Healthcare providers in the UAE can confidently weave diagnostics at the point of care, expansion of critical care with 24/7 remote monitoring, and patient-centric collaborations into their framework as the latest Philips’ Health Trend Research revealed that 90 per cent of UAE residents are willing to consider using telehealth solutions. The research also found that 72 per cent of respondents believe that virtual discussions with their doctors are as effective as face-to-face examinations.

This data, led by independent market research consultancy Censuswide, was collected from 495 respondents in the UAE aged between 18 and 64 years old. The survey took place between May and June last year with a set of quotas including a gender split in place.

The results present an opportunity to explore how information is exchanged between patients and providers and formulate strategies to educate people to take better control of their health. “The digitisation of healthcare is definitely a key priority. The momentum was there before COVID and continues to be there. We believe that healthcare is going to move away from hospital-centric care and move towards patient-centred care, where we deliver care through what we call an integrated delivery network,” said Marc Antoine Zora, General Manager and District Leader, Gulf & Levant, Philips Middle East. “This network is essentially going to give care where it is needed, when it is needed, and where it is the most cost-effective to deliver that care.”

Speaking about the overall attitude towards technology, Lucy Stewart, Head of Client Services at Censuswide, said that respondents are confident that it can help them manage their health effectively. “When it comes to having a better experience and ease of use in health management, more men compared to women believe that technology would help enable this,” she said.

According to Zora, these results pave the path toward meaningful change for the healthcare industry and set a stronger foundation for artificial intelligence and machine learning, which can be developed to predict health issues and initiate interventions to preserve lives.

As the population becomes accustomed to virtual care and remote devices, this would additionally free up bed space in hospitals for acute cases, and give healthcare professionals flexibility in their schedules, curbing burnout.

“The digitisation of care specifically gives support to chronic diseases because people can manage their health from a home setting. We need to ensure that patients’ health and well-being is looked after holistically. This also opens grounds for clinical collaboration. In many cases, it is important that a single patient can have his case looked at by multidisciplinary teams,” he said.

 

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In 2011, South Korea’s Jeju province started preparing to become a Northeast Asian centre for health tourism. Their efforts spanned investing and encouraging foreign companies and countries to invest in its health establishments. Fast forward 10 years, South Korea emerged as one of the top medical tourism destinations in the world in 2011, with almost 11,700 patients travelling to the country for medical reasons.

Over the last decade, this South Korean medical tourism transition spotlights and reinforces the growth potential of global medical tourism, which is expected to grow at a CAGR of 30.5 per cent between 2022 and 2032. The Korean story also doubles up as a classic example of how countries can actively make accommodations to reserve their spot in this promising economic sector.

Countries like the UAE, Croatia, India, and Thailand are also joining South Korea in the quest to turn into medical tourism hotspots. They are focusing on delivering excellent care for treatments like hip and knee surgery, bariatric surgery, cardiology, and sex change, respectively. With this, it is safe to say that the future of medical tourism looks bright.

Let us look at the current state of global medical tourism and examine which are likely to be the top destinations in the coming years.

Current state of medical tourism

The global pandemic spurred a sudden blow to the growing medical tourism industry in 2020. In response to social distancing and the sudden panic, several wellness centres, hospitals, and medical tourism service providers temporarily ceased operations. The core reasons for this drop though were the introduction of travel bans and the worldwide postponement of most elective surgeries to contain the spread of the infectious disease.

While these restrictions were unavoidable, COVID-19 successfully created a new branch within medical tourism — vaccination tourism. It concerned travellers willing to spend considerable money to go to a location with an ample supply of Covid-19 vaccinations to combine vaccination and tourism as their trip objectives.

Following reversing tides around the pandemic panic, the industry’s trajectory started changing once again. The situation is returning to the pre-pandemic patterns. Further, patients’ changing lifestyles and choices are fuelling the industry to grow stronger by the day. It has been seen that 22 per cent of patients want to pay less, while 56 per cent want access to better care. In addition, 10 per cent seek care immediately without having to wait in line, and 18 per cent look for a treatment option unavailable at home. All of this is adding up to the demand for global medical tourism.

Rising cost-consciousness

While the desire for improved care grows on one side, the raging inflation and costs of obtaining healthcare in countries like the US are making it gruelling for households to strike a balance between funding healthcare and income.

The last few years have witnessed an increase in insurance premiums, co-pays, deductibles, and other out-of-pocket costs that are eating into the finances of many households. In addition, due to regulatory issues, like the rising prices of prescription and speciality drugs, healthcare waste, and the increasing prevalence of chronic diseases, healthcare-related service expenses are skyrocketing.

In contrast to growing medical costs in the developed world, developing nations are opening doors to accessing quality care at more affordable prices. To put things in perspective, consider a heart bypass surgery. On average, it would cost US$113,000 in the US, while in Thailand, it would amount to only US$13,000 in a private hospital, which is of significant difference.

Moreover, there is also a spike in consciousness about personal appearances and self-care, leading to the demand for healthcare facilities around cosmetic, fat-reduction, and acne treatment services. Again, these facilities are more affordable in Middle Eastern and Eastern countries, driving a wave of demand for medical tourism in favour of these destinations.

Upcoming destinations

While there needs to be more precise data on which specific destinations will be the future hotspots for global medical tourism and why, the Medical Tourism Index assesses a country’s medical travel potential based on its economy, healthcare costs, quality, and public image. Some of the upcoming medical tourism destinations in line with that include:

United Arab Emirates

Business Wire reported that the healthcare sector in the UAE is expected to rise at a CAGR of 8.5 per cent between 2018 and 2023. Further, a report by Euromonitor International suggests that revenues from medical tourism in the UAE are expected to reach Dh19 billion by 2023. The advanced infrastructure of the country and its robust government initiatives can be credited for this growth. They provided tourists with hands-on access to the Abu Dhabi Medical Tourism e-portal, which supports hotel booking, transportation, and recreational activities. The capital city is also gaining growing recognition for cosmetic and beauty tourism, with a 30-40 per cent growth over the past five years. Due to regular government initiatives, it will likely continue to be significant in the coming years. The second UAE city to be a part of this list is Dubai, which has proven its mettle to be more than just a symbol of high-rise towers and premium lifestyle. Its friendly environment welcomes nearly 500,000 medical tourists annually, with 40,000 healthcare professionals in the public and private sectors. The recent launch of the Dubai Health Experience (DXH) e-portal for booking doctor appointments and planning itineraries further paints a promising outlook for the coming years.

Japan

Lower costs and top-notch technology drive Japan’s medical services, making it an attractive medical tourism hotspot. For example, Japan offers nearly 70 per cent reduced costs compared to the US for treatments like hip surgery with similar proficiency. In 2011, Japan launched the ‘visa for medical stays’ offering a good mix of treatment, check-ups, and sightseeing across the Far Eastern nation to boost this sector. These visas have been made available for the patient party accompanying the patient. Moreover, they have been carefully designed considering humanitarian aspects. With measures like these, Japan consolidates its position as a mainstay in medical tourism.

India

Medical tourism in India is expected to become a 10 billion dollar industry by 2023 with varied health services, and notable success in diagnostics, therapeutics, and vaccinations. When the world battled intense lockdowns and the medical tourism industry suffered, India issued 1,000,000 medical visas (2019-2022), emerging as one of the strongest players in the medical tourism sector. The country’s Prime Minister boasted of more than 600 nationally and globally accredited health institutes providing quality and cost-effective treatments, making health care access equitable.  India is also promoting AI and technology in health, with over 4,000 health tech startups working toward this end. This does paint a promising picture of promising prospects for the subcontinent!

Singapore

 Singapore ranks first for the quality of healthcare facilities and services globally, basking in the second position in the Medical Tourism Index. As of 2019, Singapore’s accessible and high-quality healthcare services attracted more than 500,000 overseas visitors. Singapore is renowned for its premium, all-inclusive healthcare services, which include everything from health tests to surgery, with the support of highly qualified medical professionals and state-of-the-art facilities. As a fact, Singapore has also improved its international standing by responding to the pandemic more effectively than its industrialised peers. Therefore, patients can be assured of reduced infection risks, owing to a practical, cautious, and successful strategy, making it a simple choice for travelers’ post-pandemic overseas medical trips.

The way ahead

The recent trends in medical tourism reflect that even though developed countries have advanced technologies to offer, the burden of mounting healthcare costs overpowers ordinary people’s treatment choices. With little to no deduction in quality of care, medical tourism hotspots are leading the change in health services while creating growth opportunities in national revenues. Be it a tiny Croatian town, Zabok, offering specialised orthopaedic services, or larger countries like Spain, governments are making sure to fulfill the growing demand in the sector and putting the best foot forward in offering advanced medical tourism facilities.

Kinzal Jalan is an experienced B2B content marketer with demonstrated expertise in Health, SaaS & Technology.

This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today.

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At Informa Markets, we are fortunate to have so many amazing women as part of our workforce. But we also know that brilliance doesn’t just stop at their profession. On International Women’s Day, we celebrated our colleagues' achievements and asked them their thoughts around the theme of the day, ‘Embrace Equity’. Here’s what they had to say:

Sally Thompson, Content Director, Informa Markets - Healthcare

 

What are your thoughts on the theme of this International Women’s Day, ‘Embrace Equity’?

It is so important in today’s world for everyone to embrace equity – not only in the workplace but also in our personal lives. Embracing equity is about having an inclusive world, which should be embedded into communities globally from a young age. It’s important to educate future generations to have this as their mindset from the beginning. We need all populations – men and women – to grow up knowing and understanding that women have just as many rights as men. Hats off to all the amazing women I know – from family and friends to colleagues and acquaintances. The world couldn’t survive without women, so let’s embrace equity!

What are some achievements you are most proud of as a woman?

First of all, my number one achievement is my son, Harry. He has just turned five and is the most amazing young boy. He is kind, caring and thoughtful to his friends, family and doggies, and he has the most amazing zest for life. He is a real go-getter, full of energy, and whilst he tires me out, I wouldn’t want it any other way! Every day he always puts a smile on my face, and I hope all his dreams come true.

Secondly, I am proud to have the most amazing family and friends. Being an expat, it can sometimes be challenging to call a new place home, and that is why friendships are so meaningful as they become your family. I am proud that after living in Dubai for nearly 15 years, I have the most incredible network of friends, some of whom are even colleagues, that I just couldn’t live without!

Lastly, I am proud of my work ethic and career. I am blessed to be in my 10th year at Informa, and it’s the most fantastic company that celebrates women in the workplace. I am grateful to have had various promotions throughout the years, and I couldn’t be more thankful to the people who made that happen! Perhaps it is the Capricorn in me, but I believe that opportunities must be earnt. You must put in the hard work, effort, and determination combined with the passion for succeeding. I believe in leading by example, and I would like to think my team see that in me and that I have instilled this philosophy in them too.

Rinku Kurup, Conference Producer

 

What are your thoughts on the theme of this International Women’s Day, ‘Embrace Equity’?

The theme for the day draws attention to issues that are affecting women across the world and celebrates their achievements. The call has never been more necessary or urgent. Everyone is unique and possesses different skillsets to make them who they are. I feel organisations must make it a standard practice to recognise the different circumstances individuals face and offer opportunities and resources accordingly. There can be additional steps we can take to know more about embracing equity – from providing training and development opportunities that explore the topic of diversity to having open conversations about equity, which will go a long way in building confidence in everyone. Ultimately, as an individual and, more importantly, as a woman, I want to be heard, understood and valued. Small steps do make a difference!

What are some achievements you are most proud of as a woman?

I am incredibly proud of my professional growth within the organisation. On a more personal note, I am proud of having taken care of myself and my family while coping with a personal loss and reminding myself how far I have come as an individual.

Enjy El Mokadem, Conference Producer

 

What are your thoughts on the theme of this International Women’s Day, ‘Embrace Equity’?

The theme ‘Embrace Equity’ highlights the road to actual inclusion. It’s by equity, not equality that women can have a true representation in society. I am happy awareness in this area is only getting better.

What are some achievements you are most proud of as a woman?

I am a proud mother of three daughters and am raising these “future women” with strong self-worth and awareness about their valuable role in their society.

I am also proud to be passionately working on connecting people in the healthcare sector and helping in disseminating knowledge and awareness about healthcare’s most pressing issues, and witnessing collaborations and partnerships being made as a result of the platforms I support.

Lastly, I am juggling my work-family responsibilities and studying towards receiving my MBA this year.

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Women account for 70 per cent of the global healthcare-related workforce, but only 25 per cent occupy leadership positions. This glaring disparity is not just due to family-related interruptions that female doctors experience. According to a European Society for Medical Oncology (ESMO) study, women are over-represented in fields typically associated with femininity, such as nursing, midwifery, and social care. Although these roles are related to healthcare, career progression toward healthcare leadership is often fraught with hurdles, including the much-discussed glass ceiling.

The UAE offers optimism for women in healthcare

Thankfully, some bright spots exist, especially in countries like the UAE, where women have begun to occupy leadership roles in the healthcare industry.

Huda AlBlooki, a physiotherapist at Healthpoint explains that in recent years there has been a tremendous change in how women are viewed in the country, especially in terms of professional and leadership roles. The Emirati government has been supportive and has made policy changes encouraging women to occupy leadership roles. She described the situation thus: "The UAE has witnessed significant progress within the healthcare industry due to female contribution. The nation has supported women in helping them achieve their goals, and Emirati women have achieved remarkable goals within the sector. Whether in administrative or technical roles, they have been able to keep pace with developments and help lead change." She also added, "We are privileged to see women in advanced leadership positions as a result of direct investments from the UAE's wise leadership, and organisations like Mubadala Health."

However, Louise Cremonisini, Safeguarding Specialist at Amana Healthcare, feels there is still much to be done in terms of bridging the gap between men and women who occupy leadership roles in health care. Louise said, "While female professionals fill the majority of roles in healthcare, the ratio of women to men in leadership positions may not always reflect the same. On the contrary, I am grateful to be part of an organisation where women are well-represented in senior roles. This has inspired me to take steps towards achieving my professional ambitions."

Women's progress in the healthcare industry

Dr. Shweta Narang, Medical Director & Director of Clinical Operations at the National Reference Laboratory, has a more optimistic outlook. She explains that women from diverse backgrounds occupy leadership roles today, and this trend is likely to continue. She elaborated thus: "Women have always been integral to the healthcare system. They impact the world as consumers, as decision-makers and as leaders of their communities. They are active participants in shaping decisions and work to enhance the function of corporations and society.

"At Mubadala Health, women are valued for their skills and medical and organisational expertise. A key example of this can be found in the National Reference Laboratory, where Dr. Laila AbdelWareth and I lead the organisation as two women in senior positions. We have seen a positive correlation between women from diverse backgrounds in leadership positions leading companies to success. We also know that gender-diverse leadership teams are more innovative, develop better creative solutions to problems, avoid groupthink, and are better able to adapt to market needs. International Women's Day is about celebrating women's progress, but it is also an opportunity to reflect on some of the changes we want to see."

Women today work shoulder-to-shoulder with men in nearly all specialities, according to Dr. Nahid Ebinouff, Occupational Medicine Specialist Physician, Capital Health Screening Centre, adding that a majority of the workforce in the healthcare industry comprises women, specifically in fields such as nursing, midwifery, and family medicine.

“According to the World Health Organization (WHO), women make up 80 per cent of the total number of nurses in the UAE, and a majority of family medicine doctors. I am an Occupational Medicine Specialist physician. This is a fairly new field within healthcare, and we already see female dominance within the emirate of Abu Dhabi.

“At Capital Health Screening Centre, we welcome fresh graduates and provide them with the tools to flourish within their career. With more female employees working with us, we have looked at ways to ensure that they are reaching their full potential, and in turn, will go on to shape the healthcare industry in their own way. Personally, I find this change refreshing. It makes me proud. I firmly believe that women bring a unique viewpoint to the workplace that goes to benefit society as a whole,” she said.

Policy changes accelerate gender equality outcomes in healthcare leadership

Thankfully, observing current trends certainly fills one with the hope that women will be adequately represented in leadership roles. Of course, it's not all hunky dory for women aspiring to be healthcare industry leaders. There are significant challenges that they need to overcome, ranging from gender bias, stereotypes, pay disparities and work-life balance.

This International Women's Day, it is essential to acknowledge these challenges and make policy changes at governmental and institutional levels so that more women feel encouraged to become healthcare leaders. This can include offering mentorship programmes, taking initiatives for enhancing diversity and inclusion, providing flexible work arrangements, and recognising the achievements of women in healthcare leadership roles.

Technological advancements have been longstanding catalysts for change in healthcare. Clinical laboratories have undergone major changes as well with the introduction of new diagnostic techniques and tests born out of the research of fundamental pathogenesis of diseases and progressions of new methods in themselves.

More integration between clinical information and laboratory data is now necessary due to the complexity of the modern healthcare system and the accessibility of a wide range of laboratory tests. This is especially true for genetic testing, which has warranted discussion on being carried out as an add-on to patient management and being used in conjunction with all available patient data.

Related: eBook: Navigating the healthcare market: Saudi Arabia edition

The clinical laboratory will have an impact on the medical environment of the future by maintaining the highest quality data collected, enhancing the overall quality of the process of supplying laboratory information, and maximising the impact of the laboratory results on patient treatment. More complicated, expensive, and challenging-to-interpret tests will continue to be developed as a result of advances in science and technology. Artificial intelligence will also continue to rise among other trends.

Dr. Akram Azmy, VP Commercial of Beckman Coulter Diagnostics MEA, has been leading the commercial activities of the company in the Middle East and Africa, primarily in the GCC, North Africa, Sub-Saharan Africa and Pakistan. He expands on the trends on the horizon of the medical laboratory among other predications. Excerpts from the interview:

Middle East and Africa in the limelight

According to Dr. Azmy, the difference between Middle East and Africa markets and others is their emphasis on the development and adoption of technology.

“Countries such as the UAE and the rest of the GCC are more advanced when it comes to adopting new technology and its costs. In the next few years, we predict the whole market heading towards an acceleration of technology, adoption, and personalised medicine. I see a much bigger change and challenge coming, and of course, the global economic environment will encourage better collaboration between the industry, government, and private sector. All these factors will reflect in reaching the best outcome for the patient,” he says.

Labs from an economic growth perspective

For several years, growing trends have been on the radar for Beckman Coulter, with most of them falling within the greater complexity of managing this business. Dr. Azmy describes an increase in demand for the number of samples, data, experimental variations, and several advancements in genetics.

“When we look at innovations, IT clinical connectivity is a major area of focus. There are numerous changes taking place operationally in the market, due to a stronger demand and larger laboratory facilities that are a result of continuous mergers and acquisitions in both the private and government sectors. Cost efficiency of operation is a big area of focus as well, therefore with all the various stakeholders in this operation, the industry needs to join forces to achieve all future goals,” he says.

Training and education core of elevating skills in medical and IVD fields

When asked about the role of training and education, Dr. Azmy stresses that it is a top priority for Beckman Coulter. “This is not new, and we have always believed that education and training is an integral part of our responsibility towards the clinical laboratory society and the region,” he comments. Eighteen months ago, Beckman Coulter established Beckman Coulter Vision Center in Dubai with a primary responsibility to provide training to associates, all clinicians and laboratory personnel.

“I’m happy to share that more than 400 professionals have visited our vision center since the beginning of 2022. Our educational programmes are run at different levels to accommodate all, and the centre has a full laboratory setup that supports technician training,” says Dr. Azmy.

Impact of Artificial Intelligence on lab

In recent years, the use of artificial intelligence is growing rapidly in the medical field, especially in diagnostics and management of treatment. “If you combine artificial intelligence and machine learning together, it is a powerful tool for assisting diagnostic and treatment decisions and is a true revolution for precise diagnostics. It will support the personalisation of medicine and make it possible for predicting chronic diseases such as cancer, cardiovascular diseases, as well as Type 1 diabetes. AI holds the power to truly help individual patients to finally own their own health because prevention and treatment can be personalised,” he concludes.

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This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today.

The use of alcohol is widely accepted especially in western countries. This social acceptance with ease of access may lead to over-use. Alcoholism is not only a major socio-economic problem, but it is a leading cause of severe health disorders and contributes to mortality.

There are several alcohol biomarkers available to detect alcohol consumption. However, they vary in sensitivity and specificity. This can result in the physician missing patients with alcohol abuse depending on the marker used in the screening. The first step in the correct management of alcohol abuse is the initial assessment of the case, which relies upon dependable biomarkers. This article represents an update on alcohol biomarkers and their optimum clinical uses.

Metabolism of Alcohol (Ethanol)

The liver is the primary organ responsible for the detoxification of alcohol. Liver cells produce alcohol dehydrogenase (ADH), the enzyme primarily responsible for metabolising alcohol and breaking it down into ketones. Alcohol is also metabolised in extrahepatic tissues that do not contain ADH, such as the brain, by enzymes cytochrome P450 and catalase.

In addition to the oxidative pathways mentioned, alcohol can also be metabolised by at least two nonoxidative pathways. Although the nonoxidative metabolism of alcohol is minimal, its products have a significant diagnostic relevance. The first pathway leads to the formation of molecules called fatty acid ethyl esters (FAEEs) from the reaction of alcohol with fatty acids. The second requires the enzyme phospholipase D (PLD) results in the formation of a phospholipid known as phosphatidyl ethanol.

The products of both the oxidative and non-oxidative pathways are quickly released into circulation, through which ethanol metabolites affect the peripheral organs (see figure 1).

Women have lower levels of gastric alcohol dehydrogenase, the enzyme primarily responsible for metabolising alcohol than men, and as a result, they experience higher blood alcohol concentrations upon consuming similar amounts of ethanol per kilogram of body weight.

What is the ideal marker to detect alcohol use or misuse?

To decide which marker should be used, it is helpful to understand the utility of both direct and indirect biomarkers and the suitable clinical application.

Indirect alcohol biomarkers

Indirect biomarkers are enzymes or cells which undergo typical changes in response to chronic alcohol consumption. The main indirect biomarkers are liver enzymes aspartate and alanine aminotransferases (AST and ALT), gamma glutamyl transferase (GGT), mean corpuscular volume (MCV) and carbohydrate-deficient transferrin (CDT).

ALT and AST: Both non-specific markers signify liver damage or disease at high concentrations in the blood. This could be caused by long-term alcohol abuse. They are found predominantly in the liver, but AST can also be present in the heart, muscles, and kidneys, etc. ALT levels can also increase in extra-hepatic conditions such as type 2 diabetes, metabolic syndrome, and insulin resistance.

GGT: An enzyme found in the hepatocytes. Elevation of GGT level is usually considered an early indicator of liver diseases and chronic drinking. However, data has shown that GGT levels only increased in 30 to 50 per cent of excessive drinkers, so it is not a very sensitive marker.

MCV: The MCV of red blood cells increases with excessive alcohol intake after four to eight weeks and returns to normal about four months after consumption stops. it has been reported to lack sensitivity and produces false positives in cases of smoking, liver diseases, thyroid diseases, and vitamin B12 or folic acid deficiency.

CDT: This is a biomarker for moderate to heavy alcohol consumption. Drinking 50 to 80 grammes of alcohol/day for several days decreases the carbohydrate content of transferrin, thus giving rise to free sialic acid and sialic-acid deficient transferrin. CDT levels return to normal within approximately two weeks of drinking cessation. Testing for CDT is the only FDA-approved lab test available to help doctors monitor progress toward reducing alcohol consumption.

Direct alcohol biomarkers

Direct biomarkers of alcohol use are ethanol metabolites created through the metabolism of ethanol. They reflect alcohol consumption over a period of several days, making them useful to detect acute alcohol intake. Direct alcohol biomarkers include EtG, EtS, FAEEs and PEth.

EtG: This is considered a stable marker to detect recent ethanol ingestion. The metabolite appears one hour after ethanol ingestion, with a detection window of up to 36 hours in blood and five days in urine. Due to this big-time window, many studies demonstrated the importance of measuring urine EtG in those who do not admit to consuming alcohol and provide negative breathalyser test. In addition to blood and urine, EtG is detectable in hair and other body fluids. False positive results may be reported after the use of ethanol-based mouthwash and after the consumption of non-alcoholic beers.

Peth: This can be detected in blood from one to two hours, and up to 12 days after one-time alcohol consumption, meaning this biomarker can be used to determine both current consumption and abstinence. It is also considered as the most sensitive and highly specific alcohol biomarker, as it is not affected by liver or kidney diseases. This also means it can identify recent heavy drinking earlier than indirect markers. The one drawback is that the cut-off levels tend to arbitrary and vary with different guidelines.

FAEEs: These are sensitive and specific markers for distinguishing social drinkers from heavy or alcohol-dependent drinkers. FAEE levels have been detected in blood up to 24 hours after the last drink or 99 hours for chronic drinkers, combined with blood ethanol levels which increase for only eight hours. It also detects serum concentrations of ethyl oleate, which is observed to be higher in chronic alcohol users than in binge drinkers.

In summary, which marker should be used to detect alcoholism?

Testing for alcohol biomarkers should be aligned with clinical needs/expectations e.g. acute or chronic alcohol use, ruling out recent alcohol use, or monitoring alcohol abstinence. A combination of different biomarkers is often advisable, as they differ in their underlying pathomechanism.

In case of acute ethanol intoxication after the first six to eight hours is not reliably predicted by serum testing, so other biomarkers are often used to detect alcohol use as EtG and EtS. They also are useful in short-term monitoring for abstinence. On the other hand, Carbohydrate deficient transferrin (CDT) is markedly increased by moderate to heavy alcohol use and is the most useful for long-term abstinence monitoring (up to two weeks). Finally, alcohol biomarker results should be always interpreted in the context of all relative values such as history, physical and mental examination, and clinical picture.

Dr. Shereen Atef, MD is the Acting Head of Clinical Chemistry at the National Reference Laboratory, and Adjunct Clinical Faculty at the College of Medicine and Health Sciences at Khalifa University. 

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This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today.

The market for mobile health devices is rapidly changing with the development of smartphones, wearable watches, patient monitoring devices, and even rings and wristbands that monitor patient vital signs like heart rate, body temperature, sleep cycles, exercise, and even electrolytes and metabolites through the skin. But how does data from these devices get transmitted to the patient’s electronic medical record? Health portals are allowing patients to access their medical records, laboratory results and message physicians, set up appointments, and renew prescriptions online.

However, much of the data from mobile health devices stay in the company databases and never gets transmitted to other health records. With newer computer algorithms and artificial intelligence, data from millions of patients provides the opportunity to detect changes in health even prior to symptoms becoming evident, offering the possibility of personalising healthcare based on population statistics. But the storage and transmission of health data also present a privacy and security risk for patients. This manuscript will review the current concepts of e-health and m-health, as well as explore their potential and risks in laboratory medicine.

The transformation of data into information, knowledge, and wisdom involves systems thinking. Data (symbols and numbers) are processed to information which gives data meaning and a relational connection. Heart rate data of 50 beats per minute (bpm) on its own provides no meaning, but in the context of a child, 50 bpm imparts information to the clinician while in the adult context, the information may be different. Knowledge is the application of data and information and provides and understanding of patterns. It may also be explicit through written guidelines easily passed to others or implicit and internalised through experience or intuition. Wisdom evaluates understanding and places knowledge in an ethical and moral framework.

The amount of data being stored by organisations, such as laboratory data, makes traditional methods of analysis infeasible. Big data requires computer algorithms to interrogate data for information and relationships that may not be obvious. Data mining is the term for analysing and extracting interesting previously unknown relationships and patterns. Some examples of big data are the derivation of reference intervals by data mining all lab test results or the use of patient data moving averages for continuous quality control.

e-health is an emerging field at the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the internet and related technologies. e-health does not stand for “electronic” but implies a number of other “e’s” such as efficiency in healthcare, enhancing the quality of care, evidence-based interventions, empowerment of consumers and patients, encouragement of the patient/health professional relationship, education of physicians through online sources, enabling standardised communication, extending the scope of health care geographically, ethics in patient-physician interaction and equity of healthcare services.

m-health is an abbreviation for mobile health, a term used for the practice of medicine and public health supported by mobile devices. m-health most commonly references using mobile communication devices, such as mobile phones, tablet computers, personal digital assistance (PDAs) and wearable devices such as smartwatches for health services, information, and data collection. It has emerged as a subsegment of e-health and m-health applications include the use of mobile devices in collecting community and clinical health data, and the delivery or sharing of healthcare information for practitioners, researchers, and patients.

Recent US regulatory changes allow patients the right to access personal health information under the Health Insurance Portability and Accountability Act (HIPAA). A 2014 amendment to CLIA ’88 allows laboratories to give a patient or their representative access to completed test reports. This has opened the ability for patients to have easy access to personal health information and laboratory test results through institutional patient portals.

Since physicians have been the traditional “client” of the laboratory, test results are written for professional interpretation. Comments like “quantity not sufficient”, “haemolysis”, “heterophile interference”, “icteric” or “lipemic” may not be understood by the general patient consumer. The laboratory would need to consider the written form of comments in the formal test result and ensure that they are interpretable to the public in a medical record of the future, as patients often times have access to the test result before the clinician in the patient portal.

Medical knowledge has historically been passed on by experts through peer-reviewed publications and lectures. The growth of the internet and ease of access has led to an enormous increase in available information and knowledge. The danger is that very little expertise or financial support is necessary for anyone; professional, patient or “interested other” to make their experiences, knowledge, and opinions available through websites, blogs and internet forums. This has given rise to the presence of “Fake News” over the internet. How are patients to distinguish between medical fact and fiction on the internet without turning to a healthcare professional?

Multiple opportunities are growing for e-health where personal experience rather than data is driving social media discussions. Special interest groups or “communities of practice” have developed to bring together individuals with a common interest, who can share information and learn from each other. Social media platforms also encourage disease state discussions for patients with the same illness to share their experiences. These social media groups are also an opportunity for healthcare professionals to direct education and inform patients of clinical trials.

Security and privacy are e-health concerns. Despite firewalls and encryption, hospitals and even data companies have been hacked. Personal data risks being compromised, changed or even held ransom. How do we ensure the integrity of data once posted and how do we ensure the validity that what the reader sees is what was originally posted to the internet? The concern for social media is that personal health information may become public. Anytime someone posts to social media, the posts are public, and the identity of the patient may be uncovered. Even if a person is not directly mentioned by name, any personal identifiable protected health information (PHI) may compromise a patient’s privacy. Once information has been posted, it can never be retracted as posts are often read and resent by others.

Wearable wireless devices collect and transmit personal health information and data that allows trending over time. These devices connect to health apps that consolidate data from phones, watches, and other devices. However, this data may not be connected to a patient’s electronic medical record or be viewable by the patient’s physician. Device manufacturers can collect big data from many patients and connect it with health status data for population statistics, such as heart rate and body temperature, and further linked with feeling well today or feeling sick, exercise and meals. Using artificial intelligence algorithms, data can be sorted with disease progression to formulate prediction modes for use in enhancing personalised medicine and preventing chronic disease progression.

Patients want access to their medical records and health data. m-health is transforming healthcare delivery by making it more accessible, affordable, and available. e-health and m-health provide new opportunities for patients to personalise their healthcare experience and connect with their physicians remotely and in a more continuous fashion.

References available on request.

James H. Nichols, PhD, DABCC, FAACC is the Professor of Pathology, Microbiology and Immunology, and the Medical Director, Clinical Chemistry and POCT at Vanderbilt University Medical Center.

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This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today.

Looking at industrial development eras in the history of humanity, the world experienced four industrial revolutions starting with the industry 1.0 revolution by the end of the 18th century where we saw the use of water and steam-powered mechanical production facilities. It was the era of power generation, mechanical production, and railroads driven by the advancements in engineering sciences.

The beginning of the 20th century introduced the use of electrical power, which enabled work-sharing mass production and the advent of the assembly line paved the road for the industry revolution 2.0. With 100 years of electronics, production improvements and information technology leaps, automated production became the norm and computers became predominant in shaping industry revolution 3.0.

The advancement milestones in medicine started to appear on the horizon in the 1960s when the hidden secrets of human DNA data began to reveal useful information in understanding the human genome and causes of diseases at the cellular levels. This led to fast jumps in advancing diseases and syndromes’ diagnostic testing, predictions of infections, as well as advanced treatment regimes.

Trilogy matrix of healthcare

The acceleration of digital technology and discoveries of the human genome project in 2000, it became evident that six characters 0, 1, A, T, C, and G are rebooting medicine and health in modern medicine today to enhance the quality of life. Personally, I strongly believe that human DNA discoveries, combined with Information Technology (IT) and quality are forming the new “Trilogy Matrix” for the upcoming generations, where diseases, cancers, and syndromes could be prevented — not just predicted — and the quality of human life would be much better with efficient and cost-effective treatments.

Big data, artificial intelligence, robotics, three digital printing, internet of things (IOT), social media, virtual reality, and simulation are the new tools shaping the 4.0 industry revolution. Today, cyber-physical systems are being implemented to monitor, analyse and automate all kinds of businesses, not just industrial facilities, and quality has always been the mirror of good indusial outcomes. It accompanied all manufacturing industrial revolutions without obvious exposure, until after the second world war when Dr. Edward Deming and other quality gurus started to put the framework of quality as a science and put its applications and statistical tools in action to monitor and improve processes and their efficiencies and effectiveness. They started to identify customers and classify them into external, internal, and other stakeholders. They provided approaches to measure their satisfaction, expectations, and feedback.

Rise of quality protocols

Quality control (QC) standards started to become dominant between the ‘50s and ‘60s to ensure consistency, focusing on output and based on inspectorate responsibility then matured to quality assurance (QA) between the mid-60s to mid-70s. Quality Assurance works through a system for the purpose of efficiency using a feed-forward mechanism, unlike QC which used a feedback mechanism. In Quality Assurance, each business unit carries the responsibility for it.

The concept of Quality Management was introduced between the mid-80s to 90s when corporate leadership started to recognise quality as a management style to improve business outcomes and increase market shares. In the mid-90s, Total Quality Management (TQM) was introduced as an ultimate, mature approach because it works through people with the purpose of effective results.

The focus of an organisation that adopts the TQM approach is on the outcome with special attention to corporate social responsibility. In TQM laboratories, everybody is responsible for the quality. A TQM company depends on a mutual relationship mechanism with its customers which is a much better proactive approach than being reactive and awaiting feedback after the products or services have been delivered.

The TQM model has been recognised by many organisations such as the European Foundation for Quality Management (EFQM) as a roadmap for organisational excellence, which each corporate vision aims to achieve and excel. With the advancement of industrial revolution 4.0 based on digital acceleration and quality maturity to improve the human quality of life, the international community of quality professionals claimed the start of quality 4.0 aiming to take all healthcare worldwide including clinical laboratories to a much higher paradigm. Quality 4.0 is not really a story about technology. It is about how that technology improves culture, collaboration, competency, agility, empathy, sustainability, and leadership.

We should shed the light on different laboratory accreditations models which are obtained to ensure that the laboratory is implementing a set of requirements or standards to ensure laboratory workflow from pre-analytical, analytical, and post-analytical are correctly and appropriately followed to ensure laboratory results are useful for proper diagnosis and follow ups.

In 2006, I wrote an article in Medlab magazine highlighting the importance to build laboratories based on quality, not just accreditations. Accreditation is just a destination while quality is a journey where every member of the laboratory shall join, contribute, and enjoy. From many lessons over the years, we have learned that creating healing and safe environment of care is way beyond compliance and accreditation. It is important for any leadership to understand that everyone in the organisation has a role to make quality happen not just the quality officer, champion, or department. Sharing knowledge, people engagement, and patient involvement in care planning are critical factors not only in achieving excellence but in creating a “just culture” for safety and quality.

Clinical laboratories worldwide have the right recipe in their foundation to get the biggest advantage of shaping the future of health and quality of life as a national index of social and economic well-being using 4.0 industrial revolutionary tools and a 4.0 quality approach.

Dr. Nashat Nafouri is the Medical and Quality Director, Futurelab Medical Laboratories; Chair, Healthcare Interest Group; Executive Officer, Saudi Quality Council. 

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This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today.