The Department of Health – Abu Dhabi (DOH) and Malaffi, the region’s first Health Information Exchange (HIE), showcased a population risk management analytics platform at the recently concluded GITEX exhibition. The technology will empower the healthcare sector to support care management, improve population health and assist in ensuring continuity of care.

The risk management solution, which is supported and provided by Malaffi, uses advanced AI analytic technologies such as machine learning, to build predictive models based on the clinical data and create algorithms that run in near real-time to predict cost, admissions, emergency department visits, readmissions, and diseases. Drilling down from the population to the physician and individual level, the insights will be used to predict risk, improve overall efficiencies and health outcomes.

Related: Department of Health’s Malaffi: Connected information facilitating smarter care

The analytics dashboards will enable the DOH to gain insights into and manage certain risk categories such as the risk of emergency room visits or complications of chronic conditions such as diabetes. It will further visualise the population risk distribution and trends and will provide benchmarking against best practice guidelines. For the first time, real-time monitoring of health indicators and new data points will be available to improve quality through customised benchmarks, in addition to standard performance and utilisation reports.

Malaffi currently connects almost 83 per cent of all hospitals and a total of 814 healthcare facilities in Abu Dhabi, which accounts for 77 per cent of all episodes in the Emirate. The centralised database stores 175 million patient records, for over 5 million unique patients.

Improving patient care

Related: Malaffi strengthens DOH Abu Dhabi’s COVID-19 response

Commenting on the new developments, H.E Dr. Jamal Mohammed Al Kaabi, Undersecretary of the Department of Health – Abu Dhabi, said: “We are proud to have built a healthcare infrastructure that is on par with the most advanced in the world. The addition of such sophisticated analytic technology to Malaffi is further testament of the DOH’s dedication to improving outcomes for the people of Abu Dhabi. Adoption of the latest technological advancements, which support further improvements to patient care, has always been a key part of our ambitious journey, and reaffirms the Emirate’s position as a true healthcare technology leader. Access to insights that support the management of the health status of the population, will strengthen our response to public health risks and enhance the Emirate’s emergency preparedness, and ultimately ensure excellence in healthcare now and in the future.”

While Atif Al Braiki, Chief Executive Officer of Abu Dhabi Health Data Services, added: “Malaffi is the first HIE in the MENA region, and thanks to the support we have had from the Abu Dhabi healthcare sector, in a short time we have demonstrated the true value that connected healthcare can offer all our stakeholders. The addition of such sophisticated analytics platforms only expands on the benefits that Malaffi offers and maximises the data collated. Advanced technologies such as this will provide insights that will empower both the DOH and healthcare providers, to improve their population health and care management efforts. The ability to analyse large data sets to identify risk at an early stage and by improving overall efficiencies, we can be one step ahead in improving the quality of healthcare and outcomes for our patients. The next stage in the Malaffi journey is an exciting one.”

Malaffi was launched in 2019 as a partnership between the Department of Health – Abu Dhabi and Injazat. The platform is working to connect all, more than 2000, healthcare providers in Abu Dhabi by 2021.

Stay-at-home restrictions, social distancing and the closure of healthcare facilities have led to more UAE residents using telehealth services than ever before. Recent data from UAE-based telehealth provider vHealth shows a 500 per cent increase in utilisation between March and September 2020, compared to the same period last year.

The number of UAE residents using telehealth services for mental health support peaked during key waves of the pandemic. With stress and anxiety on the increase, 60 per cent of vHealth consultations relating to mental health occurred between March and May with a further 23 per cent in August.

Related: How telenursing, video visits and nursing informatics have benefited patient care in KSA and UAE

Although the pandemic kick-started the increased use of telehealth services, customers throughout the UAE have adapted quickly. vHealth data shows that 25 per cent have already used the service more than once and seem happy to stick with the new system. In reality, it’s no longer just about COVID-19. As customers get more accustomed to telehealth, they’re starting to see the true value of the service. However, despite the progress made, there remain some common misconceptions about remote patient care and telehealth.

Relying on telehealth

Joe Hawayek, senior director & head of vHealth MEA explains: “When it comes to our health and well-being, it is not easy to alter habits. One of the biggest misconceptions of telehealth is around the quality of care; people find it hard to believe that the same quality of care is possible without being physically in front of a doctor, which can lead to reticence in booking telehealth consultations. However, in our experience, when people try telehealth, they rarely look back. It’s something we are seeing more and more with our customers.”

Related: 2020: The year that telehealth came of age

Hawayek gives an example of a recent experience with a patient in Dubai that had called into vHealth with complaints of back and chest pain. By taking a holistic approach — asking the right questions and conducting a thorough examination — it was possible to diagnose the condition accurately.

“In many ways, this is what makes telehealth unique,” says Hawayek. “Not only are our vHealth doctors highly qualified, reassuringly experienced and specially trained in telehealth, but they also are encouraged to take as much time as needed to fully understand the symptoms, diagnose the condition and proactively follow up with patients to check on their status.

“It is paying off. When you experience the meticulous process that telehealth doctors go through, you start to understand how they can be so precise and why we are seeing more people begin to use telehealth services as their first port-of-call for primary care.”

Harnessing the digital workplace to deliver value

In a session delivered in partnership with HIMSS, moderated by Dr Taghreed Justinia, Asst. Prof. Health Informatics and Regional Director IT Services, Technology & Health Informatics at King Saud bin Abdulaziz University for Health Sciences, experts from KSA and Germany looked at delivering value through the digital workplace. 

Related: How Saudi Arabia is approaching value-based healthcare

Dr Valerie Kirchberger, Consultant to the Chief Medical Officer and Head of Value-Based Healthcare at Charité Hospital, described how Charité Hospital’s path to VBH is focused on quality measurement, cost measurement and integrated care.

Yet while there is a good measurement system in place, integrated care remains a challenge (Germany having an historically fragmented care system) and there is no exchange of data. The provider decided to proceed electronically, she explained, and looked around for best practices. Charité’s vision is to have a fully integrated dashboard, with Patient-Reported Outcomes (PRO) data as part of the electronic record of the patient (she used the example of Memorial Sloan Kettering). 

Related: How telenursing, video visits and nursing informatics have benefited patient care in KSA and UAE

Dr Kirchberger caveated that while digital tools can help accelerate towards VBH, the paradigm shift - from volume to value - is more important, and everything else will follow. She explained that they were still incentivised “in the old world” - to deliver care on a short-term basis.

According to Eng. Abdullah Al-Sharqi, Chief Digital Transformation Officer at CCHI, there is a major transformation in the health sector in Saudi Arabia, and there is a new program approved as part of Vision 2030, and enabling e-health solutions is part of that.

Unifying health records will help to analyse and understand diseases, and in planning for healthcare and hospitals. He clarified that data ownership lies with the patient, while the exchange of data is the responsibility of government (SDAIA government body).

Management of non-COVID 19 public health issues during the pandemic

According to Prof Dr Scott JN McNabb, Research Professor, Emory University, Rollins School of Public Health, Emory University, U.S., it is time to modernise public health learning for the 21^st century. Prof McNabb directs the King Abdullah Fellowship Program (KAFP), a joint effort between KSA and the Rollins School of Public Health and also has an adjunct appointment at King Saud Bin Abdulaziz University for Health Sciences, Riyadh.

At the session, he said that multi-communication and e-learning is the future and that the pandemic has accelerated digital transformation and the public health sector needs to look at how they can improve public health training using latest tools.

Prof McNabb said that in the past, educational institutions were intentionally modelled on factories to standardise teaching and testing. “It has been a challenge on how to do online training that is engaging and effective,” he emphasised. “We use text messaging tools and learning management systems. Moreover, most institutions are offering online learning, but they haven’t disrupted the model. COVID-19 has presented a new model to replace old methods. It is a moment in time to rethink about platforms and training and provide the best possible service that is affordable and accessible to students.”

Below are some of the drivers for e-learning that Prof McNabb highlighted:

1. The rise in demand for cost-effective training and learning techniques in corporate and academic sectors
2. A shift towards flexible education solutions
3. Increased effectiveness of animated learning
4. Increased internet penetrations and surge in the number of smartphones with mobile learning technology
5. Micro-learning for specialised training
6. Increased emphasis on online content development and blended learning
7. A growing interest in the flipped classroom and adaptive learning
8. Increasing government participation

Furthermore, he shared that there are four characteristics shared by digital disruptors – customer obsession, exceptional service design, cross-disciplinary collaboration, and focus on love for metrics. “The strategic growth areas that public health institutions should keep in mind include scaling impact, ensuring sustainable growth and adapting to changing needs,” he concluded.

Getting digitally connected to transform quality management

In the last nine months, healthcare has seen an acceleration in digital technology, said Dr Peter Lachman, CEO, The International Society for Quality in Health Care (ISQua), Dublin, Ireland, however, this was done not out of desire but out of necessity.

At the session, he said: “In healthcare, we have been a little behind the curve. For instance, when it comes to telemedicine, we still really haven’t worked out what the standards for it are. The rest of my world is digital – I buy newspapers online and don’t go to the bank, but the only thing I can't do digitally is getting access to my health records. COVID-19 has told us where we have fallen and where we should go from here and the potential to learn from it is immense.”

While, Paula Wilson, CEO, Joint Commission International (JCI) highlighted that one of the interesting areas is how digital health can help in mitigating social determinants of health. “Governments need to digitalise countries to ensure connectivity for all citizens,” Dr Lachman added.

Wilson said: “However, the use of technology creates a new list of things we need to worry about when it comes to patient safety. One of the most serious ones is cybersecurity issues pertaining to patient’s information. Therefore, we will be adapting quality management standards to reflect the new reality.”

Moderator Dr Abdullaziz Abdulbaqi, Assistant Deputy Minister for Planning & Organisation Excellence, Ministry of Health, KSA, concluded: “COVID-19 has been an opportunity that needs to be taken seriously for public health and awareness as well. In diagnostics, the role of AI will create a huge transformation and create an efficient system that will increase the quality of diagnostics and add more value to patients by building a centralised database to create benchmarks that will improve quality of care.”

Lab session: Molecular diagnosis of COVID-19: Current situation and trend

At this session, Prof Julian Hiscox, Chair in Infection and Global Health Infection Biology, University of Liverpool, UK, highlighted that COVID-19 has a case fatality rate of 1.4 per cent. He said: “It is characterised by air hunger in severe cases and pulmonary thrombus (blood clots) is observed in severe cases in the lung.”

He stressed that one of the major questions is why people get severe COVID-19? “To understand that we have used genetic sequencing to understand the sequence of the virus and how much virus is in people. We use a similar sequencing approach in host response and how people and animals respond,” he explained.

Prof Hiscox said that his laboratory was able to offer the ability to sequence the virus quickly as they used an amplicon-based approach to identify SAR-CoV-2 and to sequence the virus from clinical samples.

To study the distribution of SARS-CoV-2 in post-mortem tissue from patients with COVID-19, his team conducted an analysis of patients who died in ICU or in hospital wards. They examined the extent and nature of pulmonary immune infiltration and the presence of the virus at an organ and cellular level. These examinations confirmed SARS-CoV-2 infection and evidence of lower respiratory tract disease at a median of 19.3 hours after death. The patients had a mean age of 77 years.

He added: “In people who are severely ill there is a sustained inflammatory response to COVID-19. As soon as people died, with family’s permission, we conducted a rapid post-mortem. We found SARS-CoV-2 all over the body but it was particularly focused on the respiratory organs. It is primarily a disease of inflammation of the lungs.”

At Global Health Exhibition, Dr Peter Lachman, CEO, International Society for Quality in Health Care (ISQua), Dublin, Ireland, will be discussing digital health and the future going forward. He will be shedding light on how digital technology can be leveraged to improve safety culture, collaboration, competency and leadership.

In an interview with Omnia Health Insights, he said: “Due to the pandemic, the move towards digital health has been accelerated. We are often asked questions such as how can digital health make a difference in transforming how we manage quality? I would say it's a challenge we need to tackle head-on in the future.”

Related: Quality, patient safety, and accreditation in our changed world

Dr Lachman has been the CEO of ISQua for the last four and a half years. The organisation provides accreditation standards for international accreditation bodies, through its accreditation association called ISQua External Evaluation Association (IEEA).

“We accredit accrediting bodies around the world such as Joint Commission International (JCI), therefore, we set the international standards on quality and safety,” he explained. “We also accredit accrediting bodies in Saudi Arabia as well around the world and have over 60 different organisations that we work with.”

Related: Advocating the habit of quality in the CSSD

Dr Lachman said that the standard and quality of care is very high in KSA. “The country is leading the way in patient safety and has put it as a priority area on its agenda. Moreover, the hospitals that are accredited here are very good.”

Secondly, ISQua works closely with the World Health Organization (WHO), in supporting patient safety movements and also contributes towards technical papers on patient safety. Furthermore, their experts provide advice to member states that request assistance on matters regarding patient safety. “We have made patient safety a focus area and are working to improve it on many different fronts,” he added.

Shift towards digitalisation

When asked about how digital technologies can impact quality management for the better, Dr Lachman gave the example of the banking industry. He said that there was a time when people wouldn’t be able to get money unless they went to a bank. But today, people hardly go to the bank and most transactions get done electronically.

“If you had asked the banking industry 25 years ago, how they would operate in the future, they would never have thought that everything would become electronic. The industry went from a more face-to-face experience to digital and is continuously improving because there was a need to improve security. In healthcare, we have a model of accreditation and standard evaluation, which is built on face-to-face assessments. However, the pandemic has challenged that because you can’t visit hospitals as frequently as before. So, now we have to think outside the box and think of new ways of assessing how the quality of care can be maintained and improved and how it can be evaluated electronically,” he highlighted.

Today, factors such as how healthcare systems can move to telemedicine are being considered. Also, there is an increased focus on how systems can ensure that everyone has equal access to the internet, digital health and their medical records.

He added: “Likewise, for accreditation, we have to do exactly the same. How can we have access to what goes on in the hospital in a digital way? And think of new ways of evaluating? The challenge for the next year or two is to work out how this can happen.”

Building a strong quality program

In order to build a strong quality programme, Dr Lachman stressed that the first thing is to be able to measure quality but to do that one needs to understand what needs to be measured (for instance, patient safety) and measure it over time.

To illustrate, he gave the example of the airline industry, which often gets compared to the healthcare industry. During the early days of aviation, several crashes would be reported, but today crashes are quite rare. “In the 1980s, the airline industry made quality their business. So, when you fly in a plane, the pilot says, “My job is to keep you safe, not my job is to fly the plane.” That is something we need to do in healthcare as well. We need to reach a stage where we are treating and caring for patients and making sure they are safe and at the same time ensure they receive high-quality care,” he emphasised.

Dr Lachman said that the digital age allows many avenues to improve and evolve. With just a smartphone, patients can get information in real-time about their day-to-day activities, quality of life, how well they are sleeping, what they should eat, etc.

“We in healthcare haven't really taken that opportunity so the best way is to have transparent sharing of data so that the everyone knows what's going on,” he said. “The person who's receiving care gets data on their smartphone and can access their results with ease. The risk is how we manage that data. Also, it is important to understand how misinformation can be managed.”

He concluded: “The COVID-19 pandemic has given new challenges to countries worldwide. There is a need today to collaborate and think of how healthcare systems can be transformed post this period and going forward what can we do better.”

Dr Lachman will be speaking at the ‘Getting digitally connected to transform quality management’ session at 5pm (GMT+3) on December 10 at the Global Health Exhibition

Digital health opportunities in KSA

Moderating the ‘Getting digitally connected to transform quality management’ session at Global Health Exhibition is Dr Abdullaziz Abdulbaqi, Assistant Deputy Minister for Planning & Organisation Excellence, Ministry of Health, KSA. As part of his role, Dr Abdulbaqi supervises initiatives that relate to data quality, data management, and quality management.

He shared: “At the session, the panel speakers and I will shed light on quality management during COVID-19, and about the future of quality and how technology will play a crucial role in enabling good quality in healthcare.”

When asked about the impact of digital health on improving patient outcomes, he said that it enhances accessibility and also identifies risk areas and ways in which healthcare programmes can be improved. 

According to Dr Abdulbaqi, some of the opportunities of digital health are that it allows for the integration of data and creates an efficient system that offers more transparency and connectedness.

“Artificial Intelligence (AI) is one of the major priorities of the government of KSA,” he said. “We're working and developing the infrastructure required to implement AI because we can’t use it efficiently without having a solid infrastructure of data management integration. This will help us in improving quality as well as in areas such as standardisation, coding, etc.”

Increasing readiness for future global health emergencies

Interview with Dr George F. Gao, Director-General, Chinese Center for Disease Control and Prevention 

In an interview sponsored by Lean Business Services, Dr George F. Gao, Director-General, China CDC looked at how COVID-19 may strengthen global preparedness in anticipation of the next pandemic. 

Related: Impact of COVID-19 on radiology services

Problematically, from China CDC's point of view, the virus is "clever, covert and very complicated", and while having experienced more than seven waves already in China owing to imported cases, they are still attempting to understand lessons from the first (in Wuhan). 

The virus, he elaborated further, raises important questions and problems. Initially it was assumed that the coronavirus was like SARS, MERS and Ebola, yet it proved to behave very differently. "It's very special," he admitted, "Our common sense and knowledge of Ebola, MERS and Avian flu don't work."

Related: How telenursing, video visits and nursing informatics have benefited patient care in KSA and UAE

While complicated, every imported transmission remains under control, with four provinces - Inner Mongolia, Shanghai, Tianjin and Anhui - presently experiencing outbreaks. 

Dr Gao's lab is working on developing a vaccine and the pathogenesis of the coronavirus, including trying to understand why there is immuno-suppresion. He stressed the need to go back to science. 

So far much has been learned about the virus. After one year no intermediate host has been found, Dr Gao said. While people suspects bats as a close relative, no one has yet isolated the coronavirus anywhere in the world. The scientific community has to work hard to identify the origin of the virus, he continued, lest another outbreak emerges in 5-10 years time. 

Dr Gao conceded that it was difficult to predict how the current pandemic would end - eventually herd immunity will be attained by the end of the pandemic's last year - but there are approaches that the world can take to better control the outbreak. To reopen their economy, all countries must move back to community-level control - which works in China - meaning that public health workers, doctors and nurses are activated and report suspected cases as soon as possible.

He also suggested that innovations such as digital health and nucleic acid tests can play an important role. Everyone uses a smartphone, he said, and so a "health code" was introduced in China to establish a traveller's health status (a colour code is assigned to each user depending on places they can acces). This allowed the speaker to travel recently to places such as Shenzhen and Zhuhai. 

On a final note, he concluded that while it will be "very difficult" to stop the next pandemic from happening - suggesting it was like Tom facing Jerry from the old cartoons - the global community must work together.

He also emphasised the need to maintain a good relationship with nature, saying that humanity is destroying the habitat of virus-carrying animals. Human factors and behaviours are contributing a lot, he pointed out, reminding that there were four class-1 pandemics in the previous century, along with sporadic outbreaks such as Ebola. 

Interview with Syra Madad, Senior Director, System-wide Special Pathogens Program, NYC Health Hospitals

In the last 10 months, COVID-19 has put the world back 10-15 years in terms of infectious disease goals, stressed Syra Madad, Senior Director, System-wide Special Pathogens Program, NYC Health Hospitals, U.S. Due to COVID-19, infectious diseases such as malaria, HIV, and TB, etc., are being masked all around the world.

She explained: “When hospitals get overwhelmed, PPE gets reused and because of which there might be some cross-contamination. However, the good factor has been that since COVID-19 is a respiratory disease, people are wearing masks and these preventative measures are helping in controlling the viral flu.”

According to Madad, technology can play a key role in managing infectious diseases. She said that if several of the processes are automated, it saves time when it comes to training and relying on the human factor to keep up the volume.

“There are certain aspects where we can leverage technology more, in terms of scaling up and having a robust infrastructure,” she highlighted. “For example, while contact tracing is a manual process, if we can augment it better then we don’t have to strain the contact tracing workforce. Today, some apps can track clusters and prevent outbreaks. Also, several decision support tools are being developed by the military such as POCT tests to diagnose pathogens. Our frontline doctors don’t have access to it, and while it is important to innovate and it is also essential to provide these to the frontlines.”

When asked about how COVID-19 will end, Madad stressed that it is an individual responsibility to do what is right but there is also the need to have good public policy and governance in place and provide a conducive environment so that people can do the right thing.

“It is important to realise that such outbreaks are inevitable but what is not inevitable is the way governments respond to these threats. They need to stop hazards from becoming catastrophes and can’t have bubble gum and band-aid solutions! Governments need to invest in preparedness, as it has immense return on investment. Preparedness includes having good public health infrastructure in place that can be scaled up. The best part is we know what to do and have the tools. We have made such amazing advancements, but we just need to make sure that we don’t end up in a similar situation in the future,” she concluded.

A look at the resilience of value based healthcare systems 

In a Lean Business-sponsored session moderated by Jwaher Moteb AlSaud, Chief Beneficiary Affairs Officer at PHAP-MOH, Saudi experts considered how KSA’s healthcare system is transforming from fee-for-service healthcare model to a value-based healthcare system, and benefits to different stakeholders.

The notion of “value” was perceived differently by each.

Dr. Mohammad Ibrahim Alsaghier, CEO at Health Holding Company, described three values. The first is personal, around keeping citizens healthy, while the cost of care is not high; the second is a value to the system and payer, so that the largest percentage of the population is kept healthy without significant cost (the cost is more preventative); third, the value to the technical team, to ensure that the best medical care is affordable to the community.

Dr Shabab Saad AlGhamdi, Secretary General at CCHI, believes that VBH will help the entire system – regulators, payers and providers – in Saudi Arabia to grow. Payers would like better value in their investment, and the provider would like to do a good job. Having value as a strategic pillar at national level would help facilitate the move to proactive healthcare and improve the health status of the population, along with sustaining the affordability of care. He added that CCHI adopted this in its strategic transformation to be become an internationally leading organisation and improve the quality of care and satisfaction, and ensured better guiding principles.

Marwan Arbalawi, Director of Digital Health at Lean Business, said that putting the individual as the focus is the goal of VBH, and in particular providing high value care at low cost.

Role of technology

According to Dr Shabab, it’s not possible to realise value until digitalisation is achieved. He spoke of a unified electronic services platform for Saudi Arabia called National Platform for Health Insurance and Exchange Services, comprising insurance services and unified medical records, to help achieve more granular data, whereupon a baseline can be measured and improved on.  

Arbalawi agreed that technology initiatives need to be supported to achieve VBH, suggesting that technology will enable regulators, providers and payers to “do their job”. He further elaborated by saying that payers will like to see data where they can see the right care is provided at reasonable cost; regulators would want patients to be treated in the right way in accordance with standards; and providers will be in favour of providing new ways of care.

Dr. Mohammad stated that levers need to be built into the system, but there is huge political will today with a Vision 2030 as a major enabler. He added there is a strong feeling that a lot of care cannot be provided without measuring outcomes, and so there is a push towards achieving this.

He stressed that providers believe in VBH – there is a movement behind it - quoting an example of a first five year plan to move towards VBH that was reviewed the previous week. It was an important moment, he said, in the history of the transformation of healthcare.

Jwaher Moteb AlSaud stated that the best examples of value-based healthcare were enabled by government, and described the journey towards achieving it as interesting.

Introducing VBH to the insurance market

Dr Shabab said a key driver of change is sustainability, and VBH is a “win, win, win” situation for all stakeholders: for payers, where they can have steady growth of business; providers can compete transparently; and employers can maintain some control of pay at the end of the year. The ultimate beneficiary is the customer, who has better access, better quality of care, and better satisfaction.

All these needs are included in CCHI’s strategy and aligned with the national strategic guiding principles from the Vision Realization Program (VRP). There were five strategic pillars followed by CCHI, two of which he described.

He explained the first as prioritising quality and satisfaction for the beneficiary – the end user. The CCHI is surveying nationally customers on this basis to determine areas of improvement. The CCHI is additionally collecting data from payers and providers to drive quality of outcome.

Second, there is a need to enable the private sector. Dr Shabab described a love-hate relationship between payer and provider. The CCHI is now making it a requirement for all payers to adopt care management and population outcomes (all international payers are mandated to do so, he added).

Value-based imaging

At this session, Carlos Francisco Silva, MD, EDiR, Radiologist, Member - Management & Quality Section, Portuguese Society of Radiology and Nuclear Medicine (SPRMN), Sertubal, Portugal, discussed the concept of value in radiology. He said that value equals to outcomes divided by cost. The outcomes include quality, efficacy and safety.

He further highlighted that radiology faces the problem of 30 per cent of waste in imaging exams due to tests and procedures that are unnecessary. Some of the frequent mistakes that can lead to this waste include forgetting to compare previous CT/MRI reports, missing information, a valid information request but about the wrong patient, and missing/erroneous lab data.

“Good IT support is crucial for radiologists to integrate the necessary software and clinical decision support tools, otherwise they will lose too much time,” he stressed.

Furthermore, according to Silva, even though physicians are aware of the problem they continue to order low-value tests and procedures. He shared findings where the reasons for this included malpractice concerns (87 per cent), desire to reduce uncertainty (84 per cent), “just to be safe” (78 per cent), and desire to keep patients happy and on patient’s insistence (>70 per cent).

He added: “While value-based care needs to be relationship-centric, radiologists need to work as a team, and align clinicians’ value and goals to achieve better patient outcomes.”

The role of supply chain in optimizing healthcare costs - Sponsored by Nupco

This session explored how much money can be saved from unifying and optimizing the supply chain. Tariq Alahmadi, Program Manager, NUPCO, said that demand-driven solutions can be used to optimise supply chain management. There is an increased need to monitor customer demand and identify and agree on solutions to deliver products at a suitable time to patients and healthcare provider. The performance of these systems also needs to be continuously monitored to make modifications if required.

“KSA is a huge market with more than 300 hospitals and 4,000 primary centres,” he highlighted. “To reach all these customers, you need to streamline the ordering process to have clear visibility. Therefore, one of the major investments in the supply chain processes in the country has been in automation to provide better solutions. Automation results in cost-savings by streamlining activities.”

Alahmadi stressed that when supply chain processes offer end-to-end visibility, only then will they be able to provide benefits and deliver orders promptly. This is where digitalisation could play a key role.

He said: “One of the issues we are facing is that visibility of the end-user is not clearly captured all the time. I believe providing this visibility may decrease cost leakage. One of the aspects contradicting cost savings is you need much more investment; the question is how to provide better networking and the answer is it requires one-time major investment in digitalisation of services.”

One of the other major issues, according to Alahmadi, is lack of standardisation. “Cost saving is clear when these 300 hospitals have a unified catalogue, as this would lead to cost savings in the procurement side. Quality has to be there all the time and can’t be compromised. Standardisation is one of the first steps that healthcare entities, both public and private, need to agree on to have better cost-saving methodologies.

“Focusing on streamlining services such as dispatching, will add more value to the supply chain.”

Leaders Session: Health Information Management Update - Addressing the latest updates, challenges and solutions for healthcare and insurance providers

At the session, leading American Association Experts shared best practices and leading industry standards and educational offerings in Coding, Clinical Documentation Improvement (CDI) and Revenue Cycle Management (RCM).

As part of the Coding & CDI: Best practices presentation, Melanie Endiscott, Senior Director, International Education and Training, AHIMA, said clinical documentation represents what is going on with the patient, which is turned to standardised coding, which turns to reports for reimbursement, quality reporting, public health, medical research, etc. “The standardised coding supports best possible patient outcomes,” she added.

There are seven characteristics of high-quality clinical documentation: complete, consistent (should not be contradictory), timely, clear (thorough), precise, legible, and reliable.

There are a lot of codes out there said Endiscott, for example, in the U.S. there are over 60,000 codes and 10,000 outpatient codes. In Australia, there are over 22,000 diagnosis codes and billing has over 6,000 codes. KSA also uses these Australian codes. “KSA has been using this for years. The challenge is going to be to ensure the codes are being applied consistently across the country. Fortunately, there are many technologies available such as AI that will assist in ramping up that workforce,” she highlighted.

While Joseph Fifer, CEO, Healthcare Financial Management Association (HFMA), gave a presentation on the ‘Revenue cycle management: Best practices from the U.S. and education opportunities.’ He said that KPIs help forecast performance and recognise signs of improvement or slippage, identify where labour, technology and other resources are likely to have the most impact and help determine if it makes financial sense.

“We need database decision making that is at the heart of the revenue cycle management,” he added.

Solving the global workforce crisis in healthcare – Sponsored by KPMG  

Dr Mark Britnell, Global Healthcare Expert, KPMG International, highlighted that by 2030, we face a future with too much work, with too few workers. He said: “We will be 18 million health workers short by 2030 and this represents a gap to care.”

Related: How Saudi Arabia is approaching value-based healthcare

In the UK, he shared, nearly 10 per cent of all NHS posts are vacant. In the U.S., 1 million nurses and 120,000 doctors are needed by 2030; India needs 3.9 million doctors and nurses, while China needs 180,000 obstetricians by 2022.

In KSA, a changing demographic will see the need for 30,000 more doctors and 82,000 more nurses by 2030. Keeping this in mind, the country has started to prioritise nursing, and there has been growth in medical education from five medical to schools to 37, of which 28 are public and 9 are private. Also, the growing medical workforce ratio of doctors in the population rose from 2 per 1000 to 2.8 to 1000.

Dr Britnell suggests 10 changes to tackle the global health workforce crisis:

1. Productivity. Health is wealth.
2. Entrepreneurial government
3. New models of care
4. Patients as partners
5. Communities as carers
6. Professionals. Top of their game.
7. A new cadre of care workers
8. Digital dividend
9. Agile learning organisations
10. Manage and motivate the workforce

Digitalising the nursing profession

Dr Mohammed G Alghamdi, General Director of Nursing Affairs at the Ministry of Health, commenced an engaging session on digitalising nursing (sponsored by Vocera) by raising the issue of nurse shortages, and how this was addressed through approaches that included:

• Adapting new flexible temporary contracts and workforce restoration plan
• A new staffing model to provide safe nursing care to ICU patients that was published on its website.
• Publishing clinical guidance for nursing and protocol for quarantine facilities

Competency training is critical during the pandemic, and this is something that nursing leaders need to provide. But there was also a recognised need to minimise physical gatherings, and therefore an alternate solution was sought. One solution was a COVID-19 crash course that was completed by almost 20,000 nurses. It included topics such as hand hygiene compliance and burnout ("familiar to everyone").

Furthermore, nurses and nursing directors provide Excel sheets every day, which he believed to be impractical, showing numbers for nurse infections that reported to the national emergency operating centre. This method was automated or digitalised, resulting in the ability to track any rise in infections. The outcome was a decrease in the number of confirmed coronavirus cases in nurses from 19.2% to 6.1%.

Steven Matarelli, Senior Clinical Executive at Vocera, suggested that technology can also have a part to play in cognifive overload. It all becomes a blur. Nursing leaders we need to stop and think about how to end the technology burden, and become more unified.

He recommended thinking about communication as a strategic decision in hospital, and importantly for nursing leaders to be present at the table with tech partners to determine whether or not a product hinders or helps the nurse. He offered five key points to consider:

• Information needs to be ‘contextualised’ – with patient name and date-of-birth;
• All ‘noise’ must be deflected. This means technology turned off if administering a medication;
• A single source of information is necessary – a health record needs to works for the nurse, rather than the reverse;
• Information needs to be retrieved as a mobile healthcare giver (he asked how many have written vital signs on scrub pants);
• finally, extraneous information must be left out

Matarelli said furthermore that if technology does not contribute towards creating a safe, working environment then “we must go back to old school”. Every technology purchase must therefore pass a Failure Modes and Effects Analysis (FMEA).

Dr Elham Alateeq, Chief Nursing Officer at Makkah Healthcare Cluster, highlighted how Makkah Healthcare Cluster integrated nursing informatics, which has been a very positive experience, while there is a long way to go. She agreed with Matarelli in that nursing “should be part of IT” as solutions affect nurses at the bedside and frontline. She added that her organisation is looking into offering a certification in nursing informatics.

Dr Elham emphasised the need to consider how to make it easier for nurses when sharing “masses” of information through digital solutions, as they are usually the end users of information at the core of sending it.  

Benefits of tech in nursing

Aysha Al Mahri, Group CNO at Seha, began by saying that 2020 was the year of the nurse and midwife. She drew attention to the benefits of technology in nursing, saying that it helped her organisation identify opportunities for its utilisation from bedside to desktop. In the case of the former, it was embedded in care for patients.

Examples of its utilisation included an advanced communication system and patient monitoring – including telemedicine in the form of telenursing. Seha furthermore introduced e-learning platforms for nurses to train nurses, while a dashboard enabled staff to see where they were today and predict where they will be moving forward.

Dr Elham agreed that there were many ways technology could benefit nursing. In a clinical context, smart communications allow Makkah Healthcare Cluster to program medications, meaning that the nurse needn’t return to the room, taking care of infusion and flushing.

Recognising that nurses are unable to pick up a phone from their pockets for reasons of infection control, there are now voice-activated devices to enable calls. In addition, AI can send an alert when a physician writes an order that may result in a contraindication. All of these help to coordinate care safely. Finally, she agreed that nurses must have a key role in choosing technology -they must be involved in buying equipment from smart beds to monitors.

Lab session: COVID-19: Current issues and challenges 

This session focussed on sampling and laboratory testing for COVID-19 and what is being diagnosed and what will be done with the result? Keynote speaker Prof Mike Barer, Professor of Clinical Microbiology and Honorary Consultant Microbiologist, University of Leicester, UK, said that if these questions are not answered at the onset, it is a waste of time and efforts.

He also highlighted several challenges his team experienced in developing the capacity to provide tests. “It has been a dramatic experience as we are not used to operating at this scale. The training of the staff has been important for tasks such as labelling and sample registration. Handling reagents and consumables has also been a very challenging experience. We also sometimes had to order so much material that we didn’t have space to store it, and integration of new IT systems was also essential to operate effectively,” he shared.

Prof Barer also shared the example of “Face mask sampling”, an innovative sampling method where strips are fitted in face masks and a sample is taken over 30 minutes of wearing. Developed by Dr Alaa Al-Tae, the system has been effective in detecting TB and the process has been adapted for SARS-COV-2.

Understanding co-infection

While Dr Bandar Alosaimy, Assistant Professor, Viral Oncology and Cancer Sciences, King Fahad Medical City, discussed his study titled, ‘Influenza co-infection associated with severity and mortality in COVID-19 patients’.

According to the research, during pandemics, the detection of the novel virus may lead to underreporting of other pathogens that could be the etiological agent and contribute to the disease severity. Reportedly, during the 2009 influenza H1NI, 44.3 per cent of patients had unreported respiratory viruses.

“The study highlights the importance of screening when patients are hospitalized and during their stay. From our sample, 2/3^rds of patients who died had a co-infection. Also, diabetes was associated significantly with higher mortality.

“Given the high prevalence of influenza co-infection in the study, increased coverage of flu vaccination is warranted to mitigate the transmission of the ongoing pandemic and to reduce the hospitalization and associated mortality. Vaccination will reportedly prevent 4.4 million flu illnesses,” he highlighted.

The rise of telemedicine during COVID-19: Case studies from KSA

This session provided an in-depth look at the use and adaption of telemedicine within government, public and private hospitals in KSA.

First, Mouhamad Ghyath Jamil, Consultant Pulmonary, Critical Care and Sleep Medicine and Director Tele-ICU Program, Director Transplant ICU, King Faisal Hospital and Research Centre, KSA, shared that Saudi Arabia faces several challenges such as a shortage of ICU physicians (out of 300 hospitals, only 15 have certified intensivists), unequal distribution of health professionals, unorganised referral system, and distance between facilities.

“The government is committed to providing basic health to all KSA citizens as a fundamental right,” he said. “King Faisal Hospital started a program called ‘Same Care. Everywhere’ to provide care all over the country. The goal is to improve access, reduce the cost of travel, reduce professional isolation for rural doctors, improve quality of care, and enhance decision making between patients and specialised doctors.”

Moreover, the tele-ICU programme at King Faisal Hospital was launched in 2008. The programme is now in 45 cities around the Kingdom. The number of cases reportedly increased from 478 in 2013 to 583 in 2017. Jamil stressed that to practice telehealth effectively, hospitals need to follow country related regulatory requirements and train physicians to translate their work through the camera and ensure they feel comfortable.

Discussing John Hopkins Aramco’s telehealth programme was Dr Tamara Sunbul, Medical Director, Clinical Informatics. She said that the hospital used several innovations to manage patients during COVID-19. These included telemedicine video visits, nurse care line, telephone visits, COVID-19 care line, emotional helpline, drive-thru swab and home monitoring, medication pick-up and delivery and in-patient virtual visit.

She said: “The monitor me @ home – COVID-19 programme can be accessed on a smartphone and gives questionnaires to patients every day, and the caregiver will review those, and send escalation emails if needed. To ensure optimal performance, we had a patient satisfaction survey, a chart review and return to the clinic or EMS visit for related complaint within one week of video visit, and monthly reviews of quality.

“In fact, according to our in-house survey, 85 per cent of our patients found that their medical concern was resolved by the video visit, while 87 per cent would use video visits again.”

According to Weam Qattan, Pharmacist Informatics, National Guard – Health Affairs, KSA, telemedicine pharmacy services were quite effective during COVID-19. She said that at National Guard, pharmacists would participate in meetings virtually as well as receive online training through Microsoft Teams. This also allowed to maximise the use of technology to enhance the patient experience through the patient portal, and interactive voice response and web-based applications.

However, she said that some of the challenges included breaking staff into teams to avoid cross-infection, which led to staff shortages. There was also heightened anxiety and stress levels among pharmacists and issues in delivering medications to patients.

To conclude, Maissa Almagati, Director, Saudi Telehealth Network (STN) at the National Health Information Center (NHIC), said that the network is mandated to provide a telehealth network and create governing rules for telehealth practice. STN will be official launched in 2021.

She explained: “STN’s goal is to create a national telehealth network, which will be a centralised authority bringing multiple partners under one governance structure. It will provide standards, coordination and advocacy. It will standardise practice and provide education and training and support research and evidence-based practices. Its benefits include equality of access, increased quality and increase in non-petroleum revenues.”

STN's objectives include:

• Foundations to allow the growth of telehealth in Saudi Arabia
• Give a set of common rules applicable to everyone
• Ensure safety and quality of practices for the patients
• Create the proper approach to support telehealth activities

Radiology payment model and pricing 

Dr Yoshimi Anzai, Professor of Radiology, University of Utah, U.S., spoke at this session and gave an overview of the healthcare payment models in the U.S. and the recent pressure toward the price transparency of ambulatory services, including radiology. She further discussed how consumers (patients) balance price (cost) and quality of healthcare services.

Anzai explained: “Payment is based on volume. That needs to be changed to focus more on the value and outcomes for patients. There has been a continuous decrease in reimbursements in imaging. The rising cost of healthcare has led to double-digit growth in the insurance premium. Small employers have stopped offering health insurance or redesigned the plans with cost-sharing to employees.”

In the U.S., within the High Deductible Health Plan (HDHP), a patient has to spend over US$5000 dollars before getting any benefit from the insurance companies. Also, there is a wide price variation for imaging studies. Therefore, this year, the CMS Price Transparency Rule highlighted that hospitals must disclose standard prices of 300 “shoppable” services. These are non-urgent services that include imaging or ambulatory surgery.

The value of imaging can be demonstrated through quality and service such as accurate and timely diagnosis, high quality of imaging. “For healthcare, it is not just about price or cost, but about ensuring good quality and providing value,” she said. “Also, radiology is one of the most mentally demanding physician specialities with workload likely contributing to burnout, and this is where Artificial Intelligence/Machine Learning can play a crucial role in assisting with day-to-day operations.”

In the middle of the COVID-19 pandemic, the volume of ambulatory (outpatients) imaging dropped dramatically, and elective imaging services were shut off for a while. Furthermore, several policies had to be updated in hospitals and radiology departments, regarding COVID-19 testing, PPE availability, and technologists and managers had to be trained on how to handle this new situation effectively.

In an interview with Omnia Health Insights, radiologist Yoshimi Anzai, MD MPH, University of Utah, U.S., highlighted that in the beginning, there was a lot of anxiety, confusion, and frustration. Throughout the process, radiologists learned how to be resilient and make safety their highest priority, including for technologists, nurses, faculty, trainees, and students.

She said: “We learned how to prepare for pandemics as a health system and communicate effectively. Now, eight months after the pandemic, the volume of ambulatory imaging has come back to nearly 95 per cent of pre-COVID-19 volume for most. However, the community spread of COVID-19 continues to rise in our state, and we will have the ups and downs for the next several months. Furthermore, there has been a substantial financial impact on imaging services and the imaging industry.”

At Global Health Exhibition, Anzai will be speaking at the Payment model and Pricing in Radiology session. The lecture addresses the overview of the healthcare payment models in the U.S. and the recent pressure toward the price transparency of ambulatory services, including radiology. It further explores how consumers (patients) balance price (cost) and quality of health care services.

Leveraging technology to improve radiology

Teleradiology has been wide-spread in the U.S. even before COVID-19 and some systems even completely operated under teleradiology. She said: “Our department has deployed Home Picture archiving and communication system (PACS) for faculty members, particularly those with high-risk for COVID-19 or those with childcare challenges, that started late March to May. We can read cases from home most of the time. Also, we use Skype to share a screen with residents so that we can do remote teaching.

“One of the benefits of Home PACS is that we sign off reports quickly in the morning since we do not need to commute to hospitals. Reading late night cases was not as hard as reading on-site. Faculty are happier to have a Home PACS system and enjoy the flexibility of work.”

When asked about the future of radiology, she said that imaging provides valuable information to physicians and healthcare workers, therefore, imaging will get faster to obtain, and its efficiency will continue to improve.

Some of the major challenges are related to imaging interpretation, which is a crucial component of imaging diagnosis. This is where technologies such as Artificial Intelligence (AI) and Machine Learning will come in and continue to advance to perform tasks that machines can do as good as or even better than radiologists, she said.

“We have not fully leveraged the power of medical imaging. We will continue to find the best way to extract medical imaging information and use the information to do various medical decision making or predictive analytics. How do we get to the point is the on-going discussion,” she added.

Anzai stressed that radiologists should pay attention to imaging interpretation and reporting. The narrative types of imaging reports will not help develop various AI/ML. Collecting common data elements from various imaging tests in numerous clinical contexts is the heavy lifting for the next 10 years.

She concluded: “I am thrilled to be invited to participate at Global Health Exhibition. Even though there is a tremendous difference in the healthcare delivery system, we are all connected to each other. COVID-19 is an excellent example of how infectious diseases can spread so far and wide in a short time. We all learn from the experience of each country or region. I would like to see more global collaboration rather than competition to mitigate other pandemics like COVID-19 in the future.”

Anzai will be speaking at the ‘Radiology payment model and pricing’ on December 8 at 4:30pm (GMT+3) at the Global Health Exhibition. She is a radiologist by training and is involved in various research projects, ranging from imaging technology development and clinical trials to health services research. She has had the opportunity to serve as the Associate Chief Quality officer at the University of Utah Health, which allows her to understand the health system views of healthcare delivery.

A look at the resilience of value based healthcare systems 

In sessions sponsored by Siemens Healthineers, Saudi speakers from the KSA Ministry of Health revealed that healthcare systems adopting Value Based Healthcare (VBH) models - measuring outcomes, standardising data, creating integrated care pathways and implementing payment for performance - have found themselves to be significantly more resilient than others during the pandemic.

Value based healthcare with Saudi values

Related: Elevating the clinical laboratory's role in healthcare transformation

Dr Reem Bunyan, Chief Executive, Center for Improving Value in Health, KSA Ministry of Health, Co-chair, G20 Health Working Group in Riyadh, established the premise for VBH, namely that people are getting older and are facing more chronic conditions, and that along with more options for treatment, the cost of care is on the rise.

If health systems continue to function in the same way, therefore, they will not be sustainable going forward. Accordingly, they are embarking on change to focus on outcomes.

Related: Impact of COVID-19 on radiology services

Defining what VBH is, Dr Reem, emphasised is 'extremely important'. At its basic core is the need for balance between outcomes that matter to patients relative to cost, resources and effort. The Harvard definition is the more famous out there, she explained, and the WEF has published papers based on this. The Oxford group, meanwhile, included other dimensions in a separate defintion.

The EU customised its definition based on its respective values - an approach that Saudi Arabia adopted.

Dr Reem underlined that Saudi Arabia envisioned a 'triple aim' of the health system that was to produce better health; better care; and both lastly at a lower cost.

The journey to establish the Kingdom's first health transformation began in 2016. This transformation journey was large-scale, encompassing new providers, a new way to pay or finance healthcare, and introducing new models of care that engage beneficiaries and customers. Many healthcare workers and facilities have been involved, along with a big budget.

Saudi Arabia looked at the value-based healthcare definitions mentioned earlier, along with unique national elements. She explained that the Saudi nation is spiritual, connected, and close to families and communities, and that therefore the Saudi approach is to maintain balance betwen outcomes that matter most versus resources.

Undestanding what the VBH movement means, she concluded, will impact how each stakeholder plays their respective role in the system. A provider, for example, will be conscious of the impact of illness on community and the population at large, and factor this into their decision-making. 

Population health management

Dr Abdullah Khoja, Head of Public Health Department, Project Lead for the Population Health Management Strategy, and Advisor for the KSA Vision 2030 Realization Office at the Saudi Ministry of Health, introduced the nation's overarching plan Vision 2030 and, correspondingly, the National Transformation Program (NTP), which set out to improve value-based care among other objectives.

He explained that VBH is at the heart of Saudi healthcare reform, and shared the three goals introduced earlier by Dr Reem: improving the health of populations; achieving better care (including quality, safety, experience and satisfaction); and reducing the cost of healthcare with financial protection and by also ensuring stability. 

Key VBH initiatives in Saudi Arabia included developing a funding mechanism for healthcare systems; developing a governance framework; and moving the current service delivery system towards an accountable care organisation (ACO).

The aim is to move towards population health management as an approach, which he described as an organised and systematic approach to healthcare systems that requires a large-scale transformation, utilisation of the best available resources, health system intelligence and the reorganisation of services.

Saudi Arabia began this large-scale transformation through using the best evidence available. This served to create the right foundation for population management; manage services at scale for the population; and establish a learning system to drive and sustain the work overtime.  

Over the past 18 months, Saudi Arabia has embarked on a population health management framework for the country - a way to achieve VBH through identifying the population, and prioritising segments within the population along with interventions required - which Dr Khoja dissected layer by layer through further slides.

COVID-19 vaccines: scientific advances, access models and vaccination acceptance 

Recently, there have been several conspiracy theories about how a COVID-19 vaccine would change our genetic makeup or that these vaccines have a chip in them or, bizarrely, are equipped with 5G. At the COVID-19 vaccines: scientific advances, access models and vaccination acceptance session, Dr Soumya Swaminathan, Chief Scientific Officer, World Health Organization (WHO), busted some of these myths.

She said: “The first fear people have is the speed at which the vaccine has been developed, as it usually takes almost 10 years. However, this was possible thanks to the investments made in platform technologies, such as mRNA, that have been developed in different laboratories around the world. This kind of science and technology has not been there in the past and that enabled the fast turnaround.”

Other factors that helped in speeding up the process included increased investments in research and manufacturing. “A lot of at-risk manufacturing took place, which means that even if there is wasted capacity, people were investing. Also, there has been global coordination. The WHO has worked with countries around the world to smooth any pitfalls and has set up a global compensation fund. Though the timelines are short, no shortcuts have been taken,” she explained.

Understanding vaccine immunity and side effects

Dr Swaminathan stressed that there has been a lot of focus on studying the immune response and it looks like it lasts for six months. “We are going to learn more from vaccine trials and will be able to compare antibodies,” she said. “Over the next few months, we will be able to define what the immunity looks like. The good thing is most of the early vaccines used the spike protein and it is eliciting immunity.”

Several questions still need to be answered, she stressed. First is about protection versus infection. It is not known if the vaccine prevents asymptomatic infection. But if it only protects an individual’s body and passes it on to other others, it will continue to circulate in the community. Secondly, would these vaccines be effective in preventing severe disease? Thirdly, it is essential to know about the safety of vaccines for women who are in the age group of getting pregnant and for children. Also, how long does the protection last?

“Over the next year, we will some interesting results from different candidates. But right now, we need to start with what we have,” she added.

When asked about side effects, Dr Swaminathan said that all vaccines have side effects and many of them are mild such as a headache or fever. But the serious side effects vary from vaccine to vaccine and nothing major has been seen during COVID-19 trials. It is always about benefit versus risk, she stressed.

Currently, Emergency Use Authorisation for COVID-19 Vaccines is being carried out globally to bring an end to the acute number of deaths due to the virus. She elaborated that this is a temporary authorisation for the vaccine to be used where the manufacturer commits to provide more information to the regulator, especially on the safety of vaccines. After a certain period, the regulator will either withdraw the use or allow it to be released to the wider population.

She concluded: “All countries need to communicate with the public on what the policy for the vaccine is for that country. How will it be rolled out? What are the side effects going to be? How is the government is going to monitor and collect data? People need to understand the scientific process, which is not very well understood.”

The future of AI in Healthcare 

COVID-19 has proven that with the help of technologies such as Artificial Intelligence (AI), solutions can be scaled very quickly, but how can these technologies be sustainable? Answering this and other concerns were Dr Shauna Overgaard, Assistant Professor, The College of St.Scholastica, Clarity Applied Intelligence, U.S., and Samar Nassar, Healthcare Director, KPMG.

Dr Overgaard shared: “I am so excited about what computers can do for humans and can, for instance, help us regain things that we have lost. There might be an opportunity if we think about it in terms of neurodegeneration, eyesight, paralysis, etc. Can we build on what we know in order to assist humans in becoming better? Can we take advantage of AI do our repetitive tasks for us so that we can continue to evolve and be innovative?

“I am not advocating that AI take the role of the radiologist, but we are in a position now where we can work together. It is not a competition but a collaboration between computers and clinicians.”

While Nassar shared that she often tells radiologists to think of an AI platform as a super assistant that provides answers in just 10 seconds. However, AI does come with its challenges such as leveraging data and data management.

“If we don’t have a strong foundation it won’t be successful. Another challenge is about policies and regulations such as cloud policy, the flow of data, patient privacy, among others.

"We are using AI for our own good, to augment our practice, drive productivity and fix that algorithm for better productivity, and provide better patient experience,” she added.

Radiology leadership and successful business

At this session, Prof Dr David Yousem, Associate Dean for Professional Development, Johns Hopkins University School of Medicine, highlighted that some of the characteristics of leaders are to seek input, admit that there are others who have more skills at dealing with certain issues and are more knowledgeable. “Advice can be critical to arriving at the best solution,” he said.

According to Yousem, strategic positioning is essential when it comes to business and includes variety-based positioning that involves the choice of product/service rather than customer segment or needs-based positioning, which targets a customer segment. It also includes access-based positioning that involves, for instance, putting imaging centres in hubs where more people can get access to it.

He stressed that radiology as a business has to deal with five competitive forces: rivalry among existing firms; the threat of new entrants; the threat of substitutions, which is where people are worried about teleradiology groups; bargaining power of suppliers; and bargaining power of buyers

“Strategic planning requires a trade-off, and the work should fit the mission, vision, and values,” he concluded.

Leaders insights: Supply chain and increasing hospital efficiency

In a session on supply chain and increasing hospital efficiency (sponsored by Nupco), experts looked at how supply chain contribute to an increase in the treatment capacity of a hospital or a hospital system or an entire country.

Jan Willem Adrian, logistics VP, Nupco (Saudi Arabia's National Unified Procurement Company), said obtaining the correct data was critical, to see if products are within the expiry date, and to ensure physical flow of products. Nupco is putting emphasis on getting the right products to the hospital on time in the right quantity, and is working with Saudi ministries to obtain better data. 

Arsalan Sheikh, Senior Partner, Continuum Consulting, shared the following three key areas or considerations:

• Healthcare and leadership needs to see supply chains as a strategic advantage, rather than a cost centre – a fundamental change that needs to be realised.  The number 1 cost for any hospital is people, followed by supply chain. Is supply chain therefore seen as a cost centre or as strategic advantage
• Efficiency needs to be seen as a directive towards waste reduction rather than as a cost saving (a by-product of waste reduction, rather than end goal)
• Supply chain is the collaborative network, or the collaboration that can be done on the network, with distributors and manufacturers. The typical activity of a supply chain in a hospital is what can be done in terms of inventory management and pushing costs up-stream towards distributors and manufacturers, instead of looking at the whole chain and reducing waste which would make it more efficient

Adrian said Nupco was formed exactly for these three reasons in Saudi Arabia, adding that it aimed to get inefficiencies out of the system, reduce stockholding for better cashflow, the availability of all products in the hospital needs to go up, and therefore value can therefore be created for the system as a whole. It’s a holistic approach.

Answering a question on how supply chains may contribute to sustainabilty and viability of hospital systems or an entire country, Adrian contributed the point that it was important to ensure that they have the best products in the market for the best treatments. Second, hospitals need to ensure that the best products are available at the right time. 

Sheikh said that the supply chain was responsible for product availability, cost and cash (in terms of inventory and payment). In a healthcare context, this means availability on time and in the right place to reduce turnaround times in turn having a positive effect on patient experience.

This will result in patients demonstrating loyalty to the hospital. Cost will drive the margins to make the hospital more sustainable, and if it can profit it will grow and continue to operate. 

Within Saudi, the margins tend to be higher in the US for every 1,000 dollars saved in the supply chain, it’s equivalent to 33-50,000 dollars of revenue. It’s easier to generate 1,000 dollars in supply chain savings. Strong negotiation will free up more cash for investment and revenue-generating activities. 

In his mind, supply chain should be responsible for end to end, so that when inventory is consumed it is reflected in the right bills and patient charges. More often than not he doesn’t see this handled by hospitals. 

Another aspect is product visibility, so in the event of a product recall hospitals know which items were used on which patient. Hospitals mostly don’t have visibility beyond central warehouses, he explained. They can’t connect this to patients, and this increases risk of patient safety.

In response to a question on how smaller hospitals may compete, Sheikh said that the solution was collaboration. Hospitals need to learn to be able to collaborate, and work diligently together through sharing information – this will in turn benefit the patient. Each hospital presently sees each other as a competitor. 

Adrian told of an online Nupco marketplace similar to Amazon that allows hospitals to join and access rates that were negotiated for the overall contract for smaller individual shipments. Lastly, Nupco has also launched a programme which allows access stock to be shared with other entities to reduce shortages. It's an effort to take waste out of the market. Finally, demand planning will be key (wrong products are bought), to reduce expiry and overstock – and this is about having the right consumption data.

In conclusion, Sheikh described the evolution of GPU-type models an important initiative that should be established in the private sector. In the region supply chain evolution is 10-15 years behind the US, he told, and that the next logical step was a group purchasing organisation (GPO).

Adrian concluded by saying that all panelists were aligned in wanting to improve the healthcare system in Saudi Arabia, but they also needed to get better at communicating and exchanging information in what will be a long journey with small steps. 

The clinical laboratory has an essential role in all aspects of life and the diagnosis process starts early on in medical examination through blood testing or non-invasive testing. It plays an important role in any clinical decision and will have a 30 to 100 per cent impact based on the diagnosis itself and the continuity and outcome of the medical condition, according to Dr Ismail A Bakhsh, Consultant Clinical Scientist, Director of Ancillary Services, National Medical Care.

Today, healthcare systems are moving to become Accountable Care Organizations (ACO). Laboratory services are an integral part to the success of any healthcare system and can contribute a great deal to the success of the ACO model that aims to improve patient outcomes and population health management while keeping costs at a minimum.

At Global Health Exhibition, Dr Bakhsh will be discussing ACO’s and the laboratory’s integral contribution to the success of any healthcare transformation model.

He describes an ACO model as different organisations within a healthcare system working together to improve the health of their assigned local population through integrating the services to manage the causes of illnesses. Those groups of doctors, hospitals, and/or other healthcare providers must work together with a single goal of giving better care at a lower cost and this includes laboratory services.

Dr Bakhsh explained: “ACO is a relatively new concept and highlights the shift in the way we are serving and catering for our patients and clients. ACO’s will depend a lot on the laboratory because, for example, in certain chronic diseases such as diabetes, a diabetic patient will need to visit the doctor every two to three months and the visit will not be complete if they have not done any blood tests.”

ACOs have been created to push the industry away from fee-for-service towards value-based care through care coordination and a shared savings payment model. Effective contribution of any clinical laboratory services to ACO depends on the insurance of the effectiveness of five laboratory strategies. These include:

1. Outreach services: The capacity to extend beyond the institute for wide coverage.
2. Electronic connectivity: For example, easily requesting /ordering laboratory tests and accessing tests results remotely and freely.
3. Lean processes: Better time utilisation, reduced errors, etc.
4. Utilisation Management: Effective utilisation management plays a crucial role in decreasing costs without lowering quality.
5. Aligning with the bigger picture: Laboratory data and resources play an important role clinically and for ACO planning and execution.

Impact of COVID-19 on laboratories

Several areas have been impacted due to COVID-19, stressed Dr Bakhsh. One has been the psychological impact of isolation and quarantine and how people are behaving because of it. Second, has been the financial impact due to drastic job losses, and third has been a shift in the environment of the laboratories due to the increased demand for COVID-19 testing.

“According to recent findings, there has been a reduction in about 14 per cent in the global laboratory industry, but there has also been a positive impact as the development of testing in such a short time was enhanced. So, we have seen a lot of development and enhancement in connectivity, communication, and digitalisation, among other areas,” he highlighted.

Additionally, technology has had a major impact on the day-to-day operations of the laboratory. Dr Bakhsh said that in his organisation, due to COVID-19, there was an increase in home visits, daily consultation, and telecommunication, for medical concerns.

“There has been a shift from face-to-face and physical communication, whether in the medical field or managerial roles,” he said. “Also, there been an increased use of artificial intelligence (AI) and I think it is a developing area, especially in centralising data. Moreover, AI is driven by the private sector, which more flexible and can see the return on investment.”

He concluded: “The message that I want to emphasise on is that ACO is all about the patient and how healthcare organisations should focus on providing high-quality, safe and cost-effective services.”

Dr Bakhsh will be speaking at the ‘Leaders Session: Transformation to ACO: How can the lab help?’ on December 7 at 6pm at the Global Health Exhibition.

He has over 25 years of experience in diagnostic, therapeutic laboratories and executive management. He is skilled in Epidemiology, Medical Devices, Oncology, Haematology, and Healthcare Information Technology (HIT) and also holds an MBA. His PhD, from the University of London, is focused on Haematology and Cellular Therapy.

While real-time PCR (RT-PCR) remains the gold standard for diagnosing COVID-19, every country is conducting assays in accordance with its own national guidelines, posing a problem for virologists, according to Professor Zaki Monawer Eisa, who leads the Weqaya Saudi Center for Disease Prevention and Control, Jazan Branch. 

“We all expected the WHO to lead,” he said, but the reality is that the organisation was “a little bit late” and so each country initially took its own course in areas that included diagnosis and treatment, before guidelines slowly began aligning around the world.

The China CDC rules in their guidelines, for example, that RT-PCR tests of 40 cycles showing a value of 37 or less should be reported as positive, while if the result falls between 37 and 40 the sample should be repeated (if the value is 40, or if there is no value, the test is negative).

Other country guidelines stipulate however that a value ranging between 37 and 40 should be confirmed negative, which he believes to be “personally wrong” – tested individuals will go out and freely infect others.

Prof Zaki added he will highlight this issue in his upcoming Global Health Exhibition virtual event session on Molecular Diagnosis of COVID-10: Current Situation and Trends (13:00-14:20, Thursday 10 December).

Vaccine development

With many countries presently in a race to produce a vaccine, he warned of “serious issues”, one of which was the fast-tracking of vaccine development (he wasn’t sure why this was happening specifically). Prof Zaki stressed this approach was “dangerous” for safety, as any new vaccine must first go through many stages before distribution.

Furthermore, storing a vaccine at -70c or lower will present a complication for some countries worldwide that are unable to maintain such a low temperature transporting vaccines between cities and from town to village.

In terms of who receives vaccinations first, Prof Zaki said he believed that people working for health authorities, individuals showing risk factors for chronic diseases and anyone over 60 should be prioritised above the remainder of the population.

Going forward, he continued, enzyme-linked immunosorbent assays (ELISA) will be added to measure the efficiency of a vaccine. This will involve the analysis of blood samples in the lab, looking for immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies. 

Saudi cooperation

Prof Zaki was “proud” that Saudi citizens cooperated so effectively in following instructions from the Ministry of Health or Saudi CDC, for example in respecting social distancing when going to the mosque (maintaining a two-metre gap) and wearing a mask; shopping mall security checking the temperature of visitors; and biggest of all, the Hajj, or annual Islamic pilgrimage to Mecca.

The Hajj, Prof Zaki explained, ordinarily attracts millions from around the world, and this has been postponed to next year.  The Saudi government was mature enough to make this decision, he said, and hopefully the event will be allowed to continue with the appropriate measures in place.

He added that, on top of this, no other disease has been affected by the pandemic in Saudi Arabia, owing to sufficient resources.

One reason behind Saudi Arabia’s effective cooperation was communication, with clear messages disseminated through channels including SMS, WhatsApp and even Snapchat, so that citizens behave appropriately.