The mission statement of Cleveland Clinic, drafted nearly 100 years ago, helped to guide the work of doctors at a four-storey outpatient building in Cleveland, Ohio, when it first opened its doors to patients in 1921. Today, it remains a touchstone for more than 50,000 caregivers in an international network that includes our coordinated, multidisciplinary hospital in Abu Dhabi. The statement’s clarity and simplicity has proven to be an essential point of focus across our global footprint, even as our industry has faced a growing level of complexity and range of challenges.

Keeping a clear central focus – reminding ourselves every day that we are here to serve our communities – has been one of the main success factors in establishing Cleveland Clinic Abu Dhabi as the first patient-centred complex care hospital to operate outside of the US. I would highlight four other key factors that have played a role in our development:

• The support of key stakeholders
• Recognising the potential impact of innovation
• Emphasising collaboration and information exchange
• Placing research at the heart of integrated healthcare

Understanding these success factors – and in particular how these align with today’s population healthcare management challenges - provides an insight into how we can build a new model for global healthcare delivery.

Healthcare management – serving the needs of the population
There are three key dynamics that made the development of Cleveland Clinic Abu Dhabi possible.

The first is the need within the region for complex care closer to home. With a growing population, the UAE was actively looking for ways to reduce the need for patients to travel overseas for treatment.

Second was the vision of the leadership of the UAE, who saw the importance of bringing a world-class institution to the UAE.

Finally, the strength of the partnership between Mubadala and Cleveland Clinic in the US provided the necessary foundation for us to grow our service offering sustainably.

As an organisation, we take our responsibilities very seriously, as we use all our tools – experience, expertise, technology, research, and innovation – to address the needs of our patients. The benefit of an integrated healthcare network is that patients can walk into any one of our facilities, anywhere in the world, secure in the knowledge that they will receive the highest possible quality of care from 57, 000 of the most connected minds in medicine.

Encouraging technological innovation in healthcare
Connected devices mean that preventative medicine will become an increasingly important tool in the fight against disease. People are more mobile than ever and, as technology develops, they will be able to access diagnostic and advisory services from leading medical professionals, wherever they are in the world.

These advances provide us with the opportunity to move toward a new model of healthcare, one that enables providers to use their resources and expertise to encourage the whole community to live healthier lives. We can detect problems earlier and encourage behaviours that reduce the risk of illness and infirmity in the long-term, thereby preventing disease. We can also intervene remotely at the very earliest stages of illness facilitated by sophisticated remote cardiac monitoring that we currently use at Cleveland Clinic Abu Dhabi and have deployed throughout the region.

In the UAE and wider Middle East and North Africa region, moving to this ‘healthier lives’ model will necessitate more focus on the primary care sector. Even healthy people need to see a general practitioner once a year. It is in this way that diseases are detected earlier, diagnosis is more complete, and patients are referred at the appropriate time for subspecialist care. Our regulatory partners are working toward introducing a referral system where patients are initially seen by a general practitioner before being referred on to a specialist if necessary.

Prioritising collaboration and information exchange in patient care
The ability to collaborate effectively will be a fundamental predictor of success in improving outcomes. We must significantly improve strategic outreach, combining best practices, cutting-edge innovation, and global talent with the kind of expertise that will create a step change in the healthcare provision on a global scale.

Integrating care between medical facilities requires several key steps, including the shift to a single electronic medical record system, inter-facility consultations, and real-time patient monitoring.

All Cleveland Clinic facilities have a single, integrated medical records system, allowing care teams to gain a clear understanding of a patient’s medical history across all our international locations, whether in Abu Dhabi, Florida, or Ohio. This seamless integration lets us offer carefully tailored, personalised care, regardless of where the patient is being treated. Future challenges include developing processes to include other healthcare partners in our best-in-class medical records system, while ensuring top-level data security. This will be supported by an innovative integrated healthcare network led by Mubadala.

Patients also benefit when multidisciplinary teams meet and consult with their colleagues through video-conferencing and collaborative technology. Such collaboration allows teams of physicians to discuss complex cases, adding another layer of expert evaluation when deciding on how to proceed with treatment. This can be a welcome extra layer for a patient, providing peace of mind that his or her case has had as thorough a review as possible.

Placing research at the heart of an integrated healthcare system
Research and investigation, to build our knowledge of health issues within a population, are the foundations of good health and appropriate, effective care. By understanding the reasons behind a community’s health challenges, and devising new ways to treat those problems, we can tailor treatments to meet their specific needs.

A great deal of advanced medical research is conducted in the United States and Europe, studying western populations. This approach has led to an imbalance in the quantity and quality of population data available for certain parts of the world, including the Middle East.

Closing this gap must be a priority, and we need a coordinated, multi-agency approach to developing research programmes that consider the needs of this region. As a designated human subject research facility, Cleveland Clinic Abu Dhabi has partnered with several local institutions to conduct population health studies and support core research in the region.

The need for accurate data takes on a greater urgency during a period of transformation and change. If we are investing in technology-led solutions to address medical needs in the community, and reorganising patient-facing services, decisions on how to prioritise and apply resources must be evidence-based.

Last year, our clinician scientists published 137 peer-reviewed academic medical papers, reporting on innovative treatments administered at Cleveland Clinic Abu Dhabi along with the outcomes of those procedures. Many of our caregivers are also thought leaders in their fields and known globally for their work.

At Cleveland Clinic Abu Dhabi, we also continue to expand our educational facilities, which now include a full range of post-graduate opportunities from physician internships to residencies and fellowships. We welcomed our first cohort of physician interns in 2017, and our specialist residency training programmes will commence later in 2018.

Sustaining the foundations of care
In conclusion, as the world becomes more closely connected, and the population ever more global, healthcare provision will continue to change dramatically. The formulation of strategic priorities that highlight future investment in innovation, research and the ethical use of healthcare data, will align around the shared goal of providing world-class care to an increasing number of lives globally.

Change presents opportunities for high quality, specialised care providers to make a global impact, building the hubs that will deliver a new form of preventative, connected and community-focused care. Embracing these challenges will enable us to confidently ensure the highest global standard of healthcare is delivered in a culturally appropriate way at the local point of need.

Surgeons Perform the UAE’s First Double-Lung Transplant Surgery
Multidisciplinary teams of surgeons at Cleveland Clinic Abu Dhabi have performed three transplant surgeries from a deceased donor on the same day, including the UAE’s first double-lung transplant. The surgeries – double-lung, liver and kidney – took place on June 10, and a kidney from the same donor was transported for a transplant operation at Sheikh Khalifa Medical City.

Double-lung transplants, also known as bilateral transplants, see both lungs removed and replaced with donor organs.

Earlier in 2018, Cleveland Clinic Abu Dhabi had performed successful lung and liver transplants, following on from the country’s first full heart transplant in December 2017.

Dr Redha Souilamas, Chair of Thoracic Surgery at Cleveland Clinic Abu Dhabi, led the double-lung transplant, assisted by a multidisciplinary team of 10 specialists, including cardiothoracic surgeons, pulmonologists, anesthesiologists and critical care nurses.

The double-lung transplant patient, a 45-year-old expatriate female, had been suffering from idiopathic pulmonary fibrosis (IPF). A progressive disease that causes extensive scarring of the lungs, there is no cure for IPF and patients are typically given a three- to five-year survival rate after diagnosis without transplant surgery.

To complete the operation, the surgical team used an innovative, minimally invasive approach without the need for a cardiopulmonary bypass, making two small incisions on either side of the patient’s chest. This ensures a faster recovery time; shorter hospital stay; and little to no scarring compared with the standard approach, said Dr Souilamas, who has performed 150 double-lung transplants over the past 10 years.

Dr Antonio Pinna, Transplant Surgeon in the Digestive Diseases Institute, led the team for the liver transplant for a female patient from Ras Al Khaimah, who was suffering from severe cirrhosis. She is recovering well following the operation.

The kidney transplant operation was led by Dr Bashir Sankari, Chair of the Surgical Subspecialties Institute and head of Cleveland Clinic Abu Dhabi’s transplant programme, providing vital surgery for another patient on the hospital’s transplant list.

Cleveland Clinic Abu Dhabi’s transplant programme works with a number of key organisations for multi-organ operations, including the Cleveland Clinic Transplant Center in the US, Mubadala, Abu Dhabi Police, the Department of Health, Ministry of Health, National Transplant Committee and a number of other government entities.

“When we opened our doors in March 2015, we made a promise to bring advanced complex and critical care services to the UAE, removing the need to travel abroad for life-saving medical care. Cleveland Clinic Abu Dhabi’s latest multi-organ transplants mark another significant moment in that journey,” said Dr Rakesh Suri, CEO, Cleveland Clinic Abu Dhabi,

“It’s worth reflecting on the incredible contribution that the donor and the donor’s family have made by sharing their precious organs – four lives have been transformed by this selfless gift. We will continue to work with the relevant authorities to support the development of a nationwide transplant list and donor management network, so that more patients will be able to benefit from this life-saving opportunity,” Dr Suri concluded.

All three patients are recovering well. 

High growth opportunities abound in the healthcare market sector of the Kingdom of Saudi Arabia. The government will cumulatively spend $180 billion on healthcare over the next 5 years in both the traditional and frontier subsectors to meet demand and tackle the Kingdom’s public health challenges. As such, investors will find significant opportunities across the entire sector including hospital and healthcare services, pharmaceuticals, and medical devices. This is in line with the Saudi Vision 2030 that aims to achieve a world-class healthcare system and establish the Kingdom as a pioneering healthcare destination in the region, and the world.

To provide a business platform for investors looking to make inroads into this thriving healthcare market, Informa Life Sciences Exhibitions, the organisers of the annual Arab Health Exhibition, in collaboration with XS Conferences and Exhibitions and under the patronage of the Ministry of Health are launching Global Health Exhibition - Saudi Arabia’s premier healthcare platform for the global market to meet and network with the pioneers and officials of the Saudi healthcare sector.

Taking place from 10-12 September 2018 at the Riyadh International Convention and Exhibition Center in Riyadh, Saudi Arabia, more than 10,000 industry professionals from the region are expected to explore +250 Saudi-based and international exhibiting companies showcasing the latest advances in health services, pharmaceuticals, training and education, and medical device technologies.

According to Peter Hall, President, Informa Middle East: “Diminishing market access barriers for foreign investment, coupled with huge investment in healthcare infrastructure, has positioned Saudi Arabia as a top-tier market for medical device manufacturers, services providers, and dealers and distributors from across the globe. Through the launch of Global Health Exhibition, companies now have an opportunity to promote their products and services to a whole new audience of buyers and make significant inroads into the Saudi market.”

Currently, 36 new hospitals with a total capacity of 8,950 beds are being established and developed in all regions of the Kingdom of Saudi Arabia, according to the Ministry of Finance. Two medical cities with a total capacity of 2,350 beds are also being constructed.

Commenting on the launch of Global Health Exhibition, Meshal Al Rubiaan, Ministry of Health spokesman said: “The objectives set out by the ‘National Transformation Program 2020’, part of the Kingdom’s Vision 2030, has enabled the Ministry to cultivate a favourable atmosphere to attract private healthcare providers and investors from abroad. We will continue to work closely with our strategic partners to support important economic trade platforms such as Global Health Exhibition that promote and facilitate the achievement of that vision. The exhibition will also attract world-class leaders and experts in the healthcare industry to support our objective to share knowledge and experience.”

The Innovation Zone
With Saudi Arabia having allocated $1.5 billion towards a healthcare IT and digital transformation programme as part of Saudi National Transformation Project 2020, this pivotal area will be a main feature at the Global Health Exhibition. The ‘Innovation Zone’ will give eHealth solution providers and digital health disruptors an opportunity to showcase their solutions and products to an audience of key decision makers, government authorities and trade and healthcare professionals from the KSA.

GLOBAL HEALTHCARE CONGRESS
Under the theme, ‘Embracing the Future’, the exhibition will also offer a multi-disciplinary Congress that “aims to delve deeper into worldwide advancements and best practices in the healthcare industry with an emphasis on Vision 2030 to identify the immense opportunities represented for healthcare advancements in Saudi Arabia,” commented Adel Abdel Shakor, CEO of XS Conferences and Exhibitions. “From emerging disruptive and innovative trends in healthcare to the impactful change at the public health and policy level, the congress will explore ways to transform and adopt the current healthcare landscape for better utilising the existing system’s capacity and capabilities in hospitals and healthcare centres, and also to enhance the quality of preventive and therapeutic healthcare services.”

The Congress is a high-level strategic dialogue and knowledge-sharing platform with an exclusive global speaker panel comprising of Ministers, CEOs and subject matter experts.

Embracing the Future Conference (September 10)
Addressing key topics such as impact of policy on healthcare, Saudi Vision 2030 and the healthcare transformative plan, investment, value-based healthcare, and healthcare innovation, amongst others, this conference is of special relevance given the rising global interest in new ways of designing healthcare systems to address the mounting challenges that threaten the sustainability of these systems across the globe.

The conference will help build a global network of leaders and aims to become the source for emerging concepts and advancement in healthcare by facilitating opportunities for strategic, operational, and academic partnerships amongst interested parties while mobilising support for the Kingdom’s vision and healthcare transformative plan.

Value-Based Healthcare Conference (September 10)
This conference will review the framework for restructuring healthcare systems around the globe with a view to improve the quality of care and align patient outcomes with financial incentives to providers. Amongst the key focus areas that will be addressed at this conference include value-based care models across the globe, population health, outcome measurement, pay for value and value driven system improvements.

Healthcare Investment, Financing and Reimbursement Conference (September 11)
How can you align investor and provider objectives and what does it take to create an attractive environment for financing healthcare innovation? This conference will provide insights into the changing investment ecosystem in the face of a changing care delivery model and will also provide solutions for investment, financing and reimbursement challenges and review perspectives from all stakeholders including hospitals, payers, pharmaceuticals, technology companies and policy makers.

The key topics under discussion will include role of healthcare incubators and accelerators, entry of sovereign wealth funds into the healthcare market, where to invest in healthcare, and creating an attractive environment for local and foreign investors in Saudi Arabia.

eHealth Conference (September 11)
Digital and technological advances are transforming healthcare. The evolution of Information Technology has become increasingly more important in providing patient-centred and cost-effective care. This eHealth conference will identify technology trends, address key questions such as telemedicine, Artificial Intelligence in improving clinical outcomes, cybersecurity and patient data privacy, and provide solutions to implementing sustainable technology to deliver value-based healthcare.

Attendees at the conference will gain greater insights into what cyber security measures healthcare providers should implement in order to provide protection of data of their patients and their facilities; assess how disruptive technologies and innovations can impact the healthcare ecosystem; and determine how connected health technologies can support delivery of new models of care, health and wellness.

Healthcare Innovation Conference (September 12)
Focusing on emerging technologies and biomedical engineering advances to watch in the year ahead, this forum will be collocated with the Innovation Zone at the Global Health Exhibition that will feature a demo zone to review products and concepts that have been earmarked as the gamechangers of healthcare.

Personalised medicine, regenerative medicine and cell-based therapy, 3D printed medical devices, applied Artificial Intelligence, and population health analytics are some of the key topics that will be discussed at this conference.

CME Accredited Conferences

Medical Laboratory Conference (September 11)
Themed ‘Outsourcing lab services: Ideal vs. reality’, this conference will review the developments and opportunities for clinical laboratories in the Kingdom. Amongst the key topics addressed here include overcoming the challenges of outsourcing lab services, driving value through lab automation, patient safety, evaluating best practices in Internal Proficiency Testing and Internal Quality Control, and improving diagnostic test utilisation, service efficiency, and “meaningful use”.

Total Radiology KSA Conference (September 12)
Presenting the latest advances in medical imaging, accurate imaging diagnosis and improvement of care quality for radiology patients, these scientific sessions will touch upon the role of big data and AI in radiology, identify disease imaging and diagnostics for oncology, breast, abdominal, emergency and respiratory, gastrointestinal, cardiovascular, nervous systems and include a comprehensive discussion of the diagnostic imaging procedures utilised in demonstrating diseases and conditions.

For more information, please visit www.globalhealthsaudi.com or email your queries to info@globalhealthsaudi.com

According to human data science company IQVIA, the compound annual growth rate (CAGR) for the total healthcare market in the Kingdom of Saudi Arabia (KSA) for 2018/2019 is expected to be 3%. So with the KSA market expected to continue growing in the coming years (Saudi Arabia represented 58.5% of the region’s healthcare market with current healthcare expenditure of US$ 37.7 billion in 2015), primarily driven by diversified investments towards healthcare, new private hospitals entering the market set up and chain pharmacies increasing in numbers, the many new facilities and healthcare initiatives provided by the government is encouraging investment and improvement in quality of healthcare system in the Kingdom.

The plans outlined in the country’s Vision 2030 identify healthcare as one of its main focus areas and, as such, the target objective of the national transformation programme is to increase private healthcare expenditure from the current 25% to 35% of total expenditure by 2020 through alternative financing methods and service providers. In order to successfully meet this target, the Ministry of Health has embarked on reforms and restructuring of primary healthcare in the country, public-private partnerships through the privatisation of medical cities and localisation of the pharmaceutical industry, increasing the capacity and quality of healthcare education, health insurance & medical services purchase schemes, and increasing the number of trained health practitioners and improving their training, amongst other initiatives.

Partnering for growth
Mohamed Mostafa, who is a senior director and general manager for Egypt and Upper Gulf at IQVIA explains that there is a lot of interest and traction in public-private partnerships in the Kingdom. “We have seen many big multinational companies signing memorandums of understanding with public universities to encourage training, for example. And we also see a trend of localisation in manufacturing where many private companies are partnering with local companies to produce locally.”

As reducing the financial burden in KSA becomes a priority, private-public partnerships are increasingly being utilised for cost-savings and improving operational efficiencies. The recent announcement of the formation of a joint venture healthcare platform with Hassana Investment, a unit of pension fund General Organisation for Social Insurance (GOSI) in KSA, and UAE-based NMC Health, a large private healthcare operator, would see the creation one of the largest private healthcare platforms operating in KSA today.

According to a statement from NMC Health, the joint venture would have a strategically unique position in the country, with a strong foothold in Riyadh, the single largest healthcare market in Saudi Arabia, as well as in multiple smaller, underserved cities. The enlarged organisation is expected to benefit from economies of scale, allowing more efficient deployment of capital, increasing patient choice and optimising returns across multiple assets. Furthermore, in-line with NMC’s existing strategy, the proposed joint venture platform would continue to build a strong pan-Saudi Arabia presence, unlocking considerable synergies across its facilities in the process. These are expected to cover business segments such as revenue cycle management, procurement, HR and IT systems among others.

NMC CEO Prasanth Manghat said, “The Saudi government’s forward-looking and investor-friendly policies make the Kingdom one of the most attractive destinations in the region for investment in the healthcare sector. Moreover, Hassana’s strong commitment to the sector, particularly in the form of strategic investments, remains a vital means of attracting and developing healthcare expertise in the country.

“NMC has been the most progressive foreign entrant in the Saudi healthcare market, and the proposed partnership with Hassana would accelerate the process of bringing international best practices to Saudi Arabia,” he added.

Commenting on the joint venture, Saad bin Abdulmohsen Al-Fadly, CEO of Hassana, said: “The proposed partnership between Hassana and NMC is driven by our view that healthcare in Saudi Arabia is one of the most attractive markets for strong long-term growth. The proposed joint venture has ambitious growth plans across different healthcare sub-sectors, with both partners committed to compounding returns over the long term, whilst providing best-of-class services to patients. Benefiting from Hassana’s role as a strong long term financial and strategic investor and NMC’s expertise as a sophisticated and successful healthcare expert in the region, the joint venture platform would be well-positioned to become one of the most dominant healthcare players in Saudi Arabia and is ideally positioned to capitalise on the health care privatisation programme in Saudi Arabia in line with the country’s Vision 2030 initiatives.”

Digitising the marketplace
As is the case in many healthcare systems around the world, and as it is in the GCC’s hospitals, up to half of annual operating costs go to third parties. According to Federico Mariscotti, who is a vice president in A.T. Kearney’s Procurement & Analytic Solutions Practice in the Middle East, although governments and private companies have spent billions of dollars to expand the region’s healthcare facilities, increasing capacity and improving outcomes, healthcare systems in the Gulf have yet to tap into a powerful way to make hospitals more efficient: optimising the way goods and services are selected and sourced.

“An advanced approach can reduce a hospital’s external costs by 20% and cut waste in half, whilst improving the quality of care,” Mariscotti says. “By making sustainable cost reduction, reinvesting these sums into healthcare priorities creates huge possibility.”

Indeed, Emdadat, a Saudi national company specialised in innovating the integrated services and solutions in KSA, has done just that with the launch of a new digital marketplace for healthcare on SAP Ariba. The procurement and business technology specialist has created a digital marketplace through which medical providers and suppliers can connect and collaborate across the entire procurement process to increase their efficiency and improve quality of care.

The platform is intended to create an online sourcing process through which buyers including hospitals, pharmacies and doctors, can connect with suppliers who can deliver the right goods and services at the right prices to meet their customers' needs. The platform will also ensure that goods are delivered to the right places at the right times under the right conditions and support healthcare entities to manage their capacity, demand, and medical equipment utilisation by integrating with supply chain and sourcing activities in real-time. Using the network, buyers can manage the entire purchasing process from end-to-end, while controlling spending, finding new sources of savings and building a healthy supply chain.

Emdadat CEO Abdullah Alfifi said about the new platform: "At Emdadat, we have successfully integrated healthcare stakeholders into a sustainable ecosystem where they can communicate and trade with greater insight, transparency, efficiency and speed, and in doing so, we are transforming the health sector in the KSA into one of the finest systems globally and setting a new standard for the way healthcare is sourced and delivered around the world."

Investing in Infrastructure
KSA has made significant investments to build hospitals, clinics, research centres and huge medical cities and complexes. According to an Alpen Capital GCC Healthcare Industry report for 2018, the Kingdom is likely to witness the largest bed requirement in the region at over 7,500 new beds to cater to its large and expanding base of population - the country’s General Authority for Statistics (GaStat) recently reported that KSA’s population registered an annual growth rate of 2.52% in 2017. In fact, Knight Frank has estimated that in order to keep pace with population growth, the Kingdom would require an additional 20,000 beds by 2035 (based on the current density of beds) and, based on the global average of bed density, KSA will face a gap of 40,000 beds by 2035.

There are a number of ongoing healthcare infrastructure projects in the Kingdom including the King Abdullah Bin Abdulaziz project for the development of Security Forces Medical Complexes which the largest healthcare project in KSA, and also the largest medical project in the GCC. Two separate medical cities for security forces are being developed in Riyadh and Jeddah on behalf of the Kingdom’s Interior Ministry adding an extra 2,000 beds to the country’s bed capacity.

Meanwhile, the US$1.27 billion King Khaled Medical City in Dammam is scheduled for completion in 2020. The 1500-bed hospital project, managed by the King Khaled Mega Project Management Office (PMO) on behalf of the Ministry of Health will include many centres of excellence, a research centre, staff accommodation, conference centre, mosque, administrative building, car parking structures and community centre.

Another mega project is the King Faisal Medical City in Asir. With an estimated project cost of US$1.06 billion, the 262,836 sqm., 1,350-bed mega hospital complex will comprise of a 500-bed main hospital and another 850 beds distributed across five speciality hospitals: cardiology, oncology, ophthalmology, neurology and rehabilitation.

Also, the Mouwasat Hospital in Al Khobar has an expected capacity of 220 beds, 60 out-patient clinics, a substation building and staff accommodation, and will be established on a 53,000 square metre land plot.

The development of oncology treatments has grown rapidly over the last two decades. The number of active compounds in clinical development quadrupled between 1998 and 2018, and nearly doubled in the last decade alone, with more than 1,600 compounds reported today in phase I-III clinical trends data.

At the same time, an unprecedented amount of data is being generated, stored, analysed, and consumed in healthcare. This data is coming from a variety of sources, including patients, providers, pharma companies, and payers. More than 13 million electronic medical records (EMRs) exist for cancer patients in the United States alone.

In addition, the global market for next generation sequencing is expected to grow by 21% annually from 2017 to 2022. In particular, the cancer biomarker market is projected to reach about USD20 billion in 2022 from about USD11 billion in 2017, driven by lower sequencing costs, increasing diagnostic applications of biomarkers in oncology, and a paradigm shift to one-test-one-patient.

In this environment, data use in oncology is exploding across all dimensions. Half of all drug submissions for Health Technology Assessments (HTAs) now use Real World Evidence (RWE), payer spend on data and analytics has grown 20% annually in recent years, and several new oncology data aggregators have emerged with backing from major venture capitalists and partnered with large pharma companies. In one example, large healthcare technology companies have developed cloud-based platforms in oncology informatics to assist with treatment decisions and promote guideline adherence. Also, select in-vivo diagnostics companies have established partnerships with top biopharmaceutical companies to develop decision-support systems, including a dashboard for oncology care teams with combined in-vivo and in-vitro diagnostics to align on treatment decisions.

In addition, rising technologies like liquid biopsy allow minimally invasive, repeated testing along the treatment cycle that complement tissue biopsy. Ultimately, these technologies may allow for screening and early detection for high-risk patients with established biomarkers. Recent approvals of biomarker-based, indication-agnostic treatment and liquid biopsy companion diagnostics in oncology – for example, the US Food and Drug Administration (FDA) has approved the Epidermal Growth Factor Receptor (EGFR) detection test – are milestones of precision medicine. Further, detection of measurable residual disease (MRD) enables greater sensitivity to assess response to treatment, detects relapse, and can accelerate decisions.

Finally, there is a large ongoing effort to aggregate data and generate insights by creating bigger and more comprehensive and longitudinal data sets of oncology patients. Several oncology analytics partnerships are already demonstrating how individual efforts around genomic data or clinical data can combine to generate valuable insights. Also, large provider systems and academic institutions have been developing aggregated data positions with patient consent.

Amid all of this activity in oncology – from clinical development to data aggregation – a dizzying array of treatment options and pathways is emerging. Compounded by the rising costs of these technologies, a compelling opportunity arises for systems and machines that are robust and sophisticated and can help medical professionals untangle the growing complexities of oncology care.

Emerging challenges in cancer care
The increasing complexity of immuno-oncology (IO), greater stratification of cancers, and a proliferation of biomarkers will make it impossible for physicians to keep pace, making optimal clinical decisions more and more difficult. IO is an experiment of unprecedented diversity, scale, and complexity. For example, the number of companies sponsoring trials for PD-(L)1 or CTLA-4 grew 70% a year between 2011 and 2018 and the monthly diversity of major tumour indications remains high, with about 43% of major tumour types having new cohorts launched each month.

Two factors are pushing the increased complexity of patient-specific biomarker information: the switch to multigene panels and the gradual lessening of reimbursement challenges. While companion diagnostics that guide therapeutic decisions directly remain the most frequent use of biomarker generation, new emphasis is being placed on multigene panels rather than single biomarker characterisations, with 83% of oncologists using multigene panels. Payer coverage of companion diagnostics is expected to expand and drive biomarker growth, as well, yielding greater opportunities for quantifying patient response in a multiple-mutation context. Indeed, already companion diagnostics are relatively common, despite a difficult reimbursement environment: only 38% of managed care organisations (MCOs) cover FDA-approved companion diagnostics.

Taken together, these factors will provoke a data avalanche for physicians.  But even as the complexity of biomarkers becomes overwhelming for physicians, oncologists are still actively seeking novel treatment opportunities. For instance, in a recent survey, 50% of oncologists said they would pursue beyond the label usage of a therapeutic that matched the patient’s biomarker results, for instance EGFR mutation.

Data illiquidity adds to the difficulties in making optimal decisions. Although 97 percent of oncology practices use EMRs, only 10% of practices had EMR interoperability with hospitals in 2018, down from about a third in 2016. The gap creates challenges for implementing learning algorithms for the best care. Additionally, oncologists are increasingly open to automated analytics, with about a third using physician-decision support (PDS) tools. Still the report showed oncologists remained isolated from the clinical flow of information, with fewer than one in four oncologists that use PDS tools reporting access to a PDS system integrated with their EMRs.

Without EMR integration, oncologists face challenges that limit further adoption of PDS tools. Integration allows PDS tools to detect novel clinical signals and improve predictions using machine learning, a benefit greatly desired by oncologists. Integration also enables PDS applications to help oncologists visualise expected outcomes. In isolation, analytics can only deliver static results that are limited primarily to data from clinical trials with long periods needed to incorporate RWE. And finally, integration can help resolve data quality issues that plague PDS tools. Without it, patient data must often be entered repeatedly, adding to the burdens on the practice and increasing the chances for data-entry and clinical errors and the risks of liability.

Practices also face a shift in patient channels, with younger oncologists opting for online patient portals and older ones relying on email. As portal use becomes more common, these online channels will become a rich source of patient response data, complementing EMRs. Portals are particularly well-suited for data analysis and learning algorithms at scale.

This growing wealth of information provides new opportunities to create evidence-based treatment options. For example, panels that produce additional data over genotyping assays would be useful for exploratory understanding of disease mechanisms. Integration with EMR and communication portals would define machine learning approaches to predict patient response. And patient-provider communications would enrich the biological and clinical data needed to understand real-time patient outcomes.

Of course, automated decision-support analytics tools bring challenges as well as opportunities. PDS tools cannot be interpreted as recommending a therapeutic course that has not received FDA support. On the other hand, clearly linking available therapeutic options and biomarker results expands the options for life-saving therapeutic usage as clinical science and regulatory submissions catch up.

Teaching machines to learn from oncologists
Data-driven decisions can improve the outcomes for oncology patients, and to deliver these benefits quickly the broad oncology community should work together. Four measures in particular could prove very powerful.

Use biomarker data appropriately and transparently
Biomarkers have been at the forefront of oncology research and development and are expected to become requisites for the field. Combining biomarker data with clinical information in EMRs would identify complex genetic signatures linked to patient responses. Ultimately, larger sample sizes will produce phase IV-quality data and enable algorithms to be trained in a patient-care setting, with results that can be submitted to regulatory agencies and payers.

Rigorous, yet practical methods and practices are needed to define and standardise the collection, analysis, and reporting of real-world biomarker data. Today, many RWE analytics are strictly retrospective and observational, both of which are problematic. Further, any recommended decisions must be susceptible to robust analytics to confirm that data methods eliminated biases, controlled for quality, and allowed for the appropriate incorporation of disparate data sources. In addition, patient data collection, storage, and use must comply with increasingly stringent data privacy laws, such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States and the General Data Protection Regulation (GDPR) in the European Union.

Integrate oncology decision support with the EMR
A range of capabilities will be needed to build a broader analytics platform that integrates oncology decision support with EMRs, crucially real-time data ingestion. Clinical data must be scrutinised through Health Level Seven International (HL7)-compliant interfaces and EMR-specific applications. Integration would reduce or eliminate redundant data entry and provide up-to-date information and knowledge for decisions.

At present, several burgeoning Fast Healthcare Interoperability Resources (FHIR)-enabled tools link to EMRs. Researchers at the University of Washington and Vanderbilt University, among others, are designing applications to visualise genomic information in real-time, using the FHIR standard to interface with data in EMRs. Early tools can already compare a patient’s genome against a distribution of thousands of other patients with links to external databases.

Oncologists will also demand that insights are displayed intuitively through effective visualisation in the EMR. The ability to visualise a patient’s expected clinical outcome for a certain therapy based on clinical trial RWE data is of great interest, with 74% and 73%, respectively, of oncologists rating the two features as very important. Not only will this enable clearer interpretation of results, it also minimises disruption to workflow, avoiding “click fatigue” as oncologists deal with a wealth of information on their screens.

Extract meaningful data from patient-provider communications
Portals can be powerful data tools when linked to physician-decision support algorithms. Yet similar to EMR data, data from portals would require interface between communications and the PDS. Additionally, well-designed natural language processing (NLP) tools would be needed to extract meaningful data from conversations. Once successful, a range of rich data would be available, including changes in regimen, medication adherence, patient engagement, adverse effects, and qualitative therapeutic benefit.

Link data-driven systems to post-approval monitoring and payer reimbursement
Decision-support systems tied to the EMR should not only support medical decisions, but also track the efficacy and safety of mass-produced therapeutics in the real world. New product introductions are increasingly complicated, featuring everything from more diverse usage patterns for patients and providers through drug-device combinations to advanced coating materials. Over the past two years, multiple studies have questioned the long-term impact of therapeutics on real-world quality-of-life and survival outcomes. Drugs passed by the FDA and European Medicines Agency were shown to have little follow-up once approved. These studies had clear limitations but highlighted the need for continued monitoring of approved medicines.

In addition, MCOs can link reimbursement processes to metrics tracked by a data-driven system in oncology. This would allow MCOs to manage costs amid a proliferation of treatment options for many indications with no clear leader. For instance, about 60% of projected haematology-oncology growth will come from classes with a high or medium degree of interchangeability. Decision-support solutions could also be linked to quality improvement programmes, documenting response to therapeutics – including patient compliance, appropriate drug utilisation, and support for the Healthcare Effectiveness Data and Information Set (HEDIS) of the US National Committee for Quality Assurance (NCQA) – with enhanced sensitivity and accuracy.
Embracing these measures will unlock a new era in patient outcomes, enabling oncologists to effectively analyse and deploy the rising abundance of therapeutics, technology, and data in breakthrough cancer treatment.

References available on request.

Children are naturally curious and are willing to explore their surroundings. They may unintentionally ingest objects or substances within reach, found most commonly in the household. The ingested foreign bodies are typically small objects such as coins, fish bones, marbles, and drugs. In particular, the accidental ingestion of magnetic foreign bodies in paediatric patients has become common due to the increasing use of toys with magnetic elements. These magnetic toys (henceforth referred to as multiple magnets) possess significant injury risk when more than one is swallowed. It is our job as healthcare providers to prevent and manage these ingestions. This article reviews the risks, management, and complications of multiple magnet ingestions in children.

What are multiple magnets?
The rare-earth metal magnets composed of neodymium, iron, and boron are 5 to 10 times stronger than the typical refrigerator magnets made of ferrite and have been increasingly used in toys and marketed as adult desk toys with different names like neomagnet, neodymium magnet, buckyballs, etc.

These sets typically consist of 20 to 216 small, powerful, spherical magnets that can be linked together to create a wide variety of shapes and patterns. Despite being marketed to adults and may bear clear warning labels on the package, these novelty toys often fall into the hands of children.

If ingested, a single magnet is typically passed unnoticed; however, if multiple magnets are swallowed together or with another metallic object, sequelae are significant and can be life-threatening. These magnets pose a unique hazard owing to their ability to forcefully attract one another across loops of bowel, leading to pressure necrosis of the intervening bowel wall, hollow viscus perforation, intestinal fistula, sepsis and potentially death.

Current Situation
In the first quarter of 2018, three children were admitted to the American Hospital Dubai due to ingestion of multiple magnets. In two of these cases, the ingestion was witnessed by the parents while the third one presented features of acute intestinal obstruction and a radiologic examination showed the presence of multiple magnets as a causative agent for the intestinal obstruction (Figure 1). Emergency operations were needed for 2 of them to remove the magnets and manage the multiple bowel perforations and fistula formations (Figure 2). One of the children was observed strictly with radiologic examination monitoring till the magnets passed out spontaneously.

At our Hospital, once the multiple magnetic materials are identified, the practice has been to remove them by endoscopy while they are still in the stomach to avoid serious sequelae. If the magnets pass through the stomach, then we try strict conservative management with serial imaging daily for a few days. If this fails, as lack of migration of the foreign bodies, serial images show a gap between magnets, or the patient deteriorates clinically, then emergency surgery (explorative laparoscopy or laparotomy) is promptly indicated. Sometimes the strict follow-up is successful, and the magnets found attached to each other all the way according to abdominal radiographs have came out with defecation after 2-4 days. Similar guidelines were published by the author in 2012.

Figure 1: Abdominal radiographs showing 14 ingested magnets

Figure 2: Showing 2 perforations in the bowel

Legislation and recalls
My previous experience with magnet ingestion was reported in 2012 and a campaign was undertaken to remove such magnetic toys from the market. Large institutions and centres published many reports from different countries and as a consequence, various consumer safety and government organisations across the globe began using regulatory powers to restrict or curtail the availability of these products.

Most developed nations have regulatory authorities tasked with ensuring consumer safety and protection. For example; in the US, this responsibility is granted to the Consumer Product Safety Commission (CPSC), and in Canada, Health Canada serves that role. These agencies must identify new hazards, quantify relative levels of harm, and use their legislated powers to promote public safety. The consumer protection agencies have various options at their disposal to enforce policy. Among these, a product recall is the strongest, and as such is typically reserved for cases where other approaches are deemed insufficient.   

In 2014, the CPSC issued a strong federal safety standard for high-powered magnets. Under the Consumer Product Safety Act, this performance standard stipulates that any magnet manufactured or imported on or after April 1, 2015, must be large enough to decrease its ingestion hazard or the magnetic force must be lowered.

In Canada, a mandatory product recall was established in 2013 and resulted in a significant reduction in the morbidity associated with ingestion of multiple magnets which was demonstrated clearly in a recent study that was published in 2017.

Prevention
In the UAE, there has been a significant rise in the incidence of multiple magnet ingestion among children that was noticed in the last couple of years (from our experience and from the direct contact with other paediatric surgeons in the UAE). This is mainly due to the availability of these magnetic toys in the market and online shops.

We think that healthcare givers should continue to counsel patients on magnet safety, discuss safe and age-appropriate toys, and warn about the serious health hazards associated with magnet ingestion. Adolescents should be discouraged from use of magnets which may lead to unintentional ingestion. In the event of ingestion, parents and patients must seek immediate medical attention, as delay in management may increase the risk of complications.

We need to clearly highlight these potential risks and ask the appropriate regulatory authorities to take an action to remove these magnetic toys from the market in order to safeguard our children from threat of multiple magnet ingestions.

Conclusions
Despite their attraction, high-powered magnets are an avoidable source of potentially life-threatening injury. Parents and caregivers should remove them from the reach of children, and medical providers should maintain a high index of suspicion of their ingestion. Consumer protection agencies need to enforce certain policies to reduce the alarming rise in multiple magnet ingestion among children in the UAE.

References available on request.

When Peter Drucker remarked, “Hospital is perhaps the most complicated enterprise ever created by mankind” – he couldn’t have been more correct. There are other businesses and there is healthcare delivery. Nowhere are the stakes as high in terms of human life and emotions as in healthcare services. The psychological association with hospitals is seldom a positive one as they are associated with pain, sorrow and sometimes even death.

The complexities in the business are many and growing with each passing day. Given below are some factors that make healthcare delivery a complicated business to be in:

• No one is unilaterally responsible for consumer experience:

Everyone plays a part in serving the customer and one cannot pin point as to who is actually responsible for the over-all service delivery. For example, a surgeon would like to think that if the surgery was done well and was uneventful then the patient has received what he came for. However, the overall patient experience consists of a lot of other elements like the quality of food, nursing care, discharge process, etc over which the surgeon has no direct control. Each stakeholder in the care cycle can only do her or his part and is not in a position to influence the overall experience of the patient.
One bad moment at any of the numerous ‘touch-points’ will cast a shadow on the good work done by others. Unlike a restaurant or air-travel, which has fewer touch-points, a patient will visit the parking attendant, the reception desk, doctors, laboratory, radio-diagnostics, canteen and pharmacy in one visit.
To make matters worse, the management control is limited to the service delivery. The people who run and manage hospitals are usually dependent on these numerous departments to deliver the desired experience and results. This adds to the complexity.

• Consumers are not equipped to judge the quality of service being provided:

How will a patient know during and after the surgery that the theatre in-charge had sterilised one instrument less for the surgery? As a result, the surgeon was not able to give his 100% skill to the surgery. How will an OPD patient come to know that if the doctor had prescribed another antibiotic, it would have been better for him?
Consumers judge the service quality through a very limited perspective. Mostly, the judgement is limited to the elements that a patient can either see, touch or feel. For instance, the ambience, the body language of the staff, the tone of voice used by the front office, will be the parameters for a patient to judge the quality of care being provided by a hospital.
Cold food served to a patient will sometimes outweigh the precision with which the surgery is done. The pain of bad service often outlives the post-operative surgery pain in the long run only because the patient cannot really assess the surgeon’s precision. An accurate diagnosis of a rare medical condition gets overlooked (even if temporarily), if the receptionist did not smile to the liking of the patient. The tangible factors tend to outweigh the non-tangible ones because the patients are not technologically equipped to evaluate the latter.

• Healthcare delivery is a service that no one wants to buy:

Going to a hospital is not akin to going on a vacation or buying a new car. No one is looking forward to his or her next surgery. People go to the hospital not out of willingness but out of necessity. The tricky question for private healthcare providers is – ‘How do you make them willing to buy from you?’ The services of a private hospital are for general good of human beings and yet they are paid for. So, it becomes a complex contradiction when your objective is to make everyone healthy and yet you want people to come to you in sickness. Healthcare is one of the trickiest services to market.

• The management of large variety of workforce makes things intricate:

From a highly-skilled neuro surgeon to a janitor, the cross-section of the work force in a hospital is huge. Unlike a software company or a law firm, where everyone is at a similar level in terms of skill and education, hospitals have a huge variety of workforce. The biggest challenge is to integrate the diversity and urge every member of the myriad workforce to work towards a common goal of customer satisfaction. The system has to work like a well-oiled machine in spite of all variance, which is not an easy thing to ensure.

• Decider, user and payer may not be the same people:

Consider this – An old man going for his prostate surgery may not be paying for it himself. His son may pay for it. However, the son is not the one who decides which hospital the old man will go to. That decision may be taken by the wife of the gentleman. Now put the insurance and third-party administrators (TPAs) in the picture, which pay up for many patients that a hospital treats today. In short, multiple people may be involved in the decision making and paying process and none of these people may be using the service. Sometimes, the ones paying for the treatment would not even know the patient personally. The hospital will get paid for the services rendered today after a few weeks. The system for claiming this payment involves complex data entry and coding. Sometimes, the hospital will not be paid the complete amount as there will be deductions from the insurance companies. This ends up in payor, provider and patient competing with each other to shift the burden of the cost on each other. Complex indeed!

• Working capital is a perpetual challenge:

The expenses of a hospital happen before the hospital earns money. Salaries, electricity bills and other overheads are to be dispensed within “this month”. A big chunk of money nowadays comes after a couple of months or more. How does a hospital meet its day-to-day expenses? Working capital is something that hospitals have to keep a close watch on all the time. Another complicated twist to an already complicated scenario!

• Technology keeps changing every passing year:

Equipment is expensive. Moreover, it gets upgraded before you have learnt how to use the existing version fully. Even if a cash-stripped hospital does not want to buy the new ‘white elephant’, it is forced to. The competitor may somehow manage to buy the new version and the hospital may lose out on the market share. Buying upgraded equipment even when you don’t need it sometimes becomes a necessary evil in order to survive the competition. Additionally, some equipment are an absolute must in order to complement the existing services. For example, a hospital may have to install an expensive MRI machine if it wants to hire and retain good neurologists.

• It is both a labour and capital-intensive business:

Most businesses are either dependent on manpower or money. Healthcare delivery is dependent on both. It requires a huge amount of investment and a high number of skilled staff to set up hospitals and maintain them. The global shortage of skilled professionals is another challenge the business has to deal with. The demand for doctors and nursing staff is far more than the supply. Most countries have their independent systems to qualify and license doctors in order to allow them to practice. This sometimes deters medical professionals to relocate themselves to other countries.

In Summary:
The business of healthcare is evolving with every passing day. Healthcare providers are learning to cope with these complexities. The riddles may never be cracked fully, but incremental progress is being made. The pace of learning will perhaps determine which player will survive in the long term. What is required of the hospital promoters is their need to widen the horizons and question the norms all the time.

Across the globe, healthcare providers are facing the same three questions. How do we improve patient care? With growing populations, how can we help more people? And how can this be achieved with budgets that have been under pressure?

Finding a solution to these questions is increasingly reliant on technology. Now the good news for healthcare providers in the Middle East is that based on findings from a recent survey, analysts at PwC believe that the region is positioned to be a first-mover when it comes to adopting technology to improve patient care. However, the responsibility of addressing these issues and ensuring that technology can deliver on these promises, is falling to the IT department within healthcare institutions. Once focused solely on ‘keeping the lights on', IT has evolved to become a strategic element within healthcare, much like it already has in other consumer focused sectors like retail and hospitality. It’s now a team focused on helping to reduce costs, on making more resources available for medical professionals and on making medical innovation a reality within the organisation.
 
It’s always been the case that by understanding more about a patient, doctors can more accurately diagnose an issue. Now medical professionals can use data in addition to their patients’ concerns to help them better understand symptoms. Everything from medical phone apps to new imaging technology is providing reams of data to support diagnosis. For example, by combining information on a patient’s lifestyle with data on their DNA structure, hereditary abnormalities in the family and heart rate and blood pressure, steps can be taken to prevent certain illnesses altogether or help doctors prescribe medication or lifestyle changes that are precisely and fully focused on the physiology of that single patient. These new innovations, and the data they generate, are increasingly helping medical professionals deliver significantly improved patient outcomes.
 
However, enabling all of this data to be accessed in the right time, in the right place and in the right format is a significant IT challenge. Estimates suggest that the vast majority of all data in an organisation is unstructured. To enable healthcare providers to benefit from this data, IT is increasingly looking towards advanced real-time analytics and 'deep learning' using advanced technologies, such as artificial intelligence (AI) and machine learning, to support the processing and delivery of data.
 
There’s no doubt that these technologies provide incredible advantages across a wide range of industries. In healthcare, the application of real-time analytics can help to detect and diagnose diseases faster, reduce time-to-treatment, lower costs and eventually lead to better patient care and outcomes.
 
We’ve seen the potential impact of this with the AMPLab at UC Berkeley, which developed a real-time analytics engine to analyse genetic make-up. This analysis allows doctors to deliver medicine which is more precisely tailored towards each patient. By combining this engine with flash storage, the Lab has also significantly reduced the time needed to sequence data-intensive DNA samples and analyse results. As a result, researchers and clinicians can generate valuable new insights and, in some cases, deliver faster answers to life-and-death questions.
 
But implementing advanced real-time analytics or an AI project isn’t that simple. Huge amounts of data need to be processed and analysed at speed, in order to make the split-second decisions that the technology is capable of. As a result, these projects need a very solid infrastructure and significant compute power to work effectively.
 
Traditional data centres for healthcare organisations have done reasonably well in terms of enabling healthcare practitioners to deliver patient care. But they were never built with the intention of running the demanding data applications now being used. The future with these applications, AI and machine learning, requires a different approach to data centre infrastructure—an approach with a particular focus on storage, designed to deliver massively-parallel access to data at a very high bandwidth.
 
But here’s the dilemma, how do healthcare organisations do this while dealing with constrained budgets? The answer lies in flash. An all-flash data platform, purpose-built for modern analytics and deep learning can enable healthcare organisations to realise the potential of AI faster and on a far smaller footprint than traditional infrastructure for high-performance computing would provide.
 
According to the PwC research I cited earlier, 33% of Middle East respondents believe that advanced computers/robots, coupled with AI can make a diagnosis faster and more accurately and 29% believe that it will help make better treatment recommendations. However, for this to be a reality, healthcare providers, in the region, today require a data platform that enables them to deploy a new class of applications, to extract new insights from data and to do so in real-time.

By ensuring innovations like AI and advanced analytics are supported from the data centre level up, they should be able to run operations with cloud-like agility, improve the economics of data analytics at high velocity and scale, and derive new insights to deliver data-driven patient outcomes and results not possible before. Ultimately, by transforming how the organisation can handle and process data, IT teams will enable practitioners to deliver the best level of integrated care possible, to more people.

With the launch of its health investment strategy 2017-2020, the Dubai Health Authority (DHA) aims to promote Dubai as a viable and competitive hub for need-based investment in healthcare. As Dubai’s healthcare sector offers significant opportunities for investors, the strategy also aims to guide and support them to build sustainable public-private partnership models in healthcare in Dubai.

However, in recent years, the healthcare providers’ landscape has changed significantly, leading to an overcapacity for certain services. So, the question really is: how will this service add value and will it prevent health investment in already saturated spaces?

“Absolutely, it will,” says Dr Ibtesam Bastaki, Director of Investment and Partnership at the DHA. “While it is a fact that some services and catchments have sufficient supply, or some are crowded and pose a risk for overcapacity, there are gaps in a number of specialities and services. Innovations in primary care models, centres of excellence in certain specialities, home-based care and rehabilitation services are key areas of investment potential.”

She added that the healthcare sector in Dubai has been growing driven by the population rise and an increase in private health infrastructure. “If you compare global estimates and look at the manner in which the population of the Emirate is rising, by 2025, at the current rate, we can expect a gap in in-patient beds, in price-positioning and in specialities. Therefore, there certainly is potential and our aim is to foster and promote health investment in areas where there are lack of services or where there are opportunities for growth,” says Dr Bastaki.

“Several countries have dedicated healthcare investment promotion agencies and frankly it is a better and more efficient way to operate. It is a win-win situation for the investor and the health sector, and patients benefit the most because it prevents oversupply, leads to availability of health specialists across various disciplines and fosters the growth and development of specialised and super-specialised health services,” she explains.

According to Dr Bastaki, the health investment strategy 2017-2020 was developed after conducting a need-based analysis and after extensive stakeholder consultations on the current healthcare investment landscape with more than 40 interviews conducted with senior leaders from both the public and private sectors.

Dr Bastaki adds that the manner and type of care needed is also changing drastically due to a number of factors, creating opportunities along the way for companies that are quick to adapt to this change.

“Rise in ageing population, rising prevalence and risk factors for chronic diseases, and changes in technology and new innovations in the delivery of care are factors that will change the global healthcare landscape in the next decade,” she opines.

“To keep up with these changes and provide patient-centric care with regular monitoring and follow-up from the comfort of the patient’s home, I expect that there would be significant growth in remote patient monitoring and coordinated care delivered through telehealth platforms and solutions,” explains Dr Bastaki. “This presents a huge opportunity for Information Technology (IT) healthcare firms to dive into the market and provide solutions that will cut costs, lead to closer follow-up and care particularly for the elderly or need-based patients that find it inconvenient to travel to clinics regularly. Of course, there are certain stringent criteria such as quality of care the technology will provide, its efficiency, ease of use, etc., but the point is that there is enough and more opportunity.”

In terms of traditional clinic-based services, she says, “Certainly, primary healthcare is a priority focus especially for regular preventive screening and early detection or as a first point-of-contact for medical cases that are not critical, and also for regular follow-up and care. There is a huge opportunity in that speciality particularly as we aim to continue enhancing the specialities we offer through the primary healthcare centres. A lot of the care that is being delivered in hospitals today will shift to an outpatient setting – leading to the growth of ambulatory care where a lot of procedures can be done in a day care setting and home-based care. Over the next few years, we can expect to see further streamlined care and continuum of care starting with primary healthcare right up till home-based care using the latest healthcare technology.”

According to Ahmed Faiyaz Sait , Advisor, Investments & PPPs at Dubai Health Authority, “There will be more of a higher demand for one-stop-shop clinics and medical centres for specialised services like orthopaedics and diabetes and this is currently the trend in the emirate. The main driver of this change will be bringing a multi-disciplinary approach and deep clinical expertise to work on a particular disease or condition that improves and delivers better outcomes. There is more to be done on how care delivered at specialised centres is integrated with primary care and home-based healthcare (remote patient monitoring) and we hope to see such care innovation taking place soon. The DHA has clearly laid out the areas of focus over the next two to five years and the department is keen on providing the dedicated investment promotion and facilitation efforts to support priority investments in Dubai.”

DHA’s investment focus for the next 2 to 3 years

Innovations in primary care
Ambulatory care
Urgent care clinics
Mental Health
Chronic Disease Management
Tertiary Care for diabetes, cardiology and oncology
Diagnostic Health and Remote Monitoring
Rehabilitation and Physical Therapy
Home-based care
Long-term and extended care

DHA’s investment focus for the next 3 to 5 years
Prevention and Pharmacy beyond-the-pill
Precision Medicine and Genetics
Population Health Management
Nursing Homes and Palliative Care

DHA’s support for investors and healthcare providers

• Provide real time information on demand for services, supply and capacity gaps
• Support and advise on investment mandates, and on green field investments exceeding AED 100 million initial investment
• Facilitate discussions with other DHA stakeholders and Dubai government stakeholders on sizeable investment mandates
• Facilitate priority investments and offer commercial incentives for priority investments through Certificate of Need policies
• Stakeholder workshops on enabling policy change to enable priority investments
• Oversee, develop and manage PPP process for partnerships with DHA for priority services / identified projects

PULL OUT QUOTE:
“Innovations in primary care models, centres of excellence in certain specialities, home-based care and rehabilitation services are key areas of investment potential.”

Security threats are, and always have been, major concerns to healthcare organisations due to the value and vulnerability of the clinical data that is being recorded and distributed. The value of the data comes from the fact that it directly affects our ability to safely treat patients. Due to its content and historical nature it can be very big, so it takes a long time to rebuild, and it contains more than just clinical data. Also included are personal, financial, and demographic data which allow it to be used for wider identity theft and payment fraud. It is immutable and persistent that in the event of a data breach you can change your email address, your credit cards, their passwords, PINs and account numbers, but you cannot change your mother’s maiden name. The vulnerability comes from the fact that there has been a revolution in healthcare with the interconnection of systems, cloud computing, Internet of Healthcare Things (IoHT) and mobile devices and the changes in working practices of clinicians such as remote monitoring, telemedicine, and working from home. This revolution in big data, AI and care has not always been matched with the security awareness, policies, practices, and budgets of healthcare organisations.

AI itself provides an open door to bad guys who wish to exploit this vulnerability, even though in most countries healthcare data is protected by data or privacy laws, and any breaches or inability to guard it properly can have legal and financial implications. Most custodians of patient data are not as aware of the changes that the use of AI imposes. As it is used more and more in patient care it needs access to larger and larger data sets from multiple sources, not just the electronic medical record (EMR). Not all of these sources adhere to the same rigour of data protection. Indeed, as most AI platforms need to consolidate large amounts of data and need extensive computing power, patient data and other information are more likely to reside outside the relatively isolated healthcare data centre, probably on third party systems, which should raise concerns as AI is mostly in the domain of technology companies who may be innovative but may not be fully aware of the security aspects of health data as their ideas have moved from innovation to production.

AI in healthcare seeks to incorporate physical, digital and bio-technology data, to create services we can only dream of today. The rise of wearables and the availability of geolocation data through mobile phones means that it is easy to re-identify people from seemingly anonymised data and understand more of their behaviours, important information for population health, infectious disease control, behavioural health and chronic disease management, but the key is to not exploit personal data.

In addition, in the globalised worlds of data clouds, AI, and healthcare, the transfer of data across man made boundaries such as states and countries are both inevitable and necessary. The world is only just coming to terms with this but the way forward is being led by the UAE with the Fourth Industrial Revolution Protocol (4IR). This visionary protocol was signed at the World Economic Forum in Davos in 2018 and is a global roadmap that seeks to ensure the well-being of the community. Adopted by the UAE government, the protocol seeks to establish an integrated and secure data ecosystem to expedite the implementation of 4IR technologies to produce unprecedented services that can transform aspects of people's everyday life. Even when this protocol becomes a reality and is widely adopted, healthcare organisations must still protect themselves against three major types of threats.

The first being the large-scale attack to get the data on as many patients as possible, for further sale or fraudulent enterprise. The second threat arises from headline grabbers, who want to attack high profile brands and famous facilities, probably for no financial gain, and the third is the targeted attack on one patient, say a celebrity or a high net worth individual for the purposes of selling the information to others such as gossip news or for blackmail purposes.

Traditional defensive methods are no longer sufficient to protect our patient’s data from the bad guys as these types of attacks are becoming more and more sophisticated. There has been an increasing number of attacks using social engineering techniques (e.g. Phishing) that can overcome “traditional” defenses such as email filters, anti-virus, rule and signature-based detection systems. But before looking at what new AI based tools can do for organisations, I would like to suggest that these are only more sophisticated tools, and without the basics in place they will fail to deliver on their promises.

Good systems management is important. The focus should be on keeping not just the central servers up-to-date with security patches but also connected devices. To do this, assessments of suppliers’ security policies and procedures should be a key part of your procurement department’s process for selecting devices which may be attached to the system.

Information governance is key; defining critical data, knowing how the data is managed both in transit and at rest, and having defined, usable policies and processes, are much more important than adding more technology to a fractured system. Similarly, education and awareness are necessary so that everyone on the system is regularly made aware of these policies, not just on induction day. As threats are evolving, staff should be kept aware of the people side of security with ongoing campaigns such as anti-phishing behaviour management. However, all this is just guess work if you do not know how effective it all is and there needs to be regular penetration testing of the systems to ensure that you know your defenses are up to date and effective.

Doing all of this means there is a shortage of security experts to help ensure that custody of your patients’ data remains as effective as time moves on. This is where AI and machine learning can help healthcare cyber security. However, as mentioned previously, merely purchasing new tools does not improve defenses; they need to be deployed, maintained and monitored to provide effective defense.

Security Information and Event Management (SIEM) software products and services provide real-time analysis of security alerts generated by network hardware and applications and are also used to log security data and generate reports for compliance purposes. By combining this real-time data gathering with Threat Intelligence, extending the storage of this data over time and applying the enhanced analytics capabilities that come with machine learning and AI techniques, it improves the detection of attacks around the clock with less skilled staff. By looking at past performance, it becomes possible to analyse user and device behaviours to detect activity that is out of sync with the expected patterns from the devices or users much quicker and more accurately than human observers can.  For example, if we unexpectedly start getting system access or requests for EMR data from unknown sources or many requests for a patient’s data from multiple sources, this should raise a warning flag.

This use of AI in healthcare cyber security is becoming more and more important for protection of on-site systems especially as healthcare networks expand and data and processing gets pushed out into the “cloud”. By the time we have fixed one vulnerability the bad guys have moved on and are attacking from a different direction. If we only rely on techniques that respond to existing attacks we will always be one step behind these bad guys. By using AI, we can be more proactive and start to be one step ahead, as we begin to detect abnormal behaviours as they happen. Then it becomes a bit like personal wellness where we identify people at risk of chronic disease and take preventative measures before it becomes a big problem. We can thus identify and stop the attacks before they snowball into a larger problem.

The AI-based tools are getting better all the time and we will see them continue to evolve and learn over the course of the next few years, so that the anticipation of attacks will be quicker and the responses stronger. The healthcare industry has been slow to react to the realisation of how valuable their data is, and we are playing catch with other industries. It does give us the opportunity to look at them and quickly match the bad guys by learning from other industries. AI and machine learning will offer healthcare organisations a way of securing their patients’ data as healthcare evolves without relying on scarce high-cost skills but will only meet its promise if the basics of information governance, awareness and education are in place first.

The application of AI in healthcare is a double-edged sword. By its very nature of openness and sharing of data to be effective it exposes us to potential new vulnerabilities while the use of AI in cyber security tools improves our ability to identify and respond to threats. The current burden is falling on individual organisations, leaving weaknesses in the whole system. As the use of big data, AI and machine learning become more collaborative and international, to safely realise their potential we will need the UAE’s initiative in establishing the 4IR protocol to ensure the Arab world is at the forefront of this change.

Dubai Health Authority unveils plans to establish Innovation Centre to create an environment for collaboration with the private sector in the field of healthcare innovation

Article provided by Dubai Health Authority
In line with the UAE vision and Dubai Health Strategy 2016-2021 that seeks to make the population of the emirate healthier and happier by providing world-class healthcare services and fostering creativity and innovation, the Dubai Health Authority has unveiled plans to establish an Innovation Centre in collaboration with the private sector to support healthcare innovation.

The new Innovation Centre will be set up behind Rashid Hospital in Dubai. The initiative intends to promote public-private collaboration in the field of healthcare innovation and also provide a permanent base for entities keen on supporting medical innovation in Dubai.

Innovation: The future of better health
Highlighting the importance of creating an environment that is conducive to innovation, His Excellency Humaid Al Qutami, Chairman of the Board and Director-General of the Dubai Health Authority, says: “Over the years, we have seen advances in medicine which have directly contributed to better patient outcomes. Health is a sector that directly affects us all and innovation in healthcare can save lives, improve patient outcomes, promote health and well-being. So, undoubtedly, innovation is the future of better health. Our aim is to promote an atmosphere that is conducive to innovation, not just for medical treatment but also in technology, healthcare management, pharmaceuticals, medical devices, etc so that all aspects of the health sector develop and thrive. Innovation cannot take place in isolation and thrives on collaboration; we are keen to work with innovators, healthcare entities, scientists and researchers so that we can improve healthcare outcomes and focus on improved patient care and experience.”

DHA is currently working with the private sector to establish the most suitable model to foster the Innovation Centre concept and to ensure round-the-year activation and participation. In the initial meeting held with the DHA team and members of the private sector in April, participants were provided a tour of the construction site of the Innovation Centre. Members from both the public and private healthcare sectors offered their inputs and a brainstorming session was held to discuss the way forward.

‘Important pillar of Dubai Health Strategy’
According to Dr Mohammad Al Redha, Director of the Department of Organisational Transformation at DHA, “In line with the vision of our leaders and in line with the DHA Health Strategy 2016-2021, innovation in healthcare is an important pillar of our strategy. For us, innovation means the ability to harness new technologies, to implement newer methods of healthcare delivery and management in order to provide patients with improved healthcare and make their lives better. At the end of the day, patient-centred care is our priority and improving their lives and providing them with happiness is our primary focus. Thus, for us, innovation is the vehicle that will revolutionise healthcare and directly lead to patient well-being and happiness.”

He highlighted that as part of the DHA strategy the innovation programme is designed to promote innovation and efficiency and ensure that Dubai residents and visitors have access to high quality services across the continuum of care. The innovation programme aims to introduce innovative care models to fill existing care delivery gaps and enable integrated, cost-effective, patient and innovation-oriented care delivery.

3D Printing and Artificial Intelligence
DHA has been working on the implementation of latest technologies such as 3D printing in healthcare and artificial intelligence.

Dr Bassam Mahboub, Consultant Pulmonologist and the head of pulmonary medicine unit and the program director for care model innovation in DHA, has stated that over the course of the past year, DHA successfully deployed 3D technology across its dental services department and carried out complicated surgeries using this technology. “The DHA also worked with the private sector on 3D-printed artificial legs that was used to provide amputees with a new lease of life,” he added. “One of the amputees described how her 3D-printed foot was much closer to the feeling of having an actual foot compared to the previous one she was wearing. One additional benefit of 3D printing is the cost-effectiveness of the technology, which makes it affordable across a wide spectrum of patients who need it.”

Presently DHA is working with the private sector on the implementation of AI in medical fitness screening and in other areas of healthcare such as stroke detection, management and diagnosis as well as rehabilitation.

First radiology AI Algorithm

Earlier this year at the 2018 Arab Health Exhibition & Congress in Dubai, UAE, the DHA announced that it would use Artificial Intelligence (AI) to sort out all chest X-ray scans required for mandatory medical fitness for residency purposes. This is expected to streamline the system, cut down processing time and provide a more efficient and consolidated system for issuing results. At the event, the DHA signed a Memorandum of Understanding (MoU) with Agfa HealthCare for validation of the first radiology AI algorithm in the UAE. The MoU was the culmination of the joint efforts of the DHA and Agfa HealthCare for over a period of two years during which the use of AI was reviewed across the radiology departments of DHA’s medical fitness centres.

“The DHA is keen to foster the use of technology in the health sector to improve efficiencies, enhance healthcare management and overall workflows and most importantly, to further improve patient-centric care,” stated His Excellency Humaid Al Qutami. “Utilisation of AI in the health sector is also in line with the UAE Strategy for Artificial Intelligence. The DHA decided to use AI for X-ray imaging across medical fitness centres because of the scale of the service and the fact that it will greatly enhance work efficiencies and will lead to optimum utilisation of manpower. The move will have a significant positive impact on the overall medical fitness system.”

Announcing the preliminary results of the Chest X-ray AI Algorithm deployed across DHA medical fitness centres, the DHA revealed that upon completion of Phase One of onsite validation in early January 2018, and on analysis of preliminary data, the algorithm was able to correctly identify diseases in Chest X-rays approximately 90% of the time. Phase Two results in March 2018 showed further improved sensitivity to 95 per cent.

The Algorithm processed approximately 4,900 Chest X-rays, and two DHA MFC radiologists reviewed the findings detected by the AI Algorithm.

"The results are very promising,” said Dr Mohammed Al Redha. “We will work together to establish an enterprise imaging strategy for the DHA to enable multi-speciality medical imaging consolidation. DHA will establish a framework of Artificial Intelligence workflow to augment radiology imaging, including in the area of detecting diseases and we will collaborate to validate machine-learning algorithms in development.”

According to Chiho Rim, Co-Founder and Chief Strategist at DrFive - one of the ten firms that took part in the initial meeting with DHA at the Innovation Centre, “Our technology uses AI to detect the exact type of stroke the patient is suffering from and we are able to detect this as AI can read the MRI and CT scan and immediately present the doctor with the needed information. We have conducted trials in hospitals in South Korea.”
Other firms present at the meeting included Etisalat Digital, Novartis, HCI group, IBM, Credit Swiss, Fasaisal, MSD and Cognitive Healthcare International (CHI).