Crimean-Congo haemorrhagic fever (CCHF) is a life-threatening tick-borne disease that is prioritised by the World Health Organization (WHO) for research and product development for early diagnostics. To address the need for serological assays for use in outbreak situations, EUROIMMUN has developed and evaluated ELISAs for the detection of IgM and IgG antibodies against the causative virus (CCHFV). The ELISAs reliably identified acute CCHF cases and are thus suitable for use in laboratories involved in on-site outbreak support.

Severe haemorrhagic disease

Crimean-Congo haemorrhagic fever (CCHF) is a highly contagious disease with a case fatality rate of up to 40 per cent, according to the WHO. The principal vector is ticks of the genus Hyalomma. Humans contract infections through tick bites or contact with blood or tissues of viraemic animals or humans, for example, through occupational work as farmers, slaughterers, veterinarians, or healthcare workers.

The estimated number of human CCHFV infections worldwide is 10,000 to 15,000 per year. The majority of infections remain subclinical, but some cases develop into severe or even fatal diseases. Initial symptoms are unspecific, for example, high fever, myalgia, headache, diarrhoea, nausea and vomiting. Patients may subsequently develop haemorrhagic manifestations in different parts of the body and organ failure. CCHF-associated haemorrhagic phenomena rank among the most severe of all haemorrhagic fevers.

Expanding geographical range

The endemic region of CCHFV encompasses countries in Africa, the Balkans, the Middle East and Asia that lie within the geographical habitat of Hyalomma ticks. Türkiye has the highest number of laboratory-confirmed CCHF cases worldwide. Climatic, ecologic and anthropogenic factors are increasing the spread of CCHF, for example in Europe. It is anticipated that ongoing climate change in the Mediterranean region will lead to an increase and northward expansion of Hyalomma marginatum habitat areas. In addition, changes in land permit the proliferation of vertebrate hosts and ticks may lead to increased CCHFV transmission.

World Health Organization priority

Due to its high case fatality rate, its potential for nosocomial outbreaks, and the difficulties in prevention and treatment, CCHF is included in the WHO’s R&D Blueprint for Action to Prevent Epidemics. There are currently no internationally approved CCHF vaccines or antivirals, and chemical tick control is only realistic in well-managed livestock facilities. Management of outbreaks, therefore, relies on the rapid identification of cases and initiation of infection control measures to prevent secondary nosocomial and community-level transmission.

CCHF is difficult to distinguish clinically from other viral haemorrhagic fevers such as those caused by Ebola, Marburg, Lassa, Rift Valley, dengue and yellow fever viruses. Disease surveillance is further hindered by the absence of a universally accepted gold standard for CCHFV diagnostics and the lack of international reference reagents for calibrating and harmonising assays. Thus, validated CCHFV diagnostic assays for use in reference laboratories and point-of-care settings in CCHF-affected countries are urgently needed.

Laboratory diagnostics

A combination of molecular and serological testing has been proposed to maximise diagnostic sensitivity. Reverse transcription-polymerase chain reaction (RT-PCR) is used for diagnosing active CCHF at the early stage, as it enables sensitive detection of viral RNA. However, molecular detection is impaired by the wide genetic diversity of CCHFV strains, and its application is limited to the viraemic phase. Results usually turn negative after the first few days of the disease, and only patients with a fatal outcome remain positive until death.

Serological assays provide a second pillar for identifying infections. The major target of the immune response against CCHFV is the viral nucleocapsid (N) protein. N-specific IgM becomes detectable around two to three days after the onset of symptoms, followed by IgG one to two days later. IgM reaches peak levels in the second and third weeks of disease and usually clears after about four months, while IgG persists for several years. Severe and fatal infections, however, are often serologically undetectable due to a weak or absent antibody response. IgM assays are mainly employed to support the diagnosis of acute infections, while IgG assays are relevant at later stages and for disease surveillance.

Reliable CCHFV ELISAs

The Anti-CCHFV ELISAs from EUROIMMUN utilise recombinant viral N protein as the antigenic substrate for detection of IgM and IgG antibodies against CCHFV. In a study published by Cosgun et al in the journal Vector-Borne and Zoonotic Diseases,, the diagnostic performance of the ELISAs was evaluated against established tests. These were the EUROIMMUN CCHFV Mosaic 2 IgM and IgG indirect immunofluorescence assays (IFA), which served as reference tests, and IgM and IgG ELISAs from another manufacturer.

The EUROIMMUN Anti-CCHFV IgM and IgG ELISAs both yielded a higher sensitivity (IgM 98.0 per cent, IgG 47.1 per cent) than the other manufacturer’s ELISAs (IgM 95.9 per cent, IgG 35.3 per cent), as determined in 49 serum samples from patients with acute-phase CCHFV infection. The lower sensitivity of both IgG ELISAs compared to IFA may be due to differing antigen presentation between the two techniques and the study panel of acute-phase samples. The main value of IgG analysis is, however, in disease monitoring and epidemiological surveillance. In a further study published by Emmerich et al in the journal PLOS Neglected Tropical Diseases, the EUROIMMUN IgG ELISA demonstrated a sensitivity of 98.8 per cent in patients with subsided CCHF.

The specificity of the EUROIMMUN IgM ELISA was slightly higher (86.4 per cent) than that of the other ELISA (84.7 per cent), as evaluated in 89 sera from control patients, healthy blood donors and patients with hantavirus or sandfly fever infections. For IgG, both assays demonstrated a specificity of 100 per cent. The ELISAs from the two manufacturers thus show a substantial qualitative agreement and a very strong positive correlation of quantitative results for both IgM and IgG.

Outlook

Efficient CCHF surveillance requires reliable, simple-to-use, validated, and easily accessible diagnostic assays, enabling local laboratories to perform fast serodiagnosis at moderate biosafety levels. Analysis at local facilities bypasses the need to send patient samples to national or international reference laboratories, which increases the time and costs per analysis and involves the shipment of highly contagious material.

ELISAs are less complex than other serological methods, making them highly suitable for use in outbreak situations. The EUROIMMUN Anti-CCHFV ELISAs have proven to be standardised and easy-to-use tools that reliably detect acute CCHF cases. They can be fully automated on established instruments, providing increased standardisation and efficiency. In addition to their diagnostic application, serological tests are also useful for epidemiological studies in endemic areas, monitoring virus emergence in neighbouring regions, and evaluating vaccine immunogenicity and durability.

Dr. Jacqueline Gosink is part of EUROIMMUN, Luebeck, Germany.

Back to Laboratory

In December 2022, the International Standards Organization (ISO) released a new revision of its standard for medical testing laboratories, ISO 15189. Based on input from a wide range of professionals, academics, and government advisors from around the world, the changes in ISO 15189:2022 address the advent of new technologies, evolving laboratory structures, and advancements in the practice of patient care such as point-of-care (POC) testing.

It places heavy emphasis on patient safety and satisfaction while allowing more flexibility in terms of laboratory structure. By being less prescriptive about how requirements should be implemented, this revised standard allows labs to implement practices that work for their unique situation while continuing to keep patients safe.

Maintaining patient safety in point-of-care testing

As testing strategies have become more reliant on lower-complexity analytical tools, testing can move closer to patients providing results faster and making testing more convenient. Staff whose roles did not previously include diagnostic testing can help address global laboratory staffing shortages by being trained to perform tests at the point of care but need additional training and ongoing assessment to ensure high-quality of test results.

Related: Unite medical specialities to treat chronic kidney disease

Inaccurate diagnostic test results have a ripple effect: they burden medical systems with unnecessary procedures, erode patient trust, pollute data used to determine health policy, and – worst of all – result in patient harm. Currently, diagnostic errors contribute to approximately 10 per cent of preventable patient deaths, and medical reviews suggest that they account for six to 17 per cent of adverse events in hospitals.

To reduce the risk to patients as less specialised staff begin performing diagnostic testing, there is a strong need for quality management, oversight, and external quality analysis (EQA). Indeed, ISO 15189:2022 requires laboratories and point-of-care testing locations to subscribe to an EQA programme for each kind of testing that each site provides.

Even if a point-of-care testing site is overseen by a main diagnostic lab, each point-of-care testing site needs to subscribe to its own EQA programmes to ensure a high quality of testing at each location. The relationship between each point of care testing service location and the lab overseeing it must be elucidated and documented as part of adherence to the standard.

EQA as a tool for maintaining testing accuracy

While EQA is a necessary step for a lab to become accredited to the ISO 15189 standard, a subscription to an EQA programme can provide value beyond simply ensuring labs meet a minimum quality bar. It’s important to recognise EQA as a tool for continual improvement and education of staff and refinement of procedure and quality practice. EQA providers have a unique opportunity to be a part of improving patient safety by helping labs find sources of error and working with the lab to remediate them. Some EQA providers – like Canadian Microbiology Proficiency Testing (CMPT) – expand the scope of evaluation to the pre and post-analytical phase by offering simulated products that mimic real samples and providing critiques on not only the results of the test but on the reporting of those results.

The global COVID-19 pandemic helped highlight the many benefits – and challenges – of bringing testing closer to the patient. In Canada and throughout the world, point-of-care testing locations for COVID-19 enabled health authorities to handle the greatly expanded volume of tests required to maintain population health and safety. Tests were simple to use but were often performed by less-experienced staff who were not as familiar with the intricacies of running and interpreting Rapid Antigen Diagnostics (RADs) or Nucleic Acid Amplification Tests (NAATs). It is worth mentioning, however, that even experienced staff can make mistakes or have misconceptions about a particular test.

Related: Empowering the next generation of laboratory leaders

At CMPT, our COVID-19 proficiency testing programme was launched in March 2021. The programme was designed for RAD and NAAT testing methods and included six shipments per year, each containing four samples which either contained or did not contain the SARS-CoV-2 virus. Importantly, the concentration of the samples was varied to ensure that positive samples might be strong, medium, or weakly positive to simulate varying viral concentrations in a real sample.

While NAAT performance was high from the very beginning, RAD testing performance was initially low at 46 per cent accuracy in 2021. In evaluating this data, CMPT found that for medium positive samples, the accuracy rate was 42 +/- 13 per cent, and that weakly positive bands were largely being reported as negative.

Since CMPT was aware of testing methods being used for its samples, labs using RAD tests were identified and given coaching on how to correctly interpret a medium or weakly positive result. This intervention was near-real time and enabled labs to address the gap in training quickly. As a result, RAD testing accuracy improved rapidly, eventually reaching 93 +/- 7 per cent – roughly equivalent to NAAT accuracy – after eight months.

Total enrolment of labs in our proficiency testing programme for COVID-19 peaked in July 2022 with 110 testing locations, many of which were not testing labs and had not needed to be accredited before. When surveyed, one-third of respondents had never heard of proficiency testing and were not fully aware of the accreditation process and its requirements. Not only does this suggest an explanation as to why some testing sites may have had trouble correctly interpreting the tests, but it also indicates a need for discussion, education, coaching, and mentorship as point-of-care testing in community settings becomes more common.

Point-of-care testing is on the rise for many reasons – staffing shortages, increased testing volume, patients’ desire for convenience – and will likely be a driver of improved population health. But with this large systemic change comes a need for great care as well as increased and continual training and education. ISO 15189:2022’s requirement for testing sites to perform EQA will help ensure patients stay safe, but it is up to EQA providers to ensure their schemes exercise as much of the testing process as possible and that they identify issues and provide educational feedback to their subscribers. As bastions of testing quality, EQA providers are in a unique position to help ensure patient safety.

References available on request.

Dr. Lucy Perrone is a Professor of Laboratory Quality, Dept of Pathology and Laboratory Medicine at the University of British Columbia in Canada.

Back to Laboratory

The way healthcare is provided and accessed by patients has been revolutionised by telehealth, which has become a transformational force in the healthcare industry in recent years. Improving patient outcomes with technology while addressing the growing need for easily accessible healthcare treatments is what has made telehealth such a desirable commodity for providers of all sizes.

Patient care will only continue to improve as cutting-edge solutions are developed and integrated around the world. Let's look at the many aspects of telehealth and the benefits of automation in healthcare, from better patient outcomes and cost savings to increased access to care and the possibility of remote diagnostics.

 Healthcare organisations face major efficiency and cost challenges  

Nowadays, most healthcare organisations leverage technology for streamlined operations and cost/time savings. However, doctors frequently spend a great deal of time recording patient information, which results in more administrative work and less in-person patient contact. That's just one example of the inefficiency of traditional workflows that don't use automation and telehealth solutions to their fullest potentials.

Related: Pushing the boundaries of telehealth in hospitals and clinics

Here's how a lack of technological integration affects healthcare departments overall:

Manual data entry takes up valuable time: Clinicians have high burnout rates and less time to provide high-quality patient care due to excessive workloads and inadequate resources. Ten years ago, researchers in a groundbreaking study found that, on average, 44 per cent of a physician's time was spent on data entry. Compare that to just 28 per cent of time spent on providing direct patient care.

During a 10-hour shift, the total number of mouse clicks approaches 4,000 for one physician. So, there needs to be optimised technology and automated workflows — not simply more technology. More efficient healthcare resource allocation would boost hospital income by enabling emergency physicians to spend more time actually caring for patients.

Revenue leakage occurs due to insufficient resources: Patients outside of major cities and towns frequently receive care outside their community because rural hospitals have limited ICU beds and cannot afford to hire intensivists. These unaccounted-for ICU procedure expenses result in millions of dollars lost in ICU treatment.

A legislative report from 2012 confirmed the obvious: A decrease in patient volume often precedes a rural hospital closure, and unfilled beds might strain a hospital's capacity to meet the community's need for outpatient services. It's a multi-sided problem, as the American Hospital Association says that rural clinics accounted for one in every 12 rural jobs and generated around US$220 billion in economic activity in 2020 alone. So, rural communities suffer financially and medically when hospitals disappear.

How does automation streamline operations and mitigate financial inefficiencies for critical care delivery?

Automation can significantly transform the healthcare industry by tackling some of its most urgent problems. As previously mentioned, the workload that administrative duties place on healthcare personnel is one of the industry's main issues. Automation of a patient’s critical diagnostic data through Electronic Health Records, however, reduces the common errors associated with paper-based records by enabling healthcare personnel to access and update patient information easily.

Related: Megatrends shaping healthcare in 2024

Meanwhile, telehealth virtual visits greatly lessen the impact when there is a scarcity of intensivists and other specialists in an underserved community. This is a prime example of how telehealth can improve patient outcomes: It increases healthcare delivery to more patients in remote places. Physicians can efficiently diagnose, treat, and monitor patients for treatment risks through these telemedicine sessions, which lessens stress and allows for efficient healthcare resource allocation.

Integrating automation and telehealth means more effective healthcare

By simplifying repetitive processes like data collecting, monitoring, and drug administration — the typical list of manual administrative tasks — automation in critical care can maximise resource usage. Moreover, access to specialist treatment is made easier by telehealth, especially in rural or underdeveloped locations. Healthcare organisations can scale intensivists to provide care to several locations from one central location.

How can telehealth improve patient outcomes? Here are a few more substantial ways, particularly for smaller healthcare providers:

• Advanced monitoring systems that use artificial intelligence can identify minute changes in a patient's state and prescribe preventive care that may be used in future telemedicine. By adopting these systems, smaller institutions can improve patient outcomes and resource utilisation by offering sophisticated treatment without needing several on-site specialists.
• With the increasing proficiency of telemedicine solutions in managing large amounts of data, healthcare facilities can employ predictive analytics for improved patient flow, patient stratification, and overall operational efficiency.
• Continuity of care can be ensured for ICU patients by extending telemedicine into the home and enabling monitoring of the patients even after they are discharged. Smaller hospitals can use this technology to improve patient satisfaction, lower readmission rates, and guarantee consistent revenue from post-acute care.
• The emergence of blockchain technology leads to safer methods for exchanging patient data between various platforms. Blockchain technology can help smaller hospitals securely grow their telemedicine services, allowing them to coordinate care with larger systems and guarantee compliance with laws governing health data.

With their myriad benefits and potential for further growth, telemedicine solutions in ICU settings are set to change the future of critical care delivery. By embracing it, patients and healthcare providers can experience a new era of convenience, efficiency, and patient care.

Brian Douglas is the Chief Commercial Officer at AMD Global Telemedicine.

Back to Technology

In a ground-breaking development, the organ transplant system is poised for a significant transformation thanks to a pioneering Artificial Intelligence (AI) project named OrQA (Organ Quality Assessment). With a substantial investment of over £1 million from the National Institute for Health and Care Research (NIHR) of UK, OrQA is set to revolutionise organ transplantation, promising to save lives and substantially reduce healthcare costs. The project is a collaboration between the University of Newcastle, University of Bradford, University of Oxford and the UK National Health Service Blood and Transplant (NHSBT).

The core principle of OrQA is akin to AI-based facial recognition technology, but instead, it’s applied to evaluate the quality of organs for transplantation. This innovative approach has the potential to significantly increase the number of successful transplants. Estimates suggest that up to 200 additional kidney transplants and 100 more liver transplants could be performed each year in the UK, thanks to OrQA. This is a significant step forward, considering nearly 7,000 patients in the UK are currently awaiting organ transplants, with liver transplant waiting lists having increased notably since the pandemic.

Related: Dubai Health Authority launches organ donation awareness campaign

Development and impact of OrQA

The author of the article is the technical lead of the team behind this transformative technology. Currently, when an organ becomes available, it is assessed by a surgical team by sight, which means, occasionally, organs will be deemed not suitable for transplant. The team is developing a deep machine learning algorithm, which will be trained using thousands of images of human organs to assess images of donor organs more effectively than what the human eye can see.

This technology enables a surgeon to take a photo of the donated organ, upload it to OrQA, and receive an immediate assessment of its suitability for transplant. This rapid and precise evaluation is crucial, given that an organ can only survive outside the body for a limited time. The ability to make quick, accurate decisions is essential in ensuring the organ’s viability for transplantation.

The technology behind OrQA

OrQA’s deep machine learning algorithm is its cornerstone. This advanced AI system will be trained with thousands of images of human organs, enabling it to assess donor organs with greater accuracy than the human eye. This process involves evaluating various factors critical to a successful transplant, such as the organ’s damage, pre-existing conditions, and the efficiency of blood flushing out of the organ (organ perfusion).

Enhancing decision-making in transplant surgery

The introduction of OrQA marks a significant advancement in transplant surgery. Traditionally, the assessment of organs has been a subjective process, relying heavily on the experience and judgment of surgical teams. However, this subjectivity can sometimes lead to viable organs being deemed unfit for transplant. OrQA aims to eliminate this uncertainty by providing a more objective and precise assessment.

Colin Wilson, a transplant surgeon at Newcastle upon Tyne Hospitals NHS Foundation Trust and co-lead of the project, emphasised the importance of OrQA in supporting surgeons: “The software we have developed ‘scores’ the quality of the organ and aims to support surgeons to assess if the organ is healthy enough to be transplanted. Our ultimate hope is that OrQA will result in more patients receiving life-saving transplants and enable them to lead healthier, longer lives.”

Related: Lung transplantation programme in UAE provides hope to patients with end-stage lung disease

Benefits beyond saving lives

The benefits of OrQA extend beyond saving more lives through increased transplant opportunities. From a financial perspective, the technology is poised to bring significant savings to the healthcare system. Over a decade, a kidney transplant can save the NHS approximately £420,000 per patient. Considering the total number of patients with a functioning transplant as of March 31, 2022, is around 58,900, the potential savings are immense.

Future prospects and challenges

While the prospects of OrQA are highly promising, challenges remain. One of the key hurdles will be the integration of this technology into the existing healthcare infrastructure and ensuring that it is accessible and user-friendly for surgical teams. Furthermore, continuous updates and improvements to the AI algorithm will be necessary to keep pace with advancements in medical science and organ transplantation.

Conclusion

OrQA represents an important leap in organ transplantation, potentially improving the lives of thousands of patients awaiting transplants. This AI-driven technology not only promises to enhance the quality and efficiency of organ transplantation but also to bring about significant economic benefits. As the medical community eagerly anticipates the full-scale implementation of OrQA, it stands as a testament to the incredible potential of AI in revolutionising healthcare.

Professor Hassan Ugail is the Director of the Centre for Visual Computing at the University of Bradford, UK. 

Back to Technology

The World Health Organization (WHO) affirms that healthcare-associated infections (HAI) pose a significant global public health concern. A larger number of microorganisms are lurking in healthcare settings and causing a variety of infections whenever aseptic techniques are lacking. These infections include but are not limited to, central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections, and ventilator-associated pneumonia.

The HAI worldwide prevalence, impact, and burden triggered many countries to develop and implement several strategies to reduce their incidence. These strategies were required and encouraged because many of these HAIs are deemed preventable. The core of the strategies tackling HAI is vested in well-established and effective infection control programmes. These programmes help reduce the HAI attributable morbidity and mortality rates, reduce prolonged hospital stays, and reduce unnecessary economic costs.

Related: Addressing antimicrobial resistance and its impact on human vulnerability

Even though a precise quantification of HAIs is not easy to establish, the WHO estimates suggest that millions of patients are affected by HAIs each year, and prevalence varies across regions and healthcare settings, with higher rates often observed in low and middle-income countries. The additional medical interventions, unnecessary prolonged hospitalisation, and the use of resources such as antibiotics and laboratory tests lead to a significant financial and economic burden to patients, healthcare, and insurance providers equally. Furthermore, their economic burden extends beyond the healthcare sector to include costs related to lost productivity and the negative impact on patients’ quality of life. HAIs are considered a major driver in antibiotic resistance because antimicrobials are often needed to treat these patients.

The launch of POCT testing for infectious disease diagnosis in the past decade gained substantial attention in scientific papers. Mentioning a few examples, we appreciate its simplicity, short turnaround time, wide accessibility, and prompt diagnosis of infectious diseases especially where resources are scarce. POCT to detect respiratory viruses such as influenza allows quick identification and implementation of appropriate isolation and treatment measures. POCT for blood cultures and sensitivity can help select the most effective antibiotics, and therefore reduce the risk of antimicrobial resistance.

When used in active surveillance testing for MRSA (Methicillin-resistant Staphylococcus aureus) or Clostridioides difficile, POCT enables early detection and isolation of patients, eliminating potential outbreaks. Another use is in testing for C-reactive protein (CRP) or procalcitonin, which are the two central inflammatory markers in detecting sepsis and predicting potential deaths. The role of POCT is not limited to the inpatient healthcare settings.

Related: Strategies to optimise clinical sterilisation

During the COVID-19 pandemic, POCT gained merit for swift and efficient contact tracing. It became convenient because it allowed mass screening and surveillance. Its clinical value was indeed underscored, and, it enabled testing populations in remote or underserved areas where access to centralised laboratories is limited.

In summary, POCT provides rapid results for quick decision-making, allowing prompt isolation and management of patients when required, and in return, it reduces the risk of cross-transmission within healthcare facilities and communities.

References available on request.

Elias Tannous is an Infection Control Specialist at Cleveland Clinic Abu Dhabi.

Back to Laboratory

Telemedicine consultations have gained widespread popularity as new technology presents a more cost-effective and time-efficient alternative to traditional, in-person doctor visits. The rise in chronic diseases and the inconvenience of regular medical appointments has paved the way for an optimistic future in telehealth, creating the expansion of healthcare mobile app development services. This article examines the impact of virtual consultations and how individuals are embracing this technological shift for a more accessible and efficient approach to healthcare.

The global telehealth market presents significant advantages in modern healthcare and is projected to grow exponentially to US$55.6 billion by 2025 from US$25.4 billion in 2020, at a CAGR of 16.9 per cent during the forecast period. This technology ensures convenience, granting patients easy access to medical care without the need for extensive appointment scheduling or in-person visits. This proves especially crucial during emergencies and for those managing chronic conditions. By eliminating travel and waiting times, telehealth enhances efficiency and accessibility, particularly beneficial for individuals who do not live near hospitals or in parts of the world where they are dependent on public transport. Telehealth also streamlines follow-up appointments, allowing patients to stay at home while doctors assess recovery progress.

Related: Telemedicine industry en route to noteworthy revenues

Dr. Deborah Mukherji, Consultant — Medical Oncology at Clemenceau Medical Center Hospital in Dubai, said: “We use telehealth extensively to connect with international patients, allowing patients and their families who are not residents in the UAE to benefit from our multidisciplinary team of expert physicians. Telehealth is especially valuable for complex cases, such as cancer, where we can review patient reports and imaging studies in advance to ensure when we arrange a teleconsultation with the patient and their family we can give optimal recommendations for further investigation or treatment. Telemedicine is playing a critical role in increasing patient’s access to healthcare, especially niche medical expertise and rare specialisations.”

She added that a major benefit is to be able to review patients who are not currently in the UAE and give them access to recommendations from internationally recognised experts who work together as part of a multidisciplinary team. 

“A disadvantage, however, is that we cannot examine patients. Although we can review digitalised medical reports and imaging, if these are not available or not of high quality to assist in diagnosis then we may be limited in the scope of the recommended treatment plan discussed during the telehealth call,” she said.

Telemedicine can also be a more economical solution as it eliminates the overhead costs associated with physical clinics or hospitals. Brandon Rowberry, CEO, Digital Health at Aster DM Healthcare, said: “With some doctors now offering only virtual consultations, there is a substantial 20 per cent savings, as they operate without the added clinic or hospital space expenses.”

This shift allows doctors to provide services from pooled centres or even from the comfort of their homes, depending on the regulations of their respective geographies.

Related: Five tips for successful telehealth implementation

Thanks to new apps in smartphones, chronic diseases can now also be monitored and checked through teleconsultations. "Teleconsulting has a number of uses such as people seeking consultations for their children, as they do not want to visit a hospital for more mild things. People do not have to travel far or take a day off as they can do it in the middle of the night. The majority, 80 to 85 per cent of teleconsultations are done with general practitioners and not specialists but now they are available with specialists too, albeit more infrequently.”

He said that telemedicine is also proving invaluable for those with chronic diseases who require regular check-ins but not necessarily physical visits. “Another significant application arises in cases of distance, such as seeking second opinions or medical tourism,” Rowberry explained. However, in some cases there are limitations and instances where in-person visits become necessary for more serious symptoms.

While telehealth is already transforming healthcare delivery, it is essential to recognise its limitations. Another significant challenge lies in the dependency on internet-connected devices, acting as a potential barrier to access for both patients and healthcare professionals. The requirement for suitable technology, coupled with the necessity for a stable internet connection, can hinder the widespread adoption of telehealth services. This is particularly evident when considering the 2.6 billion people worldwide who lack internet access.

When looking at the future of healthcare, it is important to devise inclusive solutions that bridge the digital divide, ensuring that telehealth becomes a universally accessible tool for improving overall health outcomes.

References available on request.

Back to Technology

The medical laboratory field is facing a significant global workforce challenge. This shortage is due to the recent and ongoing effects of a worldwide pandemic, recruitment, and retention opportunities, as well as increased demand for laboratory services. As challenging as these issues are, they also present prospects for growth and innovation in pathology and laboratory medicine.

As decision-makers at all levels seek and implement multi-faceted solutions, leveraging credentials such as those offered by the American Society for Clinical Pathology, Board of Certification (ASCP BOC) is emerging as a key strategy. This strategy not only enhances professional skills but also opens new avenues for recruitment and retention.

Who is the ASCP BOC?

ASCP BOC is a nearly 100-year-old credentialing agency for laboratory professionals. Since ASCP BOC’s establishment in 1928, they have credentialed over 625,000 laboratory professionals worldwide. In 2006, ASCP BOC began certifying laboratory professionals with an international “ASCPi” designation. To date, examination applicants span 130 countries and over 22,000 individuals have been ASCPi credentialed from 117 countries.

Since offering ASCPi in 2006, the ASCP BOC has worked with diverse, patient-centric organisations and regulatory agencies across the globe to implement and enhance strategic engagement plans for credentialing laboratory professionals.

Related: Megatrends shaping healthcare in 2024

Global workforce challenges in the medical laboratory field

According to the ASCP BOC’s 2022 ASCP Survey, many laboratories around the world report difficulties in filling open positions. This shortage impacts the quality of patient care and the effectiveness of laboratory operations.

Credential examinations add value to the global laboratory workforce by creating a reliable and cost-effective means to ensure that laboratory team members are competent, have essential knowledge sets, and are likewise patient-centric to assure high-quality, safe outcomes. ASCP BOC believes that laboratory professionals should possess appropriate academic and clinical training, pass competency-based examinations conducted by an approved credentialing organisation, and participate in continuing education programmes for ongoing professional development.

Credentialing of laboratory professionals is also the recommended approach to address the US and global medical laboratory workforce shortage. In the article, “Severe Shortages of Qualified Medical Laboratory Professionals”, the primary resolution to help address the workforce shortage is to recruit qualified board-certified laboratory professionals.

For the next generation of laboratory professionals in the US, this means that at point of graduation these professionals take a credential examination to become board-certified by organisations such as ASCP BOC. Additionally, many employers in medical laboratory and pathology practices offer on-the-job training, which complements the formal credentialing process. This hands-on experience, coupled with the intrinsic value of ASCP BOC credentials, provides a robust pathway to success for laboratory professionals. It not only enhances their skills and knowledge but also contributes significantly to expanding the laboratory professional workforce in unique sectors.

Similarly, ASCP BOC advocates for competency-based examinations conducted by an approved credentialing organisation internationally. Towards this, ASCP BOC credentials have received both official and unofficial endorsements from countries and organisations in the Middle East & North Africa, Latin America, and Asia.

How do we know that ASCP BOC credentials add value to the laboratory by ensuring laboratory team members are knowledgeable, skilled, and contributory? In 2019, the Institute for Credentialing Excellence (ICE) administered a multi-organisational survey to measure the value that credential holders place on certification. This survey collected data from a large sampling (>12,000 individuals) of credential holders representing six organisations.

This survey sought to define credential holders’ attitudes toward and experiences with certification examinations and credentialing. The survey results indicated that respondents consider certification to be very valuable to their profession, certification requirements are appropriate, ethics and code of conduct for the certifying body are beneficial to the profession, and credentialing is important for improving competence and performance in the profession.

Related: Joint Commission International sets focus on continuous accreditation program

Workforce challenges in the MENA region

In the Middle East and North Africa (MENA) region, the situation is more acute due to rapid population growth, increased prevalence of chronic diseases, and a limited number of training programmes for laboratory and other healthcare professionals. A study published in the Frontiers of Public Health highlights the shortage of skilled personnel in this region. Moreover, political instability and economic challenges in some MENA countries exacerbate the problem by leading to brain drain and limited investment in healthcare infrastructure.

Leveraging inclusion, diversity, equity, and access (IDEA)

Sustainability in the medical laboratory and pathology context extends beyond environmental concerns. It encompasses social sustainability, which involves elevating a stable and skilled workforce in the face of challenges such as migration and talent shortages. Laboratories that adopt strategies like providing continuous professional development opportunities, career ladders based on specialist or additional credentials, fostering a positive work environment, and promoting work-life balance to retain skilled staff thrive, despite challenges. This approach not only enhances employee satisfaction but also attracts new talent.

Inclusion, diversity, equity, and access are critical components of a sustainable laboratory workforce. By creating an inclusive environment that values diversity and access, laboratories can tap into a broader talent pool and one that reflects their local community and patients. This approach is particularly important in regions like MENA, where diverse cultural backgrounds are the norm. Implementing policies that promote equity, such as equal pay for equal work and opportunities for career advancement, can elevate the retention of a diverse workforce.

ASCP BOC credentials play a vital role in promoting IDEA for the laboratory workforce. By providing a standardised assessment of skills and knowledge, these credentials ensure that all professionals, regardless of their background, are evaluated based on their competence. This objective evaluation system supports the principles of equity, access, and fairness in the workplace.

Future state of laboratories

The global workforce shortage in the medical laboratory field poses significant challenges, particularly in regions like MENA. However, by leveraging ASCP BOC credentials, laboratory decision-makers and leaders at all levels can ensure a high standard of competency among their team members. Additionally, focusing on sustainability, including social aspects like workforce migration and shortage, while embracing IDEA principles, can help laboratories attract and retain a diverse and skilled workforce. This holistic approach is essential for addressing the current challenges and ensuring the long-term viability of medical laboratory professions.

References available on request.

Dr. Amy Spiczka, MS, HTL(ASCP)CM SCT, MBCM, CPHQ, is the Executive Director of ASCP Board of Certification. 

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Cloud data storage has become indispensable for efficiently storing sensitive patient data. However, with the convenience of the cloud comes the need for stringent security measures. This article explores the advancements in healthcare's digital transformation, delving into the challenges of safeguarding patient data. It also examines cybersecurity solutions that can effectively tackle these challenges.

Electronic records are increasingly susceptible to unauthorised access and hospitals face difficulties managing large volumes of data, necessitating dedicated servers or data centres. As the cost of self-managed data centres is prohibitive, cloud storage is seen as a more economical solution. Storing data in the cloud allows universal access, enabling doctors to retrieve patient histories, diagnose conditions, and prescribe medications more efficiently. Despite these benefits, security concerns arise when entrusting medical records to third-party cloud servers.

Related: Personalised, next-gen healthcare experiences are within grasp

Healthcare professionals often face recurring concerns regarding cloud data security. Issues faced include unauthorised access, data breaches, and compliance with industry regulations such as the Health Insurance Portability and Accountability Act (HIPAA).

Recently in New York, the Carthage Area Hospital and Claxton-Hepburn Medical Center announced they are taking legal action to recover patient data stolen by the LockBit ransomware gang. LockBit has a history of targeting hospitals globally, causing disruptions and delays in healthcare services. The stolen data is now stored on servers owned by Wasabi Technologies in Boston. Seeking a court order, the hospitals aim to compel Wasabi to return the data and require LockBit to destroy all copies. This incident highlights the ongoing threat posed by ransomware attacks targeting healthcare institutions.

Cybersecurity professionals play an important role in implementing best practices to strengthen the defences against potential threats. Ali Awad, IT Director at Clemenceau Medical Center Hospital Dubai, said CMC’s patient data resides in an on-premises data centre and the hospital has strict access controls to limit access to patient data only to authorised personnel.

“All our patient-related applications use role-based access control (RBAC) to ensure that each user has the necessary level of access based on their responsibilities. We have implemented multi-factor authentication using Microsoft 365 MFA and Cisco Duo to add an extra layer of security to user logins. This ensures that even if login credentials are compromised, an additional authentication step is required. We regularly review, and update user permissions based on their roles. We have comprehensive audit trails to track and monitor access to patient data. We regularly review these logs to detect and investigate any unauthorised access or suspicious activities."

He explained regular training sessions are conducted as part of the onboarding process and afterwards to educate healthcare staff about the importance of patient data. "We keep employees informed about the latest security threats and how to recognise and respond to potential breaches. This is extremely important as a significant majority of cybersecurity incidents involve human factors.”

Related: Digital load on healthcare infrastructure calls for 5G capabilities

With regards to using secure communication channels when sharing patient data, Mr Awad said: "When we must use email, we make sure all patient-related data files are encrypted. We regularly back up patient data and store backups in a secure offsite location. This ensures data recovery in case of accidental deletion, system failures, or cyber-attacks. In addition, robust endpoint security measures protect devices that have access to patient data. This includes antivirus software and regular software updates. We also conduct regular security risk assessments to identify vulnerabilities and potential threats to patient data. We then use the findings to implement appropriate security measures and continuously improve the overall security posture."

Understanding and addressing the concerns faced by cloud storage is crucial, with cybersecurity professionals working diligently to establish protocols such as encryption, multi-factor authentication, and employee training to prevent potential breaches. The shared responsibility model sheds light on the division of responsibilities between service providers and organisations.

Healthcare providers are increasingly adopting a hybrid cloud strategy, blending public and private clouds with on-premises infrastructure for a smoother transition. While applications and IT functions easily migrate to the cloud, sensitive patient information remains on-premises for enhanced security. The HIPAA permits cloud storage for protected health information (PHI) as long as specific privacy and security measures are in place. Using a HIPAA-compliant cloud storage service with encryption enables the secure storage of electronic PHI and supports applications processing health data.

Best practices that healthcare organisations can adopt to enhance cloud data security include employee training programmes, regular security audits, and staying informed of the latest security trends and threats. Healthcare organisations need a comprehensive strategy that integrates both technological solutions and organisational practices to keep patient data in cloud storage safe.

References available on request.

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Technology has revolutionised every facet of our lives, and healthcare is no exception. By integrating advanced technologies into patient care, healthcare providers are enhancing clinical excellence and transforming healthcare delivery.

According to Hein van Eck, who is the Chief Executive Officer of Mediclinic Middle East and possesses 20 years of experience in the private healthcare industry in South Africa and the UAE, five key technical breakthroughs have been instrumental in changing how healthcare is delivered. These are in the areas of telemedicine, AI and machine learning, robotics and automation, genetic sequencing, and wearable devices.

Improvement in accessibility

The use of telemedicine has increased exponentially, especially in the wake of the COVID-19 pandemic and allowed patients to access healthcare services from the comfort of their homes or offices, improving accessibility, allowing for more efficient management of chronic conditions, and reducing the burden on physical healthcare facilities.

Enhanced treatment outcomes

Artificial intelligence and machine learning have also been applied to various aspects of healthcare, including diagnostics, treatment planning, and predictive analytics. These technologies can analyse large datasets to identify patterns including predicting disease outbreaks, assisting in early disease detection, sometimes noticing indicators that may be missed by the human eye, and enhancing treatment outcomes.

Surgical precision and efficient operations

Robotics and automation are now more sophisticated. Advances in robotic surgery are allowing minimally invasive procedures to be carried out with enhanced precision and accuracy, leading to quicker recovery times and reduced complications. Automation has also been beneficial in managing administrative tasks, such as scheduling appointments, managing patient records, improving the accuracy of coding, and assisting in revenue cycle management, freeing up more time for healthcare professionals to spend with patients.

Reduced costs

Technological advancements have significantly reduced the cost of genetic sequencing, and these improvements have paved the way for precision medicine, where treatments are tailored to the individual based on their genetic makeup, lifestyle, and environment. How to integrate this into everyday medical care is still evolving, however, and has a way to go.

Related: Diagnosing the future of sustainability in healthcare

Real-time monitoring

Wearable devices like smartwatches are also having an impact on healthcare. These devices can track an individual’s heart rate, sleep patterns and activity levels, and are increasingly being integrated with healthcare systems to monitor patients’ health in real time, helping to prevent disease and manage chronic conditions. Increasingly these technologies are also being used in the hospital setting to improve patient safety, early detection, and efficiency.

“Technology has revolutionised healthcare over the last 10 years, leading to huge advances in accuracy, safety, clinical outcomes, accessibility, the patient experience, and the extent to which we can tailor healthcare to the individual, with treatment modalities focused on ever smaller groups of patients,” Van Eck added.

Mediclinic Middle East, one of the UAE’s leading private healthcare companies, has been at the forefront in this aspect, harnessing the power of technology to enhance the quality of care and patient experience.

“The COVID-19 pandemic was a game changer not only for us, but every healthcare provider across the world and crystallised our thoughts on how we could use technology to better serve our patients. Our telehealth service was developed in the space of about one month, and despite the challenges we faced in terms of connectivity and behaviour change amongst both staff and patients, the service has gone from strength to strength,” he added.

Patient welfare at the core of operations

Mediclinic Middle East operates seven hospitals with almost 1,000 beds, and 29 outpatient facilities with clinics dedicated to IVF, dialysis and cosmetics, alongside several specialised units including two comprehensive cancer centres, and others focused on areas such as transplantation and stroke.

From a technologically progressive standpoint, the team at Mediclinic Middle East further established a dedicated portal where patients can access their health records and test results. Additionally, patients can manage appointments with a medical practitioner through an app without the need for human intervention.

“We were also one of the first UAE healthcare providers to partner with Malaffi in Abu Dhabi and Nabidh in Dubai to ensure that doctors across the UAE, not just in Mediclinic, could access patients’ medical records, facilitating greater accuracy and improved patient care,” he added.

Aligning themselves with the UAE’s Centennial 2071 vision, Mediclinic Middle East is in the process of utilising artificial intelligence and automation to enhance e-health delivery systems.

Related: Megatrends shaping healthcare in 2024

“We have started along this road with a project in revenue cycle management (RCM) to use AI technology to automate coding and improve accuracy and I am pleased to say that it is already boosting efficiencies and allowing our clinical staff to focus further on providing seamless continuity of care and a superior client experience for their patients,” he said, adding that the organisation now uses specially designed bots to drive speed and efficiency in RCM, HR functions, and medical records, driven by a newly established automation function at a group level.

Mediclinic Middle East’s notable achievements extend to implementing sophisticated surgical technologies, such as the da Vinci Xi HD 4 arm robotic system, for both adult and paediatric patients. As a result, the team has performed over 1,000 surgeries with outcomes that allow patients a better quality of life.

Mediclinic Precise, its genetic testing and profiling service, offers genetic testing carried out using the very latest sequencing technology at its specially commissioned precision medicine laboratory at Mediclinic City Hospital.

“Our multidisciplinary team of medical doctors, scientists, genetic counsellors, and molecular geneticists offers support to healthcare professionals and their patients affected by or at risk of suffering from a genetic disease. This also links to our newly established personalised medicine function which aims to create bespoke prevention and treatment plans based on an individual’s medical health history and genetic makeup,” said Van Eck.

Future plans

In addition to actively considering new growth opportunities, Mediclinic Middle East will focus on its patient digital offering, which involves enhancing the digital services available to them, including an eCommerce platform and B2C offerings.

“We also anticipate some significant developments in genetic profiling and personalised medicine and are entrenching our clinical collaboration with our Swiss counterparts Hirslanden in the areas of oncology and cardiology to continue to ensure we deliver world-class care in the UAE,” he concluded.

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