Step 1: Know Your Network, Inside and Out
To secure the network that your IoT infrastructure connects into, it’s important to know exactly what’s running on it. As more employees and users become more network savvy, it’s hard to keep track of what is being connected to the network because it’s no longer just IT professionals who are making the connections. 
To combat this threat, a modern network access control solution is a great starting place, with a roles-based management and network segmentation solution. These solutions will enable network and security managers to set policies around ‘things’ and devices, meaning that not just anyone can connect to the network. On top of this, it’s also possible to set permissions on what data and applications they can access, as well as setting rules to who can manage and maintain these networks and devices. 

These solutions automatically monitor connections to the network and can isolate without the need for IT staff to action the quarantine. Assigned IT staff will then be notified to act against the suspected malicious incident. 

Step 2: Users, Devices and Things Have Roles, Know Them
To ensure the efficient running of the network, it’s important to consider the myriad of devices that carry the ability to transmit data, locate them on the network, and consider how they could be used to create an integrated and innovative experience. 

In healthcare, patient monitoring within a surgery ward could keep track of vital signs, such as heart rate, without physically attending the bedside. This ability could be critical in detecting a potential issue quicker and acting (for example alerting a nearby nurse) without the need for caregivers to be everywhere at once.
Clearly, this use case is integral to safe and efficient running of healthcare institutions, and it also fits into part of the IoT puzzle within healthcare, helping those running the institutions to better make use of the equipment they already have. 

Step 3: Use AI to Monitor Change
By bringing devices together in a single management platform on the network, security staff are better able to take a holistic view of all equipment and begin to build smarter security policies. The unfortunate truth is that, no matter how much planning and patience is put into securing a network, threats will find their way in. 

Thankfully, for organisations that want to combat this to their utmost ability, AI-based machine learning is becoming more sophisticated in helping to identify early and mid-threat scenarios. Sophisticated cyberattacks manifest themselves slowly over several months but through leveraging analytics, this technology can spot changes in behaviour that often indicate that the profile of a user’s device is not conforming to usual patterns. In fact, a recent report showed that two thirds of breaches were perpetrated by insider actors, and not internal forces.

The combination of integrating a powerful Access Control solution, along with AI, allows suspicious devices or actors to be temporarily quarantined to support security teams to focus their precious time on analysing only the most pertinent anomalies. The savings associated with this model is allowing IT teams to rebalance their workload to a more proactive security posture.

Step 4: Shape the Network Around Better Security
With the global rise of cyberattacks, there can no longer be a disconnect between network and security teams. Primary security elements must now be embedded into the network to allow more sophisticated security policies to leverage the network to gate or grant access to bandwidth.

The challenge with this is that historically some of these features were not embedded as standard but charged as optional extras. Therefore, devices and applications were able to bypass flaws in the network design, creating exposure to risk. Today, there are far more robust security features that are deeply embedded into the wireless and wired network allowing security teams to build around this in a world where the attack surface has grown exponentially due to mobility and IoT. This requires an inside out view of the security strategy.

Step 5: Don’t Just Use Default Settings
It’s surprising to find the frequency of breaches that occur as a result of not changing default credentials and passwords. The fact is, most IoT-related breaches to date were as a result of organisations failing to update these details and have suffered as a result.

Vendors are now getting wise to this and have started offering more unique options than the standard ‘admin’ and ‘password’ defaults, which, surprisingly, is well documented on the Internet. However, this does not require unique credentials for every connected device. Instead, role-based credentials that adhere to security recommendations for character length and combinations can be supplied to all of the same devices. In healthcare, this could mean that all door locks, or heart monitors that have their set roles, can have unique credentials. 

For employees, having the correct login credentials based on their roles can access certain applications depending on the context of their location, device type and organisational governance. This allows security teams to use these parameters to set polices so that when they change a number of actions can be performed; ranging from multi-factor authentication to a security software update or perhaps quarantine for further inspection. 

Step 6: People are Usually the Weakest Link in Security
Regardless of the technology in place, or the permission set into practice, individuals using and accessing devices remain critically important to educate, inform and monitor. Traditionally, unsafe practices are usually a result of a poor understanding and therefore, it’s key to regularly review and recertify all staff members to understand the protocols in place to keep the organisation safe. 

By creating a set of processes and practices with password hygiene and prompts, employees can do their bit in ensuring the network remains safe. Password prompts that are unique to the individual is key to building a strong protective perimeter with everyone owning, and protecting their own credentials, and ultimately the network.

Step 7: Reassess and Revise
No matter how much effort is put into securing the network, the work is never really complete. Instead, organisations should always look to evolve and improve their practices as new technology and recommendations become available. This shouldn’t mean that everyone has to become experts in security.

Rather, it would mean that organisations look at their vendors and partners for what is new and improving the industry. By taking all these steps security isn’t guaranteed but the healthcare organisation that takes its security hygiene seriously will mitigate for the majority of weak links whether that be people, process or technology.

There was one buzzword that dominated the discussion at Arab Health Exhibition & Congress 2018 — Artificial Intelligence (AI). Whether it was computer-assisted robotic technology being showcased on the exhibition floor, or an in-depth discussion about whether AI will eventually replace humans in the future taking place in the seminar rooms, everyone was talking about it. Arab Health Magazine sat down with Rajat Karol, who is the general manager of GE Healthcare Digital for the Eastern Growth Markets & Africa to find out his taken on whether AI is a magic pill for the challenges we face in healthcare, or if we still have a long way to go before we see any real progress.  

How far has AI come in the last decade or so?
As the name implies, AI means that you are trying to get to a decision, or you are trying to add precision to a decision, automatically. AI is a new word, but this is something that a lot of businesses have been doing for a long time. It used to be called Machine Learning; how do you make a machine learn to do things on its own.

The challenge in the past was that while the algorithms existed, for example, IBM’s chess-playing computer Deep Blue, they used to fill the size of a room in its entirety. In essence, AI was technologically bound. What has happened now is that with the same algorithms, all the computing power of GPPUs (general purpose processing unit) has taken away a big technological barrier that has existed for the past 20 to 30 years.

Rajat Karol, general manager of GE Healthcare Digital for the Eastern Growth Markets & Africa

This is precisely what happened with computers. You used to have big mainframes that only a select number of people had access to. So even if you had a great idea for an application, you were still constrained by not having access to the mainframe. And as we moved into the microcomputer world, everyone was able to programme. As such, we need to think of AI as a revolution because the restrictive factors that used to exist are being taken away. 

What is the philosophy behind AI?
Essentially there are two philosophies of what we are trying to do here. Firstly, we are trying to understand how the human brain works and then we try to replicate this. This has been challenging because, ultimately, we still don’t really fully understand how the brain works. The other theory is that by definition, the process is artificial. So, you start as a seed with something small and teach it like it is a child, who then becomes an adolescent and then an adult. A human takes around 20 years to mature, but with computing power at your disposal, you can now greatly accelerate that to just six weeks. 

A great example of this is technologies that teach machines how to play a game. In fact, they don’t teach, instead, they show someone else playing the game and the technology sees how that works. When the machine sees how the games are played, the AI sometimes plays the game in a very counter-intuitive way because it does not work in the same way that a brain would work when playing the game. Rather, it finds new pathways and it makes moves that a normal player would not make. This is because, as humans, our brains are also inhibited by what we can physically do or by our known and unknown biases. 

AI doesn’t have these limitations and by giving it raw computing power, it allows it to experiment and it iterates, greatly accelerating the process.

What it means for us, in this world, is that we will reach an inflection point where us humans will not even fully understand what AI does and how it does it because it is beyond our comprehension. 

What we see today with the likes of Siri and Alexa are just the user interfaces by which they interact with us mere humans. Once AI has reached that level of ascendance, they need to come back down to our level to explain it in our terms.

How does GE Healthcare use AI to make medicine more precise? 
Applied Intelligence, which we are already today doing at GE Healthcare, means that we are taking not a general AI approach, but rather, we are taking a very specific problem statement — like solving the needs of a hospital and the patients. For example, as a radiologist, I am looking at an x-ray scan, and I am asking the AI if this particular area of the lung looks normal. So, it is a very specific application for a general intelligence. This allows us to focus our energy and reduce the data to get to that particular outcome.

GE has been in this business for over a hundred years and we have sold a lot of big machines (MRI, CT, for example) that have been used for complex diagnosis and we get a lot of images out of these machines that are being used by doctors and radiologists to understand and diagnose disease. Our main focus is how to help the physician make the right decision and, in our new strategy for 2018, our CEO talks about this as ‘Precision Healthcare’; how to make healthcare more precise. 

Today, a lot of medicine is like throwing darts at a board and seeing what sticks. The first step is to be more precise in order to avoid the patient having to go through eight therapies, only to find that the ninth therapy is the one that stuck. From a patient perspective, this can be harmful, and, from a hospital perspective, this can lead to unnecessary expense.

For example, at GE we make products with contrast medium. What this means is that let’s say you want to do a CT scan of soft tissue. As soft tissue is difficult to see in an x-ray, we will give the patient a contrast medium that goes inside the patient’s body, so that when you do the x-ray, the contrast medium scintillates. However, as some of that contrast medium has to be given in very small doses, we are now producing applications that use AI to determine how much of the contrast medium a particular person needs — this means the ideal dose that allows you to diagnose, but causes minimum harm, particularly when it is done on a patient that needs regular monitoring. This is our whole model of Applied Intelligence and we are trying to apply it to make our products work in the best possible way and provide the best possible outcome.

How do you do this?
We are doing this in two different ways. When you talk about medicine there are two different axes. The first axis is the precision of diagnosis and the other is the efficiency in the hospital. For example, Japan and the U.S. have the highest number of radiologists per million people. This means that it takes the least amount of time to make the diagnosis and, therefore, treatment can start sooner. In places where there is a distinct lack of radiologists, even if you have a million-dollar machine, if you have no one to make the diagnosis, you cannot make this work. 

Part of the solution to use AI is to ensure that the workflow is fast and efficient, allowing you to give care to the patients who need it first — workflow, then precision in the diagnosis. And this is just the start of what we think we can do.

The scope is immense. We are working on recent partnerships with companies to better understand the diseases that are happening at a tissue or cell level. This means trying to get data from our cells to see what are the biomarkers that either give you a higher or lower chance of getting a disease. In 2001, it cost about $1 million a year to sequence one person’s DNA. Today, you can buy a device for $1,000 that can sequence your DNA and give you a huge amount of information. This is the sort of leap of technology that no one could have imagined.

What do you see as the challenges of AI in healthcare?
Radiologists have a tough job as they are measured on productivity and are under pressure to provide an accurate diagnosis. But how do you strike the right balance between clinical outcome and efficiency? Today, this works under the peer review system where a senior radiologist will validate, depending on the complexity of the case, whether the radiologist has given the right diagnosis. 

In the future, AI could jump in at various stages and take increasingly more serious roles in this conversation. For example, the Boston Children’s Hospital has a global referral centre where a lot of complex paediatric cases get referred to them, but their biggest challenge is what we call ‘false positives’. A lot of cases get referred to them that should not have been referred to them in the first place. Because they have limited resources, they want to be able to focus on the cases that they can really help with. GE is working with the Boston Children’s Hospital on how to utilise AI to flag and remove the ‘false positives’ so that they can focus on the 20-30 per cent of cases that they can actually have an impact on.

The other segment that faces a challenge is the hospital operators and CEO’s who need to provide quality clinical outcomes, but at the same time, they are competing against other hospitals or insurance companies to provide the most cost-effective solutions. 

Perhaps what the real challenge is what we think about in terms of needs vs. wants. I want my phone to have AI, but I need my doctor to have AI. As a human race, we invest so much into things that make us feel happy, but if we could just focus our energy somewhere else, it could have such a big impact for the greater good. 

This brings me to the region as I believe that the Middle East has the ability and the thought leadership to become a world leader in the AI space. For example, the UAE is that perfect melting point where people from around the world can come together to design and develop. Here we have the infrastructure and a government that allows for the freedom to experiment and try something new; a balance that every government needs to strike.

Accounting for 26 per cent of the total healthcare spend by GCC governments, the UAE finds a spot in the top 20 countries in the world with US$1,200 per capita spend on healthcare (AED 4,400). The healthcare sector in Dubai too remains robust driven chiefly by continued growth in population and supported by economic growth and Dubai’s position as a financial, trading and aviation hub for the Middle East region. 

Innovations in clinical services, the adoption of new technology in care pathways, and mobile health solutions are changing the way health services are delivered across the world, and Dubai is also witnessing new and innovative models of care and the use of technology in early diagnosis (e.g. genome sequencing), and treatment of diseases (through precision medicine, use of 3-D printing, advanced robotic surgeries, use of VR and AI in disease management and treatment pathways). 

“The Dubai Healthcare Authority (DHA) has prioritised fostering the development of future technologies,” says His Excellency Humaid Al Qutami, Director-General of Dubai Health Authority (DHA), in an interview with Arab Health magazine. “Artificial intelligence (AI) is at the forefront of the UAE government’s strategic plans. In 2017, the country launched the ‘UAE Artificial Intelligence Strategy 2031’ – the first of its kind in the region, and this aims to bring AI tools and technology to various sectors including healthcare. In alignment with this vision, in May this year, DHA launched its Innovation and Artificial Intelligence strategy that seeks to use AI and robotics to largely automate the process.”

According to Al Qutami, the new strategy is going to be the cornerstone of all DHA projects and initiatives that aim to acquire AI to serve its objectives, projects and development programmes.

“Over the last few years, DHA has increasingly begun adopting smart technologies such as Artificial Intelligence as we recognise the potential of this technology in transforming the health sector,” he adds. “Our aim is to make a quantum leap, strengthen the authority’s health system, and empower its human capital by equipping them with the latest technologies used in diagnosis and treatment.

”The main factors that make AI important in the future healthcare landscape are faster diagnosis, accuracy, cost-efficiency and the capability of this technology to decipher  vast amounts of data that can be used for disease detection as well as prediction. “We are therefore keen to use AI in various fields of healthcare particularly to minimise and manage chronic diseases, deliver cost-effective, high-quality diagnostic and treatment services, help improve clinical productivity and enable care providers to better serve the community,” he says. “We will also use AI in screening, prevention and remote patient monitoring as we look to integrating it into the healthcare ecosystem to capitalise on the technology’s immense potential.

”The Dubai Health Authority has carried out several proofs of concepts using AI and the results have been highly promising. In partnership with Artelus, for instance, the DHA-run Dubai Diabetes Centre recently completed a proof of concept project for the implementation of Artificial Intelligence (AI) to detect diabetic retinopathy.  

“The results have shown that if we use AI, it takes only 10 minutes from the time a patient has conducted the test until a doctor sees the results, as opposed to four working days,” he says.There is no doubt that the use of AI in detection of diabetic retinopathy can revolutionise the manner in which patients are screened for retinopathy. Apart from being cost effective, it will also lead to higher-quality care and better utilisation of resources.

“Ophthalmologists will only need to see retinal images of patients with retinopathy that the system detects as opposed to the current system where they need to screen all patients,” explains Al Qutami.

In the UAE where it is estimated that one in five people are diabetic and another one in five are pre-diabetic, the benefits of using AI in detection of diabetic retinopathy are simply multi-fold.

“As per international diabetes standards, we need to have 14 retinal images per diabetic. The estimated number of diagnosed diabetics in the UAE exceeds 1 million. To interpret 14 million images per year, we need more than 50 eye specialists working full-time. Deep learning system (DLS) using artificial intelligence (AI) are capable of identifying diabetic retinopathy and related eye diseases using retinal images with a high degree of accuracy. Thus, using AI can not only help provide retinopathy screening for a large number of diabetics but also lead to better utilisation of resources and time of ophthalmologists.” 

The American Academy of Ophthalmology has recently selected the abstract of this study as a Poster for its Annual Meeting in Chicago in October this year.
Earlier this year, DHA announced plans to use AI technology for chest X-ray scans required for mandatory medical fitness for residency purposes. The move is aimed at improving the workflow, ensuring faster image analysis and automating reports. Accordingly, DHA signed a Memorandum of Understanding (MoU) with Agfa HealthCare for validation of the first radiology AI algorithm in the UAE.

Over a period of two years, DHA and Agfa HealthCare reviewed Artificial Intelligence enabled workflows in radiology across the radiology departments of DHA’s medical fitness centres. Upon completion of onsite validation, the algorithm was able to correctly identify diseases in chest X-rays approximately 95 per cent of the time.

The DHA will first trial the technology in a few medical fitness centres, before expanding it to other facilities, informed Al Qutami. Given the huge scale of this service and the vast number of people who use this service per year, undoubtedly using AI will lead to faster image analysis, automated reports and improved clinical efficiency. We will continue the validation process with Agfa HealthCare to further improve the accuracy of AI Algorithm detection.”

Dubai Future Accelerators Initiative and AI Technology
In March this year, DHA selected four firms for the fourth cohort of the Dubai Future Accelerators Initiative where Artificial Intelligence (AI) and its deployment in the health care setting are a key focus during this cycle.

“The aim of the DHA as part of the Dubai Future Accelerators initiative is to explore the latest in technology,” says Al Qutami. “We aim to revolutionise the way healthcare is delivered while focusing on patient-centric care. We are looking for ways to improve the lives of patients and on ensuring patients lead a high quality of life to the best extent possible.”

DHA has signed MoUs with four cutting-edge international companies to adopt their inventive healthcare innovations in AI. This includes the implementation of virtual health through an app in partnership with Babylon, which uses AI technology to provide remote General Practitioner, GP, consultations round-the-clock. Additionally, the app syncs with 100 devices so that information about the patient’s daily activity is recorded. This information is available to the GP along with the patient history at the time of consultations.  

“Another innovation we are working on that promises to have huge potential to enhance patient-care is in partnership with Healthcare and Innovative New Technology (HiNT),” he adds. “We carried out trials at the DHA run Rashid Hospital to see the usage and viability of HiNT’s innovative stroke detection headband. They have developed a wearable point-of-care monitoring device that detects when patients at high-risk are having a stroke. The device alerts the caregiver, the ambulance and the emergency within minutes. Every minute counts when a stroke takes place as two million brain cells die every minute when a patient is having a stroke. Our doctors are working with HiNT to see whether this system can be used not only for home-patient monitoring but also in hospital set-ups.”

In association with Bodyo, DHA is also planning to set up free to use AI pods across Dubai that will do quick health scans for the public and give immediate results. 

“Bodyo has developed mobile AI-assisted pods or cubicles where people can step in and be screened for body temperature, blood sugar, blood pressure, body composition such as height, weight and other such vital parameters. The procedure is simple and takes not more than 13 minutes the first time. Our aim is to set up these pods across Dubai for residents to have access to free health screening,” he elaborates. 

Preventive health is also being taken to the next level by deploying flow cell sensors that will detect sudden drops in vitals in ICU patients. Admetsys is the fourth company chosen for the Dubai Future Accelerators’ current project.  “Admetsys has developed flow cell sensors to detect sudden drops in vitals in ICU patients through an algorithm that measures these vitals constantly and it can be read by a nurse on the monitor at a glance,” explains Al Qutami. “Any drop or rise is alerted by an alarm system. This saves vital time for the nurse and makes round-the-clock monitoring possible. DHA is currently studying the viability of this project in hospital settings.”

In the previous cycles of the Dubai Future Accelerators Initiative, DHA worked with 3-D printing firms and deployed the technology across its dental services. As a result, several complicated surgeries were performed using this technology and 3-D printed artificial legs were used to provide amputees with a new lease of life.

Healthcare facilities in Dubai to be rated from 2019

Dubai Health Authority (DHA) will rate all healthcare facilities including public and private hospitals and day-care health centres in Dubai in accordance with the Dubai Health Facilities Performance Framework (DHFPF).
The framework, known as Qeyas, will be finalised and implemented by the beginning of next year and has five pillars which include patient safety, clinical quality, patient happiness, financial and operational indicators.

The DHA’s Health Regulation Sector recently held a workshop with the private health sector to discuss the design and implementation of the framework. This is one of the several workshops and feedback cycles conducted with an aim to design a framework with buy-in from hospitals and other healthcare facilities.

Dr Marwan Al Mulla, CEO of the Health Regulation Sector said, “Benchmarking and measuring the quality of care is fundamental to help build a robust health system where patient-centric care and patient safety is the cornerstone. We are working closely with the private sector to design a system which uses health data intelligently to help enhance health service delivery.”

Following the implementation of this system, DHA will be able to: 

- Improve quality across the health system in Dubai
- Provide consumers with information to help empower them to make better choices about healthcare providers
- Provide medical tourists with trustworthy, independently validated information about Dubai’s healthcare quality
- Develop a long-term reimbursement strategy, which is based on evidence of the quality of care provided

Dr Mohammed Al Redha, Director of Project Management Office, Informatics and Smart Health Department at the DHA said, “The methodology will be data-driven and grounded in sound principles of data consistency, relevance, accuracy and integrity in order to drive crucial decision-making and strengthen the health sector in Dubai.”

The DHFPF will include data from e-claims, Sheryan (DHA’s health regulation system), Salama (electronic patient file system for all DHA health facilities) and a range of private healthcare providers. The DHA will also engage with major private hospitals, day care surgery centres, selected polyclinics, Dubai Healthcare City (DHCC) and Ministry of Health & Prevention (MoHAP) facilities in Dubai and support them to help provide data.

Within the industry’s changing model of care — with an increasing focus on prevention and wellness, rather than a sickness model, and emphasis on collaboration across the sector, including public-private partnerships — digital technology has a vital role to play in supporting the aim of providing access to high quality, cost effective, sustainable and safe patient care, with improved medical outcomes.

According to Alpen Capital’s GCC Healthcare Industry report 2018, “technology will remain the core factor in upgrading the GCC healthcare sector over the coming years. Technologies such as electronic health records, e-visits, telemedicine, connected medical devices, robotic procedures, health monitoring wearables and health analytics are gaining acceptance in the region”.

In Dubai, the emerging smartest city in the world, we have the added advantage of access to a digital innovation culture and the enabling technologies that make Dubai — and its healthcare system — the smartest in the region. It’s a digital transformation that is happening at every level in the healthcare sector. Thanks to the ubiquitous smartphone, the large population of millennials is increasingly adopting wearables to monitor its own health and self-diagnose, whilst the government is leading on AI, Blockchain and IoT (Internet of things) with electronic medical records and data analytics; and healthcare providers are adopting automation, telemedicine and digital hospital solutions.  

This mirrors the worldwide trends in which, according to research from Frost & Sullivan, smart healthcare will make up 15 per cent of smart city business by 2020, underlining its position as an industry building a technology-enabled future.

Where do we find Healthcare Innovation?
Digital innovation is a strong theme across every sector in Dubai, including healthcare, and much of the applied innovation is home-grown, thanks to a strong innovation culture and environment led by the government, and which is attracting innovators from around the world.
Integrating innovation into healthcare is a priority, enabled by the smart city environment and in response to the increasing demand for healthcare services. Technology healthcare start-ups are making Dubai their home of choice: 2017 saw health start-ups from China, Germany, Nigeria, Singapore, the UK and the U.S. pitch new solutions to investors in Dubai, under the umbrella of the Dubai 100 programme, an incubator for start-ups.

Also, the Dubai Health Experience programme is the world’s first comprehensive electronic medical tourism portal designed to attract increasing numbers of healthcare tourists. Dubai’s ambition is clear: to attract 500,000 medical tourists by 2020.

Which Technologies are Transforming Healthcare?
The youthful population is building its own personal health-management ecosystems: this aligns perfectly with consumer expectations to manage and access services by smartphones, cloud computing and universal connectivity. We all want to shop, bank, and communicate with on the go, on our mobile devices. We now expect health organisations to provide us with similar innovative services and a simple and convenient experience. 

Take blockchain for example; a technology that will certainly make an impact on healthcare. It is already becoming embedded in the financial sector, and it is likely that digital healthcare start-ups will now start to leverage blockchain to give patients greater control of their personal medical data. The decentralised nature of blockchain offers an ideal trusted storage mechanism for digital health records, and with more clinical data, genomic data, and data from wearables being generated, this is significant. Dubai aims to be the world’s first blockchain-powered government by 2020, and the potential impact on healthcare records is very clear.

Furthermore, telemedicine could transform healthcare in three distinct ways, through increased access to primary care doctors and specialists, by reducing costs and by delivering improved health outcomes. Patient monitoring and data gathering takes place at home. Dubai is already taking a lead on this issue, with the launch of the 24/7 Population Health Management Program in late 2017, plus also the Dubai Health Authority (DHA) 2016-2021 initiative that encompasses 3-D printing, medical informatics and an extensive primary care scheme under its telemedicine programme.

Dubai has a clear healthcare mission and implementing the right digital technologies will help the city to continue to lead the way.

According to a recent BNC Network GCC construction intelligence report, the healthcare industry constitutes 4 per cent of all active projects in the GCC’s urban construction sector and in dollar terms, these projects account for 5 per cent of the total estimated value.

The report further highlighted that the total value of the 707 healthcare projects currently under development across the GCC exceed $60.9 billion. Of this the 445 projects collectively worth $51.9 billion are hospital projects, while the other 262 projects, worth $9 billion, are medical clinics or research centres.

These investments and rapid growth are in direct response to significant opportunities and challenges created by various socio-economic and business trends. Demand for healthcare in the GCC countries has been driven by changing demographics, including a surge in population, rise in income levels and a greater prevalence of lifestyle-related chronic diseases. Among the different factors driving this growth are the recently introduced mandatory health insurance schemes that are driving investment in hospitals, clinics, pharmacies and other healthcare facilities.

Putting a spotlight on this burgeoning sector is the Building Healthcare Innovation & Design Show 2018, taking place from October 2 to 4, in Hall 8, at the Dubai World Trade Centre, that will bring together key decision makers involved in the development, design and management of hospitals and other medical facilities. It offers a unique platform for investors, architects, consultants, contractors, developers, planners as well as healthcare professionals such as medical directors, department heads, facility managers, among others, to discuss the latest developments in the industry.

The show is co-located with Cityscape Global, one of the most influential real estate exhibitions in the Middle East that attracts influencers within the construction, design and development industry in the region.

At Building Healthcare, visitors will get the opportunity to engage with over 3,800 decision makers. Plus, they can connect with existing clients or partners and reach new hospital project representatives to build lucrative business contacts, gather market insight and key knowledge on how to do business in the Middle East, and showcase latest products and services to decision makers, architects, and government officials.

The show will bring together a targeted audience of industry professionals, such as from the architecture and design, fitting and hardware, healthcare planning, construction, and facilities management industry who will be displaying their latest design solutions, as well as be sourcing new concepts that balance the technical needs of doctors and staff with the comfort of patients for their healthcare facilities.

Along with the industrial workshops, the conference tracks based on the lifecycle of the hospital build, and the exhibition, the show gives the region’s healthcare authorities the opportunity to network and to share their knowledge and solutions to current challenges faced by a healthcare facility.

Conference Agenda
Based on the theme “Delivering fit-for-purpose healthcare facilities”, the Building Healthcare Congress 2018 aims at addressing the main challenges involved in planning, designing, building and operating a healthcare facility. Here international and national industry experts will discuss current topical issues in building different healthcare facilities.

The congress will offer access to the latest developments, innovations and best practices to keep healthcare build projects ahead of the curve in this evolving market. It is providing five half-day tracks spanning the entire lifecycle of a healthcare facility build: Vision & Masterplan; Invest; Design & Build; Equip; Operate. It is structured to align with the holistic nature of current healthcare developments and provide an all-encompassing view of the key challenges and best practices involved throughout. Below is a look at the topics each conference track will cover:

Vision & Masterplan: This session will focus on the importance of defining the vision of a healthcare facility at the beginning of a project to ensure the right facility is being built with the end in mind. It will address the challenges that arise in the planning stages of a build project while offering practical take-home solutions for a successful strategy. The session will also provide a unique platform for all stakeholders involved in the project to exchange best practice procedures and assess how to best optimise their involvement in this stage of the project.

Invest: Everyday billions of dollars are being poured into new projects to build top facilities for patients. In a region where competition is extremely high, and the market is already on the way to saturation, this session will provide the finer details on healthcare investment in the region. Join industry leaders to discuss investment perspective and the current trends and challenges when looking to invest in healthcare.

Design & Build: A healthcare facility’s design establishes the basis for safe and effective care within its environment. As the market shifts from the government to the private sector, there’s a larger emphasis on fit-for-purpose, efficiency and financially responsible designs. This implies that we analyse not only first costs but more importantly life cycle costs. Designing and executing the construction of a healthcare project requires the collaboration of appropriate expertise. This session will discuss the lessons learned as we strive to design and construct “fit-for-purpose” facilities, as well as the impacts of various construction elements such as engineering, operations and technology have on the healthcare business.

Equip: Whether equipping a new healthcare facility or keeping up to date with advances in medical technology in an established facility, it is a stage of the lifecycle that requires constant attention. Medical equipment accounts for 60-70 per cent of healthcare facility design and can be one of the biggest challenges in any new or existing project. This session will explore the latest trends and strategies from design and master planning to procurement and delivery illustrated through lessons learnt from challenging projects in the region.

Operate: This session will focus exclusively on operational planning, which addresses the hospital and its role in the health service system in a comprehensive manner. The session will outline how to set up structures for governance and staffing, develop plans for hiring, and how to create standard operating procedures for how everything will run when the hospital opens.

Seminars and Workshops
In addition to the five conference tracks, Building Healthcare will feature a range of seminars and workshops on the exhibition floor. These educational sessions will examine ongoing projects in the MENA region, discuss how to invest in new markets and assess case studies of planning, design, and construction that can be used in future projects.

The special focus sessions on regional healthcare infrastructure projects will home in on the current state of the healthcare market. Information will be provided on both current and upcoming projects, investment opportunities and gaps in the market to give attendees the knowledge needed to expand their business throughout the MENA region. 

Hospital Projects in the GCC
Building Healthcare brings out the Hospital Projects in the Middle East Report that details current and future hospital and infrastructure projects. It gives an insight into the following areas: Market Synopsis & Trends; Overview of the healthcare infrastructure; Insight into the region’s investment climate; Indication of growth drivers and challenges; and Project updates per GCC country, Iran, and Egypt. Below is a look at key highlights:

UAE: According to investment banking advisory firm Alpen Capital, the healthcare market in the UAE is projected at $19.5 billion in 2020, indicating an annual average growth of 12.7 per cent from 2015. The outpatient and inpatient markets are projected to reach $12.1 billion and $7.5 billion, respectively, in 2020. The country is likely to see a nearly 3 per cent annual increase in the number of hospital beds required, presenting a demand of more than 13,800 beds by 2020.

Saudi Arabia: According to investment banking advisory firm Alpen Capital, the Saudi Arabian healthcare market is forecasted to reach $27.4 billion in 2020, registering a CAGR of 11.0 per cent from 2015. The outpatient and inpatient markets are expected at $15.2 billion and $12.2 billion, respectively, in 2020. From less than 70,000 in 2015, the number of beds required in the Kingdom is likely to cross 76,500 in 2020.

Egypt: According to 2013 statistics from the World Health Organization (WHO), the most recent data available, health expenditure accounts for 5.1 per cent of Egypt’s gross domestic product (GDP). WHO data also shows that as of 2013, the country had five hospital beds per 10,000 residents, down significantly from 17.3 beds in 2010.

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In the wake of rapid population growth, the Middle East’s hospital systems have been under mounting pressure to serve more people. With an aging population bringing an array of health problems, healthcare providers are also facing a deluge of issues from new consumer trends, including urbanisation and more sedentary lifestyles along with dietary shifts from locally-grown, unprocessed food to more fast foods and sugary drinks. As a result, hospitals are seeing more chronic health issues from obesity and diabetes to hypertension and cardiovascular disease.

Under pressure to meet these intensifying needs, governments and private companies have spent billions of dollars to expand the region’s healthcare facilities, increasing capacity and improving outcomes. However, healthcare systems in the Gulf Cooperation Council (GCC) have yet to tap into a powerful way to make hospitals more efficient: optimising the way goods and services are selected and sourced.

An advanced approach can reduce a hospital’s external costs by 20 per cent and cut waste in half, whilst improving the quality of care. In this article, we discuss how GCC healthcare providers can use these techniques to unlock a wealth of value. A typical 1,000 bed hospital with an operating budget of $1bn, can save $100m a year in sustainable cost reduction. Reinvesting these sums into healthcare priorities creates huge possibility.

Obstacles to Reaching the Full Potential 
The GCC healthcare market is expected to grow from $40 billion in 2015 to $71 billion by 2020, with the market expanding by 11 to 13 per cent in every country. Demand for services has been growing for the past several years driven by, amongst other factors, a larger and—thanks to a longer life expectancy—aging population. Consequently, healthcare providers have a much larger base of consumers to serve. Adding to the demand for services is the higher incidence of chronic and non-communicable disease compared with more advanced economies. To address these demands, most GCC healthcare systems have focused on infrastructure: building hospitals and adding beds. This has caused spending to escalate. 

Advanced methods can reduce costs and improve efficiency while still providing high-quality patient care. This effect is even more pronounced in GCC hospitals, where up to half of annual operating costs go on third parties (Figure 1). 

Across the region, private and public organisations have made efforts to drive down external costs with different degrees of success. In healthcare, four regional challenges tend to thwart attempts to reduce costs:

Doctors’ diverse backgrounds: GCC healthcare systems are staffed with doctors from around the world. This unique diversity of backgrounds brings with it an endless array of preferences for medical equipment, consumables and pharmaceuticals, making it difficult to standardise using basic methods.

A skills shortage: There is a lack of procurement professionals who specialise in healthcare, and local schools do not offer courses to train the workforce in healthcare supply chain management. Therefore, recruiting category managers who are key to driving the advanced techniques is exceedingly difficult.
Procurement’s low status: Even when limited procurement skills do exist, supplies functions are often seen and operate as a transactional entity that simply purchase goods and services under instruction from doctors and others. Few hospitals give procurement a genuine voice in which products are purchased. 

Competitiveness of the local supply market: Local companies often have exclusive rights to international products and brands and distributor mark-ups can double costs. A nascent manufacturing sector means a limited local market for even basic products.

A Much-needed Transformation
Most GCC healthcare systems have put third-party spend into too small of a box tagged with a narrow definition of procurement: basic tendering and material handling. Much bigger benefits can be achieved if board’s give procurement a more advanced role. Four sourcing strategies can deliver substantial—and sustainable—cost reductions. (Figure 2)

Change specifications: Optimise what you buy. Hospitals have an excessive number of products, primarily because of a lack of governance and control mechanisms. For example, in the GCC, doctors and nurses often have a choice in which gloves they buy. Because of variations in personal preferences, hospitals end up purchasing a wide variety of gloves. In more advanced hospital settings, purchasing departments have a strong influence over the final decision. One hospital system we worked with was buying three brands of infant formula with identical specifications but vastly different prices. By standardising to the most affordable option, the company reduced its costs for formula by 70 per cent with no negative impact on the standard of care.

Reduce demand: Decrease waste and underuse. GCC health organisations have expanded quickly to meet the population’s needs, often without setting up clear rules for spending. Because of this, many warehouses are full of an assortment of items, often in quantities, which invariably leads to a lot of it becoming obsolete and being thrown away. Policies contribute to stockpiling because many hospitals have a use-it-or-lose-it budgeting practice that results in unnecessary purchases. What’s lacking is rigorous planning with stock thresholds and governance mechanisms that define what is desirable and what is excessive. 

Leverage competition: Do things better. Despite the region’s healthcare market being relatively small, two factors give it a big bargaining power: the growing and aging population and the fact that GCC countries tend to be cash rich and have demonstrated a willingness to invest in healthcare. This makes the region attractive for companies with an eye on growth. For example, the UAE is among the world’s top improvers in terms of its business environment, and the government is committed to foreign direct investment. Too often, however, negotiating power is lost because of poor planning. For example, one company we worked with was buying blood-collection tubes from the same supplier every few months but at hugely variant price points, primarily because orders were being placed by different hospitals. Combining demand and establishing long-term contracts lowered the cost of the tubes by 74 per cent.

Partner with the right vendors: Choose your suppliers wisely. Identifying strategic vendors and forming meaningful partnerships can create the right conditions to benefit both the hospital and the supplier. For example, a hospital in the United Kingdom has a long-term partnership with a provider of cardiac devices. The partnership extends beyond product supply into patient lifestyle sessions and follow-up clinics. This encourages both the hospital and the vendor to take a long-term view of patient satisfaction and clinical outcomes as well as the commercial opportunity.

Locking in Sustainable Results 
Four practices are proven to help keep costs down: 
Change the setup of your procurement team: A world-class procurement organisation is created by investing in talent and, infrastructure to build serious capability, and consulting support to mobilise that capability quickly and with immediate results. The return on this investment is measured by the benefits that procurement delivers, including lower costs and better results. A.T. Kearney’s unique Return on Supply Management Assets study found that for every dollar invested in developing and running a health organisation’s procurement function, the company gets $4.30 in return.

Bring stakeholders together in a cross-functional clinical value team. Advanced healthcare organisations have clinical value teams that act as decision-making groups. Comprised of doctors and nurses along with people from supply management and finance, these teams pinpoint the right specifications for the whole organisation, for example the ideal type of gloves. In addition, this level of transparency and information-sharing enhances compliance to the jointly agreed product selections

Overhaul the engine with fit-for-purpose processes. Many GCC health organisations struggle with the timely management of procurement requests. Bottlenecks and delays tend to be the norm. Strategic sourcing requires a flexible approach to adapt to both the organisation’s needs and the market’s changing conditions. Category managers need the freedom to choose the most appropriate strategy, from making purchases on demand to setting up multi-year agreements. Leading organisations standardise and automate the process, often by using dedicated software. 

Use enhanced analytical capabilities to uncover hidden opportunities. With the large variety of products that a healthcare system buys, and the countless unique item numbers, enhanced analytical capabilities are essential to uncovering the opportunities buried under all the data. Analytics can also prevent overstocking and reduce working capital by optimising inventory and defining reordering policies. In more advanced applications, statistical analysis of historical patient data from electronic medical records can be used to develop predictive models for low-cost interventions, reduce the number of readmissions, identify chronic illnesses, and evaluate the effectiveness of treatment.

The Way Forward
A forward-thinking approach to third- party spend can create significant economic gains, including reducing third-party spend by 20 per cent, which can in turn be used to support investments to sustain the region’s escalating demands for healthcare. Unlocking the full range of opportunities will require a proficiency in generating competition among suppliers to get the best prices, systematically managing demand to avoid unwarranted range complexity, creating clinical value teams to facilitate a healthier cost-benefit dialogue with clinicians, and, most challenging of all, developing differentiated supplier interaction models, including strategic partnerships, to get the most from your suppliers. 

A complete improvement transformation can take 12 to 18 months, but we have found that by working collaboratively most of the savings can be delivered in the first six to eight months.

In an environment where failure to plan is planning to fail, time and time again I have witnessed the devastating effects poor planning can have on the design and construction of healthcare facilities in both developed and developing markets. Despite the best intentions of providing healthcare to a growing market, the importance of infection control, staff efficiency, hospital workflow, as well as patient safety and comfort are often overlooked. 

This seems to occur more frequently when the project is not championed by an experienced healthcare design team, or when the structure is not built to the specific needs of a healthcare facility or healthcare market. Another major issue appears when the wrong stakeholders are asked to advise. People just don’t know what they don’t know. Most hospital CEO’s will experience one major construction project in their career. By contrast, healthcare planning and design firms will build five to 10 a year.

Related: In the future, can hospitals heal both people and place?

During a recent customer site visit, I was asked to walk through a shell and core building that I quickly realised was never intended to be a hospital. Just by looking at the architectural drawings, I discovered some clear giveaways: a small actual footprint, central core elevators and multiple stories. This building was a hotel. This kind of design makes it difficult to separate inpatient and outpatient flow due to the limited availability of vertical movement options. 

This footprint also impedes department adjacencies or the need to house some departments on a single floor, like radiology and surgical floors. Not every building can be turned into a hospital; a medical facility is a purpose-built structure.

Five Key Principles for hospital design and technology planning:

Related: Report: The Evolution of Healthcare – Patient Safety in the Post-Pandemic Era

In my 34 years in international healthcare, I have had many similar experiences, which have led me to adopt five guiding principles when advising clients in their hospital design and technology planning.

1. Equipment dictates design, design does not dictate equipment

Advisers sometimes forego critical equipment simply because they will not fit within a design or in a shell and core structure repurposed as a healthcare facility. Large, heavy pieces of equipment like MRIs for example, need to be positioned on an outside wall in the structure to plan for delivery and possible replacement. I’ve seen this dozens of times at the cost of several thousands of dollars in reconstruction.

2. Design today for tomorrow’s expansion

I particularly see a lack in vision in renovations of projects that have been constructed within the last five years, which addressed only current problems and were therefore time-locked. Most communities don’t shrink in population and a good healthcare facility will grow a community around it. 

The healthcare facility must not only address today’s issues but have vision toward future challenges. In this case, growth in number of beds, additional departments and the changing structure of population and healthcare needs should be considered during the planning phase of the facility. A good healthcare facility will last about 30 years or more.

3. Core is key

I start every design review around four key departments. Emergency Department, Radiology Department, Operating Theatres, and intensive care units. 

My thought process is that each of these departments feed patients to each other so having them in close proximity can reduce patient travel and the need for duplicate equipment. During my imaginary travels from department to department I always keep in mind what I call PDR: privacy, dignity and respect of the patient. PDR can be as simple as providing curtains, walls or doors between patients; not parking inpatients’ stretchers on corridors or public waiting! There needs to be an understanding that many patients can’t choose for themselves, so you will be making choices for them. These considerations will aid in planning the movement of patients from department to department, so they don’t cross with general hospital population.

4. Solve problems with pen and ink instead of sledge hammers

Talking through, walking through, mock ups, and 3-D renderings are all methods of identifying issues before they become real construction problems. It is important to remember that you will pay for a mistake three times; once to build it, once to tear it down and once to rebuild it. 

Moving into construction without an adequate review process, will increase the likelihood of change orders/variations further down the line. On many projects I’ve reviewed, in the rush to construction, simple mistakes that could have been avoided resulted in tens of thousands of dollars of costly corrections. An example of that is an MR landlocked in the centre of the building and walls that had to be torn down for installation.

5. Design with caregivers in mind

I apply a rule that a caregiver should never move more than 25m in any direction to obtain the supplies needed to do their job. This is accomplished by locating support rooms to adequately supply the staff. During review of plan elevations, it is important to remember simple rules; like a caregiver should never move their feet with sharps or needles in their hand. Accordingly, locating sharp disposal boxes at the site of injections is a simple measure that has great impact. Another easy fix is to mount patient monitors on articulating arms, which can be adjusted to the height of the caregiver. A nurse’s time should be spent with the patient, not chasing down supplies; so, by simply by locating support rooms within those 25m of where the care occurs can drastically reduce the amount of time a caregiver spends traveling the hallways. I believe strongly that taking care of your caregivers is a great consideration in planning and is accomplished without costly measures.

Optimised Workflows

To address some of these key guiding principles, I developed a detailed Design Review Methodology in the past years. At the heart of this methodology is the need to retain an experienced hospital technology planning team and senior technology planner. 

The overall goal of an experienced Hospital Technology Planning team is to assist in the establishment of international standards in hospital design that support patient safety, infection control and optimised workflows based on room and department placements and functional adjacencies. 

A senior technology planner can provide quick desktop reviews of designs, in depth design reviews and BOQs, in addition to supporting the Client Design Team with the application of best practices in hospital development during the design phase. In addition, the senior technology planner will support the creation of a project plan for technology installation, pre-installation and commissioning needs with their main focus being the hospital as a whole and all equipment from an agnostic point of view.

Out of the hundreds of hospitals I have had the opportunity to work on over the past 30 plus years, I would estimate one third run into trouble; and by having a hospital technology planner at the centre of the discussions you could reduce this number significantly.

Medical facilities are some of the most technically complex building projects in the world and obtaining the right advice is key; and should be applied as early as possible to avoid costly mistakes and making the project a long-lasting success.

 

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Start Right
We can say with considerable impunity, most hospitals that do not do well actually fail in the project conception stage itself. The importance of starting right cannot be stressed enough. You always start with getting the depth of demand right. The gap between what is required in the region that you are serving or looking to serve and what is already being provided has to be gauged as objectively as possible. “We have been in this business long enough to understand the gaps and there is no need for an in-depth objective analysis” is not an acceptable answer. The stakes in these capital-intensive projects are too high to be left to the ‘we know it all’ syndrome.

The demand study, among many other things, defines the following:

• Services that need to be provided
• Design required for those services
• Overall business model of the facility
• Available/unavailable service review for the market
• Technology and equipment that needs to be incorporated
• Local flavour that will need to be infused in the design and delivery of services

Once the demand depth is gauged, the team usually creates a brief on what is required from the overall design and delivery point of view. This brief is then part of all discussions with possible vendors and project partners.

Partner Right
Selection of partners can be another make or break decision for the project’s success. It is imperative to have project partners who have sound local knowledge and expertise in the overall concept that you have envisaged. There have been times when big international brands have been hired for projects and have failed to deliver, as they did not have the requisite know-how of the local markets and its regulations. 

We always recommend doing a thorough background check on the project partners, even if it means spending extra days or weeks. Find out about the previous projects delivered by them and visit those places, apart from speaking to the teams that they worked with in those projects. Try and find similar projects as you have conceptualised for yourself. Be wary of partners who hesitate to provide details of contacts in previous projects. Firms that are in bad health financially must also be avoided.

Integrated Approach
Another key element in any hospital design and planning pertains to how seamlessly the technology integrates throughout the system. In the modern times, hospitals are heavy on technology and its interface with care delivery. For instance, a patient’s journey from the ambulance, to the emergency ward to the OT to the ICU must be integrated in terms of patient care data that can be seamlessly collected and transferred among all care points. The system should integrate the pharmacy and billing too, in addition to other things. 

Beware of Buzzwords
Many a time, the promoters and project owners get smitten by the buzzwords that are doing the rounds. Be aware that not all predicted fads will become long-term trends. Have a realistic view and knowledge about what may become a necessity in future and what will pass away as a short-term fad. Just because people are talking about it in articles and conferences, doesn’t mean you spend millions in chasing those concepts. It pays well to objectively gauge the fit between your demand depth and the buzzword or new trend.

Project Management
This is where the action actually takes place. The entire plan is laid out with pre-conditions and timelines. A common mistake made by project owners here is lack of communication among stakeholders. Not everyone knows all the details about the plan. In large projects, it has been our experience that over-communication is better than under-communication. If you have to err, do it towards over-communicating. 

Information about the deadlines that are likely to be missed needs to be communicated as soon as the owner gets the first whiff of delay and not on the deadline date. This may sound counter-intuitive, but it builds immense trust and transparency among the team. Similarly, deadlines that will be met must be communicated boldly and loudly as well. This builds the momentum and encourages everyone else.

Another important factor is Change Control Management. Allowing changes during the execution of a project is the perfect recipe for delays. Design stage can have umpteen iterations, but once it is completed and frozen, changes allowed are to be very minimal to ensure on-time delivery of the project.

Get the Core Team Right
One common mistake often made is that the composition of the core project team is not adequate. For example, sometimes the head of operations comes into the picture only when he is handed over the building for commissioning. It is a bit late in the day if that happens. The senior operational team and senior medical team representatives should be part of the project from the very beginning. Some promoters think that hiring an operational team beforehand is an unnecessary expense, as the hospital is not even ready. 

As it turns out, it may prove costlier to re-do a hospital after it is done wrongly, than to hire two senior people who will be running most of the project anyway once it is ready. They need to be a part of the bigger picture right from the start. 

Cost vs Investment Mentality
This brings us to another related point. You have a choice in how to perceive the spending on various project-related items. Everything that is being conceived for the project can either be viewed as a cost or as an investment. A positive way to look at things is to see if they are an investment for the demand-based model that you are making. The investment can be dismissed if it either does not bring promising returns or it is inconsistent with the business model. Overall, having an ‘investor mindset’ is healthier and more rewarding than the ‘cost-saver mindset’.

To sum it up, in this article, we have tried to simplify in 7 points – a tedious, complex and a cumbersome process of conceiving, designing and building hospitals. The journey to create something new is exciting. It becomes even more rewarding when the project takes off on a successful note and adds the value that was envisioned for it.

Is it too bold, too brash, too arrogant to say that the majority of the those in the healthcare industry are racing blindly down a dead-end alley – and that probably includes you and the organisation you work for? Or more precisely, you may be crawling out on a tree limb that will eventually break under the combined weight of you and your peers, sending everyone crashing down into a burning financial abyss? I am specifically referring to the type, size, and the number of healthcare facilities we are plopping down everywhere like Monopoly houses and hotels, and then attempting to staff them with enough warm bodies to run these money machines. Simply put, we are building too many hospitals, with too many beds that will not be needed in the near future.

Yes, that is a very aggressive and provocative opening – and it is also painfully accurate. We are collectively making several critical mistakes when it comes to facility planning: First, we are using antiquated demand analysis models that do not take into consideration increasing market competition in this region; second, we are ignoring the massive and rapid shift to more and more “day case surgeries,” that will not require hospital admission, added to the fact that we will soon sort out how to better manage chronic diseases, which will greatly reduce bed demand; and finally, no deep analysis has been done on the impact that digitalisation and connectivity will have on healthcare facilities and their staffing.

If you were asked what has had the greatest positive impact on improving the health and well-being of our species over the past 100-200 years, you may first answer with the name of some antibiotic, like penicillin, or a surgical procedure, such as an appendectomy. You may think more deeply and consider the standardisation of medical education or improved diagnostic tools like the MRI. While each of these did contribute incrementally to the improvement of the practice of medicine, it was having access to potable drinking water and the creation of sewage disposal systems and networks implemented during the Victorian era that, in tandem, had the greatest sustained improvement on the health of the public. Improvements have been modest and incremental since then, more evolutionary than revolutionary. However, we are on the front edge of another period of revolution that may surpass anything from the past – the digitalisation of medicine.

David Taylor, Managing Director of global healthcare workforce solutions company, MEDACS Healthcare commented: “With a solid history of delivering traditional staffing solutions for nearly 30 years to clients across the globe, we know that digitalisation in the healthcare industry is going to have a significant direct impact on staffing and the entire staffing industry. The sooner we adapt our business models to fit with the objectives of the variety of healthcare facilities we serve in this new digital ecosphere, the sooner we will be able to support the changing staffing landscape; ultimately, resulting in supporting the delivery of better, and outstanding cost-effective care to patients.”

Digital Transition
My definition of “digitalisation and connectivity” includes much more than phone apps, which is the first assumption that often comes to mind when you think “digital medicine.” Smartphone applications are one small piece of the broader and deeper digital landscape that is developing around us and within us. This digitally connected ecosphere includes ubiquitous, high-speed, low-cost tele-connectivity for education, collaboration, and myriad other applications, such as cloud-based storage, the cost of which is dropping as I type, access and sharing of information, synthetic intelligence (aka AI), and sensors of all types. Individually, these various technologies are important and valuable, however, these technologies will not be used in isolation, but combined to produce many exponential benefits.

The tremendous positive impact that digitalisation and connectivity will have, specifically on healthcare staffing and facilities, will surpass the improvements in the public’s health afforded by the connection of sewage systems and having continual access to clean water, creating a paradigm shift after which their integration into medical practice will seem just as obvious and common sense as hygienic standards have become since the Victorian era.

These technologies, when combined with standardised processes and workflows, will improve access, quality, and safety, while significantly lowering cost. These integrated advances will first be embraced in developing countries, that are not handicapped by antiquated legacy systems and the intricate web of self-serving self-interest groups and individuals who are suffocating innovation and positive change in the developed world. Once these first world healthcare systems finally burn down, their practitioners will finally embrace the much more efficient and effective models that we are implementing today in developing countries and will u continue do to so over the coming decades. It’s a bold statement, but history does tend to repeat itself; humans are not very good at learning from the mistakes of their predecessors. The developing countries will leapfrog the currently developed countries over the coming decades – specifically in the areas of human resource development and utilisation and the planning and deployment of healthcare facilities.

Half of a hospital’s operating cost goes towards paying humans to work. There are tremendous supply-demand imbalances across healthcare systems, countries and the world. The healthcare workforce can be divided into two: Those workers who must be physically present to provide their work “value” and those who can provide their work value remotely (healthcare knowledge workers). I estimate that 25-50 per cent of the healthcare workforce may fit into the healthcare knowledge worker category – the daily increase in connectivity, will allow us to greatly improve the utilisation of, and access to, these healthcare knowledge workers.

Debate Around Diagnosis
The foundation of healthcare delivery is “the diagnosis.” There are many people involved in diagnosing what is wrong with us – not only the doctor or nurse in front of us but a larger assortment of caregivers that includes pathologists, radiologists, laboratory specialists and many more specialists. Diagnosing an illness or injury consists of working through algorithms and looking for familiar (known) patterns. Running algorithms and pattern recognition are functions that are much better done by computers than humans. I am not saying that there will no longer be a warm-blooded empathetic human serving as your primary interface, just that the diagnostic tasks will be performed by computers – thus greatly reducing the required manpower, speeding up the process, improving the accuracy and lowering the cost. This is already starting – but we are just scratching the surface.

Billions of sensors in and on our bodies, and within our physical environment as well – will continually feed enormous amounts of data into cloud storage that will be curated, accessed and analysed by advanced thinking machines, which will have access to all of this monitored patient data, health records as well as all published research for us.

I realise that I make “going digital” sound like a panacea, and it could be – but, there are risks and problems to overcome with this transition to digital; and no, it is not the dehumanisation of healthcare, or replacing doctors with computers. Digitalisation and connectivity will improve access and make healthcare much more personal and humane than it is today. The problem is that most healthcare IT initiatives are miserable money wasting failures. 

There was a survey conducted by McKinsey & Company several years ago of more than 2,200 hospital and health system executives – roughly 70 per cent of executives said their strategic initiatives failed. I believe the root cause of the majority of these failures, is the lack of standardisation in healthcare, process illiteracy and the wrong-headed belief that medicine is a dark art, only to be understood by mystics and wizards. Before we can properly “go digital” we must become process literate and embrace standardisation – all of that “lean sigma Kaizen event” stuff that gets a lot of talk, but not enough walk. Medicine is not a dark art; much of it can be standardised and industrialised, which would result in better patient care and experience. And upon this foundation, we can then overlay a powerful digital ecosystem.

Usually a biomedical equipment planner performs a wide range of tasks, including evaluation of different medical equipment, making recommendations on their installation and use. They are responsible for the definition of room layouts and for the validation of structural layouts and requirements of the hospital. They develop, coordinate and manage the hospital equipment list. Moreover, this professional is asked to coordinate projects with other planners and engineers, architects and administrative personnel. The role of the biomedical planner is further going to undergo major changes stemming from Artificial Intelligence (AI) and Machine Learning (ML).

While China’s first smart hospital featuring AI recently opened in Guangzhou, in the U.S. a study demonstrated that the AI health market is poised to reach $6.6 billion by 2021 and by 2026 can potentially save the U.S. healthcare economy $150 billion annually. ML healthcare applications seem to top the list for funding and press in the last three years. Many of the ML start-ups are targeting healthcare, scuh as Nervanasys, Ayasdi, and Digital Reasoning Systems.

In this context, the medical equipment planner must not only acquire knowledge about AI and ML but must understand their fields of application. They must also acquire all the technical notions to implement new technology in new projects, defining its requirements, as well as the infrastructure, the needed hardware and the management systems.

As a result, the biomedical equipment planner needs to evolve beyond the current tasks to acquire the “flexibility” and the “elasticity”, which allow him to “metabolise”, manage and implement new technologies. The biomedical equipment planner must be able to understand how AI and ML impact the current medical devices in the future and how these technologies can modify layouts, assets and operational workflows of a hospital.

A medical institution will get the greatest value from a medical equipment planner who is able to integrate the medical equipment with the infrastructure technology, including the exchange of information between disparate systems such as audio-visual, security, and information technology infrastructure and information technology systems where AI and ML are implemented. This integration, known as ME-IT, can bring the client a seamless integration of services that will result in a cost-effective design.

The biomedical equipment planner must bring this holistic approach to medical planning. This can be achieved by a professional figure with a solid clinical experience combined with a strong technical knowledge of medical devices, medical planning and ICT Systems. This unique combination of clinical knowledge and practical and technical know-how will allow the biomedical equipment planner to address the development of medical facilities with a comprehensive, holistic view. 

The biomedical equipment planner will bring together the expertise of biomedical engineering, a clinician as well as an ICT system, AI, and ML.

If on the one hand more energy and effort must be spent on acquiring new skills, on the other hand we cannot fail to see the new opportunities that the advent of these new technologies can bring not only to the entire healthcare ecosystems, but also to the figure of the biomedical equipment planner.

In fact, whenever there are big technological revolutions, there are always great opportunities for professional growth. Although many applications of AI and ML in the healthcare sector are already known, there are still wide margins of growth and entire “unexplored” areas of patient care chain, where these technologies can be applied.

A biomedical equipment planner with a wide range of skills and knowledge is a professional who can produce innovative solutions.

Researchers at Harvard spent half a decade studying the world’s greatest innovators. They found that innovators “associate” ideas and knowledge from different fields and apply them to the product or service they’re working on.

Therefore, in the next few years the biomedical equipment planner will be called on to integrate AI and ML with biomedical engineering, thus becoming a pioneer in a strongly growing sector. For more info visit www.biomedicalequipmentplanner.com.