Seasoned healthcare veteran Brian de Francesca is a man who doesn’t mince his words. 

“Healthcare is a dinosaur, “ the Baltimore founder of digital health platform Ver2 began, setting the tone for what was to become an interesting conversation.

Related: The future is not what it used to be: How AI can be a force for good in healthcare

He had come to the UAE, a future global centre of digital health excellence in his view, to play his part in disrupting healthcare, an industry he believed was antiquated, inefficient and disabling risk-averse.

He was equally dismissive of education, which like healthcare put smart people on pedestals. University professors and doctors have been deified through the ages, he stated flatly, from the time medicine and education were borne out of religion.

But change is afoot, and this “deification” will disappear with AI, a technological revolution that will see everyday tasks shifted from expensive doctors to “super nurses” (more of this later).

Today’s traditional medical education model, the Baltimorean continued, is a disaster (“at the typical CME program, you see a room full of people playing Candy Crush”). A participant or attendee will forget 80 percent of what was taught. 

As a digitalisation specialist - Ver2 provides digital healthcare services - de Francesca unsurprisingly champions a virtual learning model, in which knowledge is more easily retained through reinforced micro-learning lessons. 

There is another benefit. Virtual learning has the potential to attract the biggest names in healthcare - the “A team” - simply because star performers are better able to dedicate an hour in their typically hyper-busy schedule to share knowledge online, instead of losing a week to fly across the world to lecture in person. 

Projecting this vision of the future, de Francesca presented the following intriguing scenario: an individual visits a Sim City or Second Life-style virtual medical campus in the form of an avatar. Walking down Main Street the individual enters the Johnson & Johnson Library (by way of example), the “most massive medical library on Earth.”  

Admission into the library would be free, or perhaps costing no more than $20 - different pricing options are possible. After 15 minutes, the avatar rushes to attend a lecture in a nearby building, also delivered by an avatar. It will, de Francesca believes, democratise medical education. 

The age of the AI-powered super-nurse

While virtual worlds are not quite there yet, despite early promise, de Francesca is convinced of the immediate impact of one technology in particular: artificial intelligence. He quickly offered the example of AI unicorn Babylon Health and highlighted recent successes made in drug discovery using machine learning.

Yet he was also keen to stress that AI was still very much in its infancy with its best still another decade or two away. Furthermore, its capabilities will be truly unleashed with the introduction of another powerful innovation. 

When dropped on top of a quantum computer, de Francesca explained excitedly, AI will realise in just 3 minutes - the time it takes to boil an egg - what it will take a conventional computer to achieve in 10,000 years.

It’s a jaw-dropping proposition that sounds more like the realm of science fiction. de Francesca himself is in no doubt the results will be “incredible.” 

There will be no more clinical trials with humans involved in the new quantum era, as large molecules will be simulated (today’s supercomputers can only simulate molecules of several hundred atoms); However, de Francesca stressed that quantum-powered AI won’t be replacing people altogether – There will be significant task shifting from doctors, to other humans and from doctors to thinking machines. 

Instead, its role will be in pattern recognition and automated data retrieval, analysis and comparison. Augmented with AI, caregivers will be allowed more time with patients, resulting in greater empathy and quality of care. The age of the super nurse will have arrived.

But there is an additional benefit: cost. A decade from now, 300-qubit computers will drive pharma costs through the floor. The cost of care will be overall reduced through a powerful combination of AI augmentation, precision medicine, stream analytics, genomics and other innovations.

Healthcare’s new frontier

While AI and quantum computing promise to transform healthcare, de Francesca doesn’t believe this technological revolution will necessarily unfold in North America and Europe - ironically the two regions likely to produce world-changing technologies. 

Instead the next 20 years will see the greatest advances emerging in Africa, while cities from Chicago to London persist with existing healthcare systems and medical technologies, as ossification prevents any real change from happening. 

Growing populations and increased demand for care in Africa met with flat supply (estimates suggest it will take 300 years to close the gap) present a major opportunity to do things differently, and over time countries such as Ethopia, Rwanda and Zimbabwe may even eclipse the US and UK in healthcare. Out of necessity they will embrace new technologies. 

It’s an extraordinary assertion given the turmoils some of these countries have historically faced, but it’s already happening, de Francesca pointed out. 

With Rwanda inking a partnership with UK startup Babylon Health recently, nationals are doing health checkups through smartphones with AI. Similarly, Zimbabwe has a strong healthcare infrastructure they’re looking to build upon. 

de Francesca’s Ver2 is playing its part too, looking to establish new healthcare models in Liberia and Sierra Leone. This includes building a strong healthcare workforce. 

However therein lies a challenge. With people having to be trained and educated, today’s training materials are already out of date - medical knowledge doubles every 73 days (a statistic shared by Microsoft’s Tom Lawry recently). 

Similarly, there is a more existential challenge: any student in Africa looking to become a radiologist or pathologist today (there are relatively fewer radiologists in Liberia and Ethiopia compared to in the US and UK) will likely face the prospect of seeing AI impact their role in the not too distant future. de Francesca suggested that they could train instead to become advanced caregivers offering more compassionate care. 

Historical precedence

While talk of a healthcare revolution remains speculative, de Francesca favourably compared today’s situation with the Victorian era, when the greatest improvement to public health came not from medications or surgical procedures but from the implementation of sewage system networks offering Londoners clean drinking water.

Despite popular misconceptions, today’s technologies will have a similar public benefit. 

While many are concerned about a future where AI replaces and dominates humans, “I don’t feel certain that AI would wipe us out, “ he laughed. “I would be the first to hand over the keys to the kingdom.”

To help tackle the rapid spread of COVID-19, Program Head and Professor of Electrical and Computer Engineering at NYU Abu Dhabi (NYUAD) Anthony Tzes has developed an eco-friendly 3D printed face mask based on the N95 specifications.

The pandemic has seen N95 masks become a critical accessory for healthcare professionals and members of the public as they protect themselves against contracting the virus. Due to an ever-increasing rise in demand for protective masks, a single-use N95 mask has become detrimental to the environment. The 3D printed N95 mask provides a viable solution to meet the needs of both safety and sustainability due to its ability to be re-sterilized and re-used.

Comfortable and reusable

This innovative 3D printed mask has been created in collaboration with the Health Center at NYUAD, and is designed to be protective, comfortable and reusable while reducing the impact on the environment.

The masks are treated with heat in order to achieve a smooth surface, and then breathing filters are placed on the mask, straps are tightened, and a simple layer of recyclable, environment-friendly polyurethane is placed on its boundary. It is made of plastic, predominantly of tough Polylactic Acid (PLA), a biocompatible material that bio-degrades into Lactic Acid (LA). As the mask is recyclable, it also minimises pollution caused by waste.

Tzes said: “The mask is environmentally friendly because you can reuse them, but it is also friendly to humans, meaning it will not cause itching or irritation. I think it is the responsibility of people to step in and do what they can. I stopped my projects to do this. I could use the 3D printers to do something else but I told my postdocs to stop and think and to start generating masks. Let’s hope this ends soon but in the meantime, we must work together.”

Artificial intelligence has a vital role in helping researchers in their efforts to fight COVID-19 and is an important tool in the work being done at Mayo Clinic.

Dr. Andrew Badley is an infectious diseases specialist and leads Mayo Clinic’s COVID-19 Research Task Force. In this Q&A, Dr. Badley answers questions about the task force and the role of artificial intelligence.

How did Mayo Clinic's COVID-19 Research Task Force come together?

We like to think of it as almost a platform-approach to handling COVID-19. We created twelve parallel workstreams that deal with everything we can imagine related to SARS-CoV-2 the virus and COVID-19 the disease. And those workstreams cover basic virology. We have capabilities to basic virology experiments on the virus, to artificial intelligence activities, to database creation, to perspective biobanking, to translational studies, to immunology studies, health disparities research, to clinical trials and clinical trial implementation.

How is artificial intelligence helping with the research?

Mayo has had a significant presence in the artificial intelligence space, and it is continuing to grow. The first way which is already up and running has already made an impact on COVID disease transmission. We plot where infections are incurring. Most of the programs which track that measure just the number of positive cases that you have. If you have no positive cases, but no tests in that area, you could falsely assume there’s not a lot of cases there. We also know that if you start tracking the rate of positive cases, that if you get to a very high level of positive cases like we were seeing in Italy, that probably means we’re not capturing enough of the cases. Conversely, if you get a very low rate of positive cases, that means you’re probably testing the population well, an example of that is Japan.

Early on, Mayo Clinic created a real-time tracking platform to measure the rate of positive cases throughout all counties in Minnesota. When we did that, we noticed that there was an outlier which occurred in Martin County. The rate of a positive test in Martin County was approaching ten per cent, whereas the rate of positive testing for most of the other counties was in the neighbourhood of one or two per cent. Based on that, we said ‘we’re probably not doing enough testing in Martin County.’ We redeployed tests to that area. We’ve deployed personal protective equipment to the healthcare workers in that area who were doing the tests. Quite rapidly we investigated, we identified a significant number of additional cases. After we identified those cases, we counselled on self-quarantining and therapy as indicated. And we’d like to think that doing that activity has helped to prevent new transmission.

Along with tracking the virus, how else is AI being used for COVID research?

Understanding the disease pathogenesis is going to be critical to align different treatment strategies with different disease stages. One of the things that artificial intelligence can do, is it can synthesize massive amounts of data very, very quickly. We’ve been able to look at massive amounts of data, hundreds of millions of documents, and extract the pertinent components of that to help understand the disease pathophysiology.

Can you share an example of this approach?

One example is, using these approaches, we have identified which cells in the human body express the ACE-2 receptor. ACE-2 receptor is what the SARS coronavirus binds to gain entry and cause infection. As we did that, we identified that some tissues that you’d expect have that receptor and that includes the nasopharynx, the oropharynx and the lungs, and we all know that the virus goes there.

We also identified that other tissues that aren’t quite as expected to have a direct infection are also involved and that includes the heart and the gut and the kidney and as it turns out the testes. It turns out that all of those issues are showing evidence that they can be dysfunctional during COVID disease. We now know that there is a substantial portion of patients getting myocarditis, acute kidney injury with proteinuria and hematuria. There is a significant proportion – about 25 per cent – in our experience who have gastrointestinal symptoms and/or diarrhoea. And based on that dataset, before we’ve seen a large number of cases, we predicted that we’d start to see some case of orchitis or swelling of the testes, and lo and behold, we’ve started to see some reports of orchitis.

Moving more into the treatment paradigm knowing when GM-CSF becomes abnormal in the course of the disease, and when IL-6 becomes elevated in the course of the disease, allows us to align our immune-based therapies more closely with the stage of the disease that is being targeted.

The article was first published in Mayo Clinic's News Network.

Historically, the development of paediatric health innovation and technology has taken place in a relatively emergent manner with little formal coordination. Today, with advances in technology such as personal health devices, robotics, 3D printing, biosensors and data analytics, we have the opportunity to move away from repurposing adult technologies to promote the development of bespoke health technology that is designed for children.

Omnia Health Insights spoke to RAK Hospital’s paediatrics and neonatology specialist Dr. Vishal Mehta about his views on how to deliver increasingly complex paediatric care in an era of rapid innovation in child health technologies.

Does innovation in paediatric medicine lag behind those of adults? 

Innovation in paediatric medicine has lagged behind those of adults. One of the many reasons is that, unlike adults, paediatric are a diverse group of patients. Children are not miniature of adults. Growth, development, anatomy and a maturing body system differentiate them into different groups such as neonates, infants, toddlers and adolescents. Depending on the age group, we have a different set of problems, different challenges and different physiology. Newer technologies need to adapt to this whole range of changes with age. For example, blood pressure monitors for paediatrics requires a different size of cuff depending on the age and size of the child. 

The second reason is that children are smaller in size and volume. This poses technical challenges for newer technologies. The third reason could be the ethical challenges in evaluating newer therapies in the paediatric age group, who cannot consent. Many newer technologies or therapies are established in adults and later repurposed or adapted to paediatric age groups. Lastly, unlike economically productive adults, paediatrics is age-dependent, so there is less incentive for the private sector to invest in paediatric innovations.

Should we have bespoke health technology for children?

Yes, many paediatric problems have unique challenges requiring bespoke solutions with newer innovation in health technology. For example, a temperature check for toddlers with traditional thermometers was always tricky. An anxious child would not tolerate the device for the recommended duration, so we required a device which can measure temperature quickly, accurately with minimal or no contact with the child. The solution came in the form of infrared thermometers – a non-invasive temperature sensor that scans the forehead in two seconds and provides a medically accurate body temperature. 

Newer innovation and advances in artificial intelligence, virtual and augmented reality, robotics, 3D printing, new materials, biosensor technologies and data analytics can change how conditions are diagnosed and managed. But we have to move away from the traditional approach of repurposing adult technologies and provide a bespoke health technology for children that are anatomically, physiologically, developmentally appropriate and designed for children.
 

What are some of the newest devices and the latest developments in child health technology?

A. Paediatric micro sampling and painless phlebotomy device:

Paediatric micro sampling is a breakthrough in the collection of a blood sample from children. With this innovation, children’s comfort and safety is taken care of. Precise small-volume samples of blood are collected. Unlike venipuncture, micro sampling ensure that the child experience as little pain as possible.

B. Advanced wireless neonatal body monitors:

Babies in the neonatal intensive care unit (NICU) or paediatric intensive care unit (PICU) are monitored through a complex collection of sensors, each of which has a wire connected to a patient monitor. All these wires make it difficult for parents to bond with their children and for clinicians to access their patients. Wireless flexible sensor patches are developed to collect the same vital signs as wired devices. The new sensors can track the heart rate, respiration rate, temperature, and blood oxygenation as well as conventional sensors, and they also allow for monitoring of body movement and orientation, recording heart sounds, crying, and other audio biomarkers, and even provide a pretty accurate estimate of systolic blood pressure.

C. Smart Pill:

A sensor is built into this pill, which enables physicians and medical teams to accurately assess a patient’s condition from afar.

D. Biliblanket: 

A Biliblanket is a portable phototherapy device consisting of a fibre-optic pad and a portable illuminator for the treatment of jaundice in a newborn at home. The light emitted from a Biliblanket is used to break up bilirubin in the baby’s blood, reducing the yellowing effect in the baby’s skin and whites of the eyes. While using this system, parents can still hold, feed and play with their child.

E. High flow oxygen therapy:

Humidified high flow oxygen therapy is a form of non-invasive respiratory support. The high flow and humidification help to improve the functional residual capacity and mucocililary clearance of secretions. This, in turn, reduces the work of breathing and the need for invasive respiratory support and intubation.

F. Virtual reality:

Virtual reality is used as distraction therapy; it immerses a child into being present in a different reality. Virtual reality content is developed so that children can swim with sharks, play with a favourite pet, walk with dinosaurs, be with family and learn or play a game. Virtual reality can help in paediatric pain management and to overcome phobias. This can be used during minor procedures, wound dressing and generally on the ward. It reduces anxiety to have procedures that may normally require sedation.

G. Gene therapy:

Gene therapy promises cures for many diseases and medical treatments. It can possibly prevent hereditary diseases such as cystic fibrosis and haemophilia or possibly cure heart disease, AIDS, and cancer. Gene therapy is a potential medical miracle, but still a risky procedure, so till now, the clinical trials have only been used for seriously ill children or those who cannot be cured by standard medical treatments. 

How can devices that monitor a child's condition from afar enhance paediatric care? 

Devices that monitor a child's condition from afar provide families and physicians with a way to manage their patients or children remotely, for example, blood glucose monitoring in a diabetic child or a chronically ill child on home oxygen. Many of these devices can be connected to mobile apps. It improves routine care and communication between a child’s family and their physician. Families can give the physician critical information on things such as allergies or medical equipment they rely on, along with emergency action plans, by showing the app or sending a snapshot via email. Parents can view the data in colourful graphs to see trends and patterns and communicate those patterns to a physician.

Is communication with parents more important than technology?

There is no technology to substitute for good communication with parents. Parents have a tremendous amount of anxiety over their child’s illness. Effective communication with parents giving clear facts, evidence-based advice, and a few words of reassurance may be more effective than the treatment itself. 

Young children cannot express what they experience or feel and are also dependent on parents for treatment and monitoring. It is very important to educate parents to help them understand their child’s illness, treatment plan, medication, and monitoring and follow-up plans. Even though technology cannot replace effective communication with parents, technology can improve the effectiveness of communication by engaging them in interactive information sharing.  

For example, the use of an audio-visual aid can help parents understand their child’s illness and treatment plan. Standard growth monitor applications in mobile phones can help them track the growth and wellbeing of their child. Immunisation software can send them reminders for vaccination due-dates. Hospital apps can give them access to laboratory tests results or book appointments with physicians. The use of telemedicine for chronic health issues or homecare can be helpful too.

Fine Hygienic Holding (FHH), one of the world’s leading wellness groups and manufacturer of hygienic paper products, has released the results of scientific testing conducted by the University of Arizona. The study confirms that the Livinguard technology incorporated in its masks effectively neutralises pathogens of all kinds upon contact, including Human coronavirus 229e.

The scientific tests, conducted by the Tucson university’s Department of Environmental Studies under the supervision of Charles Gerba PhD, showed that the textile technology, made in partnership with Swiss microbiology and material sciences company Livinguard, effectively eliminates pathogens of all types, including Human coronavirus 229e.

Effective in the fight against COVID-19

The tests affirm that textiles treated with the breakthrough technology can kill the coronavirus by 99.99 per cent. Dr. Gerba, Professor of Microbiology, Virology, and Immunology, said: “Livinguard textile technology holds promise in the fight against COVID-19.”

Regarding the findings of the study, FHH CEO James Michael Lafferty said, “As a leader in the wellness and hygiene industry, FHH is dedicated to providing hygienic solutions which go beyond the set market standards. Fine worked closely with Livinguard over the past couple of years to develop products that keep consumers safe and healthy.

“We are proud to be their exclusive partner in the MENA region, providing our communities and consumers across the globe with one of the most technologically advanced and effective hygienic face masks on the market today. We are encouraged by the confirmation of the newly-available test results from the University of Arizona and look forward to making masks treated with the Livinguard technology even more widely available.”

Fine Guard Comfort masks are reusable for up to a year and Fine Guard N95 face masks are reusable for up to three years (the effectiveness of Livinguard technology lasts for one year, while the N95 filter remains effective for another 2 years), offering a more sustainable alternative than disposable masks.

Everyone is talking about Artificial Intelligence and its impact on society and business. International tech founders debate on social media over whether AI poses a threat. And of course there is major excitement in healthcare, where AI is expected to become a $36.1 billion market by the end of 2025.

Yet despite the buzz, it’s important to recognise that we’re still in the early stages of the AI journey. As with any new technology, during the first decade great things happen, and then the market evolves.

Looking ahead, we have theories around the rise of the intelligent health system – healthcare entities reinventing themselves to leverage data and AI for the efficient provision of health services, across all touchpoints, experiences and channels.

But let’s take a step back. What is AI really?

AI is software with the ability to depict or mimic human brain functions such as vision, language, speech, search and knowledge – all applied in healthcare today in unique and emerging ways. Machine learning is driving a lot of AI today, and lately we’re making great progress in using it to predict things we care about.

We are seeing a tremendous number of great ideas come forward. For example, in the United States we’re seeing patient risk assessment, and there are also projects worked on in the long-tail of genomics and precision medicine.

Region on the rise

Much of AI’s evolution in healthcare will happen in the Middle East. There is an openness to trying new things in the region that is different from Europe or the United States.

Middle East consumers are more willing to adopt new healthcare options than in other countries, a PwC report shows. Two-thirds of consumers are willing to receive healthcare in a non-traditional setting.

In addition, the Middle East has the second largest mobile phone market in the world - 91% of the UAE population are currently using smartphones, and we know that smartphones are having a huge impact on how healthcare is delivered globally.

Of course, the pandemic has brought non-traditional healthcare even more into focus. One leading hospital group in the UAE for example is doing nearly 150 telemedicine appointments a day on its digital platform run through Microsoft Teams.

Human transformation

As a healthcare leader, what do you need to do today? Let’s begin with data.

Consider this: medical knowledge is growing exponentially. It’s now said to double every 73 days.

The data explosion gives us all superpowers – you get to choose how to use them. How you manage and leverage data as a healthcare leader is critical; if you don’t get it right, none of the excitement over AI really matters. Do you manage data in a way similar to how you manage your financial assets?

You also need to consider that AI is a very different technology from anything we’ve seen before. Systems will act like humans and humans will act less like computers, simply through removing the more administrative tasks we go through. It’s changing the way that systems interact with each other and patients, and that means acting and behaving differently as a leader.

So what do we do as leaders to make this technology work? A recent survey by Accenture among global executives showed that 78 percent of companies struggle to see digital transformation results. In my view, most transformational initiatives fail because many leaders don’t recognise the difference between being a “change master” and a “transformation leader”. Transformation is both multidimensional and complex, rather than one thing.

Digital transformation will only happen through workforce transformation. We often talk about technology, but we don’t talk enough about training and workforce management, which is a huge transformation component.

Some medical roles will be automated out of existence. But mostly jobs will change - based on how AI will free people up so that they can be the knowledge workers they want to be. No AI can take away “human” qualities such as reasoning, caring, empathy, judgment, empathy and problem-solving.

The challenge is how to balance the best of AI with the best that we can do with knowledge workers. AI can be a force for good; you as leaders will get to make that decision today.

AI for Health

At Microsoft we’re excited about the possibilities for AI and healthcare. Our CEO Satya Nadella describes AI as representing one of technologies most important priorities, with healthcare its most urgent application.

We recently launched AI for Health, a new US$ 60 million, five year philanthropic program created to empower nonprofits, researchers and organisations tackling some of the toughest challenges in global health.

Areas that we’re providing AI expertise in include reducing health inequity and improving access to care for underserved populations; supporting fundamental research capabilities; accelerating medical research to advance the prevention, diagnoses and treatment of diseases; and increasing our shared understanding of health and longevity to protect against global health crises.

With AI being so new still, we can all learn from each other. In this vein, I encourage you to visit our website to learn more about how we’re impacting healthcare with Microsoft AI, and you can also catch me virtually at Omnia Health Live, an online networking event for the healthcare community in June.

According to the 9^th edition of the International Diabetes Federation Diabetes Atlas, the prevalence of diabetes in adults in the MENA region is 12.2 per cent and in Africa is 4.7 per cent. Over the next 25 years, diabetes prevalence is expected to increase in all countries, with the greatest increase expected in middle-income countries, rising to 13.9 per cent in the Middle East & North Africa and 5.2 per cent in Africa. The increased prevalence of type 2 diabetes in the region has made it a key priority to the region’s governments’ health agenda. Lifestyle interventions and adherence to medications are central to disease prevention and management.

“As type 2 diabetes and its complications continue to overwhelm our healthcare systems, healthcare professionals, including members of the Middle East & Africa (MEA) Ramadan Expert group, have been working closely together to identify gaps between clinical ambitions and reality. However, in practice we are often faced with barriers to the successful implementation of guidelines preventing optimal care for people with Type 2 Diabetes,” explains Dr. Mohamed Hassanein, Senior Consultant in Endocrinology and Diabetes at Dubai Hospital; the Chair of the Scientific Committee of the Arab Association for the Study of Diabetes and Chairman of Diabetes & Ramadan International Alliance.

“Success in any guidelines depends on addressing all the possible contributing factors. Hence, it is crucial to engage all stakeholders to address the various health-related issues. Indeed, addressing cultural difference has a serious impact on diabetes management and it has to be taken into consideration as well.” 

Creating a successful diabetes management programme

While the Middle East has one of the highest prevalence of diabetes globally, rates of obesity, physical inactivity and smoking are high. The geographical location of the Middle East is also reflected in different lifestyles particularly from the Mediterranean region as well as from the Indian Sub-continent. It is crucial to address all the possible factors to have a successful diabetes management programme; especially in the face of unprecedented challenges such the COVID-19 pandemic.

According to Hassanein, there are different ways in which these networks have to be agile and adapt while we are in lockdown. “Technology has helped to sustain communication with the various stakeholders despite the lockdown and face to face discussions were replaced with digital meetings. Indeed, one benefit of lockdown is proving that once the will is there, the tools could be utilised for a successful outcome.”

Meanwhile, Dr. Elmas Malvolti, Medical Director for the Middle East and Africa at AstraZeneca says that these challenging times have facilitated faster adoption of digital tools and have challenged traditional ways of engagement. “We are witnessing how digital, data and AI are transforming the workplace, business processes and collaborations. Virtual meetings, virtual masterclasses, virtual advisory boards are just a few examples of this change. In addition, digital technology is putting more information in the hands of patients and empowering them to play a larger role in managing their own health.

“Even before the lockdown caused by COVID-19, care has started shifting from reactive and acute to proactive and chronic as new treatments and technology allow better long-term management of diseases such as diabetes,” he adds.

So, what then, is involved in the process of coming to a consensus on issues related to healthcare as different countries have different priorities at any given time? “The key in any consensus is compromise and setting the priorities in the beginning. Once the agreement is there for the main issues, then it is easy to accommodate differences on the lower priority issues,” says Hassanein.