Healthcare providers strive to deliver quality patient care and improve customer satisfaction profitably, however, this is easier said than done. Today’s healthcare centres struggle with keeping operational costs down and thus it is vital to receive payments from patients and insurance companies in a timely manner to keep profits up. To accomplish this, the revenue cycle – or the life of a patient account from the time their case is opened until final payment is received – must be managed effectively, this is where Revenue Cycle Management (RCM) steps in.

Omnia Health spoke to Amit Agrawal, Senior Director of Operations, ACCUMED, about the importance of healthcare RCM and how it is directly impacting patients.

What is healthcare Revenue Cycle Management? 

RCM encompasses all administrative and clinical processes in a healthcare facility. RCM tracks patient care beginning with appointment scheduling, registration, appointment, insurance eligibility, and ends with the final payment for any given treatment. The goal of the RCM function is multi-fold and includes enhancing patient experience during the entire journey of clinical care, maximising claims reimbursement and revenue, improve cash flow and ensure regulatory compliance.

ACCUMED was the first company to provide specialist RCM solutions in the UAE and the GCC region at a time where the healthcare system in the UAE was embarking on transformation driven by the country’s visionary leadership.  We consider that every healthcare facility is unique, so we listen and understand their needs, and design custom solutions that are relevant, practical and scalable within the operating environment of the organisation. 

Why is RCM important?                                                                                                         

RCM has a critical role, not just in a healthcare organisation, but also at a macro level. At an organisation level, RCM directly impacts the financial performance of a healthcare organisation in many ways. 

From a strategic standpoint at individual hospital level, RCM function contributes to shaping the healthcare provider’s market segmentation and positioning which in turn determines the addressable market size and revenue generation opportunity. 

RCM deploys processes and technology to enable coordination, flow, and collation of essential administrative data across a complex eco-system comprising of front desk operators, physicians, labs, nurses, pharmacists, billing, collections and so on. 

This ensures the patient receives the right service at the right time, insurance and other healthcare payors receive accurate and timely information for their administrative purposes, and healthcare organisations bill and receive appropriate and timely remuneration. 

RCM helps in optimising revenue generation by ensuring the hospital prices its services appropriately and instilling proper process management of billing and collections from payors of healthcare services. Additionally, an effective RCM function aids in shortening the cash cycle thereby lowering the organisations’ cost of capital. 

Health insurance companies are beginning to see material efficiencies and savings in operational costs as RCM reduces the need to re-touch and re-work the same claim.
 
Lastly, RCM helps by providing insightful data and analysis allowing healthcare organisations to assess their financial performance, identify risks, make critical decisions, and take necessary corrective actions that aid right decision making. The data and insights are of importance not just at hospital level, but also at national healthcare system level as it enables stakeholders understand the healthcare needs of the population today and in future and ensure readiness to meet these needs.

How is RCM directly impacting patients?

RCM impacts patients by establishing what services the patient is eligible for in which healthcare facilities, providing timely information to payors, healthcare providers, and patients, so all parties are well informed about a patient’s condition thus providing uninterrupted healthcare treatment to the patients, and helping healthcare providers and insurance companies reduce their operational costs and therefore allows them to provide the finest healthcare services at optimised costs.

Effective RCM also aids hospitals to reduce rejection rates by insurance companies. It also helps reduce the cost of working capital by speeding up the cashflow. Lower operating costs empower healthcare operators to lower the cost of services for patients.

China is the second-largest medical equipment market in the world and has been growing rapidly with double-digit growth in the past five years. Here Omdia summarises the key events and milestones in China in the past year and explores the trends for the year 2022 and beyond. 

1. The aging population shall keep driving the growth of China’s healthcare equipment market

Demographic change is the biggest factor underpinning the growth of China’s domestic healthcare market. On January 17, 2021, the National Bureau of Statistics released updated demographics of the Chinese population: The 65+ age group reached 200.5 million in 2021, accounting for 14.2 per cent of the national population. 

According to a recent United Nations forecast, the population aged 65 years or older in China is set to rise to 356 million in 2045, or 20.7 per cent of the total Chinese population. According to the OECD criteria, China is on the cusp of being classified as an “aged society” and shall become a “super-aged society” by 2045. One of the impacts of a rapidly aging society is the growing demand for medical services.

As per statistics from the National Health Commission (NHC) of China, between 2014 and 2019, the number of patient visits to hospitals grew at a compound annual growth rate (CAGR) of 5.3 per cent. The total national health expenditure increased by 104 per cent between 2014 and 2020, with a CAGR of 10.7 per cent.

The fast-increasing medical demand owing to aging requires China’s health system to upgrade and drive the fast growth of China’s medical equipment market.

2. Investments shall continue in healthcare facilities construction

The Chinese government realises the pressing need for healthcare services. Therefore, investments have been made to upgrade and expand medical facilities across the country. Between 2016 and 2020, the number of hospitals in China grew at a CAGR of 5 per cent, adding about 1,200 new hospitals every year. Also, the Chinese government issued guidelines urging hospitals to expand their premises and upgrade their facilities to meet new requirements of medical equipment and the number of beds.

These construction efforts were accelerated after the Chinese government re-examined its healthcare system since the breakout of the COVID-19 pandemic. In the latest 14th Healthcare 5-Year Plan released in March this year, the initiatives to improve healthcare infrastructure expand to strengthening infectious disease prevention and control and building state-level and regional-level medical centers. Also, an aging population means that China needs to improve rehabilitation services to the elderly. Accordingly, in June 2021, the NHC issued a document requiring the building of rehabilitation hospitals.  

Omdia foresees that demand for medical equipment will experience a surge in coming years because of the upgrade and expansion of medical and rehabilitation facilities. Demand arising from this government-led medical facility construction shall bring $600 billion in revenue for the medical equipment market between 2021 and 2025.

3. The “Health for all” state medical insurances will cover the majority of the Chinese population

By 2020, the state medical insurances covered 95 per cent of the Chinese population, including children. Released in September 2021, the National Medical-Security Plan (2021–25) continues the initiatives of “Health for all” and “Healthy China 2030” and targets universal healthcare coverage.

The National Medical-Security Plan sets several goals. One goal is to maintain the coverage of state medical insurance at least 95 cent of the Chinese population. Another goal is to further decrease the proportion of medical expenses incurred by patients to below 27 per cent of the treatment cost. To achieve those goals, financial subsidies shall continue to increase, and cost containment measures in medical supply purchases shall expand. Universal healthcare coverage enables wider access to medical care in China, thus, further bolstering China’s medical equipment market.

4. China’s healthcare reform shall deepen, and health systems shall present a new outlook

Currently, China’s high-grade hospitals are overburdened with the majority of primary care. Low-grade and grassroots healthcare centers are underutilised. 

With health system reform ongoing, a multitiered healthcare system will take shape. High-grade hospitals will focus more on critical care, and low-grade hospitals and community health centers will handle more primary care. China’s health system will shift from overreliance on public hospitals to a system supported by private hospitals and commercial health insurers. 

The Chinese government has implemented policies to facilitate the growth of private hospitals. The massive growth of commercial insurance will also help the growth of private hospitals. Between 2011 and 2020, premium revenue for commercial health insurance products grew at a CAGR of 31.57 per cent.

Driven by the ever-increasing medical demand and the boost of commercial insurance, China’s private hospitals will play a much bigger role in medical service, and the providers of health systems shall be more balanced.

5. New technologies like telemedicine, medical Artificial Intelligence (AI), and healthcare robotics will expand their applications in China

China faces challenges arising from fast-increasing medical demand alongside the shortage of healthcare resources. The applications of telemedicine (remote clinical services), medical AI, and healthcare robotics have the potential to improve efficiency and clinical results. Government-led initiatives, including “Internet + Healthcare” and state-level AI strategy, have propelled the new-tech applications in China’s medical sector and will continue to do so.

“Internet + Healthcare” has been a government-led initiative since 2018 to facilitate medical practice supported by digital tools. Laws and policies were issued to support the digital transformation of China’s health system, including health data digitalisation, sharing, and interoperability (data processing, in conjunction with each other) across healthcare providers. After the outbreak of the COVID-19 pandemic, the government stepped up the “Internet + Healthcare” efforts to include telemedicine in state medical insurance coverage, lift barriers for prescribed drugs sold online, and facilitate prescriptions shared to pharmacies by hospitals.

China’s medical AI and healthcare robotics markets are also burgeoning. Startups are mushrooming, attracting large amounts of international venture capital. Omdia estimates, in 2020, China medical AI startups absorbed 33 per cent of global venture capital funding. Some Chinese companies are starting to take the lead in these innovative technologies. One example is SenseTime, a company that is applying computer vision and AI to the merging of data from different scanning technologies (such as CT, MRI, and PET), allowing more precise analysis of medical imaging.

6. More Chinese medical device companies will become global

The Chinese government’s 14th Medical Equipment 5-Year Plan (2021–25) sets a goal to have more than six Chinese manufacturers among the top 50 global medical device companies. Therefore, the Chinese government will continue to support the growth of domestic companies in various forms, including granting subsidies and tax deductions.

Mergers and acquisitions will also accelerate the growth of Chinese companies. Mindray Medical International Co., Ltd., China’s biggest medical device manufacturer by sales revenue, is now the number four ultrasound vendor in the world. Mindray has grown partly through a series of acquisitions of overseas medical technology companies.

One reason why Chinese medical device companies want to expand internationally is that there has been downward pressure on price because of volume-based purchases in the domestic market, which has driven down profits. Mindray recently disclosed that its aim was to increase overseas sales revenues from less than 50 per cent today to 70 per cent in the near future. Increased competition in the international market is likely to become fiercer as Chinese manufacturers step up their focus on international markets.

Omdia’s Healthcare Technology team provides regular insights into the healthcare technology markets in China and around the world.

The COVID-19 pandemic has highlighted the extent to which our fates are intertwined. The lines between individual and community have become increasingly blurred; and it is now more evident that the health of one is dependent on the other. In such an environment, we have witnessed the immense value of data-driven decisions in enabling the healthcare system to adequately prepare for challenges that could impact upon the entire community–whether that’s in the form of global pandemics, such as COVID-19, or even lifestyle diseases. 

In Abu Dhabi, the Department of Health (DOH) recognised the need to have an electronic health information exchange (HIE) system that will enable the exchange and centralisation of patients’ data across the sector. Hence in 2019, the DOH launched Malaffi as the region's first HIE platform, allowing public and private healthcare providers to exchange key patient health information in real-time. When clinicians have access to a longitudinal medical record and 360° view of the patients, they are empowered to make quicker and better-informed decisions, avoiding duplication and medical errors, improving patient safety, experience and outcomes. To put the patient–and by extension the community–first, it is essential to have data-driven collaboration across the entire industry. 

Related: Shaping healthcare through digital transformation solutions

This January, Malaffi celebrated its 3rd anniversary, during which in record breaking time the platform connected all hospitals in Abu Dhabi, 99% of all patient episodes and collated 660 million unique clinical records of medical information, from patient visits and lab results to radiology reports, vital signs, medications and more. Over 45,640 doctors, nurses, pharmacists, and other staff members from the 1,919 healthcare facilities across Abu Dhabi have secure access to Malaffi and are empowered to make better-informed, safer, and more efficient decisions.  

But further to providing the information to clinicians on a single provider level, the power of HIE is truly unleashed when we think about the immense potential of having aggregated health insights for an entire population, as a basis for digital transformation of any healthcare system. 

Enabling a data-driven pandemic response 

For Malaffi, the pandemic was a great opportunity to showcase this potential. When the pandemic started in early 2020, mass testing for COVID-19 was one of the initial strategies to help manage the dire situation. At that time, in parallel with the rollout of the testing capacities, Malaffi provided solutions to manage COVID-19 laboratory results in the Emirate centrally. Leveraging the existing infrastructure, the platform swiftly scaled to capture most of the COVID-19 testing. The solution included databases that are quick and easy to search, multiple dashboards for public health decision-making, and access to test results to the frontline workers, thus becoming an essential factor in the Emirate’s successful pandemic response. 

Later, when the vaccination program was rolled out, Malaffi started supporting the massive operation via expanded searchable databases and expansion of public health dashboards. The robust response placed the UAE amongst the countries with the highest rates of vaccinated population and Abu Dhabi on top of the list of global cities with a successful response to the pandemic, according to a report by the London-based Deep Knowledge Group.   

Due to the vaccination information being centralised in Malaffi, the government and the DOH now have real-time insights into the Emirate's vaccination status. Access to this information enables the authorities to generate operational reports, plan vaccination capacities, streamline logistics and supply chain, and inform public outreach programmes. Healthcare professionals in Abu Dhabi have access to the COVID-19 vaccination information in Malaffi, which improves clinical decision making, enhances safety and the efficiency of the vaccination program. 

During the pandemic, Malaffi centralised 83,378,108 PCR test and 10,709,509 vaccination records. The DOH had real-time insights and was able to make data-driven critical pandemic decisions to protect its residents, globally recognised for its effectiveness and success.

Predicting population risk 

Aside from the pandemic, Malaffi is enabling the DOH to draw population health insights based on the analysis of the consolidated clinical data of the entire population in Abu Dhabi.  

For example, in 2021, Malaffi premiered a demonstration of a population risk management platform that will empower the healthcare sector to support care management, improve population health and assist in ensuring continuity of care.  

The platform uses artificial intelligence (AI) and machine learning, to build predictive models based on two years of historical clinical data and run algorithms to predict future population risk across different categories such as emergency room visits; development of chronic conditions such as diabetes and hypertension; and the potential costs of treatment. 

The insights help identify specific cohorts of patients that are at significant risk to develop a certain condition or complication, understand the contributing factors to his or her risk score, which can then appropriately be targeted with specific preventative measures and interventions to reduce their risk and drive the cost down.   

These insights help track the effectiveness of a screening program and how it reduces risk over time, as well as the risk of readmissions which is a significant measure of quality and cost ticket.   

Standardised data is key 

What we also realised is that the availability of quality and accurate data is crucial for ensuring patient safety and making the data effective for decision-making, population health and interoperability. Standardisation of data requires a collaborative effort at all data touchpoints across the healthcare facilities, starting from the front desk, that will ensure that all patients information is captured correctly.   

Having access to clinical data and based on the assessment of its overall quality, our team has looked at ways to enhance data quality. As a result, in late 2021 the DOH issued guidance and requirements to the healthcare facilities for adopting key coding standards (e.g. SNOMED, LOINC) and ensuring the providers are adhering to the minimum data standards and quality. The wide adoption of these standards is expected to significantly improve the quality of data captured at the site of the providers which will eventually help improve the accuracy of the population health analytics, for the better of everyone in the Emirate. 

A look to the future 

Malaffi will contribute significantly to creating advanced systems tailored for syndromic and pandemic surveillance and response. Such systems will be of the utmost value for early alerts and increased readiness to handle any potential future outbreak, ensuring Abu Dhabi remains at the forefront of public health and safety. Over time, trends in population health can be determined to ensure a more intuitive, data-driven approach to healthcare at an individual level, and a community level. Other solutions will also be developed to take advantage of advanced analytics to generate insights based on the robust population health data in Malaffi, to improve the quality of care and health outcomes for everyone in the Emirate.    

An HIE, when utilised to its full potential, can completely transform healthcare as we know it–from empowering clinicians to make safer and more efficient decisions to enabling providers and Governments to adequately prepare for major community health challenges. Whilst the technology and platforms exist, the onus is on the entire healthcare system to drive synergies and ensure better collaboration to optimise the use of these game-changing, innovative solutions. 

Digital transformation in healthcare is fundamentally about improving patient engagement, patient experience, and health outcomes. An important part of this is improving access between healthcare providers and their patients using cloud-based calling, meeting, messaging, and video solutions – ideally unified into a single application. This way, providers can expand their reach and treat patients wherever there is an internet connection – this is crucial, as the point of care is not necessarily where the physician is but where the patient is.

There are three main drivers influencing the adoption of telehealth. Firstly, the need to improve patient access to care. Telehealth removes distance and enables providers to reach patients and securely engage over their channel of choice. It enables virtual check-ins, remote evaluation services, and real-time doctor-patient consultations. Secondly, it allows providers to evaluate a larger volume of patients in a shorter time period by removing barriers such as patient travel and other factors (e.g., crowded waiting rooms) that delay appointment start times. Thirdly, it can enhance the doctor-patient relationship: there’s a socialisation of telehealth that connects doctors and patients in ways that are different from a traditional in-office visit. The encounter is more focused and immersive, with a doctor able to assess patients’ situations and also their physical environments. This personalisation not only benefits the patient, but also the physician - many of whom are looking for a more balanced work life and the option to support telehealth sessions remotely themselves.

When considering a telehealth solution, look for one that has dynamic call routing capabilities, as this will enable dedicated teams to manage all telehealth-related services calls: real-time consults, future scheduling, or triage assessment for inpatient needs. The result is a faster patient response, which will also be gained with a solution that allows voicemails to be transcribed and read versus those that can only be listened to. Solutions with multi-level IVR tools enable providers to automate patient access to up-to-date information or recorded FAQ responses facilitating patient self-service, which can help towards creating positive patient experiences. Support for remote staff is also important. A flexible telehealth platform will support the easy transition of clinic-based staff to interim or permanent work-from-home status with the same in-office message, video, and phone tools.

Look for a cloud-based communications and collaboration solution that is easy to manage and flexible, reduces operational cost, and provides quick access to innovative new features. The best should be an all-in-one platform that allows staff to connect with patients using voice, text, video meetings, fax, and team messaging across their digital channel of choice - from anywhere, on any device, at anytime.

Get in touch and let us help you with your move into connected telehealth. Reach out to me here.
 

Several significant innovations have shaped the course of cancer treatment in the past year; however, the common denominator remains to be early detection.

In 2020, there was reportedly a 40 per cent drop in patients diagnosed with cancer globally, highlighting the disruption the pandemic has had on cancer care.

Related: The 2021 Oncology Report

While the number of cancer patients is projected to increase in the coming years, the world is also on the cusp of new cancer treatments that include approaches in immuno-oncology and molecular oncology.

The free 2021 Oncology report was developed with data-driven insights from leading technology research provider Omdia, and with the support of UCLA Health, which offers inpatient and outpatient cancer care at hospitals on its campus and community-based oncology practices across Southern California.

Its pages deep dive into the impact of COVID-19 on cancer care and oncology diagnostic equipment, along with projections for the years ahead.

The report also looks at how a new CAR T approach minimises resistance and helps avoid relapse in non-Hodgkin’s B-cell lymphoma, and how quality in cancer care can be ensured through new techniques.

Breast Cancer Awareness 

While 31^st October marked the last day of global breast cancer awareness month, championing awareness and encouraging precautionary measures continued for oncologists.

Coping through a breast cancer diagnosis is life-altering, with the journey towards recovery being a process. Treatments and procedures may be overwhelming; therefore a multidisciplinary approach that helps patients navigate through options post-mastectomy is vital.

Dr. Raffi Gurunian, MD from Cleveland Clinic Abu Dhabi broke down the relationship between reconstructive plastic surgeons and surgical oncologists, and how it creates successful postoperative outcomes.

Prevention of prostate cancer

In 2018, prostate cancer was the second most common malignancy (after lung cancer) in men globally, with 1,276,106 new cases and 358,989 fatalities (3.8 per cent of all cancer deaths in men). According to WHO, presently there are 1.41 million cases worldwide. Dr. Aftab Bhatti, Consultant Urologist, Tawam Hospital, part of Abu Dhabi Health Services Company (SEHA), Dr. Hosam Al Qudah Consultant and Lead Urologist and Dr. Omer Al-Derwish Consultant Urologist from Fakeeh University Hospital, discussed how diagnostics and treatments have changed through innovation.

Dr. Hosam Al Qudah said, "In the past, detection and diagnosis were through ultrasounds and biopsies, however, now there is a prevalence in using MRIs. MRIs are beneficial for diagnosis, staging and follow-ups for patients with prostate cancer. We use MRIs now in almost all patients before the biopsy of prostate cancer, as it can detect nodules as small as five millimetres in the prostate. It also stratifies the nodules from benign or cancerous. There is a staging class and classification for this, known as PI RADS, which helps us determine if we need to conduct a biopsy or not.

It is key to use new generation MRIs, such as 3 tesla, which are recommended for the use of detection. The old machines are unable to detect accurately due to poor imaging quality."

Insight into oligometastatic and gastrointestinal cancers

At Arab Health 2022, Dr. Kiran Turaga, Professor of Surgery, Vice Chief, Section of General Surgery and Surgical Oncology, Director, Surgical Gastrointestinal Cancer Program, Director, Regional Therapeutics Program, UChicago Medicine, Chicago, Illinois, U.S., discussed curing stage four 4 cancer and understanding oligometastatic cancer. Dr. Turaga is a surgical oncologist who has been with UChicago Medicine for over five years. In an interview with Omnia Health Magazine, he discusses metastatic cancers, heated chemotherapy, gastrointestinal cancers and more. 

"Metastatic cancer has a terrible prognosis and is often treated with chemotherapy. I discuss a phenotype of patients first described by some of the scientists at the University of Chicago back in the 1990s. There is a state of cancer metastasis that isn’t necessarily fatal. They called it oligometastatic cancer, describing it as existing between cancer that is contained to where it originated and one that has spread extensively throughout the body," said Dr. Turaga.

Treating sarcomas with technology and a multidisciplinary approach

At the online Orthopaedics conference as part of Arab Health 2022, Dr. Joel Mayerson, Director, Division of Orthopaedic Oncology, The James, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, U.S., presented a live tumor board, where a group of sarcoma physicians that meet every week from all the specialities involved in the care of sarcoma, will come together to talk about patient cases and optimising their care.

From a reconstructive standpoint, Dr. Mayerson shared that customized 3D printed implants are coming into the market. “We are also using 3D printing to devise cost custom cutting guides. When we know where the core is at, we can cut closer and accurately to the tumor and use the 3D printed implants that are made to fill the void accurately and decisively where we’ve removed the bone or the tumor to be put in.”

Another advancement is the use of osseointegration for patients who have had trouble after an amputation. Osseointegration involves placing a metal rod inside the amputated patient’s bone. A small portion sticks out of their skin, and the skin is treated in a particular way to adhere to the bone to try to decrease the risk of infection. They can then snap on the prosthetic to the end of that piece of metal that allows them not to have the problems they had while using a socket, and they can walk better.

One such company is WEMED, which designs and produces connected medical devices such as stethoscopes, that are effective, affordable, and able to connect people to medical staff. The company is compatible with almost all telemedicine platforms and also with WhatsApp, Zoom, etc. The French company has stood out during the COVID-19 crisis by adapting its products, given the new need for remote diagnostic medical devices. 

We spoke to Philippe Arnaud, Head of Communications, WEMED, to understand how the stethoscope works. Arnaud has also designed the product. He said: “WEMED started 18 months ago, and the remote consultation stethoscope has been in the market for around six months.”  

Arnaud explained that the device is dedicated to the patient. So, the patient has this device at home and can use it as a regular thermometer. So, for example, if a patient is experiencing a lung or a heart problem, they can call the doctor using WhatsApp or any other communication app. And the doctor, who can be thousands of kilometres away, can listen to the heart and lungs live. 

“The innovation in this product is the fact that it is a straightforward plug and play solution,” Arnaud stressed. “Moreover, the product is affordable (costs US$90), is completely 3D-printed and has almost no electronic component or battery, making it convenient to ship. The inside is shaped like the human cochlear and acts as a filter for the sound. In fact, the sound is better than if a doctor was close to you!” 

Currently, studies are taking place for the stethoscope to work for pregnant ladies and listen to the heartbeat of the unborn child and the carotid artery in the neck. The company is also developing their own app that will leverage augmented reality. For instance, a patient might not know the exact spot where the stethoscope should be placed on the chest, and the app will be able to guide them. 

When asked about the response to the product, he shared: “We are selling it only in France at the moment, but the users are happy with it not just because of the price but because now they can limit their visits to the hospital for a regular check-up.” 

He added: “At the moment, we are looking for a distributor and the Middle East and Asia is a good place to start as there are quite a few people in the region who might stay in small towns with limited access to a doctor.” 

Another innovative medical device at the French pavilion is actiTENS, a wearable for chronic pain management that is app-controlled. 

Nicolas Karst, Ph.D, President & Chief Executive Officer, Sublimed, shared that the company started six years ago, and its product, actiTENS, is a wearable Neuro Stimulator for chronic pain management. Karst explained: “The idea behind the device is to have something that is flexible, and it weighs only 50 grams. It works directly on the skin and allows the wearer to go around and perform their normal activities.” 

actiTENS can treat different kinds of chronic pain. For example, it could be lower back pain that can be treated with a specific electrode. Moreover, it’s smartphone-controlled, so the wearer can choose the programme and the intensity of the stimulation directly through the app, which is free to download on Google Play Store and Apple Store.  

He explained: “We also have some clinical data on knee osteoarthritis that was recently published in the Therapeutic Advances in Musculoskeletal Disease journal. It demonstrated that our device is more efficient and better tolerated than opioids, and it also has no adverse effects.” 

actiTENS can also help women suffering from endometriosis by stimulating the tibial nerve. 

“Currently, in France, we have more than 20,000 actiTENS users,” Karst highlighted. “We have received great interest, and patients are happy with the device. In the UAE, at the moment, we are working with one distributor who we met with at the previous edition of Arab Health. And we are hoping to expand more in the coming months.” 

Among Malaysia’s rubber glove makers is a surprising new entrant: tourism and property giant Iconic Worldwide. Better known for mixed development projects such as Icon City in the northern state of Penang, the company began PPE production through subsidiary Iconic Medicare as recently as October 2021.

Iconic has a distinct advantage: a new, state-of-the-art manufacturing facility capable of producing 3.3 billion pieces of glove per annum, amounting to approximately 1 per cent of global market demand, in addition to face masks.

The 5.5 acre factory launched in mid-January 2022 in Batu Kawan, Malaysia, with six double former glove dipping lines in operation. By March 2022, 12 double former glove dipping lines will be installed, alongside 20 medical face mask production lines. 

“We are using all the latest technologies and automations. It’s a really modern factory," explained Danny Ong, Director – Sales & Marketing. Eighty per cent of the factory's manufacturing processes are automated. 

“We tried to optimise a lot – even our packing system – so that in the long term we are able to bring down the cost to be able to supply the market,” Ong continued.

Stretching into the future

Iconic Medicare’s chief focus is quality. The glove maker currently manufactures examination gloves with an Acceptable Quality Level (AQL) of 0.65, offering the wearer a greater barrier of protection. They offer high levels of flexibility and comfort. “When the nitrile glove was introduced, it was very hard. Now you can see the stretchiness, and they are also soft and nice to wear,” Ong said. 

Sustainability is also a major priority. “We are thinking about ESG and compliance,” said Executive Director James Tan. “We are actually in the process of upgrading our machines to a SCADA [Supervisory Control and Data Acquisition] system, to control wastage of rubber materials. This will be sustainable for the long term.”

Arab Health 2022 interest proves strong

Looking into the near future, Iconic Medicare will be expanding beyond its single factory, Tan said, and focus more on R&D. “We plan to go into speciality gloves. We have good teams that can do it,” Ong added. 

Iconic will be seeking to grow its customer base, too. With the company looking to engage a distributor to handle and promote their brand overseas, the high interest shown over the four days of Arab Health 2022 in Dubai was well received. “I was surprised,” Ong said, commenting on approaches by individuals from the UAE, Africa, Saudi Arabia and the UK. “I have been here many times, but this is the best one.”

Whole genome sequencing (WGS) is a game-changer, and it's a matter of when not if it will become involved to a greater extent in medical solutions, said Prof. Dr Arndt Rolfs, CEO and founder of digital healthcare and diagnostics company Arcensus, during his session "Digital changes in personalized medicine based on genomic technologies" on the last day of Arab Health 2022.  

“DNA is the basis of our lives,” he said, explaining it as the blueprint of human beings, helping us to understand what's going on in our body and what can go wrong in our body. “It is the most fascinating story that we are learning in detail to prevent disease”.

WGS is the analysis of the entire genome: coding and non-coding. It is a uniform coverage and detects copy number variables with no limitation in read length. It has a lower coverage required and less artifacts. 

“It is so easy to sequence and analyse total genomic information,” he said. The challenge, however, remains its proper implementation. 

He explained that it is important to take the whole genome into account. 

“If we ignore the diversity of genetic mutations in different populations, pharmaceuticals will go in the wrong direction,” he said, highlighting that while there are many examples of a mutation in a gene that can lead to cancer in people in France, the same is not true for people in Japan. 

He explained that as people sequence full genomic DNA, patients only need to test once. Based on the genomic data, people can learn with updated reports and personalised guidance based on the latest research.

“It's a big industry to improve diagnostics,” he said “DNA will be without any doubt the future in that direction,” he said. 

Whole genome sequencing now affordable

In the last few years WGS has undergone a massive transition, from a rarely used research tool into an approach that has broad application in a clinical and medical setting. Currently, it is transforming the biological knowledge, from rare diseases to cancer and beyond. “We are merging biology and medicine in interpreting information."

WGS, said Dr Rolfs, has successfully resolved the aetiology of a disease for previously undiagnosed conditions, identified cancer driver gene variants, and impacted the understanding of pathophysiology for many diseases.

He said that WGS costs have decreased steadily over the years, reaching an affordable amount today. NGS tests are available, or becoming available, in every major region worldwide. 

Using NGS methods can decipher underlying molecular mechanisms, while bioinformatics and AI can improve and automate clinical analysis, he said.

“We know that 70 per cent of people have specific mutations,” he continued. Genetics is still seen as a complex process, however - the reason it is still not a popular way to understand the human body and predict disease, he said.

WGS' interpretation and proper understanding have been the main barrier to its spread. It begins with millions of raw sequences read for a patient tumour, until pathologists and oncologists evaluate the significance of potentially clinical actionable events, and incorporate their research into patient care. 

“It is not one gene that is the cause. It's the composition and interactions of the genes,” Dr Rolfs explained. In the past this could not be predicted, but now with the genome they can.

There is no evidence that COVID-19 vaccinations cause infertility in women and men explained Dr Johnny T Awwad, Professor of Obstetrics and Gynecology at the American University of Beirut Medical Center during his session "COVID-19: Impact on fertility" on the last day of Arab Health 2022. 

However, he explained that the topic remained challenging as due to its urgency most of the published data did not go through peer review. There are only a small number of observations, and the mode of viral transmission is also likely to change with the emergence of new variants “which could make this presentation obsolete in a month,” he told the audience.

According to Dr Awwad, the SARS-CoV-2 spike protein binds to ACE2 to enter the host cell, and ACE2 is found in both male and female reproductive systems.

Female fertility and COVID-19 vaccines

Dr Awwad quoted research that said there was no influence of COVID-19 vaccines on menstrual cycle characteristics, and there were no detrimental effects on ovarian response. 

There was greater impact, however, on the length of the menstrual cycle, extended for women who received vaccination. Women who received both vaccine doses in a single cycle had a two day increase in their cycle length compared with those unvaccinated. Approximately 10 per cent have experienced a change in cycle length. 

This topic remains subject to research as it has been reported by thousands of women that their periods changed after their COVID vaccination. The American government has announced funding to further research to understand the correlation in disruption. 

Overall he said COVID-19 vaccines did not appear to influence ovarian follicular dynamics. There was no significant difference in AMH level before and after vaccination for any of the three age groups of women measured. 

He explained that the menstrual cycle changes that have been reported so far are due to an immune response to the vaccination, and do not present evidence that the vaccine causes infertility.

Male fertility and COVID-19 vaccines

Men with COVID-19 have meanwhile shown reduced sperm concentration, increased semen leukocytes and increased seminal levels of TNF-α, IL-6, and MCP-1. 

Dr Awwad explained that while motility and vitality were significantly decreased in mild cases, all semen parameters were affected moderately. He added that most of the published studies so far could not detect the presence of the virus in semen samples. Furthermore, the semen parameters following vaccination were predominantly within normal World Health Organization reference ranges.