Latrobe Regional Hospital scales healthcare communication platform to unite care teams.

The problem

For Latrobe Regional Hospital (LRH), streamlining communication was the biggest focus, both to improve patient care and to strengthen collaboration across its healthcare system. Up until the beginning of 2020, they used a combination of phone calls and pagers to interface among Emergency Services, ED, and hospital staff—resulting in inefficiencies and challenging communication for caregivers.

“I think the willingness of the ambulance to actually ring prior to Pulsara was a big thing,” said Carolyn Beltrame, an Emergency Nurse at LRH. “They knew that a lot of the time, the phone would be busy, or difficult for us to answer.”

But even when the ambulance did connect with hospital teams, communication was often faulty. “Due to spotty reception, we could miss a patient’s name or not get their date of birthright,” said Mark Scammell, Operations Community Engagement Liaison Coordinator at Ambulance Victoria. “Upon patient arrival, [we were] scrambling for the right details and pulling their old notes.”

Latrobe wanted a technology solution that could scale to meet patient needs and centralize communication for all of its departments, staff, and partners.

Latrobe is the third hospital in the state of Victoria to implement a mobile communication platform called Pulsara. Made possible by grant funding, the hospital activated the technology across multiple entities in February 2020, including ambulance partners, cardiology, stroke, and mental health teams.

Pulsara connects people when seconds matter with a secure, unified patient channel—replacing multiple phone calls, radio reports, faxes, and pagers—and allowing care teams to communicate efficiently and effectively when treating patients.

When Ambulance Victoria initiates a patient case in Pulsara, the case is able to evolve in the platform as the appropriate Latrobe team members are notified to respond. Each caregiver can easily add resources with a simple tap in the mobile app—from incoming patient data to ambulance arrival time to vitals needed for specialist consultations.

The results

By August 2020, six short months after implementation, Latrobe expanded the technology to the majority of its staff members, including all ED, nursing, pediatric, and transfusion divisions.

Most recently, the hospital’s mental health triage unit—which responds to a high number of the region’s mental health cases—has been onboarded.

Latrobe’s ED staff treats an influx of individuals with drug dependencies, and Pulsara helps manage these patients more effectively by notifying the hospital of incoming cases ahead of time. Through Pulsara, Ambulance Victoria is able to relay details on the patient’s severity, quickly informing the hospital of the needed intervention well before arrival. This allows the care team to be ready and waiting at the door when the ambulance arrives. By introducing Pulsara into their current mental health response protocols, Latrobe has increased the safety of both patients and caregivers.

Additionally, Latrobe is adding its local mental health police response to the platform to support the community management of these case types.

“Pulsara has made a massive difference in communication for all of our workflows,” said Janet May, Stroke and Pulsara Coordinator at Latrobe. “It gets the right information to the right care team members at the right time, allowing us to adequately prepare for a variety of patient cases.”

One particular case type that has benefitted from the improved communication at LRH is stroke.

“Now with Pulsara ... we are able to pre-register the patients, so stroke patients can go directly to CT on arrival,” said May. Compared to data from March through July of 2019, in 2020, LRH improved door-to-CT times from an already impressive 22 minutes down to just 7 minutes on average, a 68% reduction in treatment time.

“It’s worked from the bedside through to the ED department through to the CT scanner through to the tele-stroke consultants,” added Prof. Chris Bladin, a Neurologist at Ambulance Victoria/Monash University, and Director of the Victorian Stroke Telemedicine service, which assisted with bringing Pulsara to Latrobe.

Latrobe and Ambulance Victoria are currently using Pulsara to manage their COVID-19 patients more safely and efficiently, while simultaneously keeping the well-being of Emergency Services and ED staff a priority. Now, the healthcare system is working to expand the platform’s capabilities to further synchronize communication and innovate patient care throughout the region.

Latrobe Regional Hospital (LRH), located 150 kilometres east of Melbourne, Australia, is one of the region’s largest employers with more than 1900 staff. A purpose-built teaching hospital caring for a population of more than 260,000 people. The LRH Emergency Department is a 30 bed unit with 12 short-stay beds and sees approximately 30,000 people a year.

 

Highlighted results

Door-to-CT times improved from 22 minutes on average to approximately 7 minutes, a 68% improvement.

Healthcare Artificial Intelligence (AI) Market is set to grow from its current market was valued at over US$1.7 billion in 2019 to US$21 billion by 2026, according to a new research report by Global Market Insights.

The emergence of AI-enabled virtual assistant solutions across various domains has now enabled the global healthcare artificial intelligence market to record massive gains in the years to come. Increased application of telemedicine integrated with AI for facilitating remote services to patients residing in less-developed areas has instigated the adoption of artificial intelligence solutions in the healthcare sector.

Related: IoT-enabled devices: Transforming healthcare and supporting claims prevention

Furthermore, the growing need to minimise fraud and improve security in healthcare for better delivery of quality care is fuelling the adoption of advanced healthcare AI solutions. In addition, the incorporation of advanced technologies and consolidation of healthcare processes is also fostering business growth.

For instance, Zebra Medical Vision, in 2020, announced that its Vertebral Compression Fractures (VCF) product received the FDA 510(k) clearance. According to the company, this latest AI solution automatically detects finding suggesting compression fractures which allow clinicians to place patients at risk of osteoporosis in treatment pathways for preventing potentially life-changing fracture.

Virtual assistants

Related: The potential for AI in healthcare

This segment across the healthcare AI market is estimated to register a valuation of US$2.9 billion with a significant growth rate of 42.4 per cent through 2026. The growth can be attributed to numerous advantages associated with virtual assistants such as increased healthcare quality, patient satisfaction, and patient outcome with fewer employees. Moreover, the introduction of new AI-based virtual assistant solutions will complement the segment growth further. Citing an instance, in 2017, Nuance Communications launched an AI-powered virtual assistant system for healthcare providers. Also, the company’s Dragon Medical Virtual Assistant provides conversational dialogues along with automation of high-value clinical workflows using pre-built competencies.

Regional outlook

Asia Pacific healthcare artificial intelligence market is projected to observe a substantial growth rate of 46.3 per cent through 2026 owing to the heightened demand for improved healthcare services and infrastructure due to the presence of a large patient pool in the region. Moreover, ongoing research activities in Japan towards development of new artificial intelligence-based solutions will open new growth avenues for the industry over the stipulated time frame. Similarly, developments pertaining to big data analysis and growing usage of artificial intelligence in healthcare sector across China will also add to the business growth in the ensuing years.

Major companies operating in healthcare AI market such as IBM Watson Health, NVIDIA Corporation, AiCure, Modernizing Medicine, Sophia Genetics, etc. are also playing key role in enhancing the business growth. They are focusing on several strategies such as mergers, acquisitions, business expansion and new product launches to gain a strong market presence worldwide.

The development and duration of immunity to SARS-CoV-2 following infection or vaccination is not fully understood, but increased knowledge is crucial for the vaccination drive against COVID-19. A trio of new assays for quantitative measurement of IgG antibodies against the viral spike protein domain S1 including the receptor-binding domain (RBD), detection of neutralising antibodies targeting S1/RBD, and determination of SARS-CoV-2-reactive T cells supports the differentiated investigation of SARS-CoV-2-specific immune responses. This comprehensive analysis is especially useful for studying vaccine responses with the goal of optimising vaccination strategies.

Immune responses to SARS-CoV-2

Both humoral and cellular components of the immune system are involved in building immunity against SARS-CoV-2 and providing protection against reinfection with the virus. Antibodies of class IgG against the S1/RBD of the viral spike protein and specific long-lived T cells are suspected to play the most relevant roles in virus neutralisation and sustained immunity.

Related: Omnia Health Magazine April – May 2021

The immunodominant RBD of the S1 subunit is responsible for binding to the human cellular receptor angiotensin-converting enzyme 2 (ACE2) and mediating entry of the virus into the host cells. Specific antibodies from previous infection or vaccination can block the RBD and prevent the virus from invading the host cells. However, it is currently not known what level of antibodies confer protection against COVID-19 or how long the immune protection lasts. Establishing the correlate of protection, that is the concentration of antibodies at which immunity can be assumed, requires large-scale studies and long-term observations and is usually determined by an evidence-based approach. The quantitative determination of antibody concentrations in patients and vaccinated individuals provides valuable support in clarifying this threshold. Measurement of the neutralising activity of these antibodies is also important for confirming the functionality of the antibodies, namely their ability to inhibit S1/RBD binding to ACE2 and prevent infection. Neutralising antibodies can generally be determined 14 to 21 days after infection or vaccination.

T-cell immunity, particularly to the spike protein, appears to be associated with strong protection, even in patients who do not exhibit detectable levels of antibodies. According to current knowledge, about 10 per cent of symptomatic and 40 per cent of asymptomatic patients lose their IgG antibodies, so that a past infection or response to vaccination may only be detectable via the T-cell response. Therefore, the measurement of specific T-cell responses is an additional important tool for studies into SARS-CoV-2 immunity and vaccine efficacy.

Related: Webinar: High quality laboratory testing to transform the response to the global pandemic

As of March 2021, the World Health Organisation (WHO) and the London School of Hygiene and Tropical Medicine have documented more than 310 COVID-19 vaccine candidates, of which 87 have reached clinical trials and several are now authorised for use in various countries. The different vaccine approaches include vaccines based on mRNA, DNA, viral vectors, protein subunits, inactivated virus, virus-like particles or live attenuated virus. The spike protein constitutes the main target for COVID-19 vaccines.

Quantitative anti-S1 antibody detection

In December 2020, the WHO approved the first international reference material for the standardisation of results from anti-SARS-CoV-2 serological assays (First WHO International Standard for anti-SARS-CoV-2 immunoglobulin, NIBSC code: 20/136). This enables antibody concentrations to be measured reliably in standardised units and harmonised between test systems. As a participant in the characterisation of this reference serum, EUROIMMUN was able to rapidly align its quantitative S1-based ELISA to this standard. The new CE-marked and fully automatable Anti-SARS-CoV-2 QuantiVac ELISA (IgG) is one of the first commercial antibody tests to provide quantification of the antibody concentration in standardised units (binding antibody units, BAU/ml). The assay uses a 6-point calibration curve. The quantitative ELISA was tested using serial dilutions of the WHO reference serum (Figure 1) and yielded an excellent correlation with the standard (coefficient of determination r2 = 0.99).

The S1 antigen is the least evolutionarily conserved within the coronavirus family, therefore antibodies against it are very specific for SARS-CoV-2. The Anti-SARS-CoV-2 QuantiVac ELISA (IgG) exhibits a specificity of 99.8 per cent, as demonstrated in a large cohort including sera positive for antibodies against other human pathogenic coronaviruses or other infectious agents as well as sera from healthy blood donors collected prior to 2020 (n=1458). As the S1/RBD antigen is the main target for virus neutralisation, the antibodies detected with this ELISA are with high likelihood neutralising antibodies. To verify this, the ELISA was compared with a plaque reduction neutralisation test (PRNT) using 74 samples from patients with a past confirmed SARS-CoV-2 infection. There was a 97.3 per cent agreement between results from the ELISA and the PRNT (Table 1), confirming that the ELISA detected neutralising antibodies in all but three of the samples.

Correlation of the Anti-SARS-CoV-2 QuantiVac ELISA (IgG) with the WHO standard

Determination of neutralising antibodies

The PRNT or virus neutralisation test (V-NT) represents the gold standard for determining neutralising antibodies but is time-consuming and expensive to perform and requires biosafety level 3 (BSL-3) laboratory conditions due the use of pathogenic virus. A new CE-marked ELISA provides fast and economical determination of the inhibiting effect of anti-SARS-CoV-2 antibodies. The SARS-CoV-2 NeutraLISA is based on a competitive principle, whereby neutralising antibodies in the patient sample compete with added biotinylated ACE2 receptors to attach to the binding sites of recombinant S1 antigen coated onto the microplate wells. The results are evaluated qualitatively as positive/negative using a cut-off of 25 per cent inhibition. The ELISA is linear in the range up to 67 per cent inhibition and shows an excellent correlation with the WHO international reference standard in this range (coefficient of determination r2 = 0.98). The cut-off area of the test corresponds to a value of around 62 IU/ml. The specificity of the ELISA amounted to 99.7 per cent in a cohort including sera positive for antibodies against other human pathogenic coronaviruses or other infectious agents, sera with a negative result in a SARS-CoV-2 neutralisation test and sera from healthy blood donors taken prior to 2020 (n=759).

The performance of the SARS-CoV-2 NeutraLISA for detecting neutralising antibodies was investigated by comparing the assay with a PRNT in 74 samples from patients with a past confirmed SARS-CoV-2 infection. There was a 98.6 per cent agreement of qualitative results between the two tests (Table 1). The ELISA offers the advantage of being much quicker to perform than the PRNT, with results being available within two hours rather than days. Moreover, it does not require BSL-3 conditions and is therefore suitable for routine laboratory diagnostics. The assay can be fully automated, for example on the EUROIMMUN Analyzer I or I-2P or the EUROLabWorkstation ELISA, making it ideal for use in a high-throughput capacity.

Results from the SARS-CoV-2 NeutraLISA were additionally compared with those from the Anti-SARS-CoV-2 QuantiVac ELISA (IgG). In the tested cohort there was a 99.1 per cent agreement between the qualitative results (Table 2, borderline results excluded). In isolated cases, results from the neutralisation test and quantitative anti-S1 IgG determination may be discrepant. Possible reasons include the presence of high concentrations of IgA antibodies with an inhibiting function, which are detected in addition to IgG by the neutralisation test, but not by the Anti-SARS-CoV-2 QuantiVac ELISA. In these cases, it may be helpful to repeat the investigations 7 to 14 days later.

Analysis of specific T-cell responses

Cellular immunity to SARS-CoV-2 conferred by long-lasting T cells can be measured using the SARS-CoV-2 Interferon-Gamma Release Assay (IGRA). Interferon-gamma is an important signalling molecule of the immune system which is released by the T cells upon contact with the virus. The IGRA is performed on heparinised whole blood samples, circumventing the need to prepare purified peripheral blood mononuclear cells (PBMCs). The T cells in the patient blood samples are stimulated based on specific viral spike protein in the provided tubes. The interferon-gamma released by the T cells is subsequently determined using a fully automated quantitative ELISA. The IGRA is a particularly useful tool for studies investigating the cellular immune response in SARS-CoV-2 infected or vaccinated individuals. The EUROIMMUN assay is currently available for research use only.

Perspectives

Vaccines against SARS-CoV-2 constitute the most important arsenal for combatting the COVID-19 pandemic. The first authorised vaccines are now being applied worldwide and a myriad of further candidates are in development and clinical trial phases. The ideal vaccine induces high titers of neutralising antibodies as well as robust T-cell responses. A comprehensive evaluation of the different arms of the immune response is therefore critical for assessing vaccine responses. Establishing immune correlates of protection will aid, in particular, the rapid assessment of future vaccine candidates and the fine-tuning of immunisation strategies with regard to dosage and timing of boosters. The durability of immunological memory and cross-protection between SARS-CoV-2 variants will also remain a major focus of research. Analysing both antibody and T-cell immunity additionally facilitates long-term epidemiological surveillance, especially for modelling population-level immunity.

This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today, covering femtech, AI, IoT and much more.  

Women’s health has often, sadly, been considered underserved, underfunded, and insignificant. Currently, the global femtech (female technology) industry is at a nascent stage but growing faster than before, shared Suchismita Das, Industry Analyst, Transformational Health, Frost & Sullivan, in an interview with Omnia Health Magazine.

Femtech includes software, diagnostics, products, and services that use technology to focus on women’s health. The industry is no more a “niche” sector – it is becoming mainstream. It is catching the attention of medtech and pharma companies, but the momentum has been a little slow, stressed Das. However, the good news is that in the coming years the global femtech industry is projected to grow at a much faster pace.

Related: Omnia Health Magazine April – May 2021

In the Gulf countries, the UAE is well-positioned in prioritising women’s health and has the potential to be the leading example, globally as well as for other Middle East countries, emphasised Das. “Not only is the UAE well equipped to handle all types of women’s health needs and issues, but it is also witnessing the global paradigm shift from its focus on women’s reproductive health to other unaddressed feminine needs,” she said.

With menstruation, fertility, and pregnancy care occupying the first three ranks in the growth trajectory, menstruation, mental health, endometriosis, fibroids, pelvic health, PCOS and thyroid issues will be the new growth avenues for femtech. The global femtech market is poised to grow at a CAGR of ~11 per cent till 2025.

Related: The rise of femtech and SHEconomy

According to Das, healthcare, medtech and pharma companies can partner with femtech start-ups to provide better prediction, prevention, and post-treatment benefits. With big data and analytics, health tech companies can document health trends and create huge databases. Enhanced with Artificial Intelligence (AI), these databases can be beneficial for clinical decision support (CDS).

Reportedly, government and many public and private organisations globally have rigorously been investing in femtech over the last few years, which eventually will drive the market growth. Several start-ups functioning in the industry are focusing on developing innovative solutions to improve women’s quality of life. This area now needs even more focus due to the devastating impact of COVID-19 on women’s health.

Das highlighted: “During the pandemic, women’s health worldwide suffered intensely, right from increased mental health issues to a surge in unwanted pregnancies and stillbirths. One of the major observations had been the global rise in pregnancy rate – both planned and unplanned/unintended pregnancies. Globally, there were nearly seven million unintended pregnancies due to the COVID-19 pandemic. But all these pregnancies didn’t result in successful childbirths as there was an unusual rise in the stillbirth rate. Miscarriages, stillbirths, and birth complications inevitably led to a surge in women’s mental health issues such as depression, anxiety, and post-traumatic stress disorder (PTSD) in pregnant women or new mothers.”

Secondly, homestay during the pandemic aggravated women’s mental health across all ages due to increased domestic work. For instance, it was not easy for women frontline healthcare workers as they were exposed to increased risk of contamination. Fear of being the virus carrier forced many to stay away from their families, leading to an increase in depression and anxiety disorders in those who had pre-existing conditions. Also, violence against women increased considerably and has become a global public health concern.

“However, on the other side, the pandemic proved to be “a blessing in disguise” as it triggered the industry’s shift towards women’s issues such as PCOS, fibroids, thyroid issues, endometriosis, pelvic health, and menopause,” added Das. “We have seen a major transformation in the supply side of femtech. Many women-led companies started evolving with innovative devices, apps and/or services to address these issues. Further, we witnessed increased adoption of “at-home” solutions and services such as telehealth services.”

Suchismita Das

Telehealth: A shot in the arm

Increased adoption of telehealth services, even in femtech, has been a gamechanger in boosting women’s health solutions.

“Due to the pandemic and rise in the pregnancy rate, women were asked to stay at home. Unlike elective surgeries, which could be postponed, telehealth adoption became the most viable option for many pregnant women,” explained Das.

Similarly, for fertility care, pre-menopausal and menopausal care, telehealth truly came to the rescue. Telehealth adoption increased and became the most preferred mode for consultation and increased demand for more profound and enhanced tools such as improved remote monitoring platforms, AI-backed diagnostic solutions, and others to make remote visits/consults more meaningful.

According to Das, in the next few years, it is expected that telehealth would transform the healthcare industry, including the femtech sector, majorly by adding newer and effective innovations. Other breakthroughs include AI to improve IVF success rates, 3D printed biomaterials for breast reconstruction in breast cancer survivors, telemedicine consultations with prescriptions, anti-radiation wearables for pregnant women, genomics for fertility tracking, and others.

Tackling bias

The femtech industry still suffers from barriers such as gender-biasedness, lack of education and awareness amongst end-users and clinicians, socio-cultural stigma and taboo, and lack of clinical evidence. To address these issues, industry players have started taking measures.

For instance, to address the issue of gender-biasedness, shared Das, increasingly more women-led femtech start-ups, and dedicated femtech focused VCs and angel investors are emerging. The majority of femtech start-ups are women-led, following the “for women, by women” movement. Similarly, Venture Capital (VC) firms such as Portfolia, Avestria Ventures, Rhia Ventures are some well-known women’s health investors who are pioneering the upcoming surge of femtech innovations. Angel investors’ such as Aletta Angels, SoGal Ventures, Halogen Ventures, are also joining this movement.

Additionally, many femtech start-ups have taken up the onus of educating women about their own body, needs, and problems. Moreover, making gynaecologists aware of new solutions and services to replace the traditional, less effective ones is also a task taken up by them. For example, Germany’s Super Izzy AI and Australia’s MyMoonBox are two such start-ups that educate women about their reproductive health and better understand menstruation and PMS issues.

Medtech and Pharma industry’s interest in the femtech sector is also growing. Moreover, governments and organisations of different countries are actively introducing initiatives and reimbursements for women’s health to improve their quality of life, she added.

In conclusion, Das said the rise of the movement “for women, by women,” in femtech has been long overdue, and it is “remarkable to see how femtech women are opening/funding their start-ups, creating innovative solutions and awareness at the same time. Over the next few years, femtech’s potential would cease to be an expectation and would become the reality.”

The key mantra to achieve the above, she added, would be to be competitive and differentiate. Solutions need to be unique in terms of addressing women’s health issues. This would open up new avenues of growth and help in getting easy and quick funding from investors.

Das recommends companies to provide affordable, personalised holistic care for women of all ages and not be restricted to fertility/pregnancy care. Specially curated programmes, specialised services, and personalised plans are the way forward.

She concluded: “With the help of extensive research and innovations, femtech demands innovation-led devices and solutions that can improve and enhance women’s health across all stages of their lives.”

This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today, covering femtech, AI, IoT and much more.  

We wrote in an earlier article in Omnia Health Magazine about how oral medication errors can take place at the bedside.

The same potential errors of the Wrong Patient, Wrong Medication, Wrong Dose, Wrong Documentation, and Wrong Time apply equally to intravenous (IV) medications.

Related: Omnia Health Magazine April – May 2021

Among all the stages of the medication chain – from prescription through to administration – medication errors that occur at the point of administration are the most prevalent at 68 per cent of all IV medication errors. And with only a 2 per cent chance of detection of error, in terms of Failure Mode Effect Analysis (FMEA), the IV administration process consistently scores as a high-risk activity by virtue of this difficulty of detection, with a Detectability Score of 10 (0 = Minimum Harm Risk – 10 = Maximum Harm Risk) commonly being applied by organisations utilising FMEA.

This is the dangerous ‘gap’ that Connected Compounding Solutions and Interoperability Capable Infusion Pumps can close, as they effectively loop back IV medication administration directly to the original prescription and ensure completion of the documentation of administration.

Related: Report: The Evolution of Healthcare – Patient Safety

This can be achieved by bidirectional-interoperability capable IV pumps through direct communication with the patient’s Electronic Medical Record (EMR):

 

The barcode on the IV medication bag or syringe triggers this communication during a process of scanning the Patient’s ID band, scanning the medication to be given, and scanning the barcoded unique identifier of the IV pump. The pump is then triggered to communicate with the EMR and the confirmation with the Computerized Provider Ordering Entry system allows for auto-population of the pump with an order string that carries the correct dose, duration or rate, correct volume of the IV bag and the patient ID. This is truly streamlined safety as it can also reduce the time spent programming the pump by over 80 per cent, and healthcare needs streamlining badly. Up to 38 per cent of a nurse’s time is spent on non-value-added activities and these non-value costs can take millions of dollars per year out of an organisation’s budget. 

The hospital pharmacy is central to the above workflow as it is here where the order is electronically received from the CPOE, the medication is compounded and the individual and unique barcode with an order string is created from the CPOE, and the individual patient ID is created. It is possible to manage this process manually, but many of the critical steps involved in compounding carry potential error rates as high as 49 per cent, and it is far better to have integration between the CPOE and the compounding software to avoid breaks in the medication chain, and to reduce the risk of transcription errors. Prescribing software should also include ‘Hard Stops’ for dosing and automation of calculations for Area Under the Curve (AUC) dosing. Ideally, the CPOE gives prescribers access to computer-based standardised protocols, which reduce non-standard regimen creation, can make for a faster regimen build, and automatically calculate doses and create preparation guidance. With integration, physician prescriptions can be received electronically into the pharmacy for verification, and if approved, for push-communication to the compounding unit.

Interoperability between the EMR and IV Pumps is an ideal solution for whole hospital medication safety, as it requires an investment in communication engines to link pumps to the EMR and an organisation-wide network capable of carrying these messages, ideally via secure wireless communication. Modern smart pumps can make this a highly protected connection via Advanced Encryption Standard (AES) 128-bit key encryption using Cipher Block Chaining (CBC). This encryption applies to a vast number of connections with modern smart pump servers being able to manage up to 18,000 pump channels with full, and secure, bidirectional interoperability across hospital campuses with multiple sites.

As mentioned above efficient compounding software is a central part of any EMR interoperability solution for IV medications, as every prescription must pass through the pharmacy for reconstitution and application of the unique patient-medication matched barcodes. The pharmacy compounding unit is truly the engine house of IV medication production and of IV medication safety.

A compounding workflow software solution can undertake both preparation and documentation assistance and checks. A software suite should support initial pharmacist verification of the order, gravimetric checks, and incorporate a monitor inside the work area with a minimal interaction interface with step-by-step instructions. The software can propose a list of items that includes the minimum medication vials, diluents and consumables required to prepare the dose. Scanning of individual components ensures a recipe match for all items including the final IV administration bag. The system must also carry ‘Hard Stops’ for dosing out of tolerance (usually ±4 per cent tolerance is accepted by most institutions). The compounding system should only deliver a patient-medication label after all the steps of compounding are successfully complete, which makes it ideal for building into an FMEA process, as the steps involving risk are all before the final verification checks and issuing of the label with a unique preparation and patient identification number. The software must be capable of recording all cancelled mixes, tolerance limit breaches, incorrect item scans, and the resolutions of alerts by the user. Date-time stamps are automatically applied to all these alerts and actions by modern compounding solutions. This data is ideally stored locally on an MS-SQL database inside the hospital firewall. Documentation in the central pharmacy of compounding statistics for each preparation can be aggregated and this assists with forecasting.

Viewers and dashboards of the entire IV medication management process from prescription to administration help senior pharmacy managers to identify bottlenecks in the pharmacy fulfilment process. Compounding units can also view infusion status in all nursing units, allowing for just-in-time resupply of critical medications and prioritising of activity and queuing of compounding requests. New medication dose requests are easily identifiable in such an arrangement, and such systems are extendable into inventory control and forecasting functions.

Compounding software can also be used to extend medication safety beyond the pharmacy and into the nursing unit. This solution is a ‘lighter touch’ than full EMR bidirectional interoperability, though hybrid solutions with all the advantages of compounding software to smooth the workflow of production, married to barcode right patient-right medication verification via EMR-interoperability capable IV pumps, are also feasible.

Medication safety should always be an ongoing journey to zero patient harm and scalability and adaptability of solutions, so-called ‘futureproofing’ is a vital consideration for organisations when building their IV medication risk management strategies.

The ‘light touch’ solution requires less infrastructure and complexity as it can stand outside of the EMR or have touchpoint integration only, with access to Admission Discharge and Transfer (ADT) data from the EMR for example.

The below workflow shows how bedside BCMA scanning by nursing staff to support right patient-right medication verification at the bedside is supported by the compounding solution.

This requires the deployment of wireless connected handheld barcode scanners to the nursing unit. As the patient ID band and the patient-medication barcode label on each compounded product are scanned this potential ‘match’ is transmitted to a ‘listening post’ interface and through to the compounding solution server, where the match is tested and if it is correct for the patient, medication, dose, volume and regimen appropriateness (oncology regimens, of course, contain multiple medications and are timed and scheduled as per the CPOE order) the nurse gets a green light and can proceed with administration. 

This workflow achieves several things. It replaces a large amount of manual activity by nursing staff and should reduce the risk of medication errors as it undertakes positive patient ID and matching of the compounded product to the patient. It also means this activity takes place directly at the bedside, avoiding the risk of checks being made at the nursing station and then a mix up occurring due to distraction or other error in the ‘last few metres’ to the patient.

The two-nurse or ‘four-eyes’ check is also not required as the barcode acts to verify fully, and of course there are many reports of the ineffectiveness, dangers of positive reinforcement of error, and of time-wasting that occurs when verification is undertaken manually by two clinicians. Printed pages for regimens, which can be mislaid or placed in the wrong patient record, are also eliminated in this approach.

Activity takes place directly at the bedside, avoiding the risk of checks being made at the nursing station 

As discussed above, safety systems can also streamline practice. In a recent study in a high turnover oncology unit with 16,000 patient visits and over 14,000 compounded medications per annum, the introduction of a compounding software solution with BCMA labelling saw a 35 per cent reduction in the time required to compound each product. The introduction of handheld barcode scanners for patient-medication verification led to patient verification time falling from ≈ 6 minutes to a mean average of only 41 seconds within two weeks of its introduction. When calculated against the checking of 14,000 medications, this gives a saving of nursing time equivalent to 0.43 full-time nurses per year. The savings for a 1,000-bed hospital compounding 40,000 oncology medications per year would be 1.21 full time nurses.

Technology cannot do everything that healthcare staff can do, but what it can do is release our most valuable asset, our highly skilled staff, to undertake patient work of real value and to allow them to work in an environment that supports them in keeping patients safe.

This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today, covering femtech, AI, IoT and much more.  

The UK Healthcare Pavilion – the first virtual platform showcasing the very best of UK healthcare and Life Sciences – has partnered with The Middle East Medical Portal (MEMP) to both raise awareness and export UK innovation into the Middle East.

MEMP is a UK and Dubai-based company that serves both UK companies with market entry services and healthcare providers and authorities in the Middle East with world-class importing of innovation. MEMP has exceptional market access as it is an international CPD/CME accredited provider of medical education for healthcare professionals.

Recently launched, the UK Healthcare Pavilion provides news, insights, and interviews from a variety of key opinion leaders and policymakers offering their views on topical subjects in the sector and showcasing the strengths the UK has to offer.

Alongside this is a searchable directory of UK companies, providing overseas buyers with a simple and intuitive way to identify and engage with UK industry and healthcare organisations.

Also listed are the UK’s most prestigious private healthcare providers, highlighting why millions of people each year choose the UK as the place to access world-class treatment.

Speaking about the partnership Nathan Nagel said: “We are delighted to partner with the UK Healthcare Pavilion and be able to support UK companies to sell into the Middle East, to stimulate the UK economy, and crucially, provide world-class healthcare to patients.”

The UK Healthcare Pavilion is supported by Government departments, including the Department for International Trade, Invest Northern Ireland, Scottish Development International and the Welsh Government, as well as UK consulates, embassies, and industry bodies around the world.

Paul Benton, Managing Director, International, at the Association of British HealthTech Industries (ABHI) added: “UK healthcare solutions carry a great reputation in the Middle East, and we are so pleased to be partnering with MEMP to utilise their expertise and network, which will, in turn, bring great innovations and treatments to patients in the region.”

A mixture of trade and clinical associations are also supporting the site such as the Royal College of Surgeons, Royal College of Physicians, The National Institute for Health and Care Excellence (NICE), the British Dental Industry Association (BDIA), the UK BioIndustry Association (BIA), Medcity, OneNucleus, the AHSN Network and The Medicines and Healthcare products Regulatory Agency.

Unique platform

The UK Healthcare Pavilion is a unique partnering platform helping overseas customers discover, connect and innovate with the UK’s thriving healthcare and life science sector. It inspires cross-border collaborations that can realise large scale impact in response to local and global health challenges. The platform was created out of a need to provide a single front door showcasing the strengths of UK healthcare and life science. Its mission is to provide overseas buyers looking for UK solutions with a simple, insightful way to identify and engage UK industry and healthcare organisations – and to support UK-based medical device, diagnostics, and digital health exporters looking to engage customers around the world. The UK Healthcare Pavilion provides a global platform showcasing the very best of the sector – and highlights the strengths the UK has to offer.

This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today, covering femtech, AI, IoT and much more.  

From employee negligence and cybercrime to legal, regulatory and contamination issues, combating healthcare risks has been made even more challenging by the COVID-19 pandemic. What follows are just some of the key risks in the healthcare industry, along with advice on how best to prepare for them in an uncertain future.

1. Employee negligence and malpractice

Sometimes things go wrong in healthcare settings. Mostly this is not intentional, rarely it is.

The Medscape Malpractice Report 2017 surveyed over 4,000 physicians in the U.S. It revealed that the top five most common reasons for malpractice were failure to diagnose or a delay in diagnosis (31 per cent), treatment or surgery complications (27 per cent), poor outcomes and disease progression (24 per cent), failure to treat or a delay in treatment (17 per cent), and wrongful death (16 per cent).

In addition to these, nurses often have to deal with claims about failing to monitor patients correctly, update charts or respond quick enough.

However, administration staff, the healthcare company itself, and suppliers can be on the receiving end of a malpractice lawsuit. The cost of these can be huge. According to Willis Towers Watson calculations, claims over US$ 1m in the healthcare sector have almost doubled since 2000.

Be prepared for negligence and malpractice

Choosing the right liability insurance can be tricky – options include healthcare/hospital professional and general liability, nursing home professional and general liability, and miscellaneous healthcare facility liability.

But more than that, knowing how much liability limit is required can cause sleepless nights. This often requires a fairly in-depth discussion with actuaries, attorneys, and/or insurance professionals to assist in determining the most effective programme structure for your scenario. So, seek professional advice.

Also, be aware of the COVID-factor. We’re seeing a number of claims arising out of the pandemic – the spread of the virus or failure to properly clean the premises, for example. Unfortunately, these can be excluded by insurers leaving healthcare organisations limited in terms of coverage. So, it’s worth reassessing cover with the pandemic in mind.

2. Cybersecurity and data breaches

Healthcare collects more personal data on people than any other industry, making it prime for cybercrime. Ransomware and phishing attacks are popular methods to extract data, perform cyber extortion and cause network disruption.

Information security and privacy are big concerns for everyone. So much so that in response to the European GDPR, the UAE issued Federal Law No 2 of 2019 (Health Data Law). This regulates the use of IT and communications across the healthcare sector, imposing strict regulation on how data is processed, protected, and stored, with the long-term aim of building a centrally controlled health data management system.

Be prepared for cyberattacks

Cybersecurity is an ongoing task. However, the Willis Towers Watson 2017 Cyber Security Risk survey revealed that over half of companies have no cyber risk strategy at all.

Cyber threats are constantly evolving, so make sure security software not only exists but is up-to-date. Something as simple as selecting auto-update can make a big difference. And don’t forget smartphones. We’re seeing more and more cyber-attacks on these devices, via rogue apps that access high-risk data.

Cyber insurance is a must. These policies generally cover companies for liability for first-party and third-party losses. This means for things such as legal support, forensic services, business interruption expenses and cyber extortion. Check policy wordings carefully.

3. Virtual medicine

Virtual medicine stands as a risk in its own right, but also as a great example, of how the two previous risks – employee negligence and cybersecurity – have rapidly evolved in the face of COVID-19.

Healthcare organisations are more reliant on their IT systems than ever before. The Willis Towers Watson 2020 Healthcare delivery survey found that 84 per cent of the 397 U.S. companies surveyed now offer telemedicine through their insurance provider. Just over half (52 per cent) felt this would become more important in a post-COVID world.

The rapid shift to telemedicine and the ongoing need for some staff to work from home is leaving many healthcare organisations completely unprepared for this reality, exposing them to network and personal data security breaches.

It also leaves employees exposed in terms of negligence as well. Issues’ surround collecting informed consent and practising medicine outside of a licensed jurisdiction. It doesn’t help that the regulations on the use for telemedicine are wide-ranging within the UAE, with variations on who can practice this even between the Dubai Health Authority (DHA) and Health Authority Abu Dhabi (HAAD).

Be prepared for more virtual medicine

Keep on top of what new software is being installed by staff as they begin more virtual working and do so from home. Assess how these changes affect your overall cyber risk position.

Be sure to keep insurers or brokers in the loop concerning changes to the business and watch out for trends that take advantage of the pandemic. For example, the National Cyber Security Centre recently reported that coronavirus themed e-mails are already been used by criminals to extract data or extort funds.

4. Pollutants and cross-contamination

Cross-contamination of pathogens across a healthcare system has long been known to be a problem, but it’s never been a more prominent issue in the eyes of the public.

The spread of infectious disease hit the headlines as healthcare systems around the world struggled to contain the coronavirus. The issue here isn’t just to do with the spread of the virus from staff to patients, but from staff to family members too.

Be prepared for cross-contamination

The Willis Towers Watson 2020 report on Risk Management and Insurance briefing in response to COVID-19 makes the assertion that there is expected to be a high volume and variation in employer’s liability claims. This is particularly the case with employees contracting COVID-19 and then transmitting it to family members. Check insurance policies provide sensible coverage here, but also that record-keeping – reporting of incidents and advice provided – is kept up-to-date.

5. Employee disruption

The challenges that healthcare organisations are facing in recruiting, hiring, and retaining qualified employees are ever-increasing.

This is particularly true in the Gulf as highlighted by the 2017 World Health Organisation Report Framework for Action for Health Workforce Development in the Eastern Mediterranean Region. This report placed the UAE, Saudi Arabia, and Kuwait in Group 1, which means they faced a shortage of health workers, high reliance on expatriate staff and high staff turnover over the coming decades.

What affect will COVID-19 have here? It’s a little too early to tell, but a fair expectation could be expatriates looking to return home to be with their families in times of uncertainty. Given the costs of hiring new employees, healthcare companies need to monitor this situation closely.

Be prepared for employee disruption

Use data to begin predicting the expected staff turnover rate for your company and set aside cash flow to deal with this. Also, consider implementing improvements in employee wellness programmes and work-from-home policies (where possible) to help attract and retain employees.

6. Regulatory and legal change

Things can change quickly when a new piece of regulation comes into practice across the healthcare sector.

In 2019 alone, there were numerous new UAE healthcare laws and regulatory developments. The impact can be costly if caught unaware. Take the DHA Medical Display Screens Circular as an example. This demanded that all medical images must be read on screens meeting specific requirements including being LCD and having minimum requirements for pixel resolution. Any company with old technology has been forced into a rapid upgrade.

Be prepared for regulatory change

It’s clear that regulations are changing fast, so keep on top of them. Proposed changes are often published well in advance so should never come as a surprise. If the pandemic means you need to circumnavigate normal procedures (such as onboarding or training), then be sure to check with regulators concerning the level of leeway allowed during these pressing times.

Pressing times, changing risks

The healthcare sector will always be one packed with as much risk as reward. But many of the risks are highly predictable. Staying on top of them, performing regular risk assessments and keeping insurance policies up-to-date is the best advice I can give. Sound advice, in fact, no matter what industry you work in.

Rajendran

This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today, covering femtech, AI, IoT and much more.  

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

To create more awareness around this phenomenon, recently, a campaign called ‘New Normal, Same Cancer’ was launched in the UAE by Friends of Cancer Patients (FoCP) and Emirates Oncology Society, in partnership with AstraZeneca. The campaign saw UAE experts warn of a steady decline in people attending cancer screenings across the country due to fear of visiting medical facilities during the pandemic.

In an interview with Omnia Health Magazine, Peter Raouf, Director of Oncology Business Unit, AstraZeneca GCC, said: “Cancer does not press pause during a pandemic. We are responsible for battling the disease, and our best shot is through early detection and prevention. Our goal is to reach a point where cancer is no longer a life-threatening disease, and where dying from cancer is no longer accepted as the norm. We believe this can be achieved through an emphasis on cancer screenings, and therefore, we must continue to work against the effects of the pandemic and limit the long-term disruption to cancer care.” Excerpts:

Tell us about the ‘New Normal, Same Cancer’ campaign. Why was it launched?

With the pandemic causing significant disruption to cancer care, we felt it was our responsibility to act against this and encourage people not to wait. People across the world are waiting for the pandemic to settle or even pass before getting in touch with their doctor, despite noticing symptoms. We have launched the ‘New Normal, Same Cancer’ campaign in the UAE with the priority to encourage the return to cancer care without delay. We hope that the campaign will play an important role in urging patients to get checked.

How has COVID-19 impacted cancer care?

The pandemic has caused widespread panic and an undeniable concern for one’s health, and this has then been amplified amongst cancer patients – both diagnosed and undiagnosed. Going to visit the doctor has been a daunting experience for many, fearing the risk of catching COVID-19 when just stepping outside.

Furthermore, the impact of COVID-19 on cancer care is a complex issue. Due to travel restrictions and the enormous strain on health systems on fighting the pandemic, cancer services have been disrupted across the globe, significantly delaying diagnosis and treatment, and inevitably impacting the chances of early detection and survival for patients.

What is the current state of cancer care in the GCC and UAE in particular?

As cancer is the third leading cause of death in the UAE with approximately 4,500 cancer cases per year, there has been significant investment by the UAE Government to enhance the quality of cancer care in the UAE. However, cancer still remains a burden for the UAE and GCC in general. For example, according to the World Health Organization (WHO), the number of annual UAE breast cancer cases and lung cancer cases is expected to rise by 184 per cent and 437 per cent by 2040, respectively.

Peter Raouf

What is your long-term outlook for the healthcare sector in the GCC?

Our focus now is for cancer services to return to normal and for the public and those living with cancer to have confidence in cancer services as they work to take necessary precautions to avoid COVID-19 transmission. In the long-term, our focus is, as always, to re-shape cancer care in the GCC and follow the science to understand cancer and all its complexities to discover, develop and deliver life-changing treatments to those who need it most in the GCC.

Are there any other partnerships that AstraZeneca is looking to explore in the GCC?

We truly believe that collaboration is key to success and that having the right partners in place will help us amplify our message to as many people as possible. With many governments across the GCC striving to build robust healthcare ecosystems and elevate cancer care, we are keen to partner with bodies that share the same value as us in putting patients first. 

References available on request

This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today, covering femtech, AI, IoT and much more.  

As government authorities instituted stay-at-home orders during the COVID-19 lockdown last year, millions of patients had to stay away from their physicians to stay safe. This pandemic pressure accelerated the increased digitisation of the healthcare industry, especially the use of telehealth services.

Since April last year, hospitals and clinic call centres across the UAE have been flooded with patient queries. In September, for example, the Abu Dhabi Telemedicine Centre (ADTC) revealed a 2,000 per cent rise in the number of calls received since the start of the pandemic. As a result, healthcare providers have been ramping up their telehealth and telehealth capabilities.

However, new ways to deliver health care can face some hesitancy from some patients and doctors, and fully adapting a national health care system to new technologies and processes brings new challenges. Questions about the costs, administration and related coding and billing needed to be understood.

“Even before COVID-19, there was some hesitancy adopting telehealth services in the region,” said Dr Osama Elhassan, co-founder and the vice-chair of Emirates Health Informatics Society and Health Informatics Specialist at Dubai Health Authority. “We had to get the right digital frameworks in place so that we can ensure the quality of telehealth platforms, the flow of reimbursement processes, and also address privacy and security when using those platforms.”

To help overcome these challenges, the American Medical Association (AMA) aligned Current Procedural Terminology (CPT®), a unique medical terminology that describes services and procedures used to care for patients, to support the delivery of procedures across care settings. The CPT code set currently includes 70 telehealth-related codes and content describing comprehensive telehealth delivery solutions to support clinical interoperability and reimbursement for these remote care services.

The CPT Editorial Panel enlists physicians and engages with clinical innovators to update the code set to reflect the latest medical care available to patients. CPT codes have been adopted in Dubai, Abu Dhabi, and elsewhere across the Gulf region to help drive digital health solutions and enable coordinated care critical during a pandemic.

“Standardized CPT codes that reflect the emerging types of telehealth services improves confidence in the data quality and management process. The CPT code set has advanced quickly to ensure that hospitals, health care workers, and health authorities can coordinate, analyze, and improve care for patients in the midst of an acute health crisis,” said Dean Parisi, the AMA’s Director for International. “The AMA convenes experts and invests a significant amount into an editorial process ensuring that the CPT content is continuously modernized to remain clinically relevant in today’s rapidly evolving healthcare delivery systems.”

While the delivery of telemedicine has expanded rapidly to create a safer care environment during a pandemic, it also is positioned now as a crucial tool for delivering care.

“This pandemic period has helped to identify areas where telehealth can be extremely useful in delivering care, such as the ICU, stroke, and radiology,” Dr. Elhassan explained. “Telemedicine delivery will be more crucial in providing value, both in terms of quality and cost effectiveness, to healthcare systems. By learning from each other in the region, we have been able to understand the strengths and the limits of telehealth. In Dubai, our comprehensive regulatory approach allowed us to implement telehealth quickly as it became instrumental to the healthcare system.”

“It is vital that this momentum from telemedicine can continue to improve outcomes, deliver cost savings and better access to health care systems,” said Mr. Parisi. “The CPT code set helps health authorities and providers in the region as they drive this transformation to adopt more virtual care capabilities.

In the wake of the COVID-19 pandemic, Cleveland Clinic began using telemedicine and virtual health strategies to provide care for patients – especially in primary care and home care settings. In the span of just five weeks, Cleveland Clinic outpatient visits increased from 2% remote (virtual or phone) to 75% remote.

“In the early stages of this pandemic, we did not know a lot about how the virus behaved and affected people. So out of an abundance of caution, any visit that could be done virtually was done virtually,” says Kristine Adams, MSN, CNP, Associate Chief Nursing Officer of Care Management and Ambulatory Services. “Telemedicine was critical in this stage to keep our patients safe yet engaged in their ongoing care, preventing worsening of the disease and potential infection with the virus.”

To quickly and effectively ramp up telehealth services, several steps were taken almost simultaneously. Cleveland Clinic expanded telehealth privileges, trained and reorganized its workforce (including nurses), and created new documentation and workflows. “Our ambulatory care management nurses pivoted quickly to a virtual and telephonic platform to manage our highest risk chronic disease patients, as well as our COVID-positive patients who were not in hospital but being monitored for signs and symptoms at home,” says Adams.

Home monitoring of COVID-19 patients

Using a unique technology available through Epic’s MyChart, Cleveland Clinic was the first healthcare system to customize MyChart Care Companion to enhance the Home Monitoring Program for patients who test positive for COVID-19 at a Cleveland Clinic facility or is suspected of having it. Patients must agree to be enrolled in the easy-to-use program, which is available through their MyChart account on a mobile app or website.

“Once the COVID-19 test comes back positive, we reach out to the patient to learn more about their symptoms, provide education, offer support and help them sign up for the MyChart Care Companion platform,” says Michelle Card, MSN, RN BC, CCTM, Manager for Primary Care Coordination, who led the Home Monitoring Program team.

For 14 days, patients receive a daily questionnaire about their symptoms, and if they are better, the same as or worse than yesterday. Any worsening symptom response triggers a real-time message to a pool of registered nurses, prompting a phone call to the patient to further assess and determine next steps, such as additional care at home, a virtual visit with a provider or getting to an emergency department if necessary.

“A diagnosis of COVID-19 causes a lot of stress and anxiety for patients,” says Card. “Our regular contact helps to alleviate some of that anxiety by providing ongoing support, human contact during a time of isolation and reassurance to the patient that we are watching for those MyChart Care Companion responses.”

Ultimately, the program is intended to address emergent symptoms sooner, preventing hospital admissions and an inpatient surge. But it’s also designed to increase patient engagement.

Managing patients with chronic conditions

Soon into the pandemic, it became clear that patients with chronic diseases were not visiting their physicians. Cleveland Clinic began using the MyChart Care Companion platform to monitor these patients at home. To ensure that the health of patients with chronic conditions was being managed, nurses and care coordinators also called patients weekly to see if patients had any new or worsening symptoms they would like to discuss with their physician. If they did, then the caregiver found out more information and took action accordingly based on patients’ responses.

“Our priorities are to keep our patients with chronic conditions well at home, ensure they have the medications they need, provide education on how to remain safe and reduce their chance of contracting COVID-19, support the stability of their chronic disease and provide for any psychosocial needs,” says Card.

“During this pandemic, it is critical that we don’t minimize the importance of supporting our patients with chronic conditions,” she says. “Collaborating with many healthcare providers and leveraging technology allowed nurses to reach more patients, address changes in their health and connect them virtually to the right providers.”

This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today, covering femtech, AI, IoT and much more.