Emirati internal medicine consultant Dr. Farhana bin Lootah served on the steering committee collaborating on preparing a document proposing key recommendations for global policymakers that was released to mark International NASH Day 2019.

"We know the prevalence of NASH is rising parallel to obesity and type 2 diabetes. This is a real problem in areas where these conditions are prevalent, such as the Middle East,” says Dr. Farhana. “We need to integrate NASH into existing policies and initiatives aimed at preventing and reducing obesity, especially among children and young people.” - Dr. Farhana bin Lootah

Key recommendations

The report titled ‘Creating a policy narrative around NASH in Europe and the Middle East’ made recommendations that, as a critical starting point, we need to improve our understanding of NASH – in terms of who and how many people are affected, what influences disease progression and how to effectively prevent and treat it.

A multidisciplinary approach to non-alcoholic fatty liver disease (NAFLD) and NASH is needed and should be reflected in the integration of NAFLD and NASH into public health policies on obesity and multidisciplinary models of care.

Also, the intrinsic links between NAFLD, NASH, obesity, type 2 diabetes, CVD and other NCDs should also be underlined in health promotion initiatives, professional education and policy efforts.

A multidisciplinary approach is needed and should be reflected in the health policies on obesity.

“We also need to improve the diagnosis and management of NASH in clinical practice. The lack of reliable, non-invasive diagnostic tests for NASH hinders early diagnosis and misses opportunities to prevent disease progression. It also complicates the discovery of potential treatments for NASH: as long as people with NASH remain undiagnosed, clinical trials will struggle to recruit participants and will thus remain unable to test potential new medicines,” the report concluded.

So, you’ve invested in technology, trained the medical staff, upgraded to an Electronic Health Record (EHR) system, updated the hospital Stock Keeping Unit (SKUs) and still the compliance rate of usage reporting inside the operating room (OR) is low, the reports are inaccurate, the charges are missing, and countless coding errors occur. This means that the hospital has trouble meeting U.S. Food and Drug Administration (FDA) requirements regarding digital updates to the patient’s file, its inventory isn’t efficiently managed, and it is losing money, a lot of money – needlessly so.

Many hospitals attempt to deal with these challenges by purchasing supply chain management software. By 2026, the healthcare information industry is forecasted to grow by 8.2 per cent. It seems that wherever we turn, we hear terms like Data Mining, Data Analysis, Big Data. Hospitals utilise advanced software solutions to improve processes, streamline workflow, and optimise resources. Yet while these solutions specialise in data management and analysis procurement processes, they are not suited to the specific needs and work conditions in hospitals, resulting in deficient data collection.

Any effective solution must answer the changing and exclusive needs of operating rooms, which differ greatly from other work areas.

For instance, the process of dispensing of items is carried out in the OR by the medical staff, which does not specialise in supply management. In many ways, this process diverges from that of other logistics systems, in which the dispensing is done in a dedicated area such as the cashier or in the warehouse, against a receipt or a delivery request.

Another distinguishing factor of OR data collection stems from the structure and uniformity of the barcodes. While in other industries the structure and the contents of the barcode are uniform, giving organisations the ability to rely on the barcodes received from the suppliers, in the medical field the reality is completely different. Hospitals cannot rely on the manufacturer’s barcode – it is necessary to attach an internal barcode sticker to the items, creating additional work for the OR staff registering the item into the hospital stock. Add to this the fact that hospitals are increasingly moving toward a consignment model, which requires precise charge capture and a shared management system. These factors taken together raise a pressing need to create OR-tailored supply chain management solutions.

Yet first, it is crucial to understand why collecting information in the OR is vital. How does it affect supply chain management and the hospital’s cash flow? From this understanding, clarified below, the need to improve the ability to collect operational data as part of the medical procedure, with minimal reliance on the human factor in the OR, will come into focus.

The financial dimension – data integrity is worth money

Gathering information in the OR has enormous economic implications. First and foremost, it gives us the ability to know how much surgical procedures cost. Today, hospitals rely on historical diagnosis-related group (DRG) repositories, which in turn rely on statistical past analyses and general cost studies. Times have changed, technologies have changed – there is no reason to make economic forecasts based on old data.

An average hospital consumes about 5,000 implants and medical devices a month. Although hospitals strive to record each item individually, the level of reporting today is below 60 per cent. In other words, the hospital has up-to-date information only on around half of the implants used. Why is the reporting level so low? Take items such as sewing thread or stampers – though they are present in almost every procedure and can run up costs by US$200 in some cases, they are not reported at all. In addition, items that cannot be tagged (such as sterile orthopaedic implants – screws, plates, etc.), or bulk items are often not reported.

Add to this the time spent on coding errors and the need to submit applications for reimbursement from insurance companies or Medicare programmes (which often require applications within 72 hours) and you have a full-fledged recipe for inefficient cost retrieval. Today, there is a whole market of companies that offer this service at a fee, and hospitals share with them the money received from the insurance company and government programmes.

The human dimension – why shouldn’t hospitals rely on the medical team to collect the data?

Medical teams’ function under often stressful circumstances and focus on treating patients rather than on office work. This, alongside documentation that is carried out manually in notebooks or in complicated ERP programmes, is a formula for error.

Research shows that procurement software and hospitals’ information management systems (ERPs) that are advanced and designed for health systems in practice slow down nurses’ work even more than manual documentation.

Indeed, human error, including coding errors and lack of reporting, is the main reason for the low compliance rate in the OR. Therefore, no matter how advanced the management software is, if it does not have the right tools to collect the information without involving the medical staff it is not an appropriate solution that can achieve 100 per cent reliability and integrity of data.

The cataloguing dimension – the importance of maintaining an updated and complete item master

The medical staff will rightly claim that even if it adheres to report usage of each item and receives training on logistics software, the software sometimes simply does not recognise the item.

The first step in maintaining an updated item master begins with the consumption of the medical device. The medical staff needs to report the item usually through scanning techniques. If the existing software does not identify the scanned item, the incomplete information needs to be completed from other sources.

Most of the hospitals receive medical implants according to the manufacturer’s SKU and then give the implants an internal catalogue number. This SKU does not specify an expiration date, production series, and other essential information about the item since that would require much work and the ability to read multiple manufactures barcodes. The manufacturer’s SKU often changes, items age, new suppliers are added, and as a result, the maintenance of the item master becomes one of the hospital’s biggest problems, with financial and clinical implications.

The clinical dimension – full documentation in the patient’s file equals to patient safety

Generally, patients are oblivious to any logistic processes. We would probably never hear a patient before surgery asking a nurse to check the implant expiry date, even though it could be a life-threatening case. The patient relies on the hospital. The hospital relies on the medical staff.

Occasionally there is a recall, which requires the hospitals and the supplier to locate all items and the patients that use the implants. This is an impossible task when there is no complete listing of all items used and full documentation in the patient’s medical file. A thorough process would be terribly time-consuming.

Although the importance of the integrity of the information and the synchronisation of the data is essential, unfortunately, the consolidation of such information is not the norm.

The regulatory dimension – Medical Device Reporting (MDR)

Medical Device Reporting (MDR) is the FDA regulatory tool for monitoring the performance of medical devices. When suspicion arises as to the safety of a product, medical organisations must provide critical information such as patient information, date, description of the case involving the medical device, brand information – product code, model number, serial number, expiration date, etc.

Yet in reality, without the consolidation of clinical and logistic information and high documentation compliance by the medical staff, hospitals are unable to provide the above information despite their obligation to do so. This is one of the main factors driving hospitals to purchase information management software.

Most of today’s tools rely on technologies that have been adapted to work in the operating room but do not fully address the problems mentioned here. In other words, advanced software does not include advanced data collection in the field. The full solution for consumption reporting and charge capture in the operating room has not yet been formulated.

Solution: Meet the sixth dimension – the digital dimension

The digital dimension is primarily based on a change in perception in the OR – the human is no longer part of data-processing. The solution is fully automated: The medical team does not need to enter any information and is uninvolved in documentation and data management.

In the digital dimension, the data is the goal rather than the means. The hospital must strive for 100 per cent documentation in the OR – from medical devices to a single sewing thread. Technologies that can autonomously collect data from the OR, exist in the world of machine learning.

Machine learning is a subset of computer science and Artificial Intelligence (AI) that refers to statistics and optimisation. The main goal is to handle real-world data for solving a particular problem when conventional computer software is insufficient. One of the capabilities is, for example, the solving of an identification problem that a human expert can solve but is unable to produce specific software because the rules of identification change frequently, just like in the operating room.

AI is not uncommon, and we are already enjoying its services. In the near future, AI processing will be increasingly utilised in the field’s end devices, introducing new image processing technologies, OCR, ICR, microphones or even sensors. These technologies can collect, process, and manage the information optimally.

The good news is that the future is in many ways already here. Hospitals are already investing money in comprehensive data collection solutions to help complement their existing ERP systems. Software companies and ERP systems, for their part, are also investing money in developing such solutions. This trend is expected to intensify as more hospitals recognise the benefits of automated data collection.

Figures have revealed that 17.3 per cent of the UAE population between the ages of 20 and 79 have been diagnosed with type 2 diabetes. People with diabetes are known to be more at risk of developing eye conditions, such as cataracts, glaucoma, or retinal vessel occlusion. Diabetic retinopathy and Diabetic Macular Edema (DME) are two of the top five eye problems affecting UAE patients, so there is a huge need to raise awareness of the serious consequences.

Arab Health Magazine spoke to Dr. Saleh Saif Al Messabi, Head of the Emirates Ophthalmology Society, about the impact of diabetic eye disease on the UAE society.

What are the most common diabetic eye diseases in the UAE and what are the prevalence rates?

Diabetic retinopathy is the leading cause of blindness among working-aged adults and is the most common diabetic eye disease. It is a leading cause of irreversible blindness in adults in the UAE. It usually affects both eyes and is caused by ongoing damage to the small blood vessels of the retina.

Poor glucose control and hypoxia cause new weak blood vessels to grow and leak fluid into the retina. Abnormal blood vessels also grow on the surface of the retina, which can bleed and block vision. The progression of Retinopathy is gradual, advancing from mild to advanced. One study found prevalence of retinopathy to be 19 per cent in the UAE and was more likely to occur in older males.

DME in particular is caused by a complication of diabetic retinopathy. The leakage of fluid into the retina may lead to swelling of the surrounding tissue, including the macula. DME is the most common cause of vision loss in people with diabetic retinopathy. Poor blood sugar control and additional medical conditions, such as high blood pressure, increase the risk of blindness for people with DME. It can occur at any stage of Diabetic Retinopathy, although it is more likely to occur later as the disease goes on.

What are the symptoms and how is it detected?

Primary symptoms of Diabetic Retinopathy and DME include spots in vision, blurred or fluctuating vision, impaired colour vision, dark of empty areas in vision or vision loss. If only one eye is affected, patients may not notice vision is blurry until the condition is well advanced.

The condition is diagnosed through various eye exams looking for abnormalities in the retina, including dilated eye exams where drops are placed on the eye to dilate the pupil. A fluorescein angiogram or optical coherence tomography may also be carried out to conform diagnosis.

How can people with diabetes protect their vision?

Early detection is imperative for positive outcomes with Diabetic Retinopathy, hence a broad range of primary care facilities offer screening programmes for DME across the UAE. Patients are urged to have their eyes examined as soon as they are diagnosed with diabetes (particularly type 2), as in some cases Diabetic Retinopathy has already manifested.

The key to preserving eye health and reducing the risk of diabetes complications is to tightly regulate your blood sugar as high blood sugar can damage the tiny blood vessels in the retina. It’s also important to manage blood pressure, as this can also affect eye health.

One study found prevalence of retinopathy to be 19 per cent in the UAE and was more likely to occur in older males.

Are there any new therapies to treat diabetic eye disease?

There are many treatment options and therapies to help diabetic patients diagnosed with Diabetic Retinopathy and DME including laser treatment, invasive intraocular injections into the eye, or steroid implants. Many potential new therapies for Diabetic Retinopathy with new targets are currently being studied in clinical trials and look promising. These include various inhibitors that suppress the detrimental effects of hyperglycaemia on the retina. Preventative approaches such as phototherapy, advanced glycation end product blockers and antioxidants are also being trialled. Also, being studied are surgical and technological approaches for vision restoration.

References
Al-Maskari F, El-Sadig M. Prevalence of diabetic retinopathy in the United Arab Emirates: a cross-sectional survey. BMC Ophthalmol. 2007;7:11. Published 2007 Jun 16. doi:10.1186/1471-2415-7-11

Most commonly found in elderly patients, cataracts are the clouding over of the lens of the eye. This slowly decreases the amount of light that enters the eye which, over time, seriously reduces the quality of vision.

Symptoms

Early symptoms include blurred vision, decrease in contrast, rapidly changing glasses prescription, glare in the presence of light, and difficulty reading from far and near.

Cataracts are most likely to affect people over the age of 50, although diseases such as diabetes, side effects of some medications, previous eye surgery or even myopia can also lead to the onset of cataracts. It is estimated that by age 65, over 90 per cent of people will have developed or sought treatment for cataracts. The chances of a person losing some vision, due to cataracts, increases by 50 per cent between the ages of 75 and 85.

Correcting the problem

However, when 48-year-old Dubai-resident Mark Costello began experiencing deteriorating vision, seeing halos around light and an uncomfortable dryness in his eyes, he quickly sought help from Moorfields Eye Hospital Dubai.  

After meeting with Dr. Avinash Gurbaxani, Consultant Ophthalmic Surgeon in Uveitis and Medical Retinal Diseases and Cataract Surgery at Moorfields Eye Hospital Dubai, Costello was diagnosed as suffering from cataracts and booked in for surgery to correct the problem.

The operation to remove Costello’s cataracts and correct his vision took just 20 minutes and was carried out by Dr. Avinash, with support from the team at Moorfields Dubai. Costello had trifocal intra ocular implants, which means he can read, work on the computer and tablet and see in the distance without glasses. This one-time treatment gives patients spectacle independence for the rest of their lives.

Causes

“Most people will develop cataracts in their lifetime, and this is mostly due to age,” explains Dr. Gurbaxani. “Anyone suffering from blurred vision, decrease in contrast, changes to their glasses prescription, glare in the presence of light, and difficulty reading from far and near should seek attention, as there is a strong chance that they have cataracts.”

However, Dr Gurbaxani adds that there are several things that can cause cataracts in younger individuals. “Trauma is one reason for developing a cataract. Excessive sun exposure, smoking as well as the use of certain mediations (such as steroids) can cause early age cataract. Uncontrolled diabetes can also be a cause of developing a cataract under the age of 50.”

In the UAE, in particular, Dr. Gurbaxani is seeing an upward trend of cataract formation in younger individuals, which he believes could be related to the excessive sun exposure and possibly to a widespread habit of smoking.

Excessive sun exposure, smoking as well as the use of certain mediations, such as steroids, can cause early age cataract.

The journey of medical tourism in Dubai started back in 2012. The initiative was launched by His Highness Sheikh Hamdan bin Mohammed bin Rashid Al Maktoum, Crown Prince of Dubai and Chairman of the Executive Council, who gave the Dubai Health Authority (DHA) the responsibility for building a strategy around medical tourism. It was approved by Sheikh Hamdan in 2014 and since then the Medical Tourism office came into existence and was under the regulation department at the DHA. The department has had an organic growth and became the Medical Tourism Council in 2016. In 2018, with the change of the structure at DHA, it evolved into a department under the Health Regulation sector.

In an interview with Arab Health Magazine, Linda Abdullah Ali Ruhi, Consultant, Health Tourism Department, DHA, shares: “The interesting thing is that in Dubai, health tourism is under regulation and the focus is more on quality care rather than commercialising healthcare. That is going to be our outlook and that is how we are working towards strengthening the city’s position as a destination that offers high quality of care.”

Sheikh Hamdan launched DHA’s DXH initiative in April 2016. It serves as a continuation of ‘Dubai, a Global Destination for Medical Tourism’ project and forms part of the government’s efforts to make Dubai a global health tourism destination and a gateway to the finest medical experts and premier accredited healthcare facilities. The website www.dxh.ae has two tabs – Wellness Dubai and Medical Dubai. The medical one is focused on treatments while the wellness focuses on health check-ups, preventative care, as well as alternative medicine, which is regulated in the city.

Ruhi says: “DXH has received a great response. So far, we have had an increase in year-on-year of patients coming to Dubai. Last year we had 337,000 medical tourists coming into Dubai. Our aim in 2021 is to attract half a million health tourists and are quite close to achieving it.” Excerpts from the interview.

Sheikh Hamdan launched DHA’s DXH initiative in April 2016. It serves as a continuation of ‘Dubai, a Global Destination for Medical Tourism’ project and forms part of the government’s efforts to make Dubai a global health tourism destination and a gateway to the finest medical experts and premier accredited healthcare facilities.

What do you think is currently driving the healthcare industry forward in the Middle East? What role is medical tourism set to play?

Several factors are driving the Middle East’s healthcare industry such as the growing population in the region with longer life expectancy. Another is the steady shift to value-based healthcare at reasonable costs. Innovation in technology and business models is also fuelling growth within the regional health industry as well as better organisational setting, which is increasing efficiency in the patient flow.

Furthermore, the ongoing digital transformation efforts in the region have had a dramatic impact on the health tourism sector as well as the many relevant initiatives that help bring the health community together. Patients today are more empowered as they prefer to take an active role in selecting the best and most appropriate treatments. This is what we try to provide to them through DXH, our digital gateway. The website provides an array of choices and information. We also try to keep visitors engaged through our social media channels so that they can make informed choices before they choose their next healthcare and wellness destination.

Is Dubai on its way to establishing itself as a medical tourism hub?

We are confident that Dubai is gaining great progress in its bid to become a medical tourism hub worldwide given its excellent healthcare facilities, world-class medical professionals, easy visa procedures, and extensive health packages. To date, we have over 600 packages from 72 healthcare facilities that include 18 hospitals and 54 specialties centres. In 2018, the local sector’s revenue reached AED 1.163 billion. The number of health tourists during the same year stood at 337,011. We also recorded a 9 per cent growth in the number of healthcare facilities vetted and included in the health tourism DXH Group member programme. DXH continues to participate in several global events and roadshows to reinforce Dubai’s position in the international health tourism market.

What would you say is the value of medical expenditures from visiting international health tourists? Could you share the countries from where medical tourists visited Dubai?

The sector’s 2018 revenue hit the AED 1.163-billion mark in 2018, reflecting the influx of global health tourists to the emirate. In terms of international patients, around 33 per cent came from the Arab and GCC countries, including Kuwait, Saudi Arabia, and Oman. About 30 per cent were from Asia, including India, and Pakistan and 16 per cent from Europe, including Italy, the UK, and France led the ranks from Europe. Some countries from the Africa region are also steadily becoming a source market. Health tourists come to Dubai mostly for wellness, dental, and orthopaedic treatments.

How does the future look like for Dubai’s medical tourism industry?

The UAE will continue to play a major role as the region’s medical hub and Dubai will sustain its global appeal to health tourists. This year, we will see growing adoption of the latest innovation in the field of stem cells, regenerative medicine and 3D printing, so we are spearheading such innovative techniques in the region. Moreover, DHA’s new and simplified healthcare licensing procedures will attract both investors and highly qualified medical professionals from around the globe. This will give us a strong foundation of trust that we are building with those that seek healthcare in Dubai.

Also, new investments will lead to the offering of technology-driven services delivered by the finest healthcare professionals. The services that will draw the most health tourists are dental, orthopaedic, dermatology, ophthalmology, health and wellness, aesthetics, and fertility. This will attract more and more health tourists to come to Dubai and is giving us more confidence that we will continue our appeal. We are always strengthening our USPs and will continue to create this unique experience in collaboration with our stakeholders. In Dubai, both the public and private sectors are working hand-in-hand to create a successful journey for the patient. What Dubai has achieved in this short span of time is proof that the city is working towards being the number one in whatever project it takes on. This is thanks to the higher leadership that continues to give us directions as well as directives to grow.

From our end, we will continue to create a unique experience in the healthcare delivery standard; integrate and offer new medical and wellness service packages, and open new markets for Dubai. Our focus will remain on partnerships with key stakeholders and on our #DXHWellness campaign, which aims to promote a healthy and holistic lifestyle.

Water birth is known to have less painful contractions, a shorter labour time, and reduces the need for pain relieving drugs.

Benefits

“Warm water helps you to relax and to feel more in control. Floating helps move around more easily, the effect of buoyancy lessens a mother’s body weight allowing free movement,” explains the attending Obstetrician, Dr. Sausan AbdulRahman, who is a consultant in obstetrics and gynaecology at Burjeel Hospital. “It also lowers the chances of having severe vaginal tears, and it improves the blood supply and blood flow to the uterus. Immersion in the water often helps lower the high blood pressure caused by anxiety of labour and helps the mother to relax improving the physical and mental status allowing the mother to focus on the birth process.”

Research

A team of Cochrane authors based in the United Kingdom worked with Cochrane Pregnancy and Childbirth to update the 2011 Cochrane Review assessing the effects of water immersion during labour and/or birth (first, second and third stage of labour) on women and their infants. This review includes 15 trials conducted between 1990 and 2015 with a total of 3663 women.

It found that labouring in water may reduce the number of women having an epidural. Giving birth in water did not appear to affect mode of birth, or the number of women having a serious perineal tear. The review found no evidence that labouring in water increases the risk of an adverse outcome for women or their newborns.

Alternative choice

“Water reduces stress and, by reducing stress, it also reduces stress related hormones allowing mothers body to produce endorphins which help serve as pain inhibitors,” Dr AbdulRahman adds.

With the many benefits associated with water births, more expectant mothers in the UAE now have a choice to use an alternative way to give birth.  

Giving birth in water did not appear to affect mode of birth, or the number of women having a serious perineal tear.

Predictable outcome

Orthoview is an innovative application being used by surgeons at Medcare Orthopedics and Spine Hospital in Dubai, UAE, to increase precision of preoperative planning, which allows them to achieve a more predictable outcome.

“Pre-operative planning and templating enables orthopaedic surgeons to prepare for joint replacement surgery, limit the risk of intraoperative complications, and improve patient care. These advantages translate into direct benefits for the hospital as well, ranging from more efficient implant stock management to a significant reduction in complications and complaints and potential litigation,” says Dr. Paul Macnamara, Consultant Orthopaedic Surgeon, Medcare Orthopedics and Spine Hospital.

The main driver of software-based digital orthopaedic templating was the introduction of computed and digital radiography systems.

“Using these templating systems such as Orthoview, we have a lot more confidence going into surgery compared with just using anatomical landmarks alone. The more information we have when planning surgery, the better, as this means we can perform quicker and more accurate surgeries and can holistically think about the effects on surrounding anatomy,” Macnamara explains.

Digital evolution

The advanced technology essentially places templates of prosthesis on the patients X-ray with high accuracy. Orthopaedic surgeons in particular need dimensional data with precise measurements as surgery can have a significant knock-on effect on a patient’s mobility.

“We are embracing the digital evolution in orthopaedics as these technologies greatly improve efficiency and enable us to give our patients optimal outcomes,” Macnamara adds.

As technologies and digitalisation further develop in the near future, we will see more healthcare providers seek to harness these dynamic new technologies to improve patient outcomes and offer more efficient solutions.

"We are embracing the digital evolution in orthopaedics as these technologies greatly improve efficiency and enable us to give our patients optimal outcomes." Dr. Paul Macnamara

Pre-operative planning and templating enables orthopaedic surgeons to prepare for joint replacement surgery, limit the risk of intraoperative complications, and improve patient care.

At Medtronic, I am responsible for setting-up catherization labs, hospital theatres where cardiac and vascular surgeons perform tedious procedures for repairing hearts and resolving critical vascular complications. The work is part of Medtronic’s Integrated Health Solutions (IHS) business, which was launched six years back as part of Medtronic CEO Omar Ishrak’s initiatives to drive Value-Based Health Care (VBHC). The IHS concept is inspiring and a novel one that is aimed towards helping healthcare providers enhance access, cost and quality care by transitioning hospital cath labs from a CapEx to OpEx model; whilst allowing hospitals to put more focus on clinical priorities, and less on operational tasks.

As a healthcare technology management (HTM) expert, my work at Medtronic IHS is both challenging and rewarding. From technology planning to procurement, to management, I lead the Managed Equipment Services (MES) division for Central & Eastern Europe, Middle East, Africa (CEMA) region. MES is a one-stop-shop when it comes to cath lab setup. Whether IHS customers need a state-of-the-art robotic imaging system for a hybrid operating room or a defibrillator for cardiac resuscitation, MES creates meaningful partnerships with hospital teams to deliver comprehensive healthcare technology solutions in the most efficient manner.

In this article, I will try to explain Medtronic’s IHS business from a healthcare technology management perspective and highlight the opportunities it brings to the healthcare industry.

Technology solution beyond medical devices

Since its founding in 1949, Medtronic’s mission has been to contribute to human welfare by the application of biomedical engineering to alleviate pain, restore health, and extend life. Remarkably, this mission has remained unchanged to this day. At its core, Medtronic focuses on developing life-saving devices and therapies from cardiac pacemakers to diabetes insulin pumps. However, with rapid changes to the global healthcare landscape, disease complexity, and rising costs, Medtronic as one of the world’s largest medical device companies sought solutions to address these critical challenges. Keeping these challenges in mind, the IHS business was formed to provide value creation for healthcare providers and at the same time ensure sustainable growth in the long run for the company.

Medtronic’s IHS business is built on four main pillars: Turn-key, Managed Services, Optimisation, and Development. While Optimisation and Development pillars focus on efficiency and growth in healthcare settings, the Turn-key and Managed Services pillars focus on engineering and operational aspects including design, equipping, staffing, and maintenance of cath labs and ancillary spaces. Partnership with healthcare institutions typically ranges between five to 10 years, which allows enough time to create a significant impact and value creation to the healthcare system.

Cath labs are resource-intensive departments that require investments in infrastructure, organisation, processes and technologies. Medtronic’s IHS offers a complete solution for cath labs and manage the full spectrum of services. These include maintenance, operations, and sourcing and supplying third party items that are not manufactured by Medtronic. In fact, a bulk of the capital resources required for a cath lab setup, such as imaging systems, patient monitors, cabinets and furniture, are non-Medtronic products. As a result, in addition to delivering Medtronic devices, therapies, and training, IHS assumes the role of a technology solution packager through partnerships with equipment manufacturers, construction firms, and suppliers.

Shaping a modern-day catherization lab

With the advent of multi-modal imaging technology and the growth of interventional procedures in multiple subspecialties, the cath lab suite has significantly evolved in the last decade. To deliver full cath lab solution in this intricate environment, Medtronic IHS has developed capability centres with multi-disciplinary teams of project managers, architects, HTM professionals, inventory specialists, and operations managers. All these capabilities work coherently to ensure solutions are customised according to hospital needs and are executed to the highest standards.

Like any healthcare setting, building a cath lab starts with planning and assessment. IHS subject matter experts (SME) meet with hospital administration, physicians, clinical staffs and engineers to map the entire patient care pathway, which is aligned with the business model. Depending on the type and complexity of procedures, clinical and infrastructural requirements may vary from one cath lab to another. For example, recent trends in cath lab have been evolving toward the concept of ‘hybrid suite’ and require a much larger space than a conventional cath lab; they also house a conglomeration of highly sophisticated equipment. IHS SMEs take all these aspects into consideration and develop solutions tailored to the specific needs of both the customer and the market.

Healthcare technology management in managed services

Healthcare technology management (HTM) professionals are an integral part of the hospital team for medical equipment and their life-cycle management. At IHS, HTM professionals in MES provide comprehensive healthcare technology solutions in the cath lab space, much like a clinical or biomedical engineering department renders equipment and their maintenance solutions within a hospital. Thus, HTM professionals play a crucial role in managed services in cath labs, from planning and procurement, to the setting up of maintenance strategies and refurbishment.

HTM professionals in MES engage with the hospital clinical team at an early stage to provide guidance on the latest technology in the market and comparative analysis to ensure equipment investments are aligned with clinical objectives and financial investments. Once capital equipment is selected, they provide procurement support for sourcing equipment at competitive market value. Due to purchasing volume and scalability, Medtronic IHS can leverage OEM relationships for additional savings and support, which are in turn transferred to customers. Leveraging these services and benefits eases a hospital’s burden of complex and expensive technologies, whilst allowing them to concentrate their time and efforts where they can generate more value to their business.

Highest standards and benchmarks

The key advantages of solutions like IHS are increasing revenues, containing costs, and improving quality. Healthcare organisations have access to innovative expertise, resources, and technology that may be either unavailable or commercially not viable to develop internally. With over 350 managed service cath labs across Europe, Middle East and Africa (EMEA), Medtronic IHS does continuous benchmarking, make improvements, and disseminate best practices to achieve the highest standards. This allows for IHS customers to connect and operate across a global network and become centres of excellence by adopting best practices.

Benchmarking data is also critical for enhancing business intelligence for capability centres like MES, as they bring significant value to the healthcare industry. For example, HTM professionals can bridge gaps between hospital end-users and technology manufacturers, and consequently provide key feedback and input to improve their technologies and services. Due to accessibility to large data, they are easily able to analyse various information on technology trends, standards, and financial impacts across different geographical boundaries, which can be invaluable information to healthcare policymakers.

In summary, Medtronic IHS is a promising solution, enabling healthcare organisations to deliver advanced therapies in cardiac care through a partnership model, which had not been available in the past. Through managed services solutions like IHS, healthcare technology manufacturers will play a crucial role in shaping future healthcare delivery. Technology will continue to be the main vehicle for care delivery, and subject matter experts like HTM professionals will be vital in connecting healthcare technology and their manufacturers with patients and end-users.

Best practices

Capital Health’s new Specialised Rehabilitation Hospital (SRH) hospital cements Abu Dhabi’s position as the leading healthcare destination in the Middle East using the latest transformational technologies.

“Our association with The Shirley Ryan AbilityLab, the top ranked rehabilitation hospital in America, means only the highest standards have been adhered to with the new Abu Dhabi hospital. We have access to best practices in care and treatment perfected over the years in the UAE, including Intellectual Property and patient’s treatment plans,” says Dr Mishal Al Kasimi, CEO of Capital Health and the Specialised Rehabilitation Hospital.

Importance of medical rehabilitation

A recent study conducted by Abu Dhabi's Department of Health reported that there are over 700,000 patients requiring outpatient rehabilitation services and over 4,000 inpatients requiring rehabilitation with a requirement of additional 350 beds. By 2024, this number is predicted to increase to 5,865 patients requiring 466 beds.

"In the UAE, people have now started discussing and understanding the importance of medical rehabilitation, which is made possible due to the direction set by the country’s leadership to help people with challenges and has encouraged families to talk about the conditions and seek help from experts,” Dr Al Kasimi explains. “Our hospital is one-of-its-kind in the region and aims to help people who have been affected with lifelong complications due to injuries or by birth deformities. Our goal is to create a legacy of patients whose stories will inspire hope for a better tomorrow.”

Better quality of life

Key areas of focus for the hospital are brain and spinal cord injury and conditions such as post-acute rehabilitation, acute rehabilitation and sub-acute rehabilitation. Medical professionals at the hospital will use AI technologies in the treatment of patients, helping to provide targeted and highly accurate care. Patients diagnosed with cerebral palsy will have a full range of treatments and care available to them at the hospital.

“As a paediatric consultant, I see many cases of cerebral palsy among children in the UAE. We offer the best treatments for our patients that show results faster, giving them a better quality of life. Our aim is to create an environment where people within the region don’t have to travel to other parts of the world for medical rehabilitation, thus helping in cutting down the traveling time and expenses,” Al Kasimi says.

Medical professionals at the hospital will use AI technologies in the treatment of patients, helping to provide highly accurate care.

Chronic disease

According to Dr Ashkan Haghshenas, who is a Specialist Vascular Surgeon at Burjeel Hospital for Advanced Surgery, Dubai, many people wrongly see it solely an aesthetic issue when, in reality, it is a chronic disease that affects a growing number of people in the UAE each year.

“While the majority of patients treated for varicose veins are women, men also suffer from venous diseases, even if they're less likely to seek treatment,” says Dr Ashkan. “However, factors such as heredity, pregnancy, hormone replacement therapy, contraceptives, and obesity can also contribute. In hot countries such as the UAE, the veins swell and open up in order to help cool the body and prevent overheating. This swelling makes veins larger and allows more blood to pool in one place.”

Factors such as heredity, pregnancy, hormone replacement therapy, contraceptives, and obesity can also contribute

Complications

If left untreated, varicose veins can lead to potentially dangerous complications. Although not everyone with varicose veins requires treatment, patients have choices when it comes to how they wish to undergo treatment for varicose veins: surgery or a minimally invasive varicose vein treatment.

“For many years, surgery was the only option for people suffering from varicose veins. Surgery involves an incision to find the varicose veins so they can be tied off (ligated) and removed (stripped). There is a 50 per cent chance of varicose veins coming back within five years after surgery. It is also important to be aware that vein surgery is associated with the risk of pain after operation, bleeding, scarring, infection, deep vein thrombosis, full anesthesia hospitalisation and long recovery period,” Dr Ashkan explains.

The invasive nature of surgery, along with the risk of pain and other complications, has encouraged the development of less intrusive minimally invasive varicose vein techniques. “These procedures can be performed in an outpatient setting, and if any anesthesia is needed at all, may only require an injection of a local anesthetic to numb the skin,’ says Dr Ashkan.

Treatment options

Sclerotherapy
This involves injecting a sclerosing, or scarring, agent into the vein. While sclerotherapy is very effective for cosmetic treatment of spider veins, a smaller version of varicose veins, you should note that it’s less effective for varicose veins than endovenous ablation.

Endovenous ablation
A catheter, or a thin tube, is placed inside the varicose vein, and heat, generated from a laser fiber or radiofrequency waves, is applied to the inside of the vein, causing it to close off. The success rate for endovenous therapies is above 98 per cent.

Microphlebectomy
A small prick in the skin is made over the surface of the varicose veins. Using a specialised tool, the vein is removed. This is commonly used along with endovenous ablation.