A study by McKinsey & Co highlighted that in 2019, only 11 per cent of U.S. consumers accessed telehealth services, while in 2020 it was up by 46 per cent. These statistics were shared by Peter Nardi, Network Manager, North America, GMMI Inc., who was speaking at the 'What’s on the Tele? International private medical insurance, telemedicine and remote second opinions', a session at the 2020 USCIPP annual meeting.

According to Nardi, telemedicine showed us how necessity breeds invention. He highlighted that one of the areas where telemedicine would be beneficial is bariatric surgery. This is the type of care that requires patients to have a strict adherence to protocols even before the surgery, which requires a lot of pre-care and post-care. “I think a lot of that can be done virtually. If hospitals can work on certain pricing that they can offer for these programmes that would be attractive for insurance companies. If that is done correctly, there might be a way to work with nutritionists, dieticians, and other doctors from a virtual perspective, to have these patients not travel,” he explained.

If telemedicine is here to stay, stressed Nardi, then are certain issues that need to be addressed. These include factors such as if the provider has necessary certifications to do e-prescriptions. “There are platforms and companies that provide these certifications but are all providers aware of that? Are doctors aware of that?” he said.

Other challenges include coding, pricing and reimbursement. Providers must ensure to properly code claims to reflect virtual visits as opposed to hospital visits. “There is going to be an expectation of having visibility of the fee schedules,” he added. “There should also be a look at if reimbursements should be lower. We look at it from the vantage point of if doctors are treating more patients virtually, they should be able to treat more patients overall, as time spent with those patients is less. Due to the pandemic, a lot of insurance companies also made the right decision of waiving co-pays and deductibles, so that the cost is lower.”

Regulatory challenges

The interest in cross border telemedicine has evolved from something of a novelty and a luxury to a real service line with growing revenue, highlighted William Ferreira, Partner, Hogan Lovells, at the ‘Regulatory trends in the delivery of international telemedicine and remote second opinions’ session.

He said: “Telemedicine is not just for patient care now, it’s for scientific research, remote data collection and more. What we are finding is that foreign regulation in this area is straining to keep pace with modern technology. Nobody doubts how important it is to leverage telemedicine especially during this pandemic period and beyond. But there is some doubt in many countries on how to regulate telemedicine and how to regulate it especially when the physician and the patient are in different countries.”

Compared to just a few years ago, U.S. hospitals are bringing a systematic approach to the business strategy in telemedicine. Furthermore, the amount of market research and competitive intelligence that’s being developed in this area is also substantial and growing.

However, the location of the patient is critical because it drives the law applicable to the hospital, physician and patient, whether it is a remote second opinion business or relationship with a managed care plan or an insurer, explained Ferreira.

“That’s why so many institutions have spent time exploring country-by-country regulatory parameters that apply to these programmes. It affects the viability of these virtual service lines in a very real way,” he shared. “While the practice of medicine is regulated around the globe, the practice of telemedicine can be referred to as a blurry patchwork. Where countries do regulate telemedicine, those laws do not necessarily address the circumstances where the physician and the patient are situated in different countries.”

Moreover, Adilene Rosales, Associate, Hogan Lovells, gave the example of Saudi Arabia, where they have issued telemedicine regulations that define it broadly but define teleconsultation in such a way that it can only be delivered through certain mediums. Interestingly enough, it can’t be audio-only. While in the UAE, especially Abu Dhabi, the physicians who will be consulting with each other must have an established collaborative partnership, which is evidenced by a written agreement that divides up the responsibilities and liabilities of both the parties.

Rosales added that if a country’s telemedicine framework is underdeveloped or non-existent then the regulations that govern the traditional practice of medicine could be referred to.

Nardi concluded: “Even if a vaccine does come out, I think we are going to be more creative and collaborative on figuring out ways from the international perspective of how we can keep patients in their home countries.”

What is the difference between telemedicine and second medical opinion (SMO)?

Telemedicine is using technology to treat someone at a distance. On the other hand, SMO is a service that will verify a diagnosis to the recommended treatment plan.

International Day of Older Persons, an observance first designated by the UN General Assembly in 1990, this year promotes the Decade of Healthy Ageing, bringing together UN experts, government, civil society and health professions to discuss the Global Strategy and Action plan on Ageing and Health, and raise awareness of the special health needs of senior citizens. 

As 2020 is also the Year of the Nurse and Midwife, International Day of Older Persons 2020 will highlight the role of healthcare personnel, in particular the nursing profession, in contributing to the health of older persons. Its primary focus is on the role of women, who are "relatively undervalued" and "inadequately compensated". 

Indeed, the nursing profession will be in the spotlight at a virtual event, Nurse Leadership Forum Middle East on Monday, October 12th (3pm-5pm GST), involving more than 200+ nurse leaders from across the Middle East.

Professor Ciaran O'Boyle from the RCSI Centre for Positive Psychology and Health will be joined by Associate Professor Jane Griffiths, Chief Nursing Information Officer at the Dubai Health Authority, who will provide a regional perspective on the strategies employed during the pandemic.

In addition, the International Day of Older Persons theme for 2020 aims to increase understanding of the impact of COVID-19 on older persons, and its impact on health care policy, planning and attitudes.

It explains that policy and programmatic interventions must be targeted towards raising awareness of the special needs of older persons during the outbreak of pandemics such as COVID-19. 

COVID-19 impact on older population

According to the WHO, older people and those with pre-existing medical conditions appear to be more vulnerable to becoming severely ill with the coronavirus.

COVID-19 is changing older people's daily routines, the care and support received, their ability to stay socially connected and how they are perceived. Seniors are being challenged by requirements to spend more time at home, lack of physical interaction with family members, friends and colleagues, temporary cessation of work and other activities; and anxiety and fear of illness and death.

The UN's Department of Economic and Social Affairs (UN DESA) adds that the level of risk faced by older persons varies considerably from country to country. The main determinant of COVID-19 mortality among persons aged 60 years or older is the extent to which countries have been able to contain or mitigate the epidemic. Other factors are individual frailty related to pre-existing medical conditions, the level care received and the living arrangements of older persons.

How the ageing population can remain healthy in today's world

The global population is ageing: UN DESA projects a doubling of the ageing population from an estimated 727 million aged 65 years or over by 2050, to total more than 1.5 billion people.

The proportion of the overall population is expected to grow from 9.3 percent in 2020 to 16.0 percent in 2050, and by mid-century one in six will be an older person. 

Speaking to Omnia Health Insights in a recent Patient Talk podcast episode, Prof O'Boyle revealed that there are communities worldwide where people already regularly live beyond 100 - described as "blue zones". He attributed this to lifestyle behaviours:

"There are certain behaviours in terms of what they eat - like plant-based diets, they get up from the table and they're 80 percent full, their activity is natural that is built into their day. You see shepherds in their eighties for example. There are things that individuals can do, but there are also things that cities and countries can do to create a built environment that makes it easier for people to look after their health."

One such example of an environment healthy by design is NEOM, a planned city in Saudi Arabia of open spaces that will nudge visitors and residents into a healthier living. Dr Maliha Hashmi, Executive Director and the Deputy Sector Head Health and Wellbeing and Biotech at NEOM, described this city design as a "gym", cemented by smart devices that offer reminders to take exercise and other healthy activities. 

New Year’s Eve 2020: a new beginning

The first firework of New Year’s Eve exploded in the sky above Samoa in the South Pacific. As the earth rotated and 2019 came to an end, another party started in another location, gradually heading westwards.

Auckland, Sydney, Singapore, Beijing and Delhi, into Dubai, Abu Dhabi and Riyadh, steadily onwards to Rome, Paris and London, over the Atlantic to New York, Chicago and Los Angeles, Rio de Janeiro and Buenos Aires, finally coming back to American Samoa just 100-miles from where it started 24-hours before.

As the earth revolved and millions of fireworks over hundreds of cities fizzled out, more than 7.6bn people had looked upwards with private hopes about the upcoming year.

In healthcare, the World Health Organisation had designated 2020 The Year of the Nurse and Midwife to help raise the value of nursing, choosing the date to coincide with the 200^th anniversary of the birth of Florence Nightingale, often regarded as the founder of modern nursing.

But within days of New Year 2020, another city was in the news. Few knew where to locate it. But within a month most of the world had heard of Wuhan, China.

February 2020: a new reality

By February, COVID-19 was already circling the globe faster than all those New Year firework displays and suddenly the Year of the Nurse and Midwife had taken on a completely new meaning.

Globally, an average of 5.7-people in 1,000 work in the healthcare sector, half of those in nursing. That figure is far higher in the 25% of the world with better-funded healthcare systems, whereas 50% of countries report 3-people per 1,000 population and 25% report around 1-person per 1,000.

Nursing can be a tough vocation, and so the WHO had set 2020 as a year of focus on the wonderful work of the 20.7-million nurses across the world.

In just a few short weeks the whole world had to take on an entirely new challenge. For the first time in 100-years, everyone on the planet was involved in a struggle and nobody could look at their own families, communities or countries and claim this was a problem for other people.

It felt existential. It felt as though the world was saying ‘enough’. The future looked extremely bleak.

The value of nurses and the nursing profession

Nursing has always seemed a vocation, a calling.

Nurses’ experience, knowledge and care has continually been admired by patients and clinicians, if not sometimes by legislators who can take that compassion for granted when pay and conditions are discussed.

But COVID-19 brought nurses and clinicians to the centre very quickly, and the world came to understand why nursing has been an essential, but sometimes overlooked, profession. Human nature being what it is, nursing has perhaps been overlooked not because people don’t care, but because it’s so good, so professional and so pervasive in our lives that a high level of care, compassion and commitment had become expected by the 994-people out of 1,000 who don’t work in healthcare.

We have come to expect that service and care. Now we were all faced with the realization that these people were constantly in the front line of our safety, and we started to realise their value to the world. As we woke up to the facts, nurses and clinicians were facing more challenges - ones they knew would put them in danger.

Physical and mental health

The world quickly needed to get used to new thinking, new actions, new dangers whilst talk of PPE, test & trace, lockdowns, isolating, social distancing and furlough schemes became common.

In the middle of alarming rises in the rates of COVID (and attendant deaths and cases) nurses, doctors, hospitals, healthcare workers, health authorities and governments managed to somehow bring a semblance of joined-up thinking to a confused world. Hospitals were built almost overnight, curfews put in place, safety became the total priority and thanks were expressed daily.

What we now see were strategies being put into place to protect health workers, encourage public responsibility and head off the impending doom as safely as possible.

But what were those strategies in the midst of the crisis? What were Nurse Leaders doing to learn, pass on ideas and change the ways of working? How were nurse teams being supported in a physical way through PPE etc, and from a mental health perspective?

Nurses, nurse leadership and strategies

On Monday, October 12, almost 1,000-nurses and nurse leaders have already registered to hear keynote speakers and nurse leaders share their experiences at the online Nurse Leadership Forum Middle East.

An initiative launched by OBIX Middle East, and powered by Omnia Health by Informa Markets, the event is FREE to attend for all nurses, nurse leaders, healthcare executives and clinicians.

The event Steering Group comprises 27-Chief Nursing Officers and senior staff from hospitals across the GCC, both government and private sector, and the focus of the event is “Compassion, Clinical Effectiveness and Burnout: Essential Strategies for Nurse Leadership”.

The easy to follow online event encourages participation by questions from the audience and is moderated by professional broadcaster, Brandy Scott, who many will know from her morning show, The Business Breakfast on Dubai Eye 103.8FM.

The two keynote speakers are Professor Ciaran O’Boyle, Director, Centre for Positive Psychology and Health at The Royal College of Surgeons, Ireland and Associate Professor Jane Griffiths, recently Chief Nursing Information Officer at the Dubai Health Authority, and both will be speaking to the issues with thoughts on help available for nurses in the field of mental health.

The event will also highlight other nurse leaders through a series of pre-recorded interviews with CNO’s running teams of nurses, from 200- to more than 6,000-nurses across many teams and hospitals.

When the World Health Organisation created 2020 as the Year of the Nurse and Midwife it was surely not with this crisis in mind but, as always, nurses and the nursing profession stepped up to the task.

OBIX Middle East focuses on the perinatal sector as the regional headquarters of Clinical Computer Systems, Inc., a business which has clinicians at the centre of all we do. The OBIX system runs at the heart of labour and delivery units in hospitals responsible for 25% of all births in the USA and we’re here in the Middle East with full-time staff rolling out new implementations.

Since we established in 1997, we have always offered education and knowledge back into our nursing communities, and this free-to-attend event continues this long-established principle by sharing experiences, strategies and help with the nursing profession in the Middle East.

This event is for all in nursing, no matter the discipline, and we look forward to welcoming you on October 12^th at 3 pm-5 pm Gulf Standard Time. Register now and join us for some inspiration and community.