Hollywood actor Bruce Willis’ recent medical diagnosis generated a global buzz, bringing to light a little-known but important condition that affects speech. Aphasia is a communication disorder triggered by several factors including head injury, stroke, or a degenerative disease leading to permanent damage. 

To put numbers into perspective, the National Aphasia Association states that at least two million people in the US are living with aphasia, out of which 225,000 were caused by strokes. 

Related: Breaking Borders: Providing World-Class Treatment for Peripheral Nerve Disorders in U.S. & Abroad

“Each type of aphasia affects a specific area in the brain, so when this is taken over by any disease or pathology, the patient will present either motor, sensory, conductive, or nominal type. Stroke, brain tumour, multiple sclerosis, or any inflammatory disease can affect any area in the brain resulting in special aphasia according to the area involved,” said Dr Khalid Al-Saffar, a specialist in the Department of Neurology at Dubai-based Medcare Hospital Al Safa. 

Rising demand for app-based solutions 

To date, language and speech therapy remains an effective treatment for aphasia patients, and statistics by Fortune Business Insights revealed a strong demand for dedicated software and mobile apps. The US Speech Therapy Market forecasts a CAGR of 5.8 per cent between 2021 and 2028, valued at US$6.08 billion in 2028, paving a strong route for manufacturers and software developers in healthcare. While there are no specific figures available in the Middle East region, experts are confident of the rising trends. 

Related: Clinical Communication & Collaboration Platforms: Foundational Technology for Smart Hospitals

Assistive technology featuring the use of computers, smartphones, software, and related mobile apps could help pathologists and clinicians administer the right treatment and help people with aphasia communicate better. 

The applications themselves take on different interfaces for an engaging and interactive patient experience. These can be in the form of games to practice speech and language-related tasks and exercises; and voice control that offers unlimited practice sessions without a speech therapist for articulation and pronunciation. Video therapy modules give patients a visual representation of tongue and throat movements, while flashcards assist with memory recall, learning new words and overcoming speech-language difficulties. Flashcards are particularly helpful for youth affected by aphasia as they can be modified to their needs. 

The rise of technology in healthcare sparked research into virtual reality combined with speech therapy. Combined with apps, these augmentative tools offer alternative forms of communication and give patients a different approach to identifying words and holding conversations. 

Inclusion is essential for patients 

Dr Al-Saffar explained that the region has a long way to go in addressing aphasia and executing the right treatments to retain the quality of life in patients. “The treating physician needs to address the symptoms and begin medical treatments guided by a speech therapist,” he added. 

Once a patient is diagnosed with aphasia, the impact extends to family members and can cause a certain degree of mental stress, and strain on relationships. Dr Al-Saffar emphasised that practitioners need to ensure family members, and caregivers if any, are included in the rehabilitation process for better patient outcomes. This involves offering up-to-date information, raising awareness, and educating them on the current situation and future expectations. 

What is aphasia?

Aphasia is the inability to speak caused by sustained trauma to the head or the result of a degenerative disease. Several celebrities are known to suffer from the condition, such as Hollywood actors Bruce Willis, Sharon Stone, and Game of Thrones star Emilia Clarke. The condition is divided into four categories — motor, sensory, conductive, and nominal:
 
Motor aphasia: The patient is unable express themselves and cannot pronounce words properly but can understand others’ language or command. 
Sensory aphasia: The patient cannot understand others’ language or commands but can pronounce words properly. 
Nominal dysphasia or aphasia: Patients can understand others, speak and pronounce words properly, but are unable to recall the names of objects. 
Conductive dysphasia: Patients can understand, speak and pronounce words, but tend to mispronounce words. 
 

Identifying symptoms of aphasia 

A clinical examination with the following steps can reveal the distinct types of aphasia in patients: 

-        Ask the patient to talk about himself — what is his name, age, and address to detect his speech response. 
-        Give commands. Patients should respond to instructions such as closing their eyes, raising their arms, etc. to detect their level of understanding. 
-        Ask them to read a newspaper loudly to detect minimal defects in motor speech. 
-        Ask them to respond to written commands to detect sensory aphasia. 
-        Ask a patient to name a brand of item, like eyeglasses, shirt, or pen to detect the nominal aphasia. 

Opioids can help patients manage pain, but can also be highly addictive with likelihood of a life long dependency rising just after five days of prescription opioid use — increasing risk of eventual addiction and overdose. 

Worldwide, about 500,000 deaths are attributable to drug use, according to the World Health Organization (WHO). More than 70 per cent of these deaths are related to opioids, with more than 30 per cent of those deaths caused by overdose. According to WHO estimates, approximately 115,000 people died of opioid overdose in 2017. Opioid overdoses that do not lead to death are several times more common than fatal overdoses.

"The challenge for surgeons is to minimise opioid use while optimising patients' pain control after surgery," says Kelechi Okoroha, M.D., a Mayo Clinic orthopedic surgeon and sports medicine specialist. Dr Okoroha is the senior author of both studies.

Orthopedic and spine conditions account for about 3 in 10 opioid prescriptions, and surgeons can "significantly decrease opioid-related deaths by limiting opioid prescriptions," explains Dr Okoroha 

Researchers created an approach to managing pain that eliminated opioids after common sports surgeries. In the first study, participants had undergone knee surgery to reconstruct their anterior cruciate ligament (ACL). In the second study, participants had undergone surgery to repair their rotator cuff. All received a nerve block before surgery.

In each study, one group of participants received a standard opioid regimen to manage pain. The other group took part in a pain management approach without opioids. The nonopioid regimen included pain relievers, nonsteroid anti-inflammatory drugs and muscle relaxants.

Both studies found that the nonopioid regimen provided at least the same if not more pain control and patient satisfaction, compared with the standard opioid regimen, and the most common side effects were drowsiness, dizziness and gastrointestinal symptoms. In the rotator cuff study, participants who received the nonopioid regimen reported slightly lesser side effects than those who received the opioid regimen.

"It's a multimodal approach. Before surgery, we might give you a nerve block, and then we give you these multiple medications after surgery that should manage your pain medications such as acetaminophen to target pain, NSAIDS (nonsteroidal anti-inflammatory drugs) to target postoperative inflammation, and muscle relaxants to control muscle cramps and spasms," says Dr. Okoroha. "What we found is that using this multimodal approach, we're able to manage patients' pain with limited or no opioid use after common sports surgeries."

Dr Okoroha says one way Mayo Clinic is working to limit opioids is offering patients alternatives to traditional pain management.

"I think this is really game-changing research," Dr. Okoroha says. "We've found that it is effective in common sports surgeries. So our plan is to implement it in other surgeries and hopefully decrease the opioid burden worldwide."

Fasting in the holy month of Ramadan is one of the five pillars of Islam and is considered a religious obligation for Muslims. While fasting is not required for people with diabetes, one study found that almost 80 per cent of all Muslims with type 2 diabetes tend to fast for at least 15 days.

In this case, they are at a higher risk of complications such as hypoglycaemia (low glucose), hyperglycaemia (high glucose), and ketoacidosis due to changes in physiological parameters such as eating patterns and circadian rhythms. Therefore, healthcare professionals are responsible for delivering accurate information regarding fasting and diabetes. The foundation for safely managing diabetes during Ramadan is patient education, including instructions on expected risks, medication adjustment, glucose monitoring, nutrition, and exercise.

Related: Diabetes escalates from epidemic to pandemic in the region

In an interview with Dr Milena Caccelli, Endocrinologist at GluCare Integrated Diabetes Center, we discuss how pre-Ramadan risk assessments and benefits are key to ensuring a safe fasting experience for diabetic patients.

What type of patients qualify as candidates for pre-Ramadan risk assessment? Tell us about the process, how GluCare provides care outside the clinic, and the role of digital health in this aspect.
 

We strongly advise receiving your pre-Ramadan risk stratification and counselling from your healthcare professionals before Ramadan.

Related: Leading Healthcare Experts Highlight Importance of Multidisciplinary Treatment Approach at ‘2021 Regional Interchange on Diabetes’

Our team uses Digital Therapeutics and connects patients to a remote monitoring platform. We look at trends, intervene earlier, and provide better predictions to avoid fluctuating blood sugars during Ramadan. Digital devices such as a Continuous Glucose Monitor (CGM) and wearables can help you and your care team better monitor and adjust your treatment as necessary.

Combining in-clinic visits and a 24/7 monitoring platform, in conjunction with regular remote engagement with our care team, allows us to create individualised management plans ‘pre-Ramadan’ for each patient. During Ramadan, we will provide individualised nutritional plans and provide you with insights and advice on medication adjustment without physically visiting the facility for each adjustment. You will also receive regular feedback about your glucose values via our chat function. After Ramadan, we discuss medication and regime readjustments back to your normal routine.

How can CGM help with ensuring patient wellbeing as they observe Ramadan? How is the data received and plans adjusted by specialists?

Monitoring glucose is crucial during Ramadan. Many hours of fasting can lead to a high risk of developing hypoglycaemia and hyperglycaemia. A continuous glucose monitor (CGM) reduces the number of finger pricks by providing continuous glucose data, which facilitates the monitoring process. With real-time data, patients can act based on glucose trends. For example, if the data shows lowering glycaemic values, the patient should break their fast and correct the hypoglycaemia by eating accordingly. In addition, a care team also monitors this data and can message the patient to adjust medication (reducing, for example, the dosage of the oral tablets, or reducing insulin units) during extended hypoglycaemic events.

Dr Milena Caccelli, Endocrinologist at GluCare Integrated Diabetes Center

 

Why is it crucial to create personalised plans for patients to ensure fasting during Ramadan is risk-free?

Risk stratification is an essential aspect of all diabetes and Ramadan recommendations. The significant risks, hypoglycaemia and hyperglycaemia are faced by people with diabetes daily; however, studies have shown that fasting may increase the chances of these events occurring. With the pre-Ramadan assessment and screening, we show our patients their risk for complications during Ramadan and how to avoid them.

It is worth highlighting that the initial risk assessment can change, for example, if the risk is modifiable such as glycaemic control, frequency of SMBG, or with the development of a new complication; in these circumstances, the risk level will need to be adjusted accordingly. An individual’s Ramadan experience may vary every year, and, therefore, there is a need for a renewed risk stratification annually to make it a safe and happy experience for all.

The GluCare Ramadan programme, and digital therapeutics platform allows patients to manage diabetes fast, safely, and engagingly throughout the holy month.

Telehealth and digital advancement are proving to be key in accelerating improvements in healthcare. How do features such as chat support create an opportunity for data retrieval and ensure successful patient outcomes?

By continuously monitoring patients, our team can avoid clinical inertia common in usual care, and we can practice a more proactive approach rather than a reactive one. We do not need to wait for the regular three-month intervals to see a patient physically to modify or adjust the treatment plan and guide patients regarding medication side effects.

Are there any benefits for patients who suffer from chronic illnesses, such as diabetes, when they fast? What is the patient profile of those who can lower their insulin levels through fasting?

There are many beneficial effects of fasting that are supported by observational studies. These found that food caloric restriction and intermittent fasting are associated with deceleration or prevention of most chronic inflammatory diseases such as metabolic diseases, pain syndromes, and psychosomatic disorders. There are some results regarding the role of fasting in weight loss and maintenance loss.

Epidemiology says that grazing throughout the day increases the odds of having obesity by 57 per cent in humans. Every three hours increase in the daily duration of eating increases the risk of pre-diabetes and diabetes by 20 per cent. Regarding the frequency and timing of meals in preventing cardiovascular disease, the American Heart Association states that intermittent fasting can be used as a strategy for weight loss and eating more calories during the day. Overnight fasting is a practice recommended for most individuals.

Fasting periods (beyond the average time between meals) promote cellular repair, improve insulin sensitivity, increase human growth hormone levels, and promote longevity and disease protection. Therefore, for obese patients with type 2 diabetes, some form of intermittent fasting will improve insulin resistance.

World Health Day, celebrated to mark the foundation of the World Health Organization (WHO), has as this year’s theme the need to keep humans and the planet healthy through creating societies focused on wellbeing. 

The WHO estimates that more than 13 million deaths worldwide are the result of avoidable environmental causes – including air pollution. Over 90 per cent of people worldwide breathes air that exceeds WHO air quality limits, while one-third of deaths from stroke, lung cancer and heart disease are due to air pollution. 

According to Dr Julio Gomez-Seco, Consultant Pulmonologist and Sleep Respiratory Medicine at Fakeeh University Hospital, UAE, breathing in polluted air can damage cardiovascular and respiratory systems by causing inflammation to upper and lower airways and lungs.

“Air pollutants make their way into the bloodstream through the lungs, and eventually to the heart,” he explained. “Short term effects can include coughing, wheezing, asthma, chronic bronchitis, emphysema and sinusitis. Constant exposure to polluted air can increase the risk of lung cancer and the development of heart and circulatory diseases.”

Evidence is emerging furthermore of other effects that include diabetes and neurodegenerative conditions.

While air pollution has worsened in low and middle income countries, improvements have been made in lung diagnostics with the introduction of new technologies such as robotic, ultrasound and electro-navigator GPS guided bronchoscopes, Dr Gomez-Seco continued.

He pointed to the recent emergence of a robot-assisted platform for more precise, stable and minimally-invasive lung biopsy. “Electronic nose technology, which mimics the mammalian olfactory system of our nose, is also being used effectively for lung diagnostics. It is a system that gives real-time results which makes it a faster, easier tool for detecting lung problems.”

Advances in artificial intelligence (AI) and machine learning offer greater prospects still in medical imaging and diagnostics. The pandemic has spurred the adoption of AI in healthcare facilities worldwide and the launching of innovative new products such as Sonavi Labs’ Feelix, an AI-enabled digital stethoscope that diagnoses respiratory conditions. 

“AI and machine learning can enhance the performance of detection, and can lead to better automated interpretations,” underlined Dr Gomez-Seco. The specialist however cautioned that further clinical studies are required before they become established as technologies of choice for radiologists and doctors.

Antimicrobial resistance (AMR) continues to be among the biggest public health challenges in the modern age, but a new management tool launched by Sheikh Shakhbout Medical City and a joint venture between Mayo Clinic and Abu Dhabi Health Services Company (SEHA) may bring an end to evolving germs.

The new platform will give clinicians updated guidance on treatment choices, its local patterns, and drug-specific information on antimicrobial agents to ensure safety and efficacy. It will also offer an opportunity to connect and share experiences with a valued network of infectious diseases specialists from across the globe.

Related: Current Topics and Challenges in Antimicrobial Resistance

The launch of the tool is in aid of SSMC’s mission to promote the appropriate use of antimicrobial agents, reduce the burden of antimicrobial resistance (AMR) and shed a much-needed light on the dangers of the mismanagement and over-prescription of antibiotics.

“Antimicrobial resistance is one of the biggest public health challenges of our time, with nearly five million deaths associated with bacterial AMR were reported in 2019 alone, based on a  recent study by The Lancet,” said Dr Zahir Babiker, Consultant Physician at Division of Tropical and Infectious Diseases in Sheikh Shakhbout Medical City.

Related: Automated immunofluorescence microscopy incorporating AI

He highlighted that AMR occurs when germs present in the human body stop responding to the medications designed to kill them. As a result, germs such as bacteria, fungi, parasites, and viruses will continue to grow and pose a serious risk to the lives of people who are harbouring those germs.

“Therefore, careful use of antimicrobial agents such as antibiotics is important and requires educating people and persuading clinicians to follow an evidence-based approach for prescribing antibiotics,” he added.

Over-prescription of antibiotics is a major factor that contributes to the increase in antimicrobial resistance. Antibiotics are often over-prescribed in situations where people actively pursue a prescription, or where doctors are not recommending alternatives or are fearful of reprisals if they withhold them. These behaviours often drive a culture promoting unnecessary antibiotic prescribing. 

According to Dr Farin Foroodi, Internal Medicine Consultant in Division of Internal Medicine at Sheikh Shakhbout Medical City, the key purpose of the tool is to educate clinicians and improve access and utilisation of antimicrobial management guidelines.

“It integrates our guidelines into a user-friendly interface on mobile and web applications. It also gives our medical practitioners quick access to the best quality information that is continuously updated with the most recent antimicrobial management guidelines to support informed decisions that will improve patient outcomes,” she said.

Antimicrobial resistance transforms illnesses that are characteristically simple to treat into infinitely more complex cases.

"We still have a long way to go to raise awareness and educate the broader public about the seriousness of AMR. Antibiotics are neither a one-size-fits-all solution nor the only solution. We are optimistic that with antimicrobial management tools we can equip ourselves with the information we need to devise the best care plans for our patients, including those infected with resistant germs,” Dr Babiker concluded.

In the healthcare industry, the metaverse is rapidly gaining traction. Artificial intelligence, augmented reality, the Internet of Things (IoT), virtual reality, quantum computing, and robotics are all expected to change healthcare delivery and enhance patient outcomes. In recent years, augmented reality and virtual reality technologies have advanced tremendously, and they are now frequently employed in medical training, teaching modules, and surgical procedures to perform complex surgeries with extreme precision. These components are also employed in medical device and equipment software and hardware to improve their performance. 

During the forecast period, factors such as an expanding patient pool around the world, growing demand to improve patient outcomes, and technological advancements in the healthcare sector are likely to drive market expansion. Other factors expected to fuel market growth in the future are the emergence of metaverse-focused companies around the world, increasing collaborations to develop advanced AR and VR solutions to improve patient output and the overall surgical environment, and rising investments in research and development activities. 

Related: Is visibility the key to unlocking the cloud in healthcare?

To help shape solutions that focus on delivering experiences over products, 8chilli is rooted in deep technology and their product, HintVR™ is a metaverse platform designed to support surgeons to engage patients in immersive and interactive ways pre- and post-op, medical education, and 3D immersive training. 

Aravind Upadhyaya, Founder and CEO, discusses the details. Excerpts from the interview: 

Is the healthcare landscape changing since the announcement of the metaverse? How will it lend itself to healthcare and is it necessary to align with this development by introducing products and solutions? 

Related: AI backed hyper personalisation fuels health insurtech’s future

Healthcare applications are all about the evidence, and to clear the fad from the fact, multiple randomised control trials continue to take place across the world to prove the efficacy of the VR system over traditional methods. The metaverse is here to stay and we need to adapt.  
 
As and when the hardware becomes pervasive, people are expected to spend more time in the metaverse, which is why the first-mover advantage is to devise a strategy now. The lessons learned from the implementation will be valuable. In the last five years VR, especially in healthcare, has proven to be the silver lining to attract top talent, most patients, and provide them with the best experience.  

Health systems and educational institutions that do not embrace this advanced technology for better patient care and training needs will lose the battle in the next eight years.  

Remote tech and collaboration are rapidly being embraced by healthcare. Tell us about the inception of 8chili Inc and its Mixed Reality and Machine Vision solutions. 

Data analytics is not only driving a key part of the clinical decision-making process, but it is also easing long queues at hospitals and improving patient waiting time. It also encouraged collaboration during the pandemic and accelerated the implementation of tools and resources across all verticals, including healthcare. 

Looking back, an incident at my previous start-up is what led to the birth of 8chili. I was in an operating room with a surgeon, and as I watched him showcase his techniques, I realised that medical trainees rarely have opportunities to witness this. It is no wonder that mastering a specialised skill in healthcare is such a slow process. At 8chili Inc, our core team is built on a primary vision - Democratising access to quality healthcare training and delivering a state-of-the-art experience to patients. 

Our core team is the ideal mix of experience and passion to deliver the underlying infrastructure for the metaverse. 

Aravind Upadhyaya, Founder and CEO, 8chilli

 

The future is here with HintVR™. Tell us more about how it will enhance the patient engagement experience, and support medical education and healthcare training. 

HintVR™ is an end-to-end platform that can be customised as required for engagement or training. Its Engage feature enables health systems to offer end-to-end VR solutions, such as counselling, consultation, and therapy. The unified VR immersive experience increases patient satisfaction and drives higher revenues. 

Training, on the other hand, enables health systems, medical colleges and teaching hospitals to enter the metaverse with original 3D immersive training content, which creates monetisation opportunities. So now, a traditional business model of simulation as a cost centre is upended with the 8chili HintVR™ platform. 

With the HintVR™ in place, what can physicians expect? Which organisations have adopted 8chili’s deep learning solutions and what are the benefits seen to date? 

The clinician always wants the fastest and the ideal recovery path for the patient, but with many touchpoints in today’s intricately connected world, interacting with them continuously can become a challenge. 

HintVR™ helps clinicians better communicate with the patient through guided sessions that help them understand their diagnosis, clinical treatment pathways, surgical procedure, testimonials, pre-surgery counselling, and post-surgery healing. HintVR™ also enables clinicians to overcome their communication and care challenges with patients.  

So far, Apollo Hospitals Group, Aster CMI and United Hospitals in India and Spectrum Health and Valley Children's Hospital in the US are currently engaged with the HintVR™ platform. 

There are huge benefits for a teaching hospital or a health system. The HintVR™ platform not only reduces the cost of training and re-training staff but also enforces standard operating procedures in the care continuum and is easy to scale. Nurse training has been a big issue for health systems globally, but the adoption of HintVR – complemented by its fast-paced delivery - is helping some of our clients resolve their shortages.  

To date, training is implemented at West Virginia University Medicine, Arizona Simulation and Technology Education Centre, UoA Medicine, and Global Healthcare Academy.  

Can you divulge what the future holds for 8chilli and the metaverse in the healthcare ecosystem? 

I see an acceleration in the adoption of digital health technologies, especially wearables followed by AR/VR and therapeutics. In the long-term Web 3.0, or metaverse as we call it now, will play a key role in the healthcare ecosystem as countries invest more time in the metaverse. Healthcare is moving towards value-based care and VR delivers the superior outcomes required to achieve value-based care. As Fred Lee explains in his book, "If Disney Ran Your Hospital - 9 1/2 Things You Would Do Differently", the core of this is the "experience". At 8chili, our mantra is to deliver life-changing experiences that help you build trust with your care provider.  

The HintVR™ platform will address patient engagement such as counselling, consultation, and pre-op guidance sessions, as well as post-op therapy focusing on rehab, sleep, stress, and pain management in patients. The same platform will deliver the training content to the healthcare professionals to deliver care better and be experts in what they do.  

The metaverse is the experiential internet where we will immerse and interact like it is second nature to us. Forecasts say that by the end of the year, the time spent by each user on the metaverse will be an average of 20 minutes. These values point towards more investments and the adoption of solutions in the metaverse. This is the future of the web. 

Personalisation is not a new concept for insurance firms. The idea that premiums paid by consumers should be matched to the extent of the risk they're insuring against is central to what insurers do.

Hyper-personalisation has the potential to help insurers manage risk more effectively and provide reduced premiums to clients. However, to make this automated vision of the future a reality, the industry's data experts must overcome considerable obstacles. By harnessing artificial intelligence (AI) and real-time data to provide the most appropriate suggestions and experiences to clients at scale — based on their location, time, date, and even behaviour.

Related: Is digital medicine affecting costs in healthcare?

According to Accenture, 82 per cent of insurance consumers are willing to disclose information about their behaviour to their insurers, if it will help them enhance their coverage.

Omnia Health Insights spoke to Wellx.ai, the Middle East's first wellness backed InsureTech about its plans to disrupt the region's insurance business. Founded by Vaibhav Kashyap and Javed Akberali, the company provides health insurance to individuals, families, corporations, and SMEs by incentivising participation in various wellness activities such as gym visits, healthy eating, focusing on mental wellness, using wearable technology, and much more.

Related: Prevalence of insurtech in healthcare

We discuss how, as a digital-first company, they leverage data analytics tools to hyperpersonalise the insurance and wellness experience, allowing consumers to complete their insurance journeys online.

 

How is Wellx.ai shaping the future of insurtech by incentivising wellness and rewards?

Wellx.ai is working towards a new age of insurance where we are not only there to support our members financially when they fall sick, but also there to help them prevent illness to begin with. We must always keep in mind that no individual wants to buy insurance, what they want is to not fall sick.

 

Wellx.ai co-founders - Javed Akberali and Vaibhav Kashyap

 

How key was it to partner with wearables technology that focuses on performance and integrate that into a healthcare aspect?

WHOOP is the world’s best wearables technology provider. Not only does WHOOP’s AI coach provide users with in-depth knowledge on their physiological performance, they also successfully bring about behavioural change – seen by improvements in key markers such as sleep, heart-rate-variability, resting heart rate, etc. To achieve our bold ambition of building happier, healthier, and more resilient communities, Wellx.ai needed a partner that can not only provide insights but can also coach our customers on how to do better. Wellx.ai takes WHOOP’s offering one step further by providing financial incentives for customers hitting goals set by WHOOP. We provide customers with the tools they need to do better and then reward them for it.

 

How can this partnership enhance the patient experience and align with hospitals in improving outcomes? Have there been any collaborations with health organisations in the region?

WHOOP enables our customers to provide meaningful insights to doctors about their own health. These insights can enable better diagnostics and sometimes reduce the requirement for additional testing, making the healthcare experience more efficient and cost-effective through the Wellx.ai insurance program. We are already tied in with every hospital and provider in the region.

 

Wellx.ai aims to “reduce insurance claims and hyper-personalize the insurance experience” can you elaborate on this and why hyper personalisation may be vital in the future of healthcare?

As with all modern experiences, customers now expect providers to cater to their own specific needs. Everything from the content we watch, to the products that are recommended to us, are tailored to our choices. At Wellx.ai we believe that insurance shouldn’t be any different. Customers who are willing to invest in their well-being should be rewarded for their efforts. That is what hyper-personalisation means. The action of rewarding good behaviours will result in healthier individuals with a lower incidence of lifestyle-related diseases (60 per cent of all deaths in the UAE are linked to lifestyle-related diseases) and lower claims.

 

Can you also speak about the cash back policy and how it drives behavioural change?

Our cash-back mechanism works to enhance engagement in healthy activities. Walking 5,000 steps a day can count as a goal day achieved, so can eating 2 healthy meals. By achieving these simple goals 20 days in a month, customers are eligible to receive some of their premium back as rewards. We believe that wellness means different things to different people. Our ambition is not to push customers to participate in one kind of wellness. We want customers to do whatever they already are, just do more of it. If a customer pursues wellness by eating healthy, then all they need to do is do more of that, and we will reward them for it. If they choose to walk to improve their health, we incentivise them to increase their step goals. Over time, as our members engage holistically with the wellness ecosystem, they will continue to get rewarded for all their wellness efforts.

 

How can this impact/enhance healthcare providers and their treatment plans? Does it lend to a multidisciplinary approach?

Healthcare providers typically have a reactive approach to sickness. The current health insurance structure favours this approach as the focus is on the payment of bills/claims and not the prevention of illness. With the increased adoption of remote monitoring, telemedicine, and preventative treatments, we believe that the entire healthcare system’s focus will shift towards reducing the likelihood of someone falling sick. We believe the insurers and providers will compete on their ability to keep people healthy, instead of their ability to treat sick people.

The urgent need for the digitalisation of healthcare in China

Ten years ago, Ruijin Hospital, a renowned hospital in downtown Shanghai, used to be a place where there was chaos, overcrowdedness, burnt-out doctors, long waiting times, and unhappy patients waiting in corridors. Since then, Ruijin Hospital has been making efforts to digitalise.

Now, Ruijin Hospital is quite a different place.

The entire patient journey has been streamlined, from appointment scheduling to payment to in-hospital flow to continuity of care across different hospitals. From the perspective of hospital doctors, data is now shared across departments and facilities and can support them in making clinical decisions. This dramatically improves efficiency by reducing repeated exams and tests. 

Ruijin Hospital is just one example of the wave of digital transformation sweeping healthcare facilities in China. The Chinese government has implemented a raft of measures to drive the digital transformation of the Chinese health system.

These important measures address the following challenges:

Rapidly growing medical demands

An ageing population, increasing prevalence of chronic diseases, and higher expectations for medical care are driving the growth of demand for medical services. Recently, demand for medical care has been growing at a pace that has been difficult to meet. The Chinese population is continuing to age, so the health system in China will continue to face major challenges. Digital technology enables the health system to improve operational efficiency and clinical outcomes.

Fast-increasing health expenditure

Government health expenditure grew quickly at a CAGR of 10% between 2014 and 2019. This represents a major problem in terms of financial sustainability. Thus, controlling the cost of government health expenditure is a major challenge. 

The uneven use of different types of medical facilities

In China, the central government sets the prices that hospitals charge. This can lead to disparities in supply and demand. Currently, people tend to prefer to use hospitals that are centers of excellence (Tier 3 hospitals), rather than hospitals that are cheaper but lower end.

Currently, many top-tier hospitals face an excess of demand, while low-level hospitals and medical facilities are underutilised. The multitiered healthcare model is designed to address this problem.

Under multitiered healthcare models, a medical consortium is set up to integrate the health service among the various levels of medical facilities. Providers within the consortium share patient data and medical resources, referring patients upward or downward. This system requires electronic health data sharing and interoperability across medical facilities.

Government-led initiatives

The Chinese government has been vigorously driving the digital transformation of its health system. Since 2017, dozens of policies have been issued to facilitate the digitalisation of medical institutions’ information systems. This is known as the “medical digitalisation” initiative.

These policies included the following: 

In 2017, the National Health Commission (NHC) issued a document that laid out the concept of electronic medical records and guidelines for their implementation. After that, in 2018, the NHC urged hospitals to build electronic medical records and kicked off the construction of China’s health information system. 

Later in 2018, the NHC defined the criteria used for measuring the adoption of electronic medical records in hospitals. The criteria used a nine-grade model, going from 0 to 8, with 8 meaning excellent adoption and 0 meaning poor adoption. 

The NHC set targets requiring all Tier 2 and Tier 3 hospitals to achieve Grade 3 (data sharing across clinical departments) and Grade 4 (data sharing across the organisation) by the end of 2022 (NB, hospitals in China are categorised into three tiers based on their quality of care, equipment, and technology. Tier 1 hospitals are the least advanced, while Tier 3 hospitals are the most advanced).

The “smart hospital” initiative was launched in 2019. “Smart hospitals” are measured in three ways:

• The adoption level of electronic medical records
• The adoption of digital technology for healthcare
• Hospital management

All public hospitals were required to transform themselves into smart hospitals per a timetable by 2025. Policies have been issued to promote telemedicine to integrate online and offline medical services.

In 2021, the National Health Security Administration (NHSA) launched a Three-Year Action Plan for Payment Reform. This plan will roll out diagnosis-related groups (DRG) and Diagnosis-Intervention Packet (DIP) payment systems among hospitals under state health insurance coverage by 2025 to control medical costs.

DRG is a payment management system to categorise patients with similar clinical diagnoses and determine payor reimbursement rates. DIP is a payment management model using big data to fine-tune the categorisation of diagnoses already established in the DRG system.

The adoption of DRG and DIP systems will help control medical costs. The implementation of DRG and DIP systems requires health data sharing and interoperability among patients, hospitals, and state insurance administrators.

Impact and progress

Driven by government-led initiatives, the digitalisation of the information system in China’s hospitals has been greatly accelerated. By 2020, the average grading of electronic medical records reached 3.46 in Tier 3 hospitals and 2.03 in Tier 2 hospitals. 

In 2021, the National Medical Insurance Service Platform was launched and put into use. This platform is designed to implement DRG and DIP systems to connect medical financial data among patients, hospitals, and state insurance administrators. By 2021, more than 100 cities started to implement the DRG and DIP payment systems as a pilot run. The effect of DRG and DIP implementation on medical cost saving will play out in the coming years.

The “smart hospital” initiative has greatly promoted digitalised services and improved operational efficiency. The appointments scheduled via digital tools (e.g., smartphone applications and websites) accounted for nearly 50 per cent of the total appointments in Tier 3 hospitals, an increase from 32 per cent in 2015.

Trend and forecast

The implementation of the “medical digitalisation” initiative has significantly stimulated the health IT market in China. Omdia estimates the China health IT market reached Y80bn ($12bn) in 2021.

Looking forward, with the rollout of the “medical digitalisation” initiative alongside the number of hospitals increasing by 1,200 every year and the ongoing expansion of existing hospitals (see China Healthcare Market Update – July 2021: What is happening in the China healthcare sector?), Omdia estimates the health IT investment in China will accelerate in the coming years.

By 2025, hospitals will have to upgrade their IT systems to adapt to DRG and DIP payment systems and to achieve a higher level of digital technology adoption.

Omdia projects China’s health IT market will demonstrate strong growth with a CAGR of 15 per cent into 2025 when this market reaches Y140bn ($20bn). China’s health system is still in its early stages of digital transformation. There are strong expectations for China’s health system to continue advancing quickly in terms of the adoption of digital technologies.

Sally Ye is the Healthcare Technology Analyst at Omdia.

Healthcare has been slower to migrate to the cloud compared to other industries. An assumption may point toward fear, lack of will and inadequate resources, but the reality of the slow progress is that this is due to the complex and opaque nature of the medical IT system. Therefore, real-time visualisation of these systems may be the key to unlocking the cloud in healthcare.

In the UAE, digital technologies are slowly but steadily changing medical education and healthcare delivery. For example, the Thumbay Group, which operates hospitals, pharmacies, and a medical college in the UAE, uses augmented and virtual realities to give students a realistic situated learning experience. Its flexibility enhances training and can lead to better outcomes in patient care.

Address system complexity and interdependencies

Related: Webinar: How to achieve better outcomes through patient-centred care

Healthcare organisations are incredibly complex. Clinicians catering to patients depend on applications that rely on technology infrastructure, which must be maintained by staff that follow specific workflows. That is a lot of interdependencies between people, workflows, and IT systems.

There are very few industries with as many overlapping and interdependent IT systems as healthcare. Every healthcare organisation has a myriad of applications that have been layered on top of one another over the years. There is rarely any documentation of how applications interact with the organisation’s technology infrastructure and other applications.

Related: Omdia 2021 Healthcare IT Survey unveils the picture of digital transformation in healthcare facilities around the world

It is my belief that system complexity coupled with the lack of understanding of how those systems interact (aka degree of opacity) is one of the biggest impediments to the adoption of the cloud in healthcare.

Most clinical applications fall into two categories — highly complex (a lot of interdependencies and connections) and highly opaque (not well understood in the context of other applications). Therefore, it is not surprising that healthcare IT leaders have not pushed for the migration of these applications to the cloud.

Instead, they have focused on applications such as HR, payroll, building maintenance, marketing automation, project management, and help desk. These systems have fewer connections and are better understood, making them better candidates for migrating to the cloud.

To migrate highly complex applications, IT leaders can decrease the application’s complexity by refactoring or simplifying it. Regarding the application’s opacity, organisations need to start by better understanding its interdependencies and connections to other systems. In other words, increasing the visibility of the application and service delivery.

Create system visibility for optimised performance

System visibility is really important for three reasons. Firstly, for laying the groundwork, visibility is critical to building a complete understanding of existing applications so that it is clear which workloads can be migrated as lift-and-shift versus refactor.

Secondly, regarding the transition to the cloud, visibility across a hybrid cloud environment is vital to ensuring the performance and security of the new cloud-based applications and existing on-premise ones.

Lastly, for deploying and operating cloud services, visibility is needed not only to help optimise systems to improve clinician and patient experience, but also to investigate vulnerabilities and threats.

Analyse traffic data

Another way to achieve system visibility is by analysing traffic data. This type of data represents every action and transaction in the infrastructure, and it is a robust data source that can guide the migration to the cloud.

During the cloud migration, traffic data can be useful in determining whether the newly migrated application has been properly reconnected to existing systems that were dependent on it. The metadata derived from traffic data could also be used to ensure that the information flowing between the premises and the cloud is being transferred securely.

After the migration is complete, traffic data can help maintain the clinical and patient experience. Nothing erodes trust in a new system more than performance issues do. If an application performs worse than before or in unexpected ways after migrating to the cloud, it will weaken energy from the organisation, and future cloud migrations may become more difficult.

Accelerating digital transformation with confidence

It is important to note that system visibility means more than traffic data. That data is just one of many ways to gain visibility. To improve visibility, organisations will need tooling and instrumentation.

Visibility is key to unlocking the cloud value and accelerating digital transformation with confidence. With visibility into their internal systems, IT leaders at healthcare organisations can make rational, evidence-based decisions. What was vague and unknown before can suddenly become clear. That clarity leads to prudent decision-making, and it is critical for cloud migrations.
 

Emad Fahmy is the Systems Engineering Manager, Middle East, NETSCOUT.

We are well into 2022 and it is not unreasonable to consider that the worst of the pandemic is now behind us. But rather than return to “normal”, we can expect many changes to the way we work and live that we saw emerge in the past two years to accelerate and deepen.

It is a significant opportunity. We can and should do better.

One area that merits further and immediate attention, that is close to my heart, is diversity and inclusion. Pre-pandemic, we saw how offices welcomed mothers to the office with toddlers with the provision of daycare services, while Muslims were provided with a prayer area at work, so that they didn’t have to seek somewhere suitable to pray.

Today we have seen how the pandemic has ignited the digital transformation of industries, including healthcare, meaning that this new technological landscape, already sweeping the old world aside, must also take into account diversity and inclusion needs.

In particular we need to take a closer look at health data – the new oil (as some call it) underpinning many of the new innovations disrupting healthcare and set to grow enormously in volume. By 2025 there will be an expected 163 zettabytes of data worldwide, and 30 per cent of this will be in healthcare. That is a big number: a zettabyte is equivalent to a trillion gigabytes.

Here's why we need to take data seriously. A February 2022 paper by Imperial College London found that data-driven technologies including AI, while demonstrating potential in the diagnosis and treatment of diseases such as skin cancer, could worsen the health inequalities experienced by minority ethnic groups if biased algorithms, poor data collection and a lack of diversity in R&D are not addressed. 

Unconscious and conscious bias in AI is partly fuelled by the lack of diversity in academia among AI developers, according to the report, and at strategic levels of the health system and beyond. Having diverse teams is key.

In its call for evidence for a Women’s Health Strategy for England, the UK government saw that future research should recruit and consider groups of women who have been under-represented historically in research and data collection so that research outcomes may benefit all women in society. Its ambition is furthermore to have the right data, and to make better use of the data collected to tackle sex-based data gaps with the goal of improving women’s health outcomes, reducing disparities and supporting a life course approach for women’s health.

Today’s data-driven products and services will become more sophisticated and ubiquitous as the “Fourth Industrial Revolution” continues apace. Talk is growing of a quantum AI and there are already major investments in the “metaverse”, touted as the new internet, meaning that we must begin now and with urgency.

Any investment in or deployment of new technology must factor in diversity and inclusion from the outset – at the design stage – with an understanding of how datasets will work for us all. These technologies are not only used in areas such as imaging and diagnostics; they are increasingly used in the hiring process, with AI-powered tools used to find and recruit professionals.

Key questions include who is collecting the data, how is the data being collected, and is that data representative of a complete global picture? Who then analyses and interprets the data, and how will it be applied? According to Heather Mattie, co-director of the Applied Artificial Intelligence for Health Care programme at the Harvard T.H. Chan School of Public Health, algorithmic bias can “creep into” the process anywhere. 

For the avoidance of biases, and to ensure that the data is to be used ethically, mixed teams are required at all stages (gender, ethnicity, age, religion, and more) must be deployed at every stage.

In healthcare, as has been noted by the Imperial College London paper authors, the patients and the public must be involved and consulted throughout, while a Journal of Global Health paper also called for clinicians to be involved to offer a deep understanding of the clinical context.

Aside from this, there is a need for specific legislation and regulations in AI to minimise bias and ensure that the rights of the individual are protected. Legal frameworks to watch include a draft AI act unveiled by the European Commission in late 2021 which focuses on the specific utilisation of AI systems and associated risks, and the Algorithmic Accountability Act of 2022 in the United States.

International Women’s Day this year had as its theme #breakthebias. As we pause to consider how we can better challenge stereotypes and discrimination, let us also give thought to the data challenge. It is important to get this right.