It means that CRC screening has two different targets, the early cancer and the adenomatous polyp. This is different, for example, from breast cancer screening, in which the target is the detection of an early cancer only.

A screening programme targeted to the detection of an early cancer can reduce cancer mortality: this is true both for mammography and any colonic test. But a screening programme targeted to the detection and removal of a benign cancer precursor has the greatest advantage of reducing not only mortality, but also cancer incidence. In other words, it can prevent the onset of new cancer cases per year. And this is true only for CRC and not, for example, for breast cancer, in which a benign cancer precursor is not known.

Despite the favourable natural history of CRC, which makes this tumour particularly suitable to be prevented by a test able to investigate the colon when an individual is still asymptomatic, incidence is still high for at least two major reasons: 1) unavailability of organised CRC screening programmes in many countries; 2) poor adherence of population to available CRC screening tests.

Radiologists can now fully support and help in improving CRC screening, thanks to the availability of Computed Tomography Colonography (CTC). CTC is a minimally invasive colonic test, which has reached its mature stage. Apart from being considered the examination of choice in patients who underwent an incomplete colonoscopy, CTC has an important diagnostic role in frail and elderly patients and in the assessment of diverticular disease. As far as CRC screening is concerned, three randomised clinical trials investigated the performances of CTC in asymptomatic average-risk individuals, in comparison with flexible sigmoidoscopy (FS), faecal occult blood test (FOBT) or colonoscopy (CC). Those studies demonstrated:

1) good adhesion rate to CTC, lower than FOBT, but higher than FS and CC. It means that a higher number of asymptomatic individuals would accept to undergo CTC as a screening test rather than FS or CC, because CTC is perceived to be less invasive and because bowel preparation is much less demanding compared with CC.

2) good adenoma detection rate at CTC, slightly lower than CC, but much higher than FS and FOBT. It means that, if CTC is performed, a higher number of cancers and polyps would be detected compared with stool tests, with a hypothetic, but realistic, further reduction of CRC mortality.

CTC is also more patient compliant than CC, it can be performed with a reduced bowel prep and burden of radiation exposure is not an issue thanks to the available CT technology for dose reduction. With the latest CT scanners, dose exposure is less than 1 mSv, which represents less than ¼ of annual background radiation.

In the setting of CRC screening, CTC has different roles, depending if an organised governmental CRC screening programme is available or not.

If an organised governmental CRC screening programme is not in place, and an opportunistic screening approach is the strategy, CTC is now included among the optional screening tests. Among those options, two groups can be identified: a first one, including stool tests (FOBT, Faecal Immunochemical Test, FIT, and the most recent stool DNA), whose target is the detection of an early cancer and the goal is the reduction of CRC mortality; a second group, including CTC, FS and CC, whose target is the detection of both cancer and polyps, and the goal is the reduction of CRC mortality and incidence.

Many different scientific societies, including the American Cancer Society, the American College of Radiology, the U.S. Multisociety Task Force on Colorectal Cancer, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), the European Society of Gastrointestinal Endoscopy (ESGE) or agencies, such as the U.S. Preventive Services Task Force, consider the current scientific evidences sufficient to endorse the use of CTC as a screening method in average-risk individuals. In this case individuals should be informed about benefits and possible drawbacks of CTC in comparison with other tests and a repetition of CTC every five years should be advised. This will help in recruiting for CRC screening particularly those individuals who are reluctant to undergo CC.

In individuals at risk higher-than-average, it means those with a first-degree relative with either cancer or polyp, CTC should be considered a back-up strategy, in the case those individuals refuse CC, which remains the examination of choice.

In many European countries, established screening programmes based on FOBT/FIT are available. In this case, CTC has its own role as a back-up examination for an incomplete CC, performed after a positive FOBT/FIT. Alternatively, CTC might be offered as an alternative test in those patients (between 15 per cent and 20 per cent) tested positive at FOBT/FIT, but who refuse CC.

But the real ultimate frontier in CRC screening might be using CTC as a population screening test, thus replacing FOBT/FIT. Multiple advantages exist for using CTC: accuracy higher than stool tests, direct non-invasive inspection of the colon with detection of both cancers and polyps, safety, patient comfort, detection of extracolonic findings.

However, before a new test can replace the current screening options, demonstration of a more favourable cost-effectiveness compared with the available screening tests is needed.

Although previous studies failed in this demonstration, a recent publication, using the real cost analysis of the Dutch trial, demonstrates that CTC dominates CC in CRC screening, if the adherence rate is the same observed in the trial (CTC, 33.6 per cent vs CC, 21.5 per cent), a 6-mm polyp cut-off is implemented and more than two CC in lifetime are planned.

In conclusion, Radiologists, thanks to the technological progress and the scientific evidences available for CTC, are already important actors in CRC screening programmes. In countries where governmental organised CRC screening programmes are in place, CTC is fully integrated as a backup test for incomplete CC and to recruit patients with positive FOBT/FIT who refuse CC. In geographical areas where opportunistic screening is the strategy, CTC is one of the tests recommended by the major scientific societies worldwide. The ultimate goal, which will offer Radiologists a real leadership in CRC screening, will be the full endorsement of CTC as primary population screening test by policy makers.

References available on request.

With the rising burden of diseases, favourable government policies in the Asia-Pacific and the presence of strong developing economies in India, China and other countries in the region, companies are flocking to develop their presence and expand across the APAC.

This is where Asia Health, one of the leading medical products, services, and technology exhibition and congress, plays a key role. The free-to-attend event is set to take place at the Suntec Singapore Convention Centre, Singapore, from March 26 to 28 and brings together healthcare professionals from across the world. The event is well-known for being a must-attend exhibition for those who value the power of learning and networking, while doing business.

Offering over 200 product categories from 24 exhibiting countries and eight international pavilions, Asia Health is a one-stop-shop for all healthcare sourcing and procurement needs.

Furthermore, accompanying the exhibition are a number of business, leadership and Continuing Medical Education (CME) conferences and forums providing the very latest updates and insights in Patient Safety, Oncology and Healthcare Procurement. New for 2019, Asia Health will boast an array of both educational and innovative features and give special emphasis to topics such as Artificial Intelligence, Oncology, and Patient Safety.

This year, GE is a platinum sponsor of the event and also have a speaker taking part at the Oncology conference where the company will highlight its latest research. GE is well-known for its innovative solutions for oncology and supports cancer centres and hospitals all over the world to help improve cancer care from screening to treatment through advanced medical technologies, providing physicians and technicians with greater clinical insights. Over the years, the company’s solutions have helped improve the development of cell therapies, including CAR-T cell therapy. From stem cell recovery through separation and modification to expansion, harvesting, and testing, its functionally-closed systems and single-use solutions enable end-to-end production of cell therapies.

Plus, the Patient Safety & Quality Conference is being introduced at the event this year. Some of the key topics it will cover include reviewing the latest International Patient Safety Goals (IPSGs) and ways to implement them in the local medical practice setting; identifying strategies to achieve high-value healthcare to deliver top-tier quality service at the lowest cost, and identifying comprehensive solutions that ensure patient safety, risk, and quality activities are aligned with the strategic goals of the organisation.

The conference will also assess the current roles in patient safety to clarify responsibilities and reduce duplication of effort and discuss technology use to coordinate and streamline process changes, data collection, data analysis, monitoring, and evaluation.

The event will be co-located with MEDLAB Asia Pacific, which is in its sixth edition this year, and is one of Southeast Asia’s premier international laboratory and healthcare exhibitions. The 2019 edition of the event will host 15 CME-accredited conferences, eight international pavilions, over 200 product categories, and more than 250 exhibitors.

Fore more information visit www.medlabasia.com/asiahealth/en/home.html

Experts from Dubai Health Authority’s (DHA) Primary Healthcare Centre and Rashid Hospital have collaborated with 3D printing healthcare start-up Sinterex, to save the jaw of a patient who had an aggressive tumour. The patient, a 17-year-old girl in high school, was admitted to the hospital after discovering she had a large, fast growing tumour of the right jaw.

Dr. Khaled Ghandour, Maxilofacial Surgeon at DHA, said that the patient was diagnosed with Ossifying Fibroma, a particularly aggressive form of tumour, which meant that the right side of the jaw had to be removed.

It was at this stage that Sinterex became involved. Sinterex is a UAE-based start-up specialising in customised 3D printed healthcare products. Managing Director, Julian Callanan, explained that given the aesthetic implications and complexity of the case, it was critical to use digital planning and 3D printing to create a patient specific solution.

The workflow started with the patients CT scan, which was segmented and converted into a 3D printed physical model. This model allowed Dr. Ghandour, and his team of surgeons, to visually inspect the patient’s situation and to develop a treatment plan. After finalising the treatment plan, Sinterex 3D printed a Surgical Guide, which was fitted to the patient in the operating theatre to ensure that the surgeons drilling and cutting are guided with precision. Finally, a patient specific implant was 3D printed in bio-compatible medical grade Titanium.

Dr. Ghandour stressed the importance of utilising 3D printing in medical care. He said, “In maxillofacial surgery, we are working in an area where both aesthetics and function are important. Additionally, operating conditions are quite challenging. 3D printing models help us better visualise the patient’s situation, whilst 3D printing Surgical Guides and Patient Specific Implants allow us to translate plans into reality.” 

Dr. Mohammad Al Redha, Director of Project Management Office and Informatics and Smart Health at DHA said that this is just one further example of how the DHA has successfully used 3D printing. Other recent examples include 3D printing a prosthetic leg, removing a cancerous growth from a patient’s kidney referencing a 3D model, and saving the life of a patient suffering with cerebral aneurysm.

Dr. Al Redha said that the DHA is planning to further utilise 3D printing in medical care in line with the Dubai 3D printing strategy – a unique global initiative that aims to utilise technology for the service of humanity and promote the status of the UAE and Dubai as a leading hub of 3D printing technology by 2020.

King’s College Hospital London in Dubai, located in Dubai Hills, recently opened its doors, both for outpatients and inpatients. The 100-bed facility has started welcoming patients and begun surgical operations, including general surgery and paediatric orthopaedic cases. King’s College also operates two clinics in Dubai and one in Abu Dhabi.

The hospital has come to town through a joint venture between Al Tayer Group, Dubai Investments and the UK-based Ashmore Group. The newly-opened facility will act as a direct link to King’s College Hospital in London, a leading teaching hospital from the UK. The London-based hospital has a 175-year history of caring for patients with complex conditions and is one of the largest teaching hospitals in the UK.

A walk around the state-of-the-art facility highlights that a lot of importance has been put on making patients feel comfortable though warm hospitality.

An attendant is assigned to be with them as soon as they walk in through the doors till they meet the doctor. Plus, the latest technologies are visible throughout the premises giving prominence to clinical mobility.

Christian Schuhmacher, Chief Executive Officer, King’s College Hospital London, Dubai, told Arab Health Magazine: “This flagship hospital is our fourth facility in the UAE and now makes us a comprehensive healthcare provider in the country. We chose Dubai Hills as it is an up-and-coming area and reportedly there will be around 80,000 people living here in the near future. Our target audience are the local Emiratis and expats living around the area. We want to make it convenient and close for our patients to reach us.”

Utilising King’s College Hospital London’s expertise in healthcare will ensure efficient care is delivered at patients’ bedsides in the UAE, ensure further collaborations between UAE-based clinicians and UK-based physicians, and ensure seamless patient journeys between the Dubai and London hospitals.

He highlighted that there is a need in the local market for a product like King’s as it follows the exact same pathways as King’s College in London. “We offer a guaranteed level of clinical quality combined with world-class Middle Eastern service. Our goal is to provide evidence-based medicine that is centred on scientific findings and proven concepts and exactly deliver the amount of care that is needed, not more, not less, and cater to what the patient truly needs,” he added.

Specialised care

Schuhmacher said that the UAE has a young population, thereby it creates demand for obstetrics and gynaecologists, combined with foetal medicine. One of the hospital’s aim, he emphasised, is to offer a comprehensive package for pregnant women and their families.

Furthermore, through its visiting Faculty programme from King’s College Hospital in London, several specialised tertiary care procedures, such as foetal surgeries, where babies are operated on while still in their mother’s womb or procedures that reverse some forms of type 2 diabetes, will be made available at the hospital in Dubai. The visiting faculty will be in the UAE regularly to see patients during their pre- and post-operative care at all of King’s UAE facilities. Currently, over 70 per cent of the employed clinical staff at King’s UAE is UK trained.

The CEO highlighted that 80 per cent of the hospital’s services will be delivered by physicians locally, while 20 per cent of the more specialised and rare procedures will be delivered by visiting faculty from King’s London. Also, if a patient has to travel to King’s College in London for treatment it can be facilitated through a seamless process.

Dr. Gowri Ramanathan, Chief Medical Officer, Consultant Obstetrician and Gynaecologist, Foetal Medicine Specialist, King’s College Hospital London, Dubai, said: “Foetal medicine is an incredibly important aspect of care that we provide here. The reason is that amongst the Emirati population reportedly almost 60 per cent have consanguineous marriages, which means genetic disorders are a common issue. With genetic disorders come abnormalities in the foetuses. So, there is certainly a gap in the level of foetal care provided. What we are trying to do is to bring it to a different level where we provide foetal surgeries for unborn babies during pregnancy, which we carry out with our links with King’s London. There is also laser for twins, among other procedures. We are hoping to make this is a foetal surgical centre that goes hand-in-hand with our neonatology unit.”

Another big focus area for the hospital is orthopaedics and sub-specialised orthopaedics in terms of rare services such as hand surgery and paediatric orthopaedics. “We know that a lot of children here for different reasons need to be seen and treated by an orthopaedic doctor, and it is a very rare speciality that is not easily available,” Schuhmacher added.

The hospital also offers interventional cardiology services and is aiming to be a centre of excellence in cardiology.  

The CEO explained: “We all know that we should move a little bit more, and live a healthier life, unfortunately, if we don’t do that for too long it affects our health. Here there is a big demand for cardiology services, and we want to offer the community what is needed.

“There are also services that we link closer with King’s. In terms of chronic liver disease, this condition is massively undiagnosed and under-treated in the country. We can treat it to a wide degree and if in case a patient would eventually need a liver transplant then they would be referred and sent to London. You can expect us to do 80 per cent of the work so people don’t need to actually travel outside the UAE. Neurosurgery is another area where we are very closely linked to King’s in London, as well as metabolic and bariatric cases.”

Dr. Ramanathan added: “We are trying to bring in these services so that the patient doesn’t have to travel and can receive the UK level of specialised care right at home. We will have services such as teleradiology and teleconference where patients will have consultation directly with experts in the UK, while sitting right next to the physician here. So, that’s the benefit we have with our very close links with King’s in London. We have experts, professors in the UK who will be visiting and call managing a lot of our cases together here. We have already had a couple of cases here where patients have been successfully call-managed.”

Receiving a second opinion is an easy example of how this collaboration would work, explained Schuhmacher. If any of the patients want another opinion or if the physicians want to discuss a case with their colleagues, they can easily get in touch. This, he said, would give patients an added confidence and assurance that the level of care provided in the hospital would meet the same standards as that of King’s in London.

Emphasis on prevention

The CEO stressed that the hospital’s business model is all about delivering the right level of care. “However, the ideal care is one that you don’t have to deliver,” he said. “We take care of our patients above and beyond just prescribing drugs. One example of this would be our close relationships with schools.”

King’s runs a few school clinics in the UAE, which allows it to work closely with the institutions and shape healthy behaviours right from a young age. It works with schools in terms of offering insights into right nutrition, how to educate kids on being active, and how to look after their own health, among other factors.

The other way King’s puts emphasis on prevention is by employing the latest technology. Schuhmacher stressed that technology is important when it makes a difference to the patient and to clinicians and the whole driver behind the hospital investing in it is to achieve patient safety, enabling integration so all the systems can communicate to each other and avoid human error.

The hospital is using the pharmacy-led Omnicell end-to-end automated medication management process, an automated dispensing technology combined with barcode medication administration and electronic prescribing. This ensures medication management is optimised to a safe, fully traceable, paperless system at the point of care and clear visibility of patient therapy management.

Furthermore, King’s is reportedly the only facility in the UAE to have an EOS imaging system. It is an advanced orthopaedic imaging technology that gives doctors a clear 3D view of the patient’s musculoskeletal system and helps them make decisions regarding the patient’s treatment. This replaces the need to take four to six X-rays, as it automatically stitches the scans together and boasts greater accuracy. It only exposes patients to 10 per cent of the radiation normally required and has a micro radiation dose option making it highly effective for paediatric orthopaedics.

Also unique to the hospital is the King’s ‘Getwell Network’, which is equipped with an edutainment system offering patients entertainment, as well as interactive information about their condition at the touch of their fingertips. For example, a patient undergoing surgery can learn everything relating to their procedure, condition management and what to expect during the recovery period through interactive media that is adapted specifically to the patient. While all this information is explained by the doctor, patients benefit from having a one-stop-shop portal to access from the hospital or remotely from home at any time through the Patient Portal.

Schuhmacher highlighted: “For example, if someone comes in for a gastro procedure then they will get access to material such as nutrition, what you should be cautious of, how you can improve your lifestyle to prevent something else from happening. It’s not about treating you for a condition you have right now, but it’s about really looking after you and what we call the ‘King’s care’ that we are trying to establish.”

Dr. Ramanathan added: “Family medicine is a big part of what our services are, within the clinic as well as in the hospital setting. We want to reach out to the communities and want to be able to provide that primary preventative mechanism.”

She highlighted that one of the services they offer is the Well Baby and Well Mum clinic that offers education and antenatal classes. “We are taking some of those initiatives onto the King’s Big Bus, which will go around the neighbourhood and interact with the different communities of Dubai.”

Future plans

Schuhmacher shared that the hospital has provisions to add another 100 beds, in order to double the capacity. “From breaking ground to completing the facility, it took us 19 months. So, the moment we decide to go for the next 100 beds it would take another 18 months. We are always exploring opportunities in the UAE for any additional clinics. We have carved out our niche. There will be growth, but it will be sustainable,” he said.

Dr. Ramanathan concluded: “From the clinical perspective, there are certain identified gaps within the UAE. I think we have opened with quite a broad general spectrum of services. With time we will start providing a deeper amount of quality of care within each of those services, arm-in-arm with King’s in London.

“Teaching and training is something that we feel is important coming from an academic institution in the UK. We are planning to have comprehensive programmes for medical students, residents, undergraduates, postgraduates and nursing within our hospital.”

Services Offered

The hospital specialises in five core areas – Paediatrics, Cardiology, Orthopaedics, Obstetrics and Gynaecology, and Metabolic Diseases, as well as offer integrated pathways with King’s in London in Chronic Liver disease, Foetal Medicine, Haematology as well as several other areas. It also provides acute and general care services in Anaesthesia and Intensive Care, Emergency Department, Cardiology, Endocrinology, ENT, Family Medicine, Foetal Medicine and Neonatology, Gastroenterology, General Surgery, Vascular Surgery, Paediatric Surgery, Breast, Thyroid and Colorectal surgery, Aesthetic and Reconstructive Surgery, Radiology, Urology and Neurology.

According to a May 2018 report by global consulting services firm Accenture, Artificial Intelligence (AI) is set to give the UAE economy a US$182 billion boost by 2035 with healthcare likely to see a gain of US$22 billion in its annual gross value during the same period.

The UAE’s firm belief in an AI-based economy became evident as early as 2017 when it announced the UAE Artificial Intelligence Strategy that aims to bring AI tools and technology to various sectors including healthcare. Apart from improving patient outcomes, the transformative power of AI in healthcare stems from the fact that it promises a life-changing impact in this field be it in hospital care, drug development, improved accuracy in the early detection of diseases, and data analytics powered decisions, amongst others.

Recognising the central role AI plays and the benefits to be gained from its use in healthcare, the Department of Health—Abu Dhabi (DoH), the regulator of the healthcare sector in the Emirate, is the first entity in the region to develop and launch an artificial intelligence policy for the healthcare sector.

In an interview with Arab Health Magazine, on the sidelines of the Arab Health Exhibition & Congress 2019 that concluded in Dubai in January, Dr. Hamed Ali Al-Hashemi, Director of Strategy at Department of Health (Abu Dhabi), outlines the latest cutting-edge AI initiatives unveiled by the organisation with the aim of spearheading the fusion of healthcare and technology in Abu Dhabi, and to deliver on its promise of exceptional quality of healthcare services for citizens and residents in the emirate.

“The DoH is committed to positioning Abu Dhabi as a hub for AI and innovation in healthcare globally,” affirms Dr Al-Hashemi, who oversees the strategic planning and performance monitoring of healthcare strategies, programmes and operations of the organisation. “We have put in place a robust roadmap to fully reap the rewards of this innovative technology, and are looking to harness the power of AI to transform the way healthcare is delivered in the emirate to increase positive outcomes and thereby, enhance our patients’ healthcare journey.”

Emerging technologies and healthcare solutions

To foster a new culture of innovation and inspiring cross-industrial collaboration in the healthcare sector, the DoH launched its AI Lab at Arab Health 2019. “This is a first-of-its-kind initiative by a healthcare regulator in the region,” explains Dr. Al-Hashemi. “With the launch of the AI Lab, we aim to develop healthcare solutions through emerging technologies including AI, Blockchain, predictive analytics and the Internet of Medical Things (IoMT), amongst others.”

The AI Lab will serve as a safe platform of co-creation where DoH as the regulator can collaborate with service providers, payers, and technology companies to develop, test, and launch state-of-the-art healthcare solutions powered by emerging technologies, he explains. “Innovation at the AI Lab will be focused on four key strategic pillars: wellness & prevention; chronic disease management; clinical care, and regulatory management.”

The first project to be launched under the AI Lab is the ‘My Health Coach’ app that is designed to help the people of Abu Dhabi live healthy lives. “This is a one-of-a-kind health and wellness mobile application that encourages patients and the society to optimise their well-being through an engaging and interactive platform,” says Dr. Al-Hashemi. “The app seamlessly syncs to the fitness trackers of the user’s choice and provides personalised, informative and anticipatory coaching and guidance, according to the data collected by users.”

Dr. Hamed Ali Al-Hashemi

The app is currently available for the 700 plus DoH employees, he adds. “After six-months, it will be available for Abu Dhabi Government employees. The app will open to the public by 2020.” Available in both English and Arabic, it is compatible across all major operating systems.

The second project launched under the AI Lab is the Cognitive Virtual Assistant (CVA) that seeks to facilitate easy access to information. “Powered by AI, the virtual assistant will be able to answer queries in Arabic and English with regards to facility and professional licensing to deliver a seamless experience for our customers,” he says. “In the near future, this CVA will encompass all DoH services.”

Integrating technological transformations in healthcare

‘Malaffi’ or ‘my file’ in Arabic, is the name given to the Health Information Exchange system launched earlier this year by DoH to streamline healthcare connectivity for the emirate of Abu Dhabi. “Malaffi is a new centralised platform that will connect more than 2,000 public and private healthcare providers in Abu Dhabi, which cater to the healthcare needs of more than 3 million people in the emirate,” says Dr. Al-Hashemi. “It is a revolution in the delivery of healthcare as it greatly reduces the duplication of healthcare services and also enables physicians to make faster, more efficient medical decisions. The end result is improved quality of care and patient outcomes.”

Malaffi has been developed to comply with emirate-wide and federal health privacy laws to ensure patient confidentiality and data security. It is expected that both public and private healthcare facilities will implement Malaffi by end of 2020.

Yet another distinctive advantage of Malaffi, adds Dr. Al-Hashemi, is that “through the benefit of syndromic surveillance that it provides, the government would be able to help prevent and minimise the potential spread of disease and management of chronic diseases. This will enable efficient emergency medical response plans in real-time to help prevent epidemics.”

Powered by real-time healthcare data

Abu Dhabi’s unprecedented shift towards technology and AI in the healthcare sector saw the launch of the Open Data Dashboards initiative at Arab Health. “This online portal,” explains Dr. Al-Hashemi, “will relay the emirate’s most up-to-date health statistics in a visual and engaging manner. The launch of the Open Data Dashboards was in response to the demand for real-time healthcare data, which will provide all key stakeholders in the healthcare sector with insights to improve access, quality and financial sustainability for planning and managing healthcare services. Users will also be able to compare selected statistics with international benchmarks on the same parameters.”

Accessible to members of the public, the dashboard will be continuously updated with real-time data drawn from DoH’s database system, which is powered by AI.

Paradigm shift in healthcare

“Today, AI is no longer a mere possibility; it has moved into the realm of tangible, measurable and scalable deployment,” says Dr. Al-Hashemi. “AI applications have the potential to improve the integral core of the healthcare sector by reducing costs, improving treatments, and bolstering accessibility. The benefits AI provides are slowly beginning to reshape the healthcare landscape as precision surgery and predictive diagnostics are leading to preventive care or timely medical intervention.”

For the patients, this translates to a more accurate initial diagnosis and a more effective treatment plan, he adds. “With AI, the physician has an additional tool to diagnose and help direct therapies for patients. AI is a proven, evidence-based scientific tool that improves accuracy in clinical decision making by unlocking the relevant information stored in staggering amounts of data.”

The increasing availability of healthcare data and rapid progress of analytics techniques are bringing about a paradigm shift in healthcare. “Breaking down, correlating and analysing data are generating new insights and can be turned into meaningful solutions or procedures that can impact millions of lives,” he says. “The top AI algorithms are today continuing to advance diagnostic fields leading to better outcome prediction and prognosis evaluation, and more sophisticated patient care.”

Yet another area where AI is making a major impact is telehealth and remote health monitoring, he adds. “This has the potential to significantly improve quality of life as the patient’s disease management is taken care of outside the traditional physical clinical setting.  By leveraging technology to monitor patients in their own homes, it helps them to better manage their own health.”

As AI cements its role in healthcare, the Department of Health—Abu Dhabi (DoH) is also making efforts to ensure that the appropriate policies and regulations are put in place and are designed to encourage the implementation of the latest AI technologies. “The future of healthcare in the UAE, as in the rest of the world, is through Artificial Intelligence,” states Dr. Al-Hashemi. “It has a critical role in vastly improving the efficiency, effectiveness, safety, access and delivery of healthcare services, and all types of population and patient research. Therefore, as AI begins to dominate fast-paced technological innovations in the industry, DoH has become the region’s first entity to develop this kind of technology policy.”

The policy, which defines AI as the ‘mimicking of human thought and cognitive processes to solve complex problems automatically’, also reflects the department’s support for the development, use and adoption of customised AI technologies and software to enhance healthcare in Abu Dhabi, he adds.

Risks of patient safety

However, smarter healthcare systems also bring in a host of issues, particularly those related to data security and safety. “These require regulations in place to ensure that it does not threaten patient safety or privacy,” he says. “Inaccuracies in the data will also be reflected in the results as AI relies on patterns in data to predict, prevent or treat diseases.”

Yet another challenge, he believes, “is the fundamental question of the adoption of technology – would the end user accept the idea of communicating with a device for diagnostic consultation, away from the traditional physical setting of healthcare? However, we know that AI is the way forward and it is our responsibility to ensure that the community in Abu Dhabi is geared up to adapt to this technology.”

Accordingly, the DoH has introduced several plans and strategies to facilitate the process and in doing so, to position Abu Dhabi as the hub of AI innovation in the region and globally. “There are three dimensions within the healthcare sector that we are currently focusing on,” he says. “One is the promotion of e-care, which includes telemedicine and telemonitoring or the provision of healthcare services via telecommunication and information technology. We are enabling healthcare facilities in the emirate to adapt to this while at the same time making efforts to address the patient safety and information security concerns.”

In line with this, DoH has implemented a Service Standards for Tele-counselling, which requires providers to adhere to its regulations in data management and medical record retention, he adds.

E-analytics or the use of multiple technologies and techniques to gain insight into the vast and complex datasets that are driving medical outcomes, increasing patient safety, improving the management and quality of care, and boosting financial viability through efficiency and cost management, is vital to improve overall competitiveness, says Dr. Al-Hashemi. “The DoH has vast amounts of data compiled since the past decade. What can we do with this data? One task of the AI Lab would be to collaborate with all technology partners to make sense of and define the opportunities of capitalising on the data that is going to be available.”

Finally, to further cement the position of Abu Dhabi as a global centre for innovation, medical and scientific research including AI and 3D printing, the DoH has instituted the Technology Innovation Pioneers (TIP) Healthcare Awards to provide an innovation ecosystem to accelerate research and create innovative solutions towards key healthcare challenges. “We are the first government entity that has established a link between investors and healthcare innovators and this platform will allow innovators to share and develop ideas. They will also receive the necessary support to take these ideas to fruition, further enhancing healthcare outcomes,” says Dr. Al-Hashemi.

He adds: “We believe that innovators will lead the development and growth of the sector. Leveraging advancements from artificial intelligence and technology will pave the way for better diagnosis and advanced medical treatments. By finding creative solutions for some of the main healthcare challenges, Abu Dhabi thus seeks to enhance its position as a pioneer in healthcare innovation.”

According to a recent report by Frost & Sullivan titled Global Healthcare Market Outlook 2019, increased Public Private Partnership (PPP) opportunities in the Gulf Cooperation Council (GCC) countries will continue to drive on-going smart hospital projects and digital health initiatives such as Artificial Intelligence (AI), blockchain, and robotics. With healthcare infrastructure moving towards the private sector, particularly in the UAE and Kingdom of Saudi Arabia (KSA), we are seeing an increasing number of hospitals and beds and there is an on-going demand for more healthcare services, says the report.

Supporting demand in the UAE

In the UAE, while there are more hospitals in the private sector, the public sector still comprises around two-thirds of the total available beds indicating that it has the majority of large-sized hospitals.

However, growth in private hospitals and beds has been more robust than in the public sector and there are ample opportunities for investment in this sector.

The UAE has witnessed decent growth in terms of the number of beds in private hospitals – almost 13 per cent Compound Annual Growth Rate (CAGR) from 2010-2014, and in the range of 10-12 per cent CAGR growth of private hospital beds up to 2017. These trends have also been validated by the recent announcement that the UAE plans for the addition of 2,500 beds in the private sector by 2020 with the majority of these being in Dubai and Abu Dhabi.

“We are already touching maturity phase in terms of supply of hospitals, with six or seven new players in Dubai and Abu Dhabi alone in the last few years, so we would expect to see the number of new hospitals start to slow down and the demand has now been met in terms of supply,” explains Sandeep Sinha, Associate Partner & Head, Healthcare and Life Sciences, Frost & Sullivan.  

A major driver for the UAE, particularly in the Dubai market, is the adoption of the second phase of the mandatory health insurance in 2017. “Whenever insurance comes into the picture, you see major growth in Out Patient and In Patient volume. However, as is typical for any country that has recently adopted a 100 per cent mandatory insurance system, while the volumes have grown, margins have also come down,” says Sinha.
In order to address the issue of cash flow and price control in the UAE, both private and public healthcare facilities are adopting revenue cycle management that utilises medical billing software to track revenue generation.

“In this period of adjustment, which is often temporary, particularly smaller clinics with high overheads may suffer and we have typically seen a number of mergers and acquisitions in these cases,” Sinha explains. “On the flip side, insurance companies are also having to address their cash-flow issues and they are paying closer attention to claim management.”

PPP driving growth in KSA

The KSA had a total of 531 hospitals in 2017, with 68 per cent of these in the public sector. Growth in private hospitals has been slightly higher than in public hospitals over the last few years (3 per cent as compared to 1.7 per cent CAGR in public hospitals, between 2010 and 2016).  

Sandeep Sinha

Similarly, the share of hospital beds was higher for public hospitals (75 per cent) in 2016 out of the total 70,844 beds. However, the growth in private hospital beds (5.3 per cent CAGR between 2010 and 2016) has been better than the growth in public hospital beds (2.8 per cent CAGR during the same period).

Despite the growth in both private and public hospital beds in the KSA over the last few years, the bed density has not increased in proportion to the growing population. It also lags behind that of developed countries. In comparison, the World Health Organisation puts the global hospital bed density average at 2.7 beds per 1,000 population and in key developed countries such as the UK and the U.S. as having 2.9 beds as of 2011.

According to Sinha: “In KSA, the government has spent a large amount of time planning PPP programmes over the last three years resulting in growth in this sector. The regulatory changes allowing 100 per cent foreign ownership for hospitals is expected to drive private sector investment significantly.  In addition, Saudization, officially known as the Saudi nationalisation scheme, or Nitaqat, has addressed manpower issues by bringing nationals into mainstream employment in the healthcare sector, both on the clinical and non-clinical side.”

In KSA, while public sector outpatient volumes and share has been decreasing, the private healthcare sector has been witnessing growth in both Out Patient and In Patient utilisation and OP-IP conversion. This trend is set to be further consolidated in the future with increased insurance coverage.

The move towards value-based care

According to Frost & Sullivan analysis, globally, 2019 will be a year of value-based care, as the focus on ‘outcome-based care’ globalises, triggering maturation of risk-sharing contracts. By the end of 2019, up to 15 per cent of the global healthcare spending will be tied in some form with value-outcome- based care concepts.

As Sinha explains, “In countries such as the UAE and KSA, value-based care is a new concept that is being explored on a number of levels. This care model takes a holistic view in terms of looking at improving the quality of care, as well as making cost savings for the stakeholders such as manufacturers, insurance providers and healthcare providers. In other markets, pharmaceutical companies are tying up with the insurance companies to fix the cost of medication to provide care for a certain condition. Eventually, we may also see this move into the healthcare side of things, hospitals may need to buy into value-based care models.”

The digital coming over age

On a global level, Frost & Sullivan predicts that AI for HIT application market is expected to cross 1.7 billion by the end of 2019. Operationalising AI platforms across select healthcare workflows would result in a 10-15 per cent gain in productivity in the next 2-3 years. During 2019, digital health technology catering to out-of-hospital settings will grow by 30 per cent to cross US$25 billion mark globally. Also, by the end of 2019, Frost & Sullivan predicts that 5–10 per cent of healthcare-focused enterprise blockchain applications will move from pilot stage to partial/limited commercial availability.

He concludes: “In the future, AI will have a big impact on laboratory and imaging diagnostics. Innovation is taking place on every level and healthcare providers and hospitals must keep up. Treatments are now increasingly moving to non-invasive procedures such as laparoscopy and keyhole surgeries and hospitals are now increasingly adopting Smart Hospital Concepts where clinical process, management process, and patient care data will be linked to HIT platforms. This will help hospitals manage their costs, improve clinical outcomes and give patients a better experience.”

Traditional Chinese therapies have been popular in the West for some time, and this popularity is not showing signs of waning anytime soon. Millions of people outside of China use acupuncture, Chinese herbal therapies and other forms of traditional Chinese Medicine every year to treat ailments.

The question is, do these treatments work, if only to some degree? The medical community has long been sceptical about Chinese medicines, because the premises behind them are not based on scientific evidence. Few medical professionals would prescribe traditional Chinese remedies as a treatment for disease or ailment. However, do they have a role to play in combination with evidence-based medical treatment, as complimentary therapies? Let’s take a look at the arguments.

What is traditional Chinese medicine?

Traditional Chinese medicine, also known as Chinese herbal medicine, is a series of practices and treatments which date back more than 2,500 years. Rooted in the ancient philosophy of Taoism, Chinese medicines encompass not only herbal treatments to be taken orally, but also a range of therapies such as acupuncture, dietary therapy and tai chi.

One of the central tenants of traditional Chinese medicine is the belief in treating the whole self, because the physical body, mind and psyche are all interwoven. This is why a series of treatments may be recommended to treat a seemingly unrelated illness.

Chinese herbal medicine uses primarily plants (leaves, roots, stems, flowers and seeds) but also minerals and animal products to create medicinal products. Generally, these products are combined in formulas and taken in the form of herbal teas, capsules, liquid extracts, granules or powders. Acupuncture, another central practice of traditional Chinese medicine involves using needles or other methods to stimulate certain pressure points on the body. Tai chi, which involves gentle movement, mental focus, breathing and relaxation, is also often used in combination with other therapies.

What does science say about Chinese medicine?

To date, there was been little targeted scientific research on the effectiveness of Chinese herbal medicine and therapies. This is partly due to scepticism among the scientific community, and partly because the holistic nature of these practices makes them difficult to study. There has been some research on the topic within China, however, where these practices are taught as a distinct subject from biomedicine.

There have been a number of scientific reviews on certain techniques and remedies in traditional Chinese medicine, however according to the U.S. health body National Center for Complementary and Integrative Health (NCCIH), they “were unable to reach conclusions about whether the technique worked for the condition under investigation because there was not enough good-quality evidence”.

The same source, however, reports that a 2012 analysis of 29 studies found that patients receiving acupuncture for back or neck pain, osteoarthritis, or chronic headaches reported better pain relief compared to patients who did not receive acupuncture.

Is traditional Chinese medicine dangerous?

The active ingredients in Chinese herbal medicines can be quite potent, therefore they should be used with caution. In particular, traditional Chinese treatments may be harmful if taken in too high of a dosage, or when interacting badly with other treatments. This is why, if traditional Chinese therapies are to be used, they should be prescribed and monitored by a physician who is knowledgeable on the subject.

Dangers also arise when Chinese herbal medicines are taken for uses other than those which are traditionally recommended in the practice. For example, ephedra or ma huang to the Chinese, has been used in traditional Chinese medicine for over 3,000 years as a remedy for respiratory issues. It became popular in the U.S. in the 2000’s as a weight-loss treatment, and, was banned by the FDA in 2004 after being linked to the death of professional baseball player Steve Bechler, who was using the herb to lose weight.

Another issue is that there is no guarantee of what you will receive. In the U.S., for example, Chinese herbal medicines are general listed as dietary supplements by the Food and Drug Administration (FDA). This means that they are not subject to the regulations and controls, which apply to medications, and manufacturers do not need to substantiate that their product has the effects as claimed. This means that although there are some authentic Chinese herbal products on the market, there are many which are poor quality, have little relation to traditional Chinese remedies, and/or are contaminated with pharmaceutical drugs, heavy metals or toxins.

Using Chinese medicine with medical therapies

Some health institutions and bodies acknowledge that traditional Chinese therapies may be useful as a complimentary treatment to mainstream medical therapies, for example to assist with easing symptoms of chronic diseases or helping to lessen side-effects of medication. The reputable organisation Cancer Research UK, for example, recognises that traditional Chinese medicine may assist cancer patients in combination with modern forms of treatment. They do take care, however, to stress that these treatments may interfere with cancer medications and so should only be conducted under supervision by a physician.

The major concern is around patients using Chinese herbal medicine or practices as an alternative to research-backed medical treatments and foregoing the latter, particularly in the cases of severe and chronic diseases such as cancer. A secondary concern is patients self-subscribing Chinese herbal treatments in doses which are too high and therefore dangerous or may have negative reactions with the other medications they are taking.

In this context, when medical practitioners are treating a patient who has expressed an interest in traditional Chinese medicine, they may do well to, rather than simply attempting to shut down the patient’s use of these therapies, seek to supervise and monitor their use in conjunction with the treatments they prescribe.