Headquartered in The Netherlands, Wolters Kluwer Health is a healthcare information technology (HIT) provider working on the front lines of clinical care at institutions in over 190 countries. With a focus on clinical effectiveness, research and learning, safety and surveillance, and interoperability and data intelligence, the company’s solutions drive effective decision-making and consistent outcomes across the continuum of care.

Dr. Denise Basow is at the helm of the business as president & CEO of Clinical Effectiveness for Wolters Kluwer Health, which is the division of the company that provides solutions from clinical effectiveness including UpToDate; a suite of Clinical Drug Information offerings, featuring Lexicomp and Medi-Span; and the patient engagement solution Emmi programs.

Speaking exclusively to Omnia Health Magazine, Basow tells us that the company’s clinical effectiveness division was formed to try and address the problem of unwanted variability in healthcare. “How you get diagnosed and treated can vary widely depending on what doctor you see and where you might live, rather than by what is the right evidence-based thing to do,” she explains.

UpToDate is Wolter Kluwer’s most global product with 1.7 million clinicians using it to answer common clinical questions – about 1.4 million a day - that come up at the point of care.

“This is content that we have developed and synthesised from the medical literature and clinicians can access it through our website www.uptodate.com, our Mobile App and we also embed the solution within Electronic Health Records (EHR) as it is the most effective when used at the point of care,” says Basow.

Clinical Drug Information is aimed at trying to help doctors, nurses and pharmacists make fewer prescription errors. Basow describes the Lexicomp solution as the “reference side” whereas Medi-Span uses similar data to Lexicomp, but instead of the clinicians having to pull information out of it, it is deeply embedded in EHR, screening patient details and alerting the clinician if there is an issue. Both Lexicomp and Medi-span are also sold globally.

Emmi programs is the company’s patient engagement solution in which patients can interact on the device of their choice, anytime and anywhere, in the format that works best for them. Emmi programs help patients take an active role in their health while enabling care teams to track activity and adjust follow-up.

“Emmi programs is important because as clinicians have come to trust UpToDate rather than Google, they also want their patients to benefit from reliable information too,” Basow says. “Right now, Emmi programs is only offered in the U.S., and we are investigating where we should launch globally.”

The application of decision-support tools improve EHR

According to Wolter Kluwer’s regional leader for the Middle East and Africa, Alaa Darwish, EHR is being implemented across the region in order to improve clinical output.

“We recently hosted a think tank with CEO’s from both the private and public sector in the UAE, as well as regulators and insurers, and EHR adoption was touched upon as a topic,” he explains. “EHR adoption is quite high in the UAE. However, there is still a lot of groundwork to be done when it comes to getting optimal benefits from the platforms.”

Darwish believes that the integration of UpToDate into EHR would have a very positive outcome when it comes to patient satisfaction as they have single sign-on to access information from one patient record. In addition, it provides faster results to the clinicians. Medi-span is also deeply integrated into EHR synchronising with patient data and prescriptions.

“We see the integration as happening at a much faster pace right now, and this will undoubtedly have a positive outcome on enhancing the clinical outcomes for patients and reducing unwanted variability of care in the region,” he says.

According to Basow, although EHR is essential for healthcare, it has been proven that EHR itself doesn’t actually improve outcomes as it only begins to improve outcomes when you begin to embed decision-support tools to use that data. “You will see more impact faster when you put the tools around it to make it more effective,” she says. “EHR is vital but is just one piece of the solution.”

Improving clinical pathways

Since its release in February 2018, the use of Wolters Kluwer’s latest solution - UpToDate Advanced - continues to grow significantly around the world. In 16 months, nearly 700 hospitals and health systems in 25 countries, as well as 17,000 individual UpToDate subscribers in 139 countries have taken advantage of the interactive pathways to improve care.

Interactive pathways help clinicians reduce care variability, inappropriate testing and unnecessary antibiotic prescribing. “Clinical pathways are becoming more important globally, and organisations try to develop their own. However, usually, they find that it is hard to keep them updated, which is the core of what we do,” Basow explains.

Harnessing Artificial Intelligence and Innovation

Wolters Kluwer has a large team of PhD data scientists that are continually working on different use cases for artificial intelligence (AI). As Basow explains: “We are not trying to do AI for the sake of doing AI, rather, we are doing things to make it easier to access or enhance our content in some way.”

As an example, Wolters Kluwer has been using machine learning for almost 10 years in their UpToDate search results. By anticipating what clinicians need, most of them can log in and out of UpToDate in under a minute.

Another example is that when implementing Medi-Span into EHR, in the past, this has been a manual process of mapping an individual hospital’s drugs to the Medi-Span database. Today, the Wolters Kluwer AI team is working on a solution that would make it that much more automated allowing a more seamless and easier implementation.

“These applications of AI don’t make headlines, but they make our products better, and they make it more accessible to gather information,” Basow notes.

When it comes to innovation, for Wolters Kluwer, it means remaining focused on what the company does well. “Most of our innovation is focused around taking what we already do and making it more accessible in the workflow because we know that the more clinician’s access UpToDate, the better the clinical outcomes will be,” says Basow.

Towards the future

Basow believes that there is still a lot of opportunities to grow with their current solutions, which means that Wolters Kluwer is currently focused on increasing product penetration in markets such as the Middle East, Singapore, Europe and Latin America, as well as the U.S. From an innovation perspective, over the next two to four years, Wolters Kluwer will be focused on the implementation of its workflow-integrated solutions.

“This is going to be fairy revolutionary because when you move from a pull model of content to a push model, this brings a whole new level of engagement and impact,” Basow explains.

The golden triangle of ideal healthcare consists of accessibility, affordability and quality. The sustainability of healthcare depends on the latter two, hence, it is important that we look at the ways in which it can be made accessible for the communities we serve.

Healthcare accessibility

The healthcare sector is one of the most important domains that impacts the entire global population and is closely linked to the development of any country. It also plays a crucial role in how a country is perceived in maintaining economic stability. As such, healthcare systems form a key part of government strategies across the world, and the level of industry expenditure is projected to increase at an annual rate of 4.1 per cent globally between 2017-2021.

Related: eBook: The integration of accessible healthcare in the GCC

However, as healthcare spending increases and the industry continues to evolve, accessibility remains a key challenge. At least half of the world’s population does not have access to the health services they need, which is an alarmingly high rate, particularly as this is a sector that impacts most people at some point in their life. In addition to this, it is estimated that 100 million people are driven into poverty each year through out-of-pocket health spending, given the lack of access to quality, affordable healthcare.

Countries with a robust healthcare framework often have long waiting lists to access the relevant specialist or have a simple surgery carried out. Some countries have systems in place that do not provide the best quality care due to lack of resources or budget constraints. And less-developed countries have a limited number of facilities that are understaffed and under-resourced, with those living in rural or remote areas having to travel long distances to obtain the healthcare assistance they require.

This leads to patients spending beyond their means on healthcare – in fact, globally, 800 million people spend at least 10 per cent of their household budgets to get the required treatment for themselves or someone in their family. Unfortunately, more often than not, these expenses are forcing more households into poverty each year.

The World Health Organization’s (WHO) Universal Health Coverage (UHC) initiative aims to tackle this and is supported by the UN, setting UHC as one of the targets when adopting the Sustainable Development Goals in 2015. So, what can be done by the private sector to support these goals and increase access to quality healthcare in local markets?

Working hand-in-hand with the public sector

With increasing spend on healthcare comes increased pressure on governments to provide health services to the community. Working closely through public-private partnerships (PPPs), as well as maintaining a dialogue between the two sectors, creates a healthy ecosystem to ensure that as many people as possible have access to healthcare.

The private sector should also provide affordable healthcare options for all members of the community, including those in the lower-income bracket. This relieves some of the pressure of the public sector and provides patients with quality healthcare options and affordable prices.

Educate and empower the health workforce

The WHO estimates a projected shortfall of 18 million health workers by 2030, and states that countries at all levels of socioeconomic development face some degree of difficulties in the education, employment, deployment, retention and performance of their workforce. It is important that we invest in the education and training of our local workforce, placing patient-centred care at the core to ensure that we are contributing not only to battle the shortfall, but to work towards increasing accessibility.

As we are passing through a digital revolution, markets with more developed healthcare systems, such as the UAE, have an opportunity to leverage this. Through implementing digital solutions and upskilling teams on how to use them, we can empower the health workforce to utilise the latest technologies in healthcare solutions.

Investment in research and development (R&D)

Developments in technology over the past decade have had a huge impact on the healthcare industry, and we have only just scratched the surface. As we are progressing through the fourth industrial revolution, there is still a long way to go before we utilise the full potential of technology to improve accessibility in healthcare, globally. Currently, there are fitness trackers and mobile apps that allow individuals to monitor their own health conditions remotely in more developed markets. Digital health is being touted as a progressive solution for some of healthcare's most intractable issues. Although at its infancy in healthcare, advocates claim that the digital future will bring more precise interventions, higher health outcomes, more efficiency, and eventually lower healthcare costs. Through investing in R&D, key players in the private sector will be able to develop solutions that can further enhance remote patient care and cater to specific patient groups, particularly those in remote areas with limited access to healthcare facilities.

The UAE Vision 2021 strives to achieve a world-class healthcare system and through its efforts, it aims to be among the best countries in the world in terms of quality of healthcare. The private sector has a key role to play, and while it is often related to profit, I strongly believe that profit should be a by-product and not our purpose in healthcare. Through working together with the public sector, as well as giving back to the communities that we serve, we can work towards improving access to healthcare in our local markets with the intention of battling a larger, global issue, one country at a time.

Dr. Azad Moopen

References available on request.

 

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eBook: The integration of accessible healthcare in the GCC

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In response to the rising demand from a growing number of international health tourists and keeping abreast with evolving health tourism and wellness trends across the globe, Dubai Health Authority (DHA) has been playing an active role to further streamline and enhance the emirate’s health tourism sector. The brand Dubai Health Experience (DXH) was conceived by DHA to deliver Dubai’s health tourism services under this brand in a highly streamlined and unified manner. Furthermore, the launch of the revamped DXH portal dxh.ae stands out among a series of milestones achieved by the Authority for various reasons.

The DXH website caters to a broad spectrum of age groups, cultures and lifestyles, clearly conveying the universal language of wellness. It offers updated and most relevant information to health tourists in English, Arabic, Chinese, Russian and Hindi currently. In addition to providing the user with comprehensive information about Dubai’s medical tourism services and assisting them in planning their health holidays in Dubai, the website also features details on Second Medical Opinion programme, which is available for end-users from outside Dubai. This is an added advantage that enables users to make more informed decisions while choosing their treatment options prior to travelling. Information on the DXH is also available through a mobile app that is available on Apple, Android and Huawei platforms.

Led by a clear vision that envisages the delivery of world-class health tourism services with the support of state-of-the-art infrastructure and latest technologies according to the highest international standards, Dubai continues to design and launch innovative healthcare packages and policies that raise the standards of healthcare services delivery in the region. Considering this, it is no surprise that more and more health tourists are choosing the emirate for their health and wellness needs. This, coupled with the fast-approaching Expo 2020, and the ongoing overall development of the emirate’s healthcare sector, are set to accelerate the achievement of Dubai government’s goal of attracting more than 500,000 medical tourists by the end of 2021. More than 337,000 health tourists visited the emirate seeking services in various health specialities in 2018, according to DHA.

The quality of services is probably the most important among all factors that are considered by health tourists before finalising the destination. Therefore, the availability of a comprehensive healthcare system and services at a competitive price is an important factor driving Dubai’s continuing growth as a highly preferred healthcare destination.

Dr. Marwan Al Mulla, CEO of DHA’s Health Regulation Sector said that 96 per cent of the emirate’s hospitals are internationally accredited, employ highly skilled doctors and health professionals, and offer world-class infrastructure and personalised care. He added that Dubai’s medical tourism services offer patients with several options for high-quality healthcare across key specialities as well as provide them with guidance and convenience to make their journey smooth and comfortable. Additionally, an important aspect is the fact that the health sector in Dubai is well regulated.

Linda Abdullah, DHA Health Tourism Department Consultant, adds: “The number of facilities under the umbrella of DXH Group continues to grow every year and, therefore, tourists are continuously being presented with more options in relation to where they can receive treatment. Today, consumers typically select short-term wellness treatments as their priorities have generally changed in recent years; and this is why we have added a new section on the website for people seeking wellness treatments in Dubai. The section includes facility listings under Dental, Wellness, Traditional & Complimentary alternative Medicine, Preventive Wellness, Beauty & Spa and Retreats.”

Ruhi adds: “Today’s idea of wellness is highly comprehensive and covers physical, emotional, spiritual and intellectual health of individuals. Keeping pace with these developments, the emirate offers activities and programmes designed for holistic healing, personal growth and relaxation in the safest and most secure environments. Bearing testimony to this fact is a wide array of integrated health centres, globally renowned wellness resorts, centres, beauty and aesthetics and dental clinics licensed and regulated by DHA. Highly personalised care is what health tourists receive from these facilities, which aid their overall well-being and happiness.”

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

Read the magazine online today >>

Patients continue to suffer from medication harm despite 40 years of research; anaesthesia providers have been slow to recognise the implications and acknowledge the extent of the problem. Research efforts to define the incidence, causes, and associated human factors, after a slow start in the 1980s and 1990s, have taken off.

History and epidemiology

Research in anaesthesia medication errors has somewhat paralleled research on the epidemiology of medical errors. Three studies in the 1980s and 90s reported anaesthesia mishaps and adverse events. Craig and Wilson reported the rate of any medication mishap was 0.14 per cent or 1 in 694 anaesthetics. Human error was the most frequent cause. Nine years later, Chopra et al found that the failure to check, lack of vigilance, inattention, and carelessness were the main causes of anaesthesia complications, finding the rate of drug error to be only 0.012 per cent, and acknowledging that minor medication errors were probably missed due to the study design. Wilson et al found drug error to be the 4th most common adverse event, resulting in permanent disability 17 per cent and death 8 per cent of the time, respectively, with 51 per cent deemed preventable.

The 2000 landmark article from the Institute of Medicine (IHI), “To Err is Human”, found that 7 per cent of hospital admissions experience a serious medication error. Webster et al found the incidence of medication error in anaesthesia to be 1 in 133 anaesthetics. This incidence was significantly higher than previously reported and suggested many more errors were not being reported or recognised. In a retrospective review, Yamamoto et al found the incidence of medication errors to be 1 in 450 anaesthetics, noting limitations that included the retrospective study design, lack of comprehensive education about how to report, no active encouragement to report, and unreported minor drugs errors. Llewellyn et al, in a prospective design based on voluntary reporting similar to the earlier Webster study, found the incidence to be 1 in 274 aesthetics. The first report in the United States also employed a prospective design based on voluntary reporting and found the incidence to be 1 in 203 anaesthetics.

A recent study, published by Nanji et al, attempted to define the incidence using a mixed-methods, human factors ethnographic study. The authors used trained observers backed by a detailed chart review of almost 3,700 individual drug administrations, and found 193 errors (5.3 per cent), equating to one in every other anaesthetic. 79.3 per cent of errors were considered preventable, of which 64.7 per cent were considered serious and 3 per cent as life-threatening. Sanduende-Otero et al reported in 2019 that most frequent types of adverse drug events reported were wrong treatment regimen and wrong medications with vasoconstrictor agents, benzodiazepines and muscle relaxants and opiates most likely to cause harm.

Four studies in the 1970s-90s specifically attempted to define adverse events, or which human factors play a role in medication errors. From New Zealand in 2001, Webster et al reported a failure to check, misread syringe/vial, and “syringe swaps” as the most common human factors leading to error. These were closely followed by distraction, inattention, and pressure to proceed. Cooper et al found identical results 11 years later, in an entirely different culture and environment.

There are several reasons for the wide variation in the reported incidence of medication errors in anaesthesia. Early research efforts on anaesthesia mishaps only incidentally found the error rate. Differences found between 2001 and 2017 were based mainly on study design. Three prospective studies with a similar design found similar results. The 2016 Nanji study adopted a different methodology and found a much higher rate. Using commonly accepted definitions of medication error and medication harm will help resolve some of the variance in future studies.

Definitions of medication error, ADEs, and ADRs

When a patient experiences a drug-related event under anaesthesia one wonders if this is an expected outcome or a known hazard that could have been prevented. Should this be defined as a medication error, adverse medication event, near miss, or simply a reflection of the patient’s underlying illness? The terms adverse drug event (ADE) and adverse drug reaction (ADR) are useful markers to help anaesthesiologists assess and understand why patients react in certain ways. The International Conference on Registration of Pharmaceuticals defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer.”

Pharmacovigilance addresses the time intervals between the drug administration and the adverse event, pathophysiology and competing causes for the event, response to de-challenge (for example, stopping vasopressor infusion or a drug dose reduction), and the response to re-challenge (i.e., protamine re-administration).

Types and mechanics of reporting errors

Observation studies have consistently found higher rates of error than those relying on voluntary reporting. Cohen, in an editorial, stated that voluntary reporting underestimates the actual incidence of medication error by many-fold but maybe the most effective method of reporting. In an observational study, Cullen et al reported that a retrospective chart review found at least a five-fold incidence of errors compared to voluntary reporting. Classen et al, compared the IHI “Global Trigger Tool” (GTT) to voluntary reporting and the Agency for Healthcare Research and Quality’s Patient Safety Indicators chart review. The authors found that both fared poorly in comparison to the GTT and missed 90 per cent of adverse events. The IHI GTT found at least 10 times more confirmed and serious events.

Voluntary reporting assumes that the person making the error recognises an error was made and will be honest, take the time, and report the error. There may be a rational fear of retaliation, adverse legal action, or reports made to the National Practitioner Data Bank or medical/nursing boards, leading to a hesitation to report. In the current healthcare climate, production pressure leaves little time between cases to report. Computerised risk management software programmes exist in most hospitals, yet many are cumbersome and require extensive data entry. The three prospective studies referenced above employed a simple piece of paper included with each anaesthesia record, facilitating voluntary reporting and preventing the need to spend time on the computer. In the era of electronic medical records (EMR) and paperless charts, paper systems have mostly fallen by the wayside. A potential solution is an electronic error report, ergonomically designed to mitigate the workload on clinicians, with dropdown menus linking directly into a secure and confidential database facilitating ease of reporting, analysis and feedback to the clinician.

Causes of medication errors

Cooper et al first described “syringe swaps” in 1978 as one of the top three causes of preventable anaesthesia mishaps. The authors identified human factors associated with these types of medication errors, including haste, inattention /carelessness, fatigue, distraction, and poor labelling and failure to check or read the label, among others. While progress has been made to address these human factors, in some ways they haven’t gone away and their impact may even be more prevalent, given the organisational emphasis on productivity above all and the surge of new and poorly designed technologies and EMR adding more work and stress to providers.

The most common medication errors in one of the largest prospective studies were wrong dose, labelling, and failure to deliver correct medication errors. Is it the correct entrance port (IV catheter vs epidural catheter = mismatched connection); or in the case of continuous infusions of drugs, the wrong drug was connected to the wrong site. The most common medications associated with errors in the O.R. were propofol, phenylephrine and fentanyl; neuromuscular-blocking agents and opioids have also been documented as common offending agents.

The causes of these socio-technical system safety failures are embedded in professional, cultural and organisational norms, including rampant normalised deviance, in which unacceptable actions or professional violations are ignored, ignoring human factors, lack of data and outcomes transparency, and organisational secrecy. Poorly designed medication dispensing systems/carts, labels and fonts, vial sizes, and unaddressed embedded human factors constraints, including the existence of confusing drug names and look-alike/sound-alike dissimilar drugs are the most common causes of medication errors worldwide. The anesthesiologist working alone in poor ambient light conditions, to draw up, dilute, label, and administer medications with little or no oversight is clearly a contributory factor.

While labelling may now be more standardised, with ASTM colour-coded syringe standards and computer-generated labels being readily available, we still rely on the “read the label” exhortation. Pre-filled syringes are available with barcoded labels, yet in the U.S., there is no commercial anaesthesia computer system that will seamlessly read the labels and integrate them into the EMR. There are no auditory or visual alerts to help anaesthetists avoid giving the wrong medication or the wrong dose. Fewer than one in 10 physicians routinely read drug labels, despite their clear and accepted warnings. A manual independent risk-reduction strategy of double-checking high-alert medications that has been a strategy widely promoted by nurses and pharmacists has long been disputed and ridiculed by anaesthesia providers. The ability of independent double checks by two people to detect up to 95 per cent of errors has been demonstrated in numerous studies.

The most important organisational barrier to medication safety is the prevalent risk culture. A culture of safety is created when an organisation endorses medication reporting and where physicians, nurses and pharmacists feel psychologically safe to speak up and report errors or other improvement opportunities. Staff can report on dangerous or inadequate processes or outcomes and will not be censured or suffer reprisal unless their actions were malicious or deemed to have intent to cause patient harm. Careful investigation of these ADE leads to thoughtful and meaningful steps that make sense to clinicians and are likely to endure. This type of environment has been described as a learning environment, and in conjunction with concrete learning processes and practices, is the first step towards creating a learning organisation. Conversely, a blame culture instigated by the department head or hospital leadership can lead to staff fear and a dramatic reduction in reported medication incidents. We might learn from New Zealand and Sweden, where a no-fault medical liability system promotes more open discussions and supports learning.

Conclusions

There is substantial potential for reducing medication-related harm, and there are many opportunities to improve safety in the perioperative setting. Anaesthesiologists are the reason patients can undergo surgery safety while receiving dozens of drugs as well as under the effects of the patient’s home medication. We need to rethink the design of medication administration workflow and support implementing specific actions to prevent adverse medication safety in the perioperative setting. However, little prevents anaesthetists from making simple and harmful medication errors. There are few checks and balances, at odds with all other high-risk industries where safety records are multi-fold better than medication safety in anaesthesia. We believe that in spite of all we know about preventing harm due to medication errors, their persistence may be related to three important drivers. First, most medication errors are near misses; i.e., there is no patient harm and, thus, may not be considered important to report or prevent. Second, the anaesthetist who makes an error must realise they made the error and third, they must report the error. Observational studies have consistently shown that physicians under-report the majority of their medication errors and their complications. Truth-telling and data transparency through national registries regarding the prevalence and causes of medical errors and medication adverse events are essential if the trust is to be enabled, leading to a culture of safety.

References available on request.

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

Read the magazine online today >>

It is generally accepted that even with aggressively managed hospital formularies, matching Automated Dispensing Cabinet (ADC) medication libraries, extensive and ongoing training, and compliance monitoring that medication errors will still take place at the bedside. This is simply because these systems, whilst they do much to protect the patient from error during the prescription and dispensing parts of the medication chain, can do very little to prevent errors at the point of administration, which can extend to Wrong Patient, Wrong Medication, Wrong Dose, Wrong Documentation, and Wrong Time. Indeed, the Joint Commission International (JCI) consistently retains ‘Identifying Patients Correctly’ before any therapeutic intervention as its ‘International Patient Safety Goal Number One’ in every renewal of its standards.

Furthermore, among all of the parts of the medication chain – from prescription through to administration – medication errors which occur at the point of administration are the hardest to detect. With only a 2 per cent chance of detection of error, in terms of Failure Mode Effect Analysis (FMEA) the administration process consistently scores as a high-risk activity by virtue of the difficulty of detection, with a score of 10 commonly being applied by organisations utilising FMEA (FMEA Detectability Scale: 0 Minimum Harm Risk - 10 Maximum Harm Risk).

This is the dangerous ‘gap’ that Connected Mobile Medication Carts can close, as they bring the medications for the patient right to the bedside in secure compartments, allow for documentation of administration at the point of care, and through integration, with the patient’s Electronic Medical Record (EMR) they can achieve closed-loop Bar Code Medication Administration (BCMA).

BCMA via Integrated Mobile Medication Carts is capable of mitigating the following types of administration errors: Wrong Patient, Wrong Medication, Wrong Dose, and Wrong Time. They also ensure correct recording of medication administration. Auto-documentation via BCMA is made directly into the patient’s EMR and is certainly superior to manual completion of the medication record as manual documentation may be delayed or inaccurate as clinicians attend to emergent situations or distractions. Once clinicians return to their documentation after a patient care event such as medication administration, they often transcribe from memory, and commonly introduce human error into the process.

Connected Mobile Medication Carts complete the closed-loop and bridge the gap of the last few meters from the ADC to the patient through a simple workflow underpinned by close integration from the Connected Mobile Medication Cart into the ADC-Pharmacy inventory system to avoid drug unavailability and to the hospital EMR and Computerized Provider Ordering System (CPOE) to ensure that the Right Order is dispensed to the nursing unit and correctly administered at the bedside.

For the user, the workflow is straightforward:

• Each drawer of the Connected Mobile Medication Carts is electronically labelled and auto-assigned to a specific patient based on the EMR synchronising its Admission, Discharge and Transfer data with the cart. The individual, patient-specific drawers can be loaded with medication in the pharmacy, or from the nursing unit’s ADC.
• Specific patient orders can be routed to individual carts, so in large nursing units, primary nursing and named-nurse patient care can be maintained.
• When a medication is administered, the nurse scans the patient’s wristband and the appropriate compartment, containing only that patient’s medications, unlocks automatically.
• Higher capacity carts are capable of managing a 32 bedded nursing unit, but it is advisable to restrict the ‘loading’ of any cart to a maximum of 16 patients simply to allow for multiple medications and larger items to be loaded (pre-mixed subcutaneous injections and even intravenous medications can be loaded into the cart) and to ensure timely medication delivery to every patient on the nurses’ medication rounds.
• Bespoke sizes of compartments and drawers, dividers and shelves within the Connected Mobile Medication Cart should allow for complex treatments that require multiple medications or mixing of components for non-oral orders.
• Each cassette must be removable and interchangeable from cart to cart, to allow for patient transfer from one area to another, and to match the Admission, Discharge and Transfer patient data. (Figure 1) There must be multiple drawer configurations, allowing drawers to be switched from cart to cart without the need for tools, and employing RFID embedded technology to avoid patient assigned cassettes from being mixed-up.
• Overrides can be made in the event of a patient emergency or facility power failure.

Figure 1

Connected Mobile Medication Carts carry a lot of technology and a lot of weight! Ideally then, they should be powered to assist the clinician in moving between patients, and such is the nature of nursing that one-hand operation is desirable for ‘care on the go’. As the Connected Mobile Medication Cart will be used by multiple clinicians in any nursing unit it is also desirable that it can adjust automatically to each user’s height.

For senior nurses and for pharmacists, Connected Mobile Medication Carts have several powerful advantages over the traditional ‘administer and sign’ medication administration as every user event is recorded including

• Clinician log-ins.
• Patient barcode scans.
• Manual overrides for access and drawer opening/closing.
• Admission, Discharge and Transfer notifications are sent directly to the Connected Mobile Medication Cart, allowing medication needs and orders to keep up with rapid patient movement through the organisation.
• Active Directory integration must be available on the Connected Mobile Medication Cart in order to manage access to the cart based on each clinician’s privileges within the organisation and with an organisation-wide Single Sign On. In times of high staff turnover and staff needing multiple accesses to networks, services and medical devices, this is vital.

All of this brings a high level of accountability and visibility into the medication administration process.

In a recently held Medication Safety Advisory Board Meeting in Switzerland, the chief concerns of the assembled pharmacy, medical and nursing specialists were:

• End-to-end medication safety.
• Improved clinician and IT efficiency.
• Enterprise medication inventory optimisation.

The Advisory Board saw the overarching aim of the medication chain to be the administration of the correct medicines at the correct dose, at the correct time, in a patient-led and safe manner. The advisory board also made clear that any bedside verification system implemented should be extremely prescriptive and clear and follow as a logical and transparent chain from the CPOE through dispensing systems and ADCs directly to the bedside.

In practical terms, the Advisory Board stated that this requires a move from documentation at the nursing station or ‘desk’ to the documentation at the bedside and that nurses should both document the patient’s vital signs pre-medication if required, and then move directly to scanning prescribed medications before administration directly at the bedside. In terms of Connected Mobile Medication Carts, this requires the ability to include automated extensions of the ADC to assign drugs to a specific drawer on the Connected Mobile Medication Cart, in order to improve transferability, to allow for control of narcotics, and to allow for accurate and complete billing.

The deployment of Connected Mobile Medication Carts speaks directly to a central issue in modern healthcare, that of Return on Investment (ROI) as systems employing interoperability between the patient’s Electronic Medical Record and Connected Mobile Medication Carts through closed-loop Bar Code Medication Administration require investment. But with medication errors costing an average of US$9,000 per event and causing an average Length-of-Stay extension of 4.8 days, we cannot afford to keep ignoring all those ‘Mind The Gap’ warnings.

References available on request.

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

Read the magazine online today >>

By investing in barcode scanner-equipped enterprise mobile devices such as clinical smartphones for patient point of care, hospitals can build a transformative data-powered Internet of Things. The resulting powerful information system instantly connects them to the vital clinical data they need, anywhere on the floor and at any time. The healthcare sector is taking the lead in digitising operations with data-driven, collaborative workflows—and enhancing both patient safety and staff efficiency in the process.

Bedside data access boosts patient safety

Mobile data capture can be a critical part of a change management strategy designed to limit medical errors. When hospitals implement barcode printing and scanning technology for sample and tissue tracking, for example, nurses and other staff gain instant access to the data needed to safeguard patients’ health throughout the continuum of care. The technology offers hospitals the potential to make decisions to enhance patient safety with new data-powered workflows.

Here are some examples:

• Scanning patients’ barcoded wristbands provide real-time access to their Electronic Health Records (EHR) in a single view, including name, date of birth, medical number, previous conditions and allergies. Accessing such information enables more timely, collaborative and informed care.
• During patient test specimen collection, a nurse can also scan a barcoded specimen collection order and a labelled test specimen container, completing a three-point check that can prevent misdiagnoses and unnecessary tests and treatments.
• Barcode Medication Administration (BCMA), which can drastically reduce medication errors according to a New England Journal of Medicine study, employs a similar three-point check. It involves scanning barcodes on the medication container, the patient’s wristband and the clinician’s ID badge.

End-to-end data traceability verifies drugs and supplies safety

Barcode scanning technology represents a powerful countermeasure to the inherent challenges in ensuring a safe pharmaceutical, vaccine and blood supply. From the hospital supply chain to clinicians, anyone can trace pharmaceuticals and medical implants and monitor the temperature of vaccines and blood bags. Medical error reduction strategies and new regulations drive change in the healthcare sector.

Since European Directive 2011/62/EU, aka the Falsified Medicines Directive (FMD), went into effect across Europe in February 2019, pharmaceutical traceability has become even more important. Regardless of how Brexit plays out, the FMD stipulations will remain until December 2020.

Under the FMD, all new packages of prescription medicines sold in the EU must have two safety features: an anti-tamper device and a 2D barcode. Pharmacies and organisations that supply medicines to the public have to authenticate them i.e. visually check the Adult Therapeutic Dose (ADT) and scan them for confirmation of authenticity in the European Medicine Verification System (EMVS) prior to dispensing.

Powerful solutions are also available to help healthcare organisations maintain the safety of perishable cold-chain assets such as vaccines, blood bags and certain pharmaceuticals. Package-affixable time and temperature indicators enable manufacturers, warehouses and hospital pharmacies to document the temperature of these assets throughout the supply chain to ensure their viability for safe use.

Mobility adoption depends on staff and workplace considerations

Innovative, patient-centric healthcare organisation leaders know that effective change management through bedside data access and traceability implementation requires major capital investments in staff mobility and data capture. But as they plan these investments, they need to keep their staff’s needs and the hospital environment in mind.

As the number of devices available to hospital staffs—phones, pagers, cameras, laptops/tablets and scanning devices—has grown in recent years, they have experienced diminishing efficiency returns as clinicians have juggled so many of them. Rugged mobile computers and tablets present a great opportunity to consolidate devices—to the staff’s benefit.

Giving nursing staff rugged mobile computers, for example, enables them to pull up patient history records; confirm current medications and allergies; discuss patient care with physicians, family members and other staff via voice calls or secure texts; capture high-quality pictures of wounds or other medical issues; complete routine reporting regarding patient interactions; and receive critical alerts—from anywhere in the hospital and on one device.

Not all mobile technology is up to hospital environments. Consumer-grade smartphones and tablets might offer the staff familiar touchscreen navigation, but they aren’t built to withstand occasional drops, continuous disinfection, offer the shift-length battery power or healthcare-compliant data security to perform as well as purpose-built enterprise healthcare devices.

At Zebra, we serve as a trusted advisor to clinical teams to deliver a point-of-care smartphone that mobilises the teams while reducing the risk of Health Care-Associated Infection (HCAI).

Like any other IT system components, mobile technology must adhere to the UK’s National Health Service (NHS) patient data security standards. Data security features to focus on include data encryption and application permissions, unauthorised user access prevention and the capability of running healthcare-certified applications.

Wayne Miller

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

Read the magazine online today >>

In collaboration with Injazat Data Systems, the Department of Health – Abu Dhabi (DoH) recently announced the launch of a new digital platform, ‘Remote Healthcare’ App for smartphones that allows users easy and safe access to preliminary medical diagnostic services, information and guidelines.

This comes in line with DoH’s efforts to maintain the safety and well-being of all members of society and provide them with the necessary healthcare services without having to physically visit healthcare facilities.

The application provides the necessary medical support to people with chronic diseases, the elderly, and those in need of medical prescriptions and wish to not visit hospitals given the current situation, as well as those who have been infected with COVOD-19 and are under home isolation.

The application features an Artificial Intelligence-driven tool for examining symptoms and diagnosing non-emergency cases, as well as a system for booking appointments and remote consultations with doctors via voice or video calls or texts, as well as, medical prescriptions and logistics services.

Shaikh Abdullah bin Mohammed Al Hamed, Chairman of DoH, said, "This launch comes in line with our ongoing efforts to curb the spread of the new coronavirus, COVID-19, and ensure the safety and well-being of all members of the community. The Department of Health – Abu Dhabi continues to work closely with all relevant authorities in the UAE to further improve the health sector services.

"Through this initiative, we are keen to harness the power of Artificial Intelligence and bolster the digital infrastructure of the healthcare sector and provide a comprehensive digital platform that allows access medical support and guidance to all members of the society."

Features

Through the new application, users can obtain medical support and advice and get access to diagnostic services for non-emergency situations while at home, through healthcare facilities in the Emirate of Abu Dhabi that are available on the application and are regularly being updated.

People who have been infected with COVID-19 and are required to stay under home isolation can also benefit from the app, by reaching out to a specialised medical team of doctors, nurses and healthcare professional, who will provide all the necessary healthcare support remotely, and closely monitor the patient’s situation until they are fully recovered.

In addition to that, DoH will ensure providing the patients will all the necessary precautionary guidelines and all essential supplies that they might need while they are under home isolation.

The app will enable doctors to communicate remotely with their patients to provide consultations. It allows registered users to book and manage their appointments, and request for prescriptions online. These prescriptions will be assigned to pharmacies that will deliver medicines directly to patients via online channels, upon obtaining the approval of insurance companies. The app is available on Android and iOS devices, in both Arabic and English language.

DoH launches new digital platform

DoH also recently launched a new digital platform that allows clinical staff from across the UAE to volunteer their support or apply to work for the emirate’s healthcare sector. The volunteers can now register online through the portal called the Abu Dhabi Health Workforce Management System and highlight their key skillsets to provide support to the sector’s facilities in the emirate.

Healthcare facilities in the emirate will be able to log on the portal, review the profiles of registered staff, and communicate with them directly. Using the platform, facilities will be able to assign the volunteers the right roles based on their skillsets and preferred conditions for employment. DoH called upon all healthcare providers and staff who are able to offer their support, to register for free using the portal, to volunteer or work full-time or part-time.

DoH has identified a number of categories for which volunteers can register to their support through the online portal. These categories include full or part-time workers in a clinic or hospital in the region that are willing to work additional hours; those who hold an eligibility letter or have previously passed DoH’s healthcare exam; clinical experts who have completed the procedures of dataflow or have obtained a medical license from the Dubai Health Authority (DHA) or the Ministry of Health and Prevention (MOHAP); retired healthcare workers who wish to return to medicine; volunteers who are licensed to work in the healthcare sector; volunteers who wish to obtain a license to practice medicine in Abu Dhabi.

Dr. Jamal Al Kaabi Acting Undersecretary of DoH commented: “The past few months have seen clinical cadres of various clinical disciplines make exceptional sacrifices for the safety and well-being of the Abu Dhabi community. These clinicians have worked tirelessly and with an unwavering commitment to protect the safety of all members of society coping with the spread of the COVID-19 virus. In line with DoH’s vision to continue working towards ensuring the delivery of comprehensive, continuous and timely healthcare services to locals and residents in Abu Dhabi, we have established the volunteer platform that provides an opportunity for healthcare staff who are willing to supplement these efforts by volunteering their time and expertise.”

Al Kaabi continued: “We appreciate the efforts made by clinical personnel in the sector to provide the community with the necessary healthcare services whilst also enhancing the quality of services and ensuring a high level of safety for all members of the Abu Dhabi community. We look forward to providing the public with all the necessary support as part of our precautionary plans to ensure that the local sector remains fully committed to respond to the spread of COVID-19 virus.”

Imagine a world where…

…people spend less time travelling to medical appointments because they can get check-ups and consultations at home …

…every patient has a single 360-degree medical record continuously updated by care teams, devices, and self-reporting …

…Highly visual, personalised dashboards streamline physician workflow and help analyse patient data in real-time …

…The costs and complications of chronic disease begin to drop as remote patient monitoring and virtual coaching become routine practice …

Welcome to the world of Connected Health, where smarter, faster, more accurate interactions between people, devices, data, analytics, and applications are transforming the way healthcare is delivered. A convergence of challenges and enabling technologies are bringing change across the care spectrum—and the pace of change is accelerating.

More simply, we define Connected Health as connecting doctors to data, connecting patients to healthcare providers, and connecting practices to networks—all with the objective of delivering better, more integrated care and health outcomes. So, as the sector becomes more inter-connected, a web of intelligent communication and actionable information sharing with the intention of improving patient outcomes—is transforming the way healthcare is delivered.

Enter the Internet of Things in healthcare. While Connected Health builds on decades of healthcare-specific experience with mobile health (mHealth) and telehealth solutions, it is propelled by a rapidly evolving Internet of Things (IoT) that connects intelligent sensors, devices, software and networks across the Internet.

What is the potential impact of Connected Health?

According to a report from MarketResearch.com, the Internet of Things in healthcare is expected to reach US$117 billion by 2020, while the mobile health segment continues to reshape care delivery, with an estimated growth of US$59.15 billion by 2020. Sceptics might doubt that the healthcare industry, noted for its slow adoption of information technology, will undergo dramatic change quickly. However, powerful drivers and enablers are converging in ways that signal that a tipping point is indeed on the horizon.

• Healthcare is a priority in most national government agendas: The GCC healthcare market is projected to grow at a 12.1 per cent compound annual growth rate (CAGR) from an estimated US$40.3 billion in 2015 to US$71.3 billion in 2020 and is poised to cross US$100 billion mark by 2023. There is an increasing consensus in governments, about the urgency of moving the needle on seemingly intractable healthcare challenges of access, quality, and cost.
• Ageing populations, chronic disease: Two compelling drivers are ageing populations and the high incidence of chronic disease, which consume a disproportionate amount of health resources.

In the UAE, the country’s Vision 2021 National Agenda aims to achieve a world-class healthcare system to help tackle and prevent lifestyle illnesses such as heart disease and diabetes that are prevalent in the region. According to the International Diabetes Federation, Saudi Arabia and the UAE ranked 10th and 12th respectively in the prevalence of diabetes globally in 2018. As such, it has become more important to track disease trends and monitor chronic patients’ adherence to treatment schedules and recovery progress.

How can organisations get ready for Connected Health?

So, what are some of the technology challenges that face healthcare providers today? And what do they need to address to become leaders in this digital era?

Too much data, too little insight: As healthcare becomes more interconnected with the increasing adoption of telehealth, mHealth, and enabling technologies from IoT to digital sensors, familiar data challenges must be addressed to realise the full promise of Connected Health. Being able to get patient data from all healthcare services to the right people at the right time remains a challenge. Today with Edge and IoT devices, health leaders are identifying opportunities to derive actionable insights. When analysed using Big Data analytics, these individual points reveal unexpected trends, patterns and insights to improve care delivery and outcomes.

Lack of integration and interoperability: The Healthcare Information and Management Systems Society (HIMSS) defines interoperability as “the extent to which systems and devices can exchange data and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present. The lack of interoperability between devices and systems exists either because these remain closed systems and/or because they contain non-standardised data. New technology vendors entering the healthcare space continue to build closed IoT devices, making it difficult to share data generated from these devices.

Security first, last and always: Cybersecurity tools and privacy protections must be incorporated when building digital infrastructure. The security architecture must encompass data governance and security requirements across users, applications and devices, looking at how authentication and validation will be managed. They can guide health organisations in designing and deploying a multi-faceted security approach with identity management, access management, encryption, proactive security analytics and network security.

A new world of tech: Human-machine partnerships are reshaping how we share medical information, treat disease and discover new therapies more precisely. Dell Technologies recently partnered with Vanson Bourne to survey healthcare business leaders and found a divided vision of the future, but agreement on the need to transform and how to get there. 60 per cent of healthcare business leaders report their organisations struggle to keep up. But all of them agreed on the need to transform and are optimistic they can provide essential infrastructure to achieve their digital business goals within the next five years. The data is hugely positive and indicates that the industry is poised to leap ahead as 89 per cent of organisations expect to complete their transition to a software-defined business with 80 per cent using artificial intelligence (AI) to pre-empt patient demands.

To conclude, the healthcare market is poised to leapfrog, but there is a critical step that must occur before digital transformation can be completely realised. Achieving true transformation requires healthcare organisations to cross the digital divide: the gap between connecting IT transformation (modernising the infrastructure) with business transformation (being efficient at analysing and digitising operations). It’s, therefore, important that healthcare organisations select the right technology partners to create a Connected Health ecosystem and advance in the digital era, transforming the way they work so that they can, in turn, transform the lives of people.

Scott Andrew

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

Read the magazine online today >>

The COVID-19 pandemic is having a major toll on people's wellbeing worldwide, as they are having to confront challenges such as social distancing, loneliness and the infectious disease outbreak itself. 

In a recent American Psychiatric Association poll, more than one-third of Americans said that the coronavirus was having a serious impact on their mental health, and most (59 percent) said it was having a serious impact on their day to day lives. 

Related: Destigmatising mental health through social media

Healthcare workers are particularly affected. A cross-sectional study of 1257 healthcare workers in 34 hospitals equipped with fever clinics or wards for patients with COVID-19 in China showed that a "considerable" proportion of healthcare workers reported symptoms of depression, anxiety, insomnia, and distress. This was especially true of women, nurses, those in Wuhan, and frontline health care workers directly engaged in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19.

Doctors and nurses revealed to TIME recently that they'd harboured dark feelings owing to fears of speading the disease to families, frustration about a lack of adequate protective gear, exhaustion and deep sadness for dying patients.

Advice for managers in health facilities

Patient Talk Podcast: How healthcare leaders can prevent burnout

Related: Coronavirus update: COVID-19 impact on healthcare workers

Professor Ciaran O’Boyle, Director, Centre for Positive Psychology and Health at The Royal College of Surgeons in Ireland, shares strategies for dealing with emotional exhaustion in our podcast interview from September 2020:

BMJ article: Managing mental health challenges faced by healthcare workers during covid-19 pandemic

An Analysis article in the BMJ on Managing mental health challenges faced by healthcare workers during covid-19 pandemic warned that healthcare staff are at increased risk of moral injury and mental health problems when dealing with challenges of the coronavirus pandemic.

The authors, led by Neil Greenberg, Professor of Defence Mental Health at King's College London, offered measures that healthcare managers need to put in place to protect the mental health of healthcare staff having to make morally challenging decisions. They include the following:

• Healthcare managers need to proactively take steps to protect the mental wellbeing of staff
• Managers must be frank about the situations staff are likely to face
• Staff can be supported by reinforcing teams and providing regular contact to discuss decisions and check on wellbeing
• Once the crisis begins to recede, staff must be actively monitored, supported, and, where necessary, provided with evidence based treatments

Videos messages from Dr Ryan Kemp, Clinical Psychologist, Director of Therapies, Central and North West London NHS Foundation Trust

The following video tips on managing coronavirus worries, and how to stay focused and energised, were shared by Dr Ryan Kemp, Central and North West London NHS Foundation Trust in the UK:

Video message from NHS Traumatic Stress Clinic in London, the UCL Institute of Mental Health and the COVID Trauma Response Working Group

The following video message was shared by doctors, psychologists and researchers at the NHS Traumatic Stress Clinic in London, the UCL Institute of Mental Health and the COVID Trauma Response Working Group to healthcare workers worldwide affected by the coronavirus COVID19 pandemic:

WHO mental health considerations

Recognising that feeling stressed is an experience that many health workers are likely going through, the World Health Organisation (WHO) Department of Mental Health and Substance Use has developed a series of mental health considerations that can be used in communications to support mental and psychosocial wellbeing.

Their messages for team leaders or managers in health facilities are as follows:

• Keeping all staff protected from chronic stress and poor mental health during this response means that they will have a better capacity to fulfil their roles. Be sure to keep in mind that the current situation will not go away overnight and you should focus on longer-term occupational capacity rather than repeated short-term crisis responses.
• Ensure that good quality communication and accurate information updates are provided to all staff. Rotate workers from higher-stress to lower-stress functions. Partner inexperienced workers with their more experienced colleagues. The buddy system helps to provide support, monitor stress and reinforce safety procedures.
• Ensure that outreach personnel enter the community in pairs. Initiate, encourage and monitor work breaks. Implement flexible schedules for workers who are directly impacted or have a family member affected by a stressful event. Ensure that you build in time for colleagues to provide social support to each other.
• Ensure that staff are aware of where and how they can access mental health and psychosocial support services and facilitate access to such services. Managers and team leaders are facing similar stresses to their staff and may experience additional pressure relating to the responsibilities of their role. It is important that the above provisions and strategies are in place for both workers and managers, and that managers can be role-models for self-care strategies to mitigate stress.
• Orient all responders, including nurses, ambulance drivers, volunteers, case identifiers, teachers and community leaders and workers in quarantine sites, on how to provide basic emotional and practical support to affected people using psychological first aid.
• Manage urgent mental health and neurological complaints (e.g. delirium, psychosis, severe anxiety or depression) within emergency or general healthcare facilities. Appropriate trained and qualified staff may need to be deployed to these locations when time permits, and the capacity of general healthcare staff capacity to provide mental health and psychosocial support should be increased (see the mhGAP Humanitarian Intervention Guide).
• Ensure availability of essential, generic psychotropic medications at all levels of health care. People living with long-term mental health conditions or epileptic seizures will need uninterrupted access to their medication, and sudden discontinuation should be avoided.

Wolters Kluwer podcast on COVID-19 and anxiety

In a 23 minute AudioDigest podcast from Wolters Kluwer, Martin Hsia, Psy.D., Licensed Psychologist, PSY22978, Clinical Director, Cognitive Behavior Therapy Center of Southern California, addresses a wide range of subjects on coping with coronavirus anxiety.

They include how clinicians can help patients deal with the mental health aspects of this pandemic, how clinicians themselves can monitor and support their own mental health, how to help ease elevated stress levels of patients suffering from anxiety and OCD and more:

Wellbeing tips from Mental Health Foundation of New Zealand

In New Zealand, the Mental Health Foundation offers wellbeing tips for both managers and healthcare staff working through the pandemic that include:

• Acknowledge it's hard
• Hold regular team checkins
• Set up a buddy system
• Make staff wellbeing a priority

Advance Health webinar on mental health management during the pandemic

In May, industry experts from different backgrounds came together for an hour in the UAE to discuss how to boost positivity, happiness and productivity during today's 'new normal' as we work from home and stay indoors.

The webinar was moderated by Marwan Janahi, Managing Director of Dubai Science Park,and convened speakers in areas that included family medicine, psychology and industry to share perspectives on what works.

To watch the webinar, simply sign or or register for free.

National campaigns for mental health and wellbeing support

UAE 

In April, the UAE launched an online intiative named the National Campaign for Mental Support, consisting of three key components provided to the community in partnership with over 50 experts and mental heath professionals.

The campaign was introduced by the country's National Programme for Happiness and Wellbeing (NPHW) with the goal of using social media and live online sessions to broadcast advice on how to stay mentally well. 

UK

In the UK, NHS England announced the launch of a mental health hotline, as part of a package of measures to support staff as they deal with coronavirus. The phone line will be open between 7am and 11pm every day, while the text service will be 24/7.

Nursing Times launched a new campaign, COVID-19: Are you OK, to highlight the mental health pressures and needs of nurses during and after the coronavirus pandemic. The campaign will include news, opinion, helpful information and ways of providing support.

New Zealand

A campaign named Getting Through Together was launched in New Zealand, offering tips to help cope with the stress of the coronavirus pandemic. The campaign was initiatied by the team at All Right? – Community and Public Health (a division of the Canterbury District Health Board) and the Mental Health Foundation of New Zealand.

The nature of the demand for healthcare is changing. Population, disease, and demographic patterns mean that the kind of healthcare that people need is different from what healthcare systems usually deal with. These trends mean that there will be a different approach, with the stress moving from the curative care that prevailed in the past, to the preventative care that is required in the future. The result will be a radically different form of healthcare that is simultaneously digital and personal.

A major factor behind this change is the empowerment of people using healthcare services. People now see themselves as much as consumers as they are patients. This is because people are more educated, more affluent, and more middle class, particularly in such emerging markets as the Middle East. They are far better informed than in the past. This makes them more demanding and more active. They are willing to seek the best option for their health issues, providing an incentive for healthcare providers to compete even more.

The disease pattern is also different from the past. There is now a higher incidence of non-communicable diseases such as cardiovascular ailments, cancer, diabetes, and mental health problems. Non-communicable diseases are chronic, which means that they often require long-term management. Today, affluence and an often inactive lifestyle mean that the prevalence of type-2 diabetes, for example, has risen in Middle Eastern countries. This leads to expensive, and complex to treat, long-term health issues.

Demographic trends are another factor. Life expectancy has lengthened in recent decades. That means there is a larger elderly population to care for with specific requirements that go beyond healthcare in traditional facilities such as doctors’ surgeries and hospitals. Coordinating care for these patients is as important as the type of care that they receive.

All of this means that there will be a different approach to healthcare. Already the impact of the shift from curative care to preventative care is being felt with notable stress on building more outpatient clinics, rather than large hospitals.

This transformation in healthcare will not, however, happen on its own. Rather digital technology and personalised healthcare will be two key enablers of change. Healthcare spending will also be dramatically different, and every part of the industry will need to change, from doctors, nurses, regulators, healthcare providers, and payers—be they governments, insurance companies, or individuals. The nature of providers will also change, with significant contributions from technology companies who could play as important a role as traditional medical and pharmaceutical players.

Enablers of change

The first key enabler, digital technology, will allow providers to deliver healthcare outside of facilities such as hospitals or clinics. Instead, healthcare systems can provide care through wearables and devices controlled by Artificial Intelligence (AI). For example, in the near future, you will be able to wear a shirt that monitors your heart rate and that sends the data to a virtual version of you (a so-called avatar) that contains your health history. In real-time, AI will derive lessons from these data, telling you what to do—whether in terms of exercise or nutrition. Another device will administer medication to you at the right time and in the right dose. The smallest change, and sign of trouble, will be detected rapidly, allowing for early and more effective intervention.

Healthcare providers will also use technology to conduct consultations through telemedicine. The tedious business of scheduling and travelling to routine medical appointments will become largely a thing of the past.

The result will be an improvement of health outcomes as vast amounts of data become available and are analysed. You will no longer have to participate in a clinical study to contribute to medical knowledge. You will just put on your wearable. Your data will be analysed centrally and anonymously, improving your healthcare and that of countless others.

The second key enabler, personalised medicine, will customise the delivery of healthcare to individual needs. Digital technology supports personalised medicine. A central aspect of personalised medicine is gene testing. This allows personalised medicine to start even before birth, with conditions identified before they manifest themselves. Such genomic testing gives people the chance to adjust their lifestyle to prevent the onset of disease, enhancing the shift to preventative care.

Personalised medicine is already contributing to making medicines more effective. At present, some 90 per cent of standard medicines are only effective for 30 to 50 per cent of patients. Personalised medicine leads to better outcomes as it uses genomic testing, medical history, and patient risk profiles to develop individualised treatments. The result in recent years has been a notable increase in some survival rates for particular cancers, such as myeloid leukaemia. Indeed, the greatest impact of these changes in healthcare will occur in precisely those aspects of medicine that are the most difficult and costly, such as oncology, haematology, cardiovascular, and central nervous system conditions.

Regulators in GCC countries can support the development of personalised medicine. They can develop a flexible regulatory framework to make it easier to receive approvals for these interventions. Regulators can release data that will facilitate the research that leads to more personalised medicine, with encouragement for the study of genetic diseases particular to the region. Governments can also assist by providing research and development funding and consider investing in promising applications.

This should encourage knowledge sharing among pharmaceuticals companies, healthcare providers, and researchers. There will also have to be reskilling and capabilities building for physicians and laboratory staff to be able to interpret genomic data. This can help to develop a GCC-based personalised medicine sector.

All of this has implications for the cost and reimbursement structure of healthcare. At present around 20 per cent of the population generates around 80 per cent of healthcare spending. The move toward preventative care encourages the 80 per cent to remain healthy, thereby, restraining the growth in healthcare costs. In particular, there could be financial incentives for people to take advantage of their ability to influence their own healthcare.

The healthcare of the future will be intelligent and personal. It will be characterised by continuous monitoring rather than occasional visits to medical facilities. People will be empowered to play an active role in their own healthcare, preventing illness rather than looking for a medical response. The result will be a healthcare system that can have better patient experiences, improved outcomes, and better-controlled costs.

Dr. Walid Tohme

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

Read the magazine online today >>