Telemedicine has revolutionised the way medical assistance is provided globally. The COVID-19 pandemic triggered the adoption of digital healthcare solutions, which continued to gain prominence due to the convenience of remote diagnosis and personalised care.

The opportunities in digital health have paved the way for several innovations in the industry. The integration of wearables into telemedicine is one such step in the direction of remote patient monitoring (RPM), given its potential to enhance patient outcomes by seamlessly capturing patient data in real time and assisting them in making informed decisions.

Dr. Matthew Gettman, Chief Medical Officer at Sheikh Shakhbout Medical City (SMMC), said that the demand for telemedicine and wearable medical technology is projected to grow at a substantial rate by 2027 across areas of chronic disease management and diagnosis, elderly care and fitness management.

‘’Given the high rates of chronic disorders in the UAE, patients living with cardiovascular diseases and diabetes are more likely to adopt innovative digital healthcare solutions that support monitoring and managing their conditions effectively. Through its robust infrastructure and its vision of having a nationwide provision of telemedicine healthcare services, citizens and residents of the UAE are bound to benefit from managing their health through innovative means. To help support this, SSMC is working towards combining medical practice, education, and research to explore new technologies, innovate new treatment methods and streamline processes to transform the delivery of care in the region,” said Dr. Gettman.

The global RPM systems market is predicted to be worth over US$ 1.7 billion by 2027. At present, global healthcare systems are increasingly adopting RPM technologies to streamline the exchange of information between patients and caregivers. Devices such as glucose monitors prompt diabetes patients to take their insulin, simultaneously allowing their physician to monitor the disease. Additionally, digital blood pressure monitors allow patients to digitally share their blood pressure and blood oxygen level with their doctors.

In the UAE, GluCare.Health, a hybrid digital therapeutics company for diabetes management and obesity, allows patients to connect remotely with a care team member. The application collects data from connected devices, such as Fitbit, continuous glucose monitor (CGM,) or a connected weight scale and displays them on the app. The care team can then monitor patients’ data, provide information on glucose, sleep and activity, and manage medications.

Brandon Rowberry, CEO of Digital Health, Aster DM Healthcare, said that the demand for telemedicine in the region has rapidly increased since the pandemic. He believes that the wearable technology industry is still in its infancy and, in the future, will be pushed from the consumer to the healthcare side, wherein data recorded by the devices will be used to develop in-depth insights and data ecosystems, thus encouraging people to stay healthy.

As the industry continues to introduce groundbreaking technologies in day-to-day operations, the use of these solutions will prove invaluable in making the healthcare systems more efficient and significantly simplify medical processes, thus reducing the stress of the clinical staff.

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As the world celebrates World Health Day on April 7, the World Health Organization (WHO) highlights a yearly theme to raise awareness and set the tone for the future. This year's theme is “Health for All”, reminding people that health is the most valuable asset. While people tend to neglect their health due to their busy lifestyles, the WHO encourages adopting healthy habits and improving overall well-being for a happier life.

In its 75th anniversary, the WHO looks back at transformations in medicine and healthcare that have improved the quality of life for many. “The history of WHO demonstrates what is possible when nations come together for a common purpose,” said Dr. Tedros Adhanom Ghebreyesus, WHO director-general. He added: “We can only meet these global challenges with global cooperation.”

The UAE has also significantly improved public health over the past few decades and ranked among the top countries globally in 14 health indicators. The country is actively developing new and comprehensive approaches using emerging technologies such as artificial intelligence and big data.

The country has also made impressive progress in reducing the prevalence of infectious diseases and implemented several successful vaccination campaigns that have eradicated diseases such as polio and measles. The government has also taken significant steps to combat communicable diseases like tuberculosis and HIV/AIDS.

The UAE has prioritised primary healthcare services, focusing on wellness, prevention, and treatment. “Primary healthcare with a focus on wellness, prevention, and treatment should be the universally available first point of contact for anyone to access healthcare services,” said Dr. Azad Moopen, Founder, Chairman and Managing Director of Aster DM Healthcare. “It is important that mandatory comprehensive primary healthcare entry becomes the foundation for a good healthcare system. This will assure universal access for prevention and early detection of diseases and aid in improved health outcomes at a much lesser cost.”

Dr. Azad Moopen

One of the UAE's most notable public health achievements is its universal healthcare system that provides comprehensive medical services to all citizens and residents. The government has invested heavily in the healthcare sector, focusing on preventive care measures. This has helped improve the population's health and reduce the burden of chronic diseases.

Jerome Droesch, CEO of Domestic Health and Health Services, International Health, Cigna Healthcare, said making healthcare accessible to all, including lower salary band employees, is crucial. “Regulators play a key role in increasing the scope of mandatory solutions that guarantee access to care for employees. The UAE and the region are ahead of the curve in these regulations, especially compared to other markets where some crucial healthcare policies may not be accessible to the lower-earning segments of the population. For instance, the recent mandate by the UAE to implement mandatory cover for mental health is a remarkable step towards improving the overall quality of life and care for everyone.”

Jerome Droesch

He added, “The definition of quality access to care can vary based on factors such as culture, gender, biases, and more. Therefore, health insurers must develop unique solutions that cater to different clients' different needs. For patients who can't afford expensive healthcare solutions, insurers should ensure that even the lowest income segment can access care as often as required.”

With digitalisation being the future of healthcare, the insurance industry, too, is adopting technology to improve healthcare outcomes. “Innovation and new technologies are revolutionising treatments and driving emergency care, as well as the 'healthcare-at-home' market,” said Jerome.

“The use of wearable technologies in healthcare has gained traction, and the industry has grown phenomenally in the past year. This will significantly contribute to early detection, prevention, and management of key diseases, leading to overall health and wellness,” he added.

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According to the World Health Organisation (WHO), cervical cancer is the sixth most common cancer in women in the Eastern Mediterranean (EM) Region. In 2020, an estimated 89,800 women were diagnosed with cervical cancer in the region, and more than 47,500 women have died from the disease. The WHO has developed a regional cervical cancer elimination strategy adapted to the religious, cultural, social, economic and geographical contexts in the Eastern Mediterranean to eliminate cervical cancer. And to scale up efforts on ending cervical cancer, the awareness initiative’s messaging is loud and clear - Get informed. Get screened. Get vaccinated.

Cervical cancer is a type of cancer found anywhere in the cervix (the entrance to the uterus from the vagina). It's part of the reproductive system and is sometimes called the neck of the womb. It usually grows very slowly. The severity of the disease depends on the size of the affected area, its spread and the immunity of an individual. Almost all cervical cancer cases (99 per cent) are linked to infection with high-risk human papillomavirus (HPV), an extremely common virus transmitted through sexual contact. Although most infections with HPV resolve immediately and cause no symptoms, persistent infection can cause cervical cancer in women.

Awareness is key

HPV is an abbreviation for human papillomavirus, which is associated with causing cervical cancers as well as genital warts in most cases. HPV is sexually transmitted, and one can get it from anal, oral, or vaginal sex. Scientists and doctors have discovered over 200 types of HPV, but most don’t cause cervical cancer as an individual’s immune system usually controls infection. Sometimes high-risk HPV infections are not successfully controlled by immunity alone. When that persists for many years, it can form an area of precancerous cells, which, if untreated, may worsen over time and become cancerous. Research has found that it can take 10 to 20 years, or even longer, for HPV-infected cervical cells to develop into a cancerous tumour. Once high-risk HPV infects cells, it disrupts how these cells communicate with one another, causing infected cells to multiply in an uncontrolled manner.

Doctors categorise HPV into two types: (a) HPV types 6 and 11 can cause genital warts. These HPV types aren’t associated with causing cancer and are considered low-risk. (b) HPV types 16 and 18 are high-risk types.

Among women whose cervical cells are infected with high-risk HPV, several factors increase the chance that the infection will be long-lasting and lead to precancerous cervical cells. These include having a very aggressive HPV type, particularly HPV 16 or HPV 18. If an individual has either of these HPV types, one should ensure to receive diagnostic testing with a colposcopy. Also, quitting smoking can help the patient’s body to fight HPV. The weak immune system plays an important factor as well. If a person has HIV or is taking medicines that suppress her immune system, then it is ideal for them to talk to their healthcare provider about diagnostic testing and follow-up.

Screening is crucial for prevention

Screening helps doctors to check for the disease before the symptoms appear. The objective of cervical cancer screening is to find precancerous cervical cell changes and establish when/which treatment can prevent the disease from developing. This screening typically starts at age 30 and is repeated periodically. The cancer is usually easier to treat if found at an early stage. By the time symptoms such as vaginal bleeding (after sexual intercourse/menopause), pelvic pain or pain during intercourse, vaginal bleeding between periods etc., appear, cervical cancer may have begun to spread, which makes treatment more difficult.

There are three main ways to screen for cervical cancer. Firstly, the HPV test, which checks cells for infection with high-risk HPV types that can cause cervical cancer. Secondly, the Pap test (also called a Pap smear or cervical cytology) which collects cervical cells. These collected cells are examined for changes caused by HPV that may—if left untreated—turn into cervical cancer. Pap tests can find both precancerous cells and cervical cancer cells. It may also sometimes find conditions that are not cancer, such as infection or inflammation. Finally, the HPV/Pap co-test uses an HPV test and Pap test together to check for both high-risk HPV and cervical cell changes.

Vaccination is vital to save lives

The HPV vaccine protects against infection from nine HPV types; the two low-risk HPV types that cause most genital warts, plus the seven high-risk HPVs that cause most HPV-related cancers.

Vaccination provides strong and safe protection against new HPV infections. It is the best-known preventive measure but does not cure an infection once a person has it. However, the vaccine is not for treating infections or diseases caused by HPV but instead should be taken as prevention rather than cure.

The vaccine is given in two doses and offers the most protection when given at ages 9-14. It is estimated to prevent up to 90 per cent of HPV-related cancers.

Cervical cancer is one of the most preventable and treatable types of cancer. This message should be loud and clear that this disease is successfully treatable, and many lives can indeed be saved as long as it is diagnosed early and managed effectively. Patients diagnosed at later stages of cancer can also be managed with appropriate treatment and palliative care.

Since there are multiple and intersecting sociocultural, economic and health challenges in the MENA/EM region, there is a dire need for discussion and close interaction with national stakeholders to better understand the perceptions of policy-makers as well as the barriers and opportunities related to implementation. Therefore, going forward, our goal should be to educate the masses on various aspects of cervical cancer while endeavouring to create a healthy ecosystem so that they may receive the benefits of advances in medical science, be it screening, treatment or HPV vaccination – only then we can strive towards realising the dream of eliminating cervical cancer in its truest sense.

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Creating an ecosystem of sustainable healthcare is a goal shared by countries across the globe, but Finland has set itself apart from others with world-class research and development to create future-proof hospital infrastructure, secure data and analytics, implement digitally enabled care, and introduce energy efficiency in logistics and business operations.

“Finland is one of the few countries that has embraced health data as part of our business-friendly legislation and has over half a million genomic samples voluntarily given by the population. This says a lot about our dedication to disease prevention and innovations for early predictions while reducing costs,” said Meria Heikela M.Sc, Director of Business Finland.

Dubbed number one in the world for sustainable development by the UN Sustainable Development Report in 2021, Finland is further gaining prominence for personalised healthcare that demonstrates its commitment to access and inclusivity. The country is also a world leader in diagnostics and home to world-class innovation with efficient healthcare systems backed by government support.

Adding to its long list of recognition, the Global Competitiveness Report 2020 by the World Economic Forum named Finland the top creator of “markets of tomorrow” notably in areas that require public-private collaboration.

The Finland Pavilion at the recently concluded Arab Health gave visitors from around the globe the opportunity to discover some of the leading innovations set to be a game-changer. There were about eight organisations in the zone, including Business Finland, which facilitates meetings to nurture connections and build long-term partnerships between the regional and international attendees. Each brings forth top-notch healthcare solutions centred on automation, artificial intelligence, machine learning, cloud connectivity and SaaS platforms.

The Optomed Aurora IQ, for instance, is a retinal imaging camera both portable and powerful in terms of image quality. The smart, handheld device features an integrated cloud connection and can detect retinal changes, which helps professionals identify conditions such as diabetic retinopathy at an early age. The state-of-the-art equipment also comes with an optional AI service for analysis.

The solutions presented at the Finland Pavilion addressed most sectors in the healthcare industry, each armed with a theme to integrate digitalisation in healthcare. According to Anni Iso-Mustajarvi, Director of BeeHealth SaaS Platform, it is also important to create technology that brings ease of use among medical professionals. In addition, she said that the latest advancements coming from Finland are built on over 10 years of dedicated focus on digital health and well-being.

“We have universal health records, strong authentication and many more. Efficiency is also something we take into consideration. Our digital clinic model, for example, aims to serve 10 to 30 patients in one hour in a quality manner. We also strive to keep doctors happy, making technology user-friendly, accessible, and available to everyone,” she added.

This article appears in the Daily Dose 2023. Read the full issue online today.

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The future of digital health is rapidly evolving and transforming the industry. Integration of digital technologies has revolutionised how healthcare services are delivered and created new opportunities for improved patient outcomes as well as reduced costs. This evolution is expected to continue as digital health solutions become increasingly sophisticated and more widely adopted, especially with the investments by governments post-pandemic.

In recent years, the digital health industry has seen tremendous growth. According to a report by Grand View Research, the global digital health market is expected to reach US$536.6 billion by 2027, at a CAGR of 18.3 per cent into 2027. This growth can be attributed to the increasing demand for remote patient monitoring, telemedicine, and e-prescribing solutions.

A key driver is a need to provide more accessible and affordable healthcare to an ageing population, particularly in the GCC nations that serve high quality of life, thereby allowing for longer lifetimes. With an increasing number of elderly patients, the demand for home based and remote healthcare services are expected to grow. In addition, the recent pandemic accelerated the adoption of digital health solutions, with telemedicine becoming a critical component of healthcare delivery.

Leaders in digital health in the GCC believe the future of medical care will be centred around patient-centric solutions and are inviting global leaders in this space to help innovate in the sector. According to Joe Moscola, CEO of Cerner Corporation, “The future of healthcare is about putting the patient at the centre of everything we do and using technology to empower them.”

By giving patients access to their health information and the ability to communicate with their healthcare provider instantly over connected devices, digital health solutions are helping to improve patient outcomes and reduce costs, but more importantly, creating a trusted environment and ecosystem of medical care.

The investments of more than US$1.5 billion by Mubadala since 2018 into digital health and the same amount being allocated by the Kingdom of Saudi Arabia for healthcare information technology and digital transformation programmes underscores the importance being given by these two economies to the future of healthcare.

Another trend in digital health is the integration of artificial intelligence (AI) and machine learning (ML). AI and ML are transforming healthcare by providing more accurate diagnoses and treatments, particularly due to deeper and faster analysis of millions of records and big data information that can take regular human practitioners weeks to parse. “AI and machine learning are changing the way we think about healthcare, from diagnoses to treatments to patient outcomes,” said Dr. Eric Topol, a leading expert in digital health.

Blockchain technology has also entered the fray and is expected to play a key role in the future of digital health. Given the UAE and KSA’s increased focus and investment in blockchain innovation for a variety of industrial uses, the healthcare sector can expect more secure and transparent platforms for exchanging patient health information, enabling better collaboration between healthcare providers and payers, as well as improving the overall quality of care.

Despite the growth and potential of digital health, there are also challenges that need to be addressed. One of these is ensuring the privacy and security of patient health information. With the increasing amount of sensitive health data being collected and stored, it is essential to have strong privacy and security protocols in place to protect patient information. Blockchain is being seen as a key answer to this concern.

Another challenge is the lack of standardisation in the digital health industry. With so many different solutions available, it can be difficult for healthcare providers to know which are best for their patients. The lack of standardisation also makes it difficult for providers to seamlessly integrate different solutions into existing, legacy systems critical for patient care and outcomes.

The future of digital health is promising, however, there are challenges that need to be addressed, including privacy and security concerns, and the lack of standardisation in the industry. By working together, the healthcare industry and technology leaders can help to ensure that the future of digital health is one of the improved health outcomes and reduced costs for patients.

This article appears in the Daily Dose 2023. Read the full issue online today.

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Lung cancer places a heavy burden on patients’ lives and healthcare systems, as the number one cause of death in the world among both men and women. Unfortunately, most cases are diagnosed when metastatic and only about 20 per cent of the disease is responsive to curative-intent surgery. Thus, there is an urgent need to improve early detection strategies to increase the fraction of cancers diagnosed in early stages when they are most curable.

According to Dr. David Carbone, Professor of Internal Medicine and Director of the James Thoracic Oncology Center at The Ohio State University Comprehensive Cancer Center, it is always better to prevent lung cancer than to treat it, considering the high number of relapses in half of the patients despite having tumours surgically removed at an early stage. Healthcare providers are diverting their attention to reversing changes in the airway epithelium early and prevent the development of the lung disease.

At Arab Health, Dr. Carbone highlighted the advances in surgery combined with medical therapies such as chemotherapy and immunotherapy. These have recently undergone revolutionary changes, thanks to large-scale clinical trials, and will continue to develop over the next few years.

Dr. Carbone has over 30 years of experience as a specialist in lung cancer and operates a research lab dedicated to the study of different components related to the disease.

“We have witnessed dramatic improvement in our treatments and the outcomes, however, there remains huge room for improvement as we still lose many patients from lung cancer. We are looking for better approaches to personalise therapies to better understand why some patients respond while others do not,” he said.

Understanding these patterns enable the selection of the optimal current therapy for individual patients, as well as the development of new therapies that overcome resistance mechanisms, which can be administered to patients whose tumours would not otherwise respond.

Dr. David Carbone

Improving and personalising therapies

Dr. Carbone’s research over the years has focused on answering these questions, studying tumours before and after surgery, and the application of different approaches such as genetics and proteomics.

“We recently published a paper in Nature Medicine, looking at patients treated with immunotherapy before surgery, and these patients have significantly improved survival outcomes. By studying blood and tumour samples before and after therapy, we can try to discover some of the new features of patients and their cancers to personalise therapies (called “biomarker”) and discover the mechanisms of resistance,” said Dr. Carbone.

The discovery of specific biomarkers in lung cancers has transformed the way the disease is treated. Now, multiple subsets of cancers can be recognised and diagnosed, and have specific, personalised treatment approaches. “In the past, we treated all patients with the same approach and saw quite poor outcomes with lung cancer,” he added.

With biomarkers and molecular testing, specific treatments can be matched to specific patients. This has resulted in improved outcomes for patients with unresectable diseases.

“We are just learning how to best combine targeted and immunotherapies with surgery. A targeted therapy has now been approved for patients that have a specific genetic alteration in the EGFR gene, and many patients with tumours without these gene alterations are now approved to get immunotherapy in addition to surgery. Looking ahead, we are hoping that the biomarker-directed personalisation of therapies for lung cancer patients will improve outcomes,” said Dr. Carbone.

Lung cancer surgery over the years

Considered a complex surgery, lung cancer surgery in the past involved large incisions and long hospital stays. Recently, minimally invasive approaches have been developed, including robotic surgeries that involve very small incisions in the skin with faster recovery, less pain, decreased hospital stays, and a good sampling of lymph nodes.

“The other major advance in surgery is surgeons working more closely with medical and radiation oncologists to do multi-modality management of these patients. This can dramatically improve chances of survival by combining medical therapies with the surgery,” he said.

Dr. Carbone explained that chemotherapy contributed around five per cent of the five-year survival rate among patients. Now, early data demonstrate almost 80 per cent survival at three years with immunotherapies, which is almost twice of what would be expected. “This multi-speciality approach to lung cancer has transformed the way we treat patients. Selection of the appropriate medical therapy combinations requires gene sequencing and other biomarker testing of the patient's tumour. Presently, the standard of care is to conduct gene sequencing and marker testing in every patient,” he said.

The role of technology

Robotic surgery is recognised as an extraordinary innovation where a surgeon leads with a controller while a robot does the surgeries. This gives surgeons the opportunity to examine patients at angles that were previously impossible. In the case of cancers, they have a stereoscopic vision for much better visualisation of the tumour and its surroundings.

“Robots give surgeons the ability to move surgical instruments in a way that is not possible with human hands. In addition, we can now perform a genetic assessment of the tumour using only a drop of blood from a sample, instead of a tumour biopsy. The technology behind current imaging, bronchoscopy and staging with a bronchoscope by endoscopic ultrasound have all dramatically improved. All of these technologies did not exist decades ago, and are now significantly improving how we manage these patients,” said Dr. Carbone.

Looking ahead

To improve and better tune therapies to individual patients, the team at James Thoracic Center at The Ohio State University is always vigilant in identifying new features of cancers.

“In our latest research study, we discovered patterns of distinct types of immune cells in the blood of patients before treatment that were associated with whether or not they responded to immunotherapy. We also identified some markers that could be used as additional therapy targets, where rational combinations could convert non-responders to responders. This is done by selecting patients for different types of immunotherapy based on these markers. I believe this should be a priority for future research,” he added.

When asked about the importance of collaborations, Dr. Carbone commented that conferences such as Arab Health engage physicians from all over the world and help them work towards optimising care everywhere in the world.

“The latest findings and optimisation of patient multi-speciality care are a few of many topics discussed at conferences like Arab Health. While it is important that prominent universities discover cutting-edge approaches, disseminating that technology and implementing it around the world to benefit all patients is also critical. I believe that is the true goal of such a conference: to disseminate information and provide patients all over the world with access to state-of-the-art technologies.”

This article appears in the Daily Dose 2023. Read the full issue online today.

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Technological advancements today are gradually changing the practice of surgery with several innovations in imaging and robotics, among other fields. The future of surgery will increasingly require cooperation between humans and healthcare technology and successfully complement each other’s work.

In an interview, Dr. Timothy F. Witham, Professor of Neurosurgery and Orthopaedic Surgery, Director, The Johns Hopkins Bayview Spine Program; Director, The Johns Hopkins Neurosurgery Spinal Fusion Laboratory; Associate Program Director, Johns Hopkins Neurosurgery Residency, Baltimore, US, discusses the applications of different technological advancements in surgery and its potential for increasing less invasive surgeries and moving towards preventative healthcare. Excerpts:

How successful has augmented reality(AR) been in spine surgery?

AR has been quite successful. At the same time, several improvements are being made to enhance it further. Currently, the indications are relatively limited for the technology in spine surgery. It is being utilised for placing implants into the spine, known as pedicle screws, commonly used for a procedure called spinal fusion. We can use AR technology to place these screws very accurately. But it does come at the cost of taking more time than usual in the operating room. Also, the technology carries some expense to the hospital. Some of the improvements in the future will have to include making it less time-consuming, improving efficiency and utilising it for additional aspects of spine surgery.

Dr. Timothy F. Witham

What are some of the main challenges of incorporating such technologies?

Some surgeons can be reluctant to change the way they do procedures and don’t want to be slowed down by it. The way to overcome that barrier is to show them that these technologies can be an augment in making the procedures more accurate and efficient. Therefore, we have to utilise the technology better and improve it so that it’s easier to use for everyone. We’re not there yet; not everyone has adopted this technology, but it will improve.

Which technologies do you think will become more mainstream in the next decade?

I think we are going to move to the metaverse. Technologies such as robotics, artificial intelligence, machine learning, augmented reality, and virtual reality are all developing and moving forward and are going to play a key role in medicine. For example, these technologies will further enhance electronic medical records and imaging technology and ensure that we are able to communicate better through the internet. There will always be a human component to medicine, but these technologies will play a more significant role in what we do in the future.

In your opinion, how do you see the field of surgery evolving?

One of the major things that will happen in surgery is that we will be carrying out less invasive procedures thanks to advancements in technology. There will also be more focus on preventive medicine and potentially eliminating or diminishing the need for certain surgical care procedures by preventing certain diseases from getting to the point of surgery. In the future, we will also be able to do much more with imaging and testing with blood work and genetic tests, where people will get a total body scan. It will be able to show if people are at risk for certain diseases and allow for building a preventive strategy.

This article appears in the Daily Dose 2023. Read the full issue online today.

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