Using Artificial Intelligence (AI) to enable predictions related to diagnosis and prognosis of patients is fast becoming an accepted reality. But can AI be used to make predictions for the C-Suites that run and manage healthcare organisations?

The numerous factors that determine commercial outcomes in healthcare can be mapped over time, whereby creating an evident case for AI-empowered C-Suite. We have reasons to believe that AI will separate the proverbial wheat from the chaff when it comes to CEO’s in the coming years. Predictability is perhaps the biggest challenge that any business faces when it comes to sustenance and growth. AI addresses just that.

Think of this as a crystal ball that a CEO can gaze into and get a glimpse of the times to come. Then compare this with another CEO who is still making decisions on gut feeling and depends upon prehistoric tools to grapple with business challenges.

What is the undue advantage that an AI-empowered CEO gets when it comes to running healthcare organisations? Here are a few examples:

Prediction of revenue

AI algorithms can, over a period of time, predict the earnings of an organisation. AI takes it beyond the usual approach of historical data analysis. The predictions can be across various cross-sections of revenue. For example, AI can be used to predict the revenues from different departments and services.

Calculating payor rejections and payments in advance

The revenue cycle is a crucial component for all healthcare providers. Hospital management is always better off if the claim realisation can be predicted both in terms of value and time. There are numerous gains to be made if the management team knows what kind of money is expected from the payors in which month. Additionally, providers can run an AI tool to predict the outcome of claims that they are submitting each month. Imagine if a hospital CFO can know that out of the 5,000 claims being submitted for a particular amount an ‘x’ amount will get a first level rejection. Further, the CFO can also get to know which claims will be sent back by the payor and for what reasons. AI can do this faster and at larger quantities than the claim scrubbers.

Patient mix and volume forecasts

A multi-geography healthcare group, as well as a single hospital, can benefit a lot if the team running it knows the kind and numbers of patients that will walk through the doors. Knowledge of the medical conditions for which there will be more demand can help in planning the services much in advance. Inventories can be stocked accordingly, and capacities can be made ready. With advanced AI algorithms, it will also become possible to forecast the geographies and ethnicities of future patients for a medical condition. This helps the healthcare provider to be future-ready.

Moreover, the kind of revenues that the group of the hospital will make can be known in advance.

Manpower requirement

A spin-off from forecasting patient mix and volumes is the enhanced ability to plan manpower and resources. When the leadership team is near certain about the future, it can plan the manpower required well in advance. This advantage is bigger in areas where the hiring process for the technical staff is longer owing to licensing and other regulatory requirements.

Like all new endeavours, C-Suite AI has a learning curve too. It will be a while till the accuracy of predictions improves. However, there are some factors that can contribute towards a steeper learning curve.

Sufficiency of variables

It takes sufficient, if not a comprehensive list of variables to predict a business outcome. For AI to work better for the CXO’s, the data variables will need to be listed in totality. Missing out on key factors that can influence an outcome can compromise the AI prediction.

The accuracy of data

Algorithms are based on data. It is imperative for the input data to be accurate in order to get forecasts that are closer to reality. C-Suites investing in AI will need to assure that they have a system of obtaining and cross verifying data that goes into creating the sets of rules.

Timeliness of data procurement

Sometimes crucial information and data come in too late for it to be valuably used. The usefulness of AI is amplified if the predictions can be made earlier. This is possible only if the data is obtained well in time and is sanitised quickly.

How many variables can be directly influenced?

The CEO and the management team can take preventive steps and manage the business outcomes proactively only if they can control the variables that influence those outcomes. The usefulness of C-Suite AI is directly linked to the ‘influenceable’ variables in the mix. The CEO’s will need to expand their span of control over time and start controlling more elements so that they can make better use of the AI predictions.

Overall, though C-Suite Artificial Intelligence is new to the world, it has all the potential to enable a powerful and proactive C-Suite. We can safely conclude that an AI-powered CEO will have a decisive edge over a traditional one.

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This article appears in the March/April edition of Omnia Health Magazine. Other topics include AI in healthcare, patient safety, mobile healthcare and further updates around on COVID-19 from the healthcare industry.

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Nurses and midwives play a vital role in providing health services. As seen with the current Coronavirus crisis, they are at the front line of defence and are making a difference not just on individual patients’ lives but also to the community as a whole. Therefore, it is fitting that in order to honour the 200th birth anniversary of Florence Nightingale, the founder of modern nursing, the World Health Organization (WHO) declared 2020 as the International Year of the Nurse and the Midwife.

The critical role nurses play was also highlighted recently when Cleveland Clinic Abu Dhabi (CCAD), one of the healthcare facilities of Mubadala Investment Company, was granted the Magnet designation, a global credential of excellence in healthcare, from the American Nurses Credentialing Center (ANCC), marking a major step for the UAE medical sector. CCAD has become the first in the UAE to receive the prestigious designation. In addition, as a facility that opened its doors in 2015, it has become one of the youngest hospitals to earn this credential.

Magnet recognition is only granted to exceptional healthcare organisations that meet the specific criteria outlined by the ANCC. To achieve the Magnet recognition, an organisation must meet standards in quality patient care, nursing excellence and innovations in professional nursing practice.

Typically, hospitals that receive Magnet recognition deliver better patient satisfaction, improve safety and enhance the overall quality of care. A Magnet organisation meets the highest standards of nursing practice, so that means that patients can be rest assured that they are being looked after by leaders in their field at all levels.

In order to apply for Magnet designation, Cleveland Clinic Abu Dhabi underwent a detailed review process of all its operational practices including mission, vision and values, as well as policies for transformational leadership, structural empowerment and knowledge improvement. The process concluded with a stringent site visit lasting several days.

Below are excerpts from an interview with Sue Behrens, DNP, Chief Nursing Officer, Cleveland Clinic Abu Dhabi:

What is the importance of Magnet accreditation to the UAE?

This accreditation is about advancing the nursing profession in the UAE. With their support, belief and promotion of nursing, both H.H. Sheikha Fatima bint Mubarak, Chairwoman of the General Women’s Union, President of the Supreme Council for Motherhood and Childhood, and Supreme Chairwoman of the Family Development Foundation, the ‘Mother of the UAE’, and Dr. Fatima Al Rifai, Chair member and secretary of the UAE Nursing and Midwifery Council, had a strong influence on our journey. Their vision and the vision of the nation is to grow the nursing profession. To me, this is about bringing nursing excellence to the UAE, so that we can provide a model for what nursing should be, in order to begin attracting more UAE nationals to the sector.

Cleveland Clinic Abu Dhabi has a number of Emirati nurses in both patient-facing and leadership roles. Some of whom have played a huge role in getting our transplant programme up and running just three years after opening our doors to patients. We are already seeing growing levels of interest in nursing careers from UAE nationals, both from students looking to study nursing all the way to current caregivers looking to re-train to pursue a nursing career.

What does the accreditation mean for the nursing profession and how does it impact patient care?

Cleveland Clinic Abu Dhabi applied for Magnet accreditation because we’re trying to grow the nursing profession in the UAE and because we wanted to highlight the important role our nurses play in delivering care. I think that, through Cleveland Clinic Abu Dhabi receiving this accreditation, the perception of the nursing profession in the country will begin to change. It’s about celebrating nurses and their impact on patient outcomes and the safety of the care we as a hospital provide. A Magnet organisation empowers nurses, and values their contributions, making for a happier, more engaged workforce, with career opportunities and the highest levels of patient care.

A great example of that is our advanced practice nurses that we have incorporated into Cleveland Clinic Abu Dhabi. We are the first and only hospital to have nurse practitioners and physician assistants on staff.

We have also established new roles for clinical coordinators, patient educators among others to help us provide the best possible care to our patients and provide nurses with the career progression opportunities we know are so important to attract people to nursing.

Sue Behrens

 

What was the review process like for the accreditation?

The process of obtaining Magnet recognition involved caregivers from across our entire organisation, including every single nurse in the hospital. It was an extremely rigorous process. It’s not simply about readiness; it’s about the stories our nurses have to tell. We submitted stories of teamwork within the hospital and nurse-led programmes to improve patient care and well-being. It was a real celebration of all the nursing efforts we have made at Cleveland Clinic Abu Dhabi since opening.

There are multiple pillars to Magnet. It looks at how we care for our own nurses, how we look after their professional development, training, and their career opportunities.

The assessment looks at the tools we provide to enhance their level of practice, as well as the research opportunities we offer them.

Are there any initiatives you would like to highlight?

I am particularly proud of two initiatives that our nurses initiated that really demonstrate not only their commitment to delivering the highest levels of patient care, but to ensuring that our patients have the best possible experience while they are with us, feeling that not only their health but their emotional well-being is taken into account.

Nurses from our neurological long-term care unit developed a programme to take patients outside the hospital setting to enjoy the surroundings and fresh air to uplift their spirits in our hospital’s gardens and outdoor areas.

These patients are primarily post-stroke patients and may have been in the hospital for long periods of intensive intervention. This long hospital admission is stressful both on the patient and family members and inhibits the patient’s environmental stimulation. Our nurses partnered with patients and their families to ensure the programme was a success.

Also, more than 180 of our caregivers volunteered their personal time when ‘Operation Smile UAE’ visited Cleveland Clinic Abu Dhabi to offer transformative surgery for young people with cleft lip and cleft palate conditions. Our caregivers staffed the ward, directed patients, played with the patients, registered and performed the surgeries.

The experience was uplifting for those who participated, with several individuals wanting to repeat the experience and some hoping to volunteer for international missions in other countries.

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This article appears in the March/April edition of Omnia Health Magazine. Other topics include AI in healthcare, patient safety, mobile healthcare and further updates around on COVID-19 from the healthcare industry.

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Many of us have had friends or loved ones enter the hospital for a simple procedure, only to find themselves in a fight for their life with a hospital-acquired infection (HAI). HAIs afflict hundreds of millions of people globally each year with conditions like sepsis implicated in nearly 270,000 deaths in the U.S .alone at an annual cost to the healthcare system of approximately US$24 billion.

While difficult to diagnose, through a combination of awareness, better education, and technologies, more people with HAIs are being identified and treated earlier, and fewer of them are dying.

But there’s so much more to be done – and artificial intelligence (AI) has matured to the point where we can apply its power. It’s a tipping point that has the potential for us to transform healthcare in fundamental ways. We can advance the way care gets delivered by tying disparate pieces of healthcare information together so clinicians can decide how to act on the information. That’s vastly different from “AI 1.0”, which focused on the possibilities of AI without the real-world application in clinical terms.

And patients at risk of HAIs and high-risk conditions like Clostridium difficile (C. Diff) and sepsis – will undoubtedly benefit from our progress. We now not only have real-world clinical use cases thanks to the clinical expertise being applied, but we have the technology building blocks that move beyond the hype and can help us advance more quickly.

There are two major reasons AI has made such inroads in recent years:

1. the mass digitalisation of health records that makes data accessible to algorithms
2. advances in computation power, which makes theoretical algorithms practical, giving deeper knowledge to which types of algorithms and statistical models will yield the best results.

 

Why AI is a “good fit” for predictive surveillance

Machine learning, in particular, leverages big data to learn the correlations between very large sets of variables to be more predictive and to provide results based on these predictors so the clinician can decide how to act.

Through early experiments and the alignment between data science and clinical expertise, we know that detecting HAIs is an ideal use case for AI as it has the ability to monitor all the variables that really mean something and to reduce the noise in the data that can lead to “false alerts” where the monitoring data somehow gets translated into some unwanted action.

But not all AI is created equal. Creating AI models that accurately take into account the nuances of a condition is not an easy process. Anyone with a computer can now download a machine learning model without having any idea on how the algorithms work.

That accessibility is great, but it could lead to a lot of misleading hype and suboptimal models. In the rush to release AI applications in the medical domain, many researchers have used simplistic models.

The more simplistic models can be like applying a Swiss Army Knife – slicing and dicing data without regard for the order of events – and depending on aggregated metrics and values. These models apply those events as independent dimensions, losing critical information about the order and timing of clinical events along the way. This information is critical to tracking the changes in a patient to predict outcomes but is completely lost without more sophisticated approaches.

Ultimately, it’s all about time: predicting a condition early enough so that clinicians can respond and change outcomes.

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This article appears in the March/April edition of Omnia Health Magazine. Other topics include AI in healthcare, patient safety, mobile healthcare and further updates around on COVID-19 from the healthcare industry.

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Rashid Hospital’s Trauma Centre is one of the top 10 in the MENA region and Europe, a top health official recently revealed. His Excellency Humaid Al Qutami, Director-General of the Dubai Health Authority (DHA) inaugurated the 4th International Trauma Conference and highlighted the achievements of the largest trauma centre in the UAE and MENA region.

Al Qutami said that the field of Trauma care is an extremely pivotal and critical field that requires immediate, precise multidisciplinary care and protocols to save lives. He said the Authority has paid significant emphasis to this field and has invested in continuous medical development of medical professionals, smart technologies, processes and protocol management to ensure the centre provides the highest level of emergency care.

The Trauma Centre is a high-volume centre and receives 500-600 cases daily. Many of these are life-threatening such as strokes, road accidents, cardiovascular episodes, among others.

Al Qutami said given the global prevalence of traffic-accidents, and non-fatal injuries as a result of these accidents, it is highly important to provide utmost emergency care for such patients and provide them with a path towards rehabilitation to ensure patients retain maximum independence and quality of life possible.

He said the Authority continues to focus on all aspects to develop trauma care. Rashid Hospital recently introduced one of the most advanced 3D imaging equipment and navigation system for accurate and precision-based surgeries especially spinal surgeries and neurosurgery.

Robotic surgeries at Rashid Hospital

The three-in-one system known as O-Arm provides real-time imaging of a patient’s anatomy with high-quality images and a large field-of-view in both 2D and 3D.

Dr. Bilal El Yafawi, Consultant Orthotrauma surgeon and head of Orthotrauma department in Rashid Hospital and Chairman of the Trauma Conference said, “This is the future. With the introduction of the O-arm, we are able to use this system to do the CT scan in 25 seconds only. The scan is performed in the operation theatre, the O-Arm system provides us with all the images in real-time in a 2D or 3D format and provides us with 3D navigation. This allows the surgeons to precisely place the screw and fix the spine using real-time imaging. After the procedure, another CT scan is conducted in the OT again. This eliminates the need for re-surgery even in complicated cases. Moreover, the incisions in the spine are much smaller than those needed in conventional surgery, thus, recovery time is maximum three days versus a week in conventional surgery.”

El Yafawi said the centre will continue to enhance its services and its adoption of latest technologies such as robotic surgeries, which is expected to begin within the next three months.

He added that specialists have undergone extensive training in robotic surgery. He said the aim is to provide patients with minimally invasive solutions in surgery, to minimise their hospital stays, minimise their pain and assist with faster recovery.

Al Qutami also toured the exhibition area of the conference that displayed cutting-edge technological advancements in trauma management and care.

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This article appears in the March/April edition of Omnia Health Magazine. Other topics include AI in healthcare, patient safety, mobile healthcare and further updates around on COVID-19 from the healthcare industry.

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Like other jurisdictions around the world, the UAE has been impacted by the coronavirus outbreak and has taken positive measures to ensure its containment and management among its citizens and residents. These have included federally-mandated remote instruction across schools and universities nationwide, the testing or quarantining of passengers arriving into the UAE, and a campaign by the Ministry of Health to support hygienic practices to stop the spread of the disease.

Because of its preventive policy framework and protectionist legislation, the UAE does not suffer from many issues that are confronting other nations since the first reported cases of the coronavirus in December 2019.

Background

Based on perceived issues with pharmaceutical quality and efficacy from decades ago, the UAE elected to restrict the importation of pharmaceuticals and medical devices from China. The vast majority of medication imported into the UAE originates in Western Europe or North America. Indeed, the UAE counts Germany, the U.S., France, and Switzerland among the premier sources of its medication. Even a significant portion of herbal medication (often associated with Traditional Chinese Medicine) which enters the UAE arrives from the U.S. or Europe.

In recent years, the UAE has also begun the manufacture and exportation of generic drugs.

Therefore, with respect to pharmaceuticals and medical products, China is not a significant link in the medical supply chain of the UAE.

UAE law regarding the importation of pharmaceuticals and medical devices and related dispute resolution

In addition to the restrictions on country of origin, the UAE has very stringent laws and guidelines with respect to the importation of pharmaceuticals and medical devices. Specifically: no medication or device may be marketed within the country until it has been registered with the UAE Ministry of Health (MOH); medication or devices may only be imported into the UAE with a pharmaceutical or medical device import license as granted by the MOH, and medication or devices can only be sold or distributed by an agent who is duly registered with the MOH as well as the Ministry of Economy. The holder of a pharmaceutical license must be a UAE national.

Under applicable law, agency relationships between a principal and an agent are not arbitrable. Therefore, any disputes between a local agent and a foreign pharmaceutical company on contracts for the sale or importation of drugs or medical devices would have to be settled by the relevant UAE Courts.

A foreign medical drug or device manufacturer may set up a manufacturing presence within a free zone. However, the sale or distribution of such manufactured products would still need to be implemented by a licensed pharmacy or medical store. A foreign owner in such pharmacy or medical store would not be able to hold more than 49 per cent of that company’s shares.

Even in the nexus of these potential contractual relationships, it would be nearly impossible to avoid the application of UAE Law.

While parties in other jurisdictions may encounter issues relating to their pharmaceutical contracts and arbitration clauses contained therein, these are unlikely to affect the UAE because of various importation and legal restrictions.

Only time will tell how deeply other sectors of the UAE economy are affected by the coronavirus, and what legal knock-on effects may arise.

References available on request.

Sachin Kerur

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This article appears in the March/April edition of Omnia Health Magazine. Other topics include AI in healthcare, patient safety, mobile healthcare and further updates around on COVID-19 from the healthcare industry.

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A team of NYU Abu Dhabi (NYUAD) researchers have developed a new, one-pot synthetic approach to obtain water-stable and “ready to use” gold nanoparticles that can be heated with a simple green laser, improving the gold nanoparticles’ ability to penetrate and destroy malignant cells through hyperthermia and simultaneously releasing chemotherapeutic drugs. The unique design of these nanoparticles reduces the side effects of the drugs, potentially improving patients’ quality of life.

In the paper titled Aqueous Synthesis of Triphenylphosphine-Modified Gold Nanoparticles for Synergistic In Vitro and In Vivo Photo-thermal Chemotherapy, published in Chemistry-A European Journal, NYUAD Research Scientist Farah Benyettou and Associate Professor of Chemistry Ali Trabolsi, in collaboration with Professor of Biology Kirsten Sadler, presented the process of creating triphenylphosphine-functionalised gold nanoparticles by simply heating a solution of the triphenylphosphine gold (I) chloride salt in water under microwave irradiations.

How do gold nanoparticles work?

Biocompatible gold nanoparticles coated on the surface with triphenylphosphine molecules penetrate cancerous cells in preference. By combining the nanoparticles with heat, the researchers found a dramatically improved cell killing compared with heat or the nanoparticles alone. Combined therapies, and consequently improved cancerous cell killing, were achieved when cancer cells were irradiated with a green laser.

Since nanoparticles are constrained to the area of the cancerous tissue, the heat produced by absorbed laser energy causes the localised temperature to rise and release the drug that kills the cancer cells without damaging the surroundings. Therefore, nanoparticles are actually heating agents and drug delivery systems. The drug-coated particles manifested strong potential to act as an antimetastatic agent by inhibiting adhesion and invasion of cancer cells.

Speaking to Omnia Health Insights, Prof. Trabolsi explained that gold therapy (also called chrysotherapy) has always been the interest of physicians since the earliest days of civilisation. Gold and gold compounds were used in drugs for a wide range of diseases.

“In the last few decades, gold complexes and gold nanoparticles attracted significant attention as potential cancer treatments. In particular, phosphine gold complexes and phosphine-stabilised gold nanoparticles showed excellent anti-tumour activities. However, the synthesis of phosphine-supported gold nanoparticles has always been cumbersome, which limited advancements towards clinical trials,” he adds.

One-pot synthetic strategy

In the NYUAD research programme, to develop effective drug delivery systems for anticancer treatment, the research team developed a one-pot synthetic strategy that led to water stable and “ready-to-use” phosphine-supported gold nanoparticles for combined chemotherapy and hyperthermia.

The project started as the Capstone project of an undergraduate student in the Trabolsi Group at NYUAD and continued to be developed for the last three years.

“After completion of the first stage that included the synthesis and in vitro and in vivo (Zebrafish) testing of our material, we are looking to take a step forward and test our system in mice,” says Trabolsi.  “Additionally, we are working on extending our approach to other phosphine-gold complexes in order to generalise our synthetic strategy."

Egypt-based company Sixth of October Development and Investment Company (SODIC) is redirecting all its marketing resources to awareness and protection programmes on the coronavirus (COVID-19).

The move comes as part of stepped-up efforts in combating the coronavirus outbreak by joining the global community in creating awareness about the pandemic and attempting to curb its spread.

SODIC announced a multi-level approach which will see the resources redirected to creating awareness through its outdoor billboards and digital platforms, in coordination with the Ministry of Health. The real estate development company will also donate ventilators and monitors to Egypt’s Sheikh Zayed Specialized Hospital, for a dedicated unit equipped to receive COVID-19 patients.

The novel coronavirus (COVID-19) is now a global pandemic and confirmed cases and deaths are dramatically escalating. Beyond its human toll, COVID-19 is having a sizable economic impact. Many nations have shut down all non-essential business, which has devastated the global economy. National governments are now providing stimulus packages, which are injecting money into specific markets to address the severity of COVID-19 and its implications.

Nearly every industry has been touched in one way or another by COVID-19, but the healthcare market has experienced one of the most direct impacts. For many medical equipment markets, the pandemic’s impact is largely predictable—systems essential to diagnosing, monitoring, and treating COVID-19, like ventilators, patient monitoring solutions and digital X-ray, are experiencing exceptionally high demand and receiving the necessary funding, leaving little remaining budget for non-essential systems like magnetic resonance imaging (MRI) and interventional solutions. However, the prospects for medical imaging modalities, such as ultrasound, that fall somewhere in between essential and non-essential equipment are not as cut and dried.

Related: Report: Medical Imaging Trends 2020

Healthcare providers are using ultrasound systems for the triage, monitoring, and diagnosis of COVID-19 patients, however, currently neither the World Health Organization (WHO) nor the Centers for Disease Control and Prevention (CDC) are recommending ultrasound as a primary diagnostic imaging tool. Despite this, government healthcare relief funds are allocating money for ultrasound systems, but far less than the amount being allocated to purchase other imaging equipment such as digital X-ray and ventilators. The outlook for the ultrasound market is especially unclear since government intervention is not expected to completely counteract the negative impact of COVID-19. To navigate the uncertain ultrasound market, it is important to consider the following market dynamics:

Demand for ultrasound will be uneven

As mentioned before, diagnostic ultrasound can and is being used to diagnose COVID-19 in patients. The existing installed base of ultrasound imaging systems, regardless of the intended application, is being deployed to intensive care units (ICUs) where patients suffering from COVID-19 are receiving treatment and continuous monitoring. Despite this effort, demand for equipment will still be high and governments will seek to purchase necessary equipment. Healthcare expenditure allocated to ultrasound will be used primarily to purchase to point-of-care (POC) and primary care systems, causing unit shipments for these segments to spike during the crisis. POC and primary care equipment are ideal for treating sick patients in crowded hospitals because of the systems’ speed, portability, and ease of use.

While not to the same extent as POC and primary care equipment, healthcare providers will also purchase general imaging ultrasound equipment to be used during the crisis. General imaging equipment may be viewed as a viable long-term investment since it can be used to diagnose and monitor COVID-19 patients and then repurposed for many other applications once the pandemic passes.

Conversely, the demand for new larger, dedicated systems will be drastically diminished since elective procedures are being cancelled and delayed and funding is being allocated elsewhere. With healthcare providers directing their full attention toward the pandemic, their capacity to purchase any non-essential equipment will be severely limited. Instead of purchasing new equipment, practitioners are electing to extend the life of older systems during the crisis.

Supply chains are being disrupted

Even in situations where ultrasound systems are in high demand, the supply of ultrasound equipment will be limited to meet the needs. The presence of COVID-19 and its subsequent impact on the patient population has resulted in a shutdown of vast portions of the global economy, resulting in disrupted supply chains, limited materials and workforce, and slowed or stopped manufacturing. Additionally, many manufacturing plants are prioritising or even being retooled to produce other medical supplies and equipment such as ventilators, since they have the greatest need.

Overall revenues will likely decline during the crisis

POC and primary care are the two smallest ultrasound market segments and only accounted for a combined 11 per cent of ultrasound revenues in 2019. Even if POC and primary care revenues skyrocket in 2020, if the remaining 89 per cent of the global ultrasound systems market struggles to the degree that is expected, the overall market will decline.

Specific clinical applications will be hit harder than others by the pandemic. For example, demand for obstetrician and gynaecologist (OB/GYN) and cardiovascular systems, which respectively accounted for 20 per cent and 18 per cent of ultrasound revenues in 2019, will be very low during the crisis, since these systems are not related to COVID-19 and are typically less portable and more expensive than POC and primary care systems. Even within this example, cardiovascular systems will likely fair better than OB/GYN since they are easier to repurpose for COVID-19 diagnosis. It is also expected that following the COVID-19 crisis, there will be a large patient population with secondary effects of the virus, requiring a medical diagnosis of cardiovascular-related problems.

The relatively low price of POC and primary care systems is a plus for healthcare providers but will contribute to the overall decline in revenues. Since the ultrasound product mixture is shifting away from expensive, dedicated systems and toward less-expensive POC and primary care systems, the overall average selling price for an ultrasound system will drop in 2020. In 2019, the average cost for a POC system was US$20,000 compared to US$50,000 for the average cardiology, gastroenterology, urology, or breast system. Therefore, the presence of COVID-19 will have a larger impact on overall revenues than unit shipments.

The extent of the market decline will depend on the duration and toll of the crisis. The higher the prevalence of cases and the longer the pandemic lasts, the more dramatic the decline in revenues will be. If the coronavirus is contained and controlled quickly, less damage will be inflicted on the market. However, if COVID-19 is deadlier and longer-lasting than anticipated, or if there is a reoccurrence in the fall, then the impact of the illness will increase. Since the full impact of COVID-19 is still to be determined, Omdia accounted for several scenarios in its update to the forecast of the ultrasound market. Three scenarios and their effects on the global ultrasound market are defined and shown below.

The ultrasound market will rebound

For the most part, demand for ultrasound systems will only be delayed during the COVID-19 crisis, not cancelled. As a result, demand for systems unrelated to COVID-19 will be pent up resulting in elevated revenue growth in 2021 and 2022 as seen in the chart above. Ultrasound has the propensity to recover quicker than other medical imaging modalities because the equipment is quicker to manufacture and less expensive than systems like CT and MRI. Additionally, many nations are expected to increase healthcare expenditure following the crisis to revamp their healthcare infrastructure to safeguard against a future pandemic. These efforts would drive strong demand for ultrasound systems, especially for POC, primary care, and general imaging equipment, in the short- and medium-term.

COVID-19 may have long-lasting implications

While the world remains hopeful that it will stifle the virus and quickly return to normal, the pandemic will likely have long-lasting implications. One of the most significant consequences might be to the global economy. The Organization for Economic Cooperation and Development (OECD) has warned that the illness is the biggest threat to the global economy since the 2008 financial crisis and drastically downgraded its 2020 global economic projections (Source: OECD). If the global economy suffers as expected, it will likely take several years to fully recover. Along with a suppressed economy, if healthcare budgets are overextended during the battle against COVID-19, there will be little funding remaining for future investment in healthcare unless governments make it a priority.

The impact of COVID-19 will be unequal

The impact of COVID-19 varies dramatically on a geographic level. The epicentre of the pandemic appears to have shifted from the Asia Pacific to Western Europe, and most recently to the United States. Countries with a well-equipped healthcare infrastructure, like Japan, will be able to mobilise resources to effectively combat the pandemic. As a result, these nations’ death tolls and demand for new equipment will be minimised. Conversely, developing markets such as Mainland China lack an adequate installed base of equipment so they will have a high demand for systems during the crisis. Similarly, markets where POC and primary care systems are more present, like the United States and Western Europe, will be better prepared to treat the influx of patients since they have more equipment and training. However, markets like many in the Middle East that heavily favour dedicated systems will be forced to repurpose equipment, purchase new systems, quickly learn POC techniques, or rely on other imaging modalities.

There are also stark differences in healthcare manufacturers’ abilities to endure the pandemic. Clearly, point-of-care and primary care ultrasound manufacturers will see high demand for their equipment and may even benefit from the situation. Most ultrasound manufacturers do not focus only on POC and primary care and are susceptible to the ailing market caused by COVID-19. Such companies that have diverse portfolios and strong supply chains are better suited to withstand the crisis since they will be able to reorient their sales to focus on systems that are being purchased for healthcare relief. Manufacturers that specialise in dedicated systems unrelated to the diagnosis of COVID-19 will bear the brunt of the pandemic.

The future remains largely uncertain

Currently, the full impact of COVID-19 is still unclear. While most of the world is far from overcoming the pandemic, early signs of recovery in Asia-Pacific countries, such as Mainland China and South Korea, are positive indicators for other countries.

As the daily toll of those sickened from the coronavirus continues to rise across the globe, an acute shortage of ventilators is prompting a desperate search for the critically needed machines, prompting government-led initiatives as well as private-sector partnerships to come up with new ventilator solutions.

But while ventilators will be in extremely tight supply for the short term, forecasts show the ventilator market can expect an almost doubling of shipments this year compared to 2019, new research from Omdia shows in the wake of the pandemic from the coronavirus disease, also known as COVID-19.

What is unclear, however, is whether the bump in shipments, expected to spread out through the course of the year, will be enough to treat those projected to succumb to the deadly virus. Even so, ventilator shipments are forecast for growth despite initial fears, as manufacturing capacities to make ventilators will be engaged to their fullest from now until the end of the year. Many leading ventilator suppliers have plans to expand capacity, and non-healthcare suppliers are looking to support the provision of components.

Worldwide ventilator shipments in six categories are projected to reach a total of 691,840 units for the year, up 60 per cent from 430,843 units in 2019, as shown in the chart below. Translated into revenue terms, the ventilator market this year will be worth US$4.6bn, a hefty increase of 71 per cent from US$2.7bn in 2019.

In 2020, a significant increase of 104 per cent in ventilator shipments is projected in the critical care-high acuity segment, where high-end devices with advanced functionality are deployed exclusively in critical-care settings. Growth, at 87 per cent, is also high in the critical care-mid acuity segment, where the ventilators being used are also for critical-care situations but do not possess the same level of advanced features found in the high-acuity segment. In the sub-acute segment, where ventilators are designed for use outside the intensive care unit (ICU) of hospitals or healthcare facilities, shipments will increase by 136 per cent.

In the remaining ventilator segments, growth will range from 99 per cent in the emergency and transport segment, to 40 per cent for home care, where the machines are used for those on both life support and long-term non-life support. The ventilator segment with the year’s slowest growth of 13 per cent will be in the neonatal segment for newborn infants, where COVID-19 has had less effect and, subsequently, requires less demand for ventilation support.

Extreme shortfall

Despite the rise in both shipments and revenue projected for the ventilator market this year, ventilators are currently in severe undersupply. Manufacturers say they are unable to produce more ventilators because of an acute shortage in components, brought about by the closing of production lines in locations all over the world, where the components are made.

Ventilators help with breathing for those unable to breathe on their own. But the machines are complex, using specialised parts and sophisticated software.

Omdia sources say there are ongoing industry discussions to move the manufacturing of non-ventilator-related lines to produce items such as casings, electronic components, or even turbines for use in ventilators. Many non-ventilator manufacturers have also been asked to develop specific ventilator products from scratch, despite initial thought on the difficulty of producing some elements, such as the circuit board or the ventilator software.

Increased demand is also foreseen for solutions to help patients that have been hospitalised and need respiratory assistance but do not yet require a ventilator. Examples of these solutions include oxygen therapy, high-flow nasal therapy, and CPAP—continuous positive airway pressure—machines.

The players

The core players in the ventilator market include Getinge from Sweden; German-based Drager; Switzerland’s Hamilton; Philips Healthcare from the Netherlands; and U.S. makers GE Healthcare in Illinois, and both ResMed and Vyaire Medical from California.

In the UK, the government is pursuing multiple strategies to source 30,000 ventilators for the country’s National Health Service to treat COVID-19 patients. At least 12 firms have come together forming a consortium to scale up the production of already proven ventilator models made by two UK specialist firms, Smiths and Penlon. The Ventilator Challenge UK consortium includes, among others, Airbus, Rolls-Royce, Ford, McLaren, and Siemens, working on a lightweight portable ventilator from Smiths; and on a more heavy-duty machine suitable for hospital use, from Penlon. UK defence firm Babcock has also joined engineering company Dyson, the maker of household appliances such as vacuum cleaners, to produce a new medical ventilator based on specifications set by the UK government. Separately, Dyson also reported it had developed a new ventilator called the CoVent.

In other initiatives, engineers at University College London worked with the institution’s hospital clinicians and with Mercedes Formula One to build in less than a week, a breathing aid that could help keep COVID-19 patients out of ICUs. The device delivers oxygen to the lungs, forgoing the need for a ventilator, and is already approved by UK regulatory agency MHRA.

In the U.S., President Trump urged the states to look for solutions and fend for themselves. And in the absence of an official directive from the White House on how the industry might help ease the lack of ventilators and other equipment to protect the vulnerable, American companies have stepped in to fill the gap and are partnering to find solutions. 

Automakers Ford and General Motors (GM), for instance, are teaming up with ventilator manufacturers to build ventilators. Ford and GM both have a history of assisting the U.S. during national times of crises. Ford is likewise in partnership with GE Healthcare and 3M to manufacture approximately 1,000 respirators a month, utilising fans from F-150 trucks, the most popular in the country, and parts made on 3D printers. Those parts, however, must be combined with electronics that are made by other parties.

European carmakers have also been approached by their own governments to help produce more ventilators. Germany called on Volkswagen AG, which had shut down its factories, asking them to shift production to ventilators and masks. In Italy, which has the highest number of COVID-19 deaths in Europe, Ferrari NV and Fiat Chrysler Automobiles NV are in talks with the country’s biggest ventilator manufacturer to help boost output of the breathing devices. Meanwhile, Dublin-based manufacturer Medtronic Plc is in talks with Elon Musk, CEO of U.S. electric vehicle and clean energy firm Tesla Inc., to make ventilators. In the U.S., Musk had taken steps to procure more than 1,200 ventilators from China for distribution to American hospitals for free.

Knock-on impact on 2021

With demand for ventilators projected to rise significantly throughout the year, what is expected in 2021?

From all indications, the anticipated increase in ventilator shipments will be more than enough to fulfil ventilator demand for both this year and the next. Not only will replacement shipments fill the gap left by ventilators that had to be retired after COVID-19 use, but the sheer quantity of ventilators contained in the shipments will also result in the market being flooded with ventilators this year.

For 2021, Omdia projects a significant decline in ventilator demand, with initial projections of a global decline in unit shipments of 45 per cent in 2021 compared to 2020. It is likely that the market will become even more price competitive, with a surplus of vendors active and competing for share.

Other issues to consider

From the time the first cases of COVID-19 were reported in Wuhan, China, at the beginning of January, the virus has spread with alarming ferocity. Bracing for the worst, government and health authorities worldwide also say they do not know how long the pandemic might last.

Besides, the need for more ventilators are various auxiliary issues to be considered in the ongoing fight to contain the virus. These issues include—but are not limited to—the following:

• An overall lack of ICU healthcare doctors and nurses
• A serious dearth in facilities to house COVID-19 patients apart from the healthy population
• The appearance of new products in the market for which training will be required but not be immediately available
• The need for correct software coding of new products, an intensive and laborious process
• The possibility of pulling lower-acuity ventilators from sub-acute settings, such as general wards and step-down wards, to help fill the shortage of ventilators in ICUs
• The “weighing” of one life against another, as doctors determine how to allocate an inadequate number of ventilators for use in a much larger sickbay
• The “stockpiling” of emergency ventilators and similar machines not suitable for high-acuity patients for pneumonia
• The need to protect ventilator production lines from being infected