Asian Hospital & Healthcare Management - Issue 47

I S S U E 47

2020

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CONTINUOUS

SURVEILLANCE FOR AN EFFECTIVE PATIENT SAFETY SYSTEM

Associate Partner

AI Set to Revolutionise Medical Device Technology and Distribution

Decentralisation of Southeast Asia’s Healthcare Ecosystem

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Foreword Continuous Surveillance For an effective patient safety system Hospitals and healthcare systems have come under huge scrutiny by healthcare regulators for ineffective addressable of hospital-acquired illnesses. In the USA, Medicare and Medicaid Services have imposed hefty penalties on hundreds of hospitals for failing to prevent high occurrence of various hospital-acquired illnesses.

The Hospital-Acquired Condition Reduction Program (HACRP) links medicare payments for hospital claims to the quality of healthcare for in-patients. A study conducted in 2016 by Johns Hopkins Medicine indicated medical error to be the third leading cause of death in the US. While the facts of this study are being examined, lack of continuous patient monitoring and surveillance has been clearly noted.

Continuous clinical surveillance can help hospitals and healthcare organisations to improve safety standards and better patient outcomes.

Continuous surveillance allows doctors identify patients with signs of health deterioration at an early stage and take necessary actions alerting caregivers to ensure patient safety. Any delay in identifying early signs could result in deterioration of health or in extreme cases lead to patient’s death.

Although continuous surveillance is not a new term in the healthcare sector, it is interesting that patient monitoring and surveillance are used interchangeably even though there is a significant difference in both. Surveillance is based on realtime attention to patient that enables caregivers to assess patients’ health from a centralised location. Unlike the conventional monitoring, surveillance relies on active patient monitoring and the systems leverage real-time data from various monitoring devices to analyse and provide insights on patients’ health. This data facilitates intervention by nursing staff and clinicians thus preventing any life-threatening events.

Continuous surveillance involves seven key clinical attributes: attention, timeliness, recognition, intuition, analysis, action and collaboration. In today’s healthcare environment, it is quintessential for medical devices to be integrated to be able to keep the clinicians informed by providing realtime patient data to draw meaningful inferences.

Integration of medical devices for surveillance revolves around aspects such as timely delivery of accurate data, two-way communication and data integrity. Medical device integration for continuous clinical surveillance calls for a project team of experts that comprises leaders from various departments including doctors, technology team, facility management etc.

With technological advancements, today’s healthcare systems bring together different departments across locations to provide better care to the patients. Increasing patient safety and minimising medical errors can be achieved when organisations move away from isolated working models to a completely patient-centric integrated set up. Healthcare organisations will benefit from establishing surveillance systems that enable continuous monitoring of patients and support clinicians in providing effective care while avoiding potential loss of lives.

The cover story of this issue revolves around medical device integration and how essential it is for proactive patient safety.

Prasanthi Sadhu

Editor

CONTENTS HEALTHCARE MANAGEMENT

COVER STORY

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06 Drones in Healthcare K Ganapathy, Director, Apollo Telemedicine Networking Foundation & Apollo Tele Health Services

14 Decentralisation of Southeast Asia's Healthcare Ecosystem Following the money Yoshihiro Suwa, Partner, Roland Berger

20 Acute vs Primary Healthcare Payal Barde, Benefits Manager, Queensland Public Sector

MEDICAL SCIENCES 30 Can Central Nervous System be a Target for Treatment of Chronic Heart Failure and Amelioration of Exercise Performance in Athletes?

From physiology to clinical setting Robert Skalik, Consultant Cardiologist, Medical University of Wroclaw

TECHNOLOGY, EQUIPMENT & DEVICES 36 Medical Device IP strategies B Ravi, Founder, BETiC Chirag Tanna, Regd. Patent Agent and Founder, INK IDEE

FACILITIES & OPERATIONS MANAGEMENT 46 Lean Management Gurrit K Sethi, Hospital Chief Operating Officer, Care Hospitals; Strategic Advisor for Global Health Services, Global Strategic Analysis

INFORMATION TECHNOLOGY Sangita Reddy, Jt. Managing Director, Apollo Hospitals

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ESSENTIAL TO PROACTIVE PATIENT SAFETY

Mary Jahrsdoerfer, Director Healthcare Informatics Graduate Studies, Adelphi University

52 Clinical Decision Support Software FDA’s Risk-Based Approach Kyle Y Faget, Special Counsel and Business Lawyer, Foley & Lardner LLP

A SHORT NOTE

48 Transforming Healthcare Delivery through Connected Patient Rooms

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MEDICAL DEVICE INTEGRATION

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55 AI Set To Revolutionise Medical Device Technology and Distribution Sanjay Jha, Director, ColMed

24 Books

Advisory Board

Beverly A Jensen President/CEO Women's Medicine Bowl, LLC

EDITOR Prasanthi Sadhu EDITORIAL TEAM Debi Jones Grace Jones

K Ganapathy Director Apollo Telemedicine Networking Foundation & Apollo Tele health Services

ART DIRECTOR M Abdul Hannan PRODUCT MANAGER Jeff Kenney SENIOR PRODUCT ASSOCIATES Peter Thomas David Nelson Susanne Vincent

Pradeep Kumar Ray Honorary Professor and Founder WHO Collaborating Centre on eHealth UNSW

PRODUCT ASSOCIATES Austin Paul John Milton Jessie Vincent

Nicola Pastorello Data Analytics Manager Daisee

CIRCULATION TEAM Naveen M Sam Smith SUBSCRIPTIONS IN-CHARGE Vijay Kumar Gaddam

Gurrit K Sethi CEO Canta Health

Pradeep Chowbey Chairman Minimal Access, Metabolic and Bariatric Surgery Centre Sir Ganga Ram Hospital

HEAD-OPERATIONS S V Nageswara Rao

Associate Partner

In Association with

A member of Confederation of Indian Industry

David A Shore Adjunct Professor, Organisational Development Business School, University of Monterrey

Gabe Rijpma Sr. Director Health & Social Services for Asia Microsoft

Peter Gross Chair, Board of Managers HackensackAlliance ACO

Malcom J Underwood Chief, Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital

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HEALTHCARE MANAGEMENT

DRONES IN HEALTHCARE K Ganapathy, Director Apollo Telemedicine Networking Foundation & Apollo Tele Health Services

A major concern in Telehealth was that while the healthcare provider could appear on a screen and make a reasonable diagnosis in truly remote areas making available drugs or vaccines or collecting biological samples for investigations was a major constraint. Today DRONES are increasingly being used in healthcare to reach the unreached and make isolation, relative not absolute. The very word INACCESSIBLE will slowly loose its meaning. This article reviews the process of deploying drones in healthcare. The author is optimistic that proof of concept studies will soon be carried out in rural India.

A

healthcare provider can today, virtually appear on a screen, and most often make a reasonable diagnosis, and give proper advice reviewing available investigations.

Distance has become meaningless. In fact, Geography has become History!

However, in truly remote areas making available drugs, vaccines, blood or even collecting biological samples for investigations is a major constraint.

Today drones are increasingly being used in healthcare to reach the unreached and

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make isolation relative, not absolute. The very word ‘inaccessible’ will slowly loose its meaning. This overview introduces the reader to yet another illustration of potential creative disruption in healthcare. The author is confident that we will see this happen in parts of rural India soon.

We are living in a time of technological revolution. However, it is well known that healthcare providers worldwide are ultra conservative. In a recent report, Goldman Sachs estimates

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the total global spending on drones over the next five years to be around US$100 billion. Drones have been used extensively by the military in combat.

Most drone applications involve surveillance using an on board camera.

Agriculture surveillance, crop spraying, shark surveillance at beaches, monitoring wildlife for conservation, monitoring fires, , monitoring riots and international borders by police and governments, sports, entertainment, event coverage, media coverage, emergency services

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cause drones to lose their functionality.

Cost of building and maintaining drones needs to be carefully reviewed so that a cost–benefit analysis could be done.

Regulatory, legal and environmental issues need to be addressed History

The more familiar public term “drone� was first coined because of the resemblance of the loud and cadenced sound of old military unmanned target aircraft to that of a male bee. In 1942, the Navy developed a radio-controlled drone that carried a torpedo. Today the drone is all set to be a major disruptive force in transportation. The origins of UAVs can be traced back almost 100 years dating back to World War I. While UAVs were originally created for the military, they are now being used for a wide variety of applications. A few weeks ago, the US military force used a drone controlled from the USA to selectively eliminate an Iranian General in Baghdad.

Challenges

Every service provider wanting to deploy drones needs to overcome challenges ranging from payload capacity, safety, battery life and of course, regulations.

Flight paths need to be provided and drones managed to ensure that the right package is transported in right conditions at the right temperature to the right location.

Regulations in use of drones

disaster responses for humanitarian aid and scientific research and exploration are the various use cases. Amazon Prime Air is pioneering drone delivery of goods as heavy as five pounds to locations up to 30 minutes away. Today pizzas are being delivered through drones.

Drones are commonly known as Unmanned Aerial Vehicles (UAVs).

This term was first coined in the 1980s to describe autonomous, or remotely controlled, multi-use aerial vehicles.

Speed and versatility of UAV technology

offers virtually unlimited opportunities to deliver needed medical supplies and assistance to individuals in remote or dangerous areas. They can even connect doctors to patients in a more expeditious manner. Victims of natural disasters or emergency situations could be administered life-saving care by goodSamaritan bystanders who are provided remote instruction on treatment administration.

Inclement weather conditions or differences in ambient temperatures may

Aviation authorities need to work closely with Healthcare regulators before introducing specific regulations focusing on use of drones in the healthcare sector. Existing FAA (Federal Aviation Authority) guidelines state that drones must always be in the line of sight of the pilot. In addition, drones cannot exceed an altitude of 400 feet and cannot go faster than 100 miles per hour.

Community outreach and engagement, oversight, audits, enforcements, security services coordination, cross-ministerial councils, unmanned traffic management

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Key Performance Indicators and public and private data transparency need to be taken into account.

There is an increasing opportunity for countries to benefit from advanced drone operations, as associated technologies rapidly improve and evolve. Providing a planned revision of the policy or a continuous process for evaluating and re-evaluating the implementation policies for drone technologies according to KPIs is a new approach in governance. Sustainable integration of drones into health systems needs in-country capacities, markets and businesses to locally own and operate a drone-supported system.

Political awareness and desire to work with drones is increasing. Positive feedback from communities on the potential use of drones for health will ensure that political interests are aligned with drone project objectives. Commercial drone use is often held back by regulations (or the lack of it). Drones are often considered as aircrafts and pilots must adhere to strict line-of-sight rules, caps on altitude, and other restrictions. The recently released FAA new rules will hopefully regularise commercial operations.

Drones in healthcare – Some use cases

Potential applications of UAVs in healthcare are broad based. They include (1) Prehospital Emergency Care, (2) Expediting Laboratory Diagnostic Testing and (3) Surveillance. Currently, UAVs have been shown to deliver vaccines, haematological products and automated external defibrillators. In addition, they are being used in the identification of mosquito habitats and drowning victims at beaches as a public health surveillance modality.

Illustrations of use of drones in healthcare

a) Drone usage in Africa Currently in most centres in Africa it takes about 11 days to transport babies’ dried blood samples from a healthcare facility to a lab for HIV testing. It takes up to eight weeks to get the results. UNICEF led a project to try to speed up HIV testing of infants using helicopterstyle drones designed, built and programmed by Matternet.

In Rwanda, Zipline is able to maintain a ‘cold chain’ by delivering blood and pharmaceuticals to remote locations in hours. When the drones reach hospitals, they drop small packages from very low altitudes. The supplies are dropped using simple paper parachutes.

The drones return to a home base. They are prepared for the next mission by putting in a new battery and a new flight plan stored in a SIM card. Zipline has flown more than 300,000 km in Rwanda delivering 7000 units of

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Fig1: Drone ready for launch (Credit Zipline)

Fig 2: Blood units about to be packed

Fig 3: Payload packed uploaded into a Drone (Credit: Zipline)

Fig 4: Drone returning after dropping payload

Fig 5: A Zipline blood delivery in Kabgayi Hospital laboratory shortly after arrival

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blood in over 4000 flights. Not a single unit of blood has been wasted.

Unmanned vehicles successfully delivered small aid packages after the Haitian earthquake in 2012, helped in humanitarian operations for collecting data and imagery where infrastructure was destroyed or already lacking, as in the Philippines after a typhoon in 2013. In 2017, Tanzania, announced its plans to adapt the Zipline drone delivery system to improve access to essential medicines as well as basic surgical supplies. Up to 2,000 deliveries per day are planned to fly to more than 1,000 health facilities and 10 million people across the country. In Malawi, in 2016, UNICEF and Matternet piloted the use of drones to fasten HIV testing procedures.

Use of drones for healthcare in other countries Drones have been used in Taiwan, Nepal, and other countries to reach remote villages and hospitals. Zipline will bring its drone delivery program to rural communities in Maryland, Nevada, and Washington, including some Native American reservations.

Drones have delivered condoms and birth control aids to women throughout Ghana. In 2014, Médecins Sans Frontières demonstrated the use of drones for transporting sputum samples for tuberculosis diagnosis in Papua New Guinea. Drones provide fast, costeffective access to important diagnostic laboratory tests The Indian scenario The National Disaster Management Authority (NDMA) has started using drones to handle disaster relief and rescue in India. Similarly, during elections in the State of Chhattisgarh, the Central Reserve Police Force used UAVs for patrolling an area of 40,000 square kilometres and providing roundthe-clock surveillance. The Government of Uttar Pradesh has used drones for maintaining law and order at the Kumbh Mela festival in Allahabad, and so have the Mumbai police during the grandiose Ganpati festival. The National

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Drones present a tremendous opportunity to address supply chain shortcomings in the healthcare sector, reducing stockouts and wastage.

Thermal Power Corporation is using drones for predictive maintenance, and surveillance and intrusion detection in solar power plants. A UAV successfully transported a single unit of blood from a remote primary health centre in Uttarakhand’s Tehri district.

Drones could be a gamechanger in states that are particularly geographically difficult to traverse. A pilot project is expected to commence in Pune and Nandurbar. The launch will be supported through a grant from the Serum Institute of India, the largest vaccine manufacturer in the world. The government of Telangana in collaboration with Apollo Hospitals and the World Economic Forum has formalised the plan for a six-month pilot called ‘Medicines from the Sky’, starting in 2020. The project aims to explore the use of drones to increase access to healthcare for communities across the Telangana state.

Drone regulations in India Draft guidelines were originally issued in April 2016 by the Director General Civil Aviation Authority (DGCA).

UAVs were categorised by weight into

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four classes: micro can go up to 2 kilos; mini between 2 to 20 kilos, small21150 kilos, and large exceeding 150.

UAVs require a Unique Identification Number (UIN) issued by the DGCA. Moreover, all civilian UAV operations at or above 200 feet in uncontrolled airspace for any purpose require an unmanned aircraft operator permit (UAOP) from DGCA, while operation of civilian UAVs in controlled airspace is restricted. Drones are used for surveillance of disaster sites and areas with biological hazards, as well as in epidemiology for research and tracking disease spread.

Policy development considerations In December 2018, India’s Ministry of Civil Aviation released a comprehensive framework for the operation of unmanned aerial systems (UAS), also known as drones. This would permit the use of drones for commercial purposes within Visual Line of Sight (VLOS). Flying a drone would require manual controls and an operator permit for licensed operations. Further, technical guidelines were released for policy-compliant manufacturing.

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In February 2019, the Drone Ecosystem Policy Roadmap was issued by the Ministry of Civil Aviation proposing carriage of new forms of airfreight, recognition of services providers for airspace deconfliction and permission (Digital Sky) and the ability to fly drones Beyond Visual Line of Sight (BVLOS).

These policy evolutions are needed to implement drone delivery solutions for medical and other applications, as BVLOS flight is required to make drone delivery economically justifiable. Under the current regulations, drone delivery is not possible, although companies may file for an exception with the DGCA.

Operational Flow Chart followed

by Zip drones : Fig 6 Author in Zipline factory California Zipline drones – also called Zips – are specifically designed for their task. Compared to quadcopters, for example (another type of drone, with four rotors and four arms ending in propellers), battery-powered Zips are more efficient on long distances: They can deliver reliably to any site within an 80-kilometer radius on a pre-programmed route and with real-time monitoring.

A quadcopter can reach only a radius of approximately five to ten kilometers. Accelerating from zero to over 100 kilometers per hour in half a second, Zipline drones deliver essential medical products of up to 1.8 kilograms per flight.

Each Zip is sending its position every couple of seconds on the trip to and from the hospital. This way, the team can permanently track the drone and ensure a safe delivery.

Healthcare providers order blood via text message. When received,

Technical issues

Specifications Through the development of microminiaturisation and widespread production of underlying technology, including processors, micro electrical mechanical systems (MEMS) sensors, and batteries produced for smart devices, drone designs have become more capable, affordable, and accessible. The common configurations include fixed-wing, rotary-wing, multi-rotor, and hybrid designs. infrared, multispectral and hyperspectral cameras. Drones typically consist of an airframe, propulsion system and navigation system.

operators prepare the blood payload and launch the aircraft. Zip drones have a flight range of 75 miles and can carry 3 pounds of blood. At the point of need, the blood payload is dropped via parachute to the waiting medical providers. Delivery time has been reduced from 4 hours to just 30 minutes. New drones now have a range of 99 miles carrying up to 3.85 pounds. The unmanned planes are navigated using cellular networks and

Fig 6: Author in Zipline factory California

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Advancements in fields such as automation, robotics, miniaturisation, materials science, spectral and thermal imaging, and light detection and ranging have resulted in droneenabled solutions in areas as diverse as the agriculture, power, infrastructure, and telecom sectors, as well as crowd and disaster management. A dazzling variety of technologies— Wi-Fi communications, rechargeable batteries, small high-resolution digital cameras, GPS receiver chips, accelerometer chips, and other miniaturised electronics will make drones even more versatile

GPS, and can make deliveries within 30 minutes.

It has been suggested that Drones can even be used to move medicines from floor to floor. The steady rhythm of packing, launching, collecting and charging the drones belies the groundbreaking technological advances in robotics, autonomous navigation and aerospace management that underpin the business.

HEALTHCARE MANAGEMENT

Vaccines

Dropping AED devices

The response time of the drones depend on the speed, altitude, and acceleration of the drones, as well as their capacity to carry an AED and safely release it to a bystander. Dispatch to arrival time with drones was 5.21 minutes, whereas by ambulance it was 22 minutes. A drone could be summoned with a smart phone app. Bystanders would be instructed through the drone on how to perform CPR and start using the automatic defibrillator until the emergency services arrive to take over.

Off-site services By moving certain expensive functions off-site — such as food service, pharmaceuticals and inventory management — and instead delivering those goods on-demand by drone, hospitals could save funds. Drones could deliver medications and supplies to patients being cared for in the home instead of a hospital-based setting. Blood samples collected at home could be delivered to the lab through a drone.

Conclusion

Drones are increasingly being tested for healthcare purposes around the globe.

It is a tool complementary to existing transport systems offering advantages over traditional approaches in specific circumstances. How and where drones optimally fit into health systems is still being determined and will depend on

Today drones are increasingly being used in healthcare to reach the unreached and make isolation relative, not absolute.

local needs and resources. Currently, projects attempting bi-directional drone transport are still exploring possibilities, advancing the technologies and gathering real-world experiences. The integration and optimisation of new technologies into health systems takes years. As with any innovative health intervention, the sustainability of drone-supported Healthcare systems will depend on strong capacity building, an efficient impact monitoring and evaluation cycle and in-country commitment, including investment in drone regulations, project design and long-term ownership. Drone use offers the opportunity of improving healthcare, particularly in remote and/or underserved environments by decreasing

AUTHOR BIO

A recent Johns Hopkins study found that using drones resulted in a logistics cost savings of up to US$0.21 per dose of vaccine when compared to traditional delivery. Drones increased vaccine availability and decrease costs over a wide range of settings provided they are used frequently to overcome initial capital costs of installation and maintenance.

For drones to be effective, the effects of flight must not alter medical supplies.

Several studies have confirmed that there are no changes in temperature, pressure and forces of gravity.

lab testing turnaround times, enabling just-in-time lifesaving medical supply/ device delivery, and reducing costs of routine prescription care in rural areas.

The World Economic Forum’s Medicine from the Sky project aims to answer one important question: How can we accelerate the transformation from analogue and inefficient health supply chains to digital, resilient infrastructure that reduces wastage and improves health outcomes? At its core, this project focuses on multi-stakeholder engagement that drives meaningful conversations about methodology, explores challenges to current systems and unlocks opportunities for collaboration leadership between the public and private sectors alongside civil society.

Drones present a tremendous opportunity to address supply chain shortcomings in the healthcare sector, reducing stockouts and wastage. Deaths due to diseases such as dengue, conditions like postpartum haemorrhage, loss of blood due to accidents and even time critical organ grafting can be addressed through faster responses, higher-quality products and better availability. Health system shortcomings, especially those felt in rural communities suffering from a lack of infrastructure and forecasted growth that outpaces investment, can be addressed and lives saved by adopting advanced logistics systems in the sky.

We should, however, always remember that technology is not an end in itself but only a means to achieve an end. All disruptive technology also have limitations and disadvantages. These need to be factored in also.

K Ganapathy is Former Secretary and Past President of the Neurological Society of India a Telemedicine Society of India& the Indian Society for Stereotactic & Functional Neurosurgery.

He is Emeritus Professor @ the Tamilnadu Dr MGR Medical University India, a Visiting Professor Taipei Medical University & Member of WHO Roster of Experts on Digital Health

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Decentralisation of Southeast Asia's Healthcare Ecosystem Following the money

The healthcare ecosystem in Southeast Asia is set to decentralise, with delivery of medical care shifting away from the confines of hospital walls to clinics and homes.

Four major forces are disrupting the industry's traditional value chain, changing industry's business models as well as cost and revenue attainment of incumbent businesses.

Yoshihiro Suwa, Partner, Roland Berger

F

or decades, hospitals in Southeast Asia functioned as the central hub for patients to receive healthcare.

Patients needing diagnosis and treatment, from the mild to the severe, converge together at the hospital. In a trust-based industry like healthcare, hospitals are the paragon. Yet cost of visiting a hospital is increasing at an unsustainable rate, driven by rapid growth of the Asian middle class that is creating an industry crunch.

As healthcare costs continue to skyrocket and trend upwards, new forces are slowly morphing the regional healthcare ecosystem. More consumers will increasingly demand quality service at a more manageable price point. Today, game-changing innovation such as health monitoring wearable devices, machine learning platforms for screening, and online consultation services have won over a subset of consumers and showcased that they are the way of the future.

These technologies are disrupting a market that used to be dominated by

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hospitals, and are enabling remote delivery of healthcare service in locations closer to consumers.

Southeast Asia's healthcare players need to prepare for strong disruptors along four major fields: (i) services at home by digital health consultation platforms and point of care technology, (ii) services at clinics by clinical decision support systems, (iii) by insurance companies' gear-shifting towards proactive cost containment programmes, and (iv) corporate actions by conglomerates with their massive corporate reach across Southeast Asia.

Decentralisation will not be a matter of 'if' but 'when'. As consumers embrace new healthcare technology and new model of healthcare delivery, the flow of money will change. In the future, revenue attainment and associated cost will no longer be concentrated in hospitals. Players across all segments of healthcare value chain will then have to assess the impact on their businesses when decentralisation materialises.

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Four areas to watch

Why do people prefer hospitals so much despite the existence of alternative care providers such as clinics and pharmacies?

Trust, or lack of it elsewhere, is key to explaining the healthcare consumer behaviour in Southeast Asia. Nonetheless, not all hospital admissions are necessary.

In an ideal and more efficient world, hospital visitations would be focused for patients requiring treatment from critical care.

Now with the arrival of technology, a diversified set of players is equipped with the necessary skill sets to provide quality and specialised care to compete with hospitals. Tech-facilitated care would penetrate a patient's journey to a varying degree that is from preventive checkups, diagnosis screening, to treatment and treatment follow-ups.

All in all, emerging health-tech has thrown the spotlight on four areas that set the forces of decentralisation in motion. The four areas to watch are: 1. At home, driven by strengthening of online platform's gate-keeping role,

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growing sophistication of devices to manage chronic lifelong diseases, and innovation of point-of-care (PoC) testing systems 2. At clinics, facilitated by datacentric clinical decision support 3. Insurance providers and HMOs shifting their orientation towards digital solutions for cost containment 4. Asian conglomerates – the region's power movers – finding newfound interest in integrated healthcare network Decentralised delivery of care implies gradually moving outside the confines of hospital walls and to more distributed locations. In this model, a diversified set of players comprising of clinics, pharmacies and at-home service providers will compete with hospitals.

This set of players will come equipped with the necessary skill sets and financial incentives to provide care. Old and new healthcare companies would then need to prepare for a new reality in a decentralised ecosystem.

1. Decentralised healthcare at home

Rapidly developing online consultation technology has allowed digital healthcare

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platform players to transition as a credible gate-keeping management of primary care. This means that diagnosis can be done virtually anywhere without requiring hospital visit, allowing for time and cost savings for consumers. The benefit is clear, in that bringing doctors' expertise online will be substantially cheaper and more efficient than requiring patients to spend hours in a hospital visit.

In Philippines, online platform provider MyPocketDoctor has been a part of Medicard, the country's leading Health Maintenance Organization (HMO). It offers 24/7 remote online consultations with doctors, while delivery and pick-up of medication are done at selected pharmacies. With the arrival of MyPocketDoctor, consumers saw an estimated 80-90 per cent reduction in their consultation cost and over 90 per cent savings in time spent.

MyPocketDoctor’s low cost offering is effectively sustained through corporate partnership, with AXA in this case, which grants it access to large-scale membership and in turn greater leverage to secure lower prices from providers. With

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MyPocketDoctor, insurance providers and HMOs can more effectively contain healthcare budget expenditure.

Another key utility of digital healthtech is in bringing the management of chronic disease to the hands of patients and caregivers at the comfort of their home. Chronic disease, defined as an illness persisting or recurring for a long time, will be a source of perpetual medical spending to consumers. When multiplied over a lifetime, hospital visitation will accumulate as cost in perpetuity which can burden patients and/or payers if left unmitigated.

Diabetes is an example of chronic disease requiring constant monitoring and access to caregivers. Digital health providers such as Holmusk’s Glycoleap, Malaysia's HypoBand, Indonesia's Teman Diabetes, and Philippines' Diamate are offering convenient and cheap alternatives for diabetes monitoring in the form of wearables and blood glucose tracking apps. Payers benefit because doctor can monitor patients remotely without requiring expensive visits to hospital. Rest-of-life management of diabetes becomes more

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affordable through digitally-enabled preventive analysis, better qualityof-life treatments, and disease selfmanagement.

The outlook of decentralisation becomes stronger considering positive momentum of PoC testing system.

In Southeast Asia, reception and the popularity of PoC testing are increasing as consumers extract substantial value from the devices, especially through improved their access to early diagnosis.

Tests can be done at remote locations, which fit the market and meet a diversity of medical needs in developing regions.

Healthcare professionals also benefit as remotely-administered PoC tests will optimise clinical efficiency, reduce use of staff time, and is geared towards leaner process sequence.

Fujifilm’s CureSign is an example of a Do-it-Yourself (DIY) PoC testing where patients take their own blood sample, send it via mail, and receive results within 1-2 weeks. As a Blood Test Mailing Service Kit, CureSign enables rapid and early risk monitoring, particularly for lifestyle diseases and cancer. Currently available in Japan and Thailand, it is being used by about 12,000 users annually and is estimated to grow in adoption through health insurance tie-ups. Alongside Fujifilm, Southeast Asia's POC market is also home to healthcare giant Siemens.

Available across Southeast Asia, Siemens Healthineers covers chronic disease management as well as POC testing for critical care and clinical setting solutions.

Siemens Healthineers covers a broad range of tests, ranging from cardiac and diabetes to blood gas and urinalysis.

All in all, the availability of remote health-tech solutions for home use is incentivising patients to reduce their frequency of hospital visits, freeing up hospital resources for critical quality care. At-home health-tech solutions are changing the orientation of healthcare business to be more patient-oriented than ever, with services delivered at greater convenience at a more

manageable cost. For consumers, this will be a monumental phase in the history of healthcare in Southeast Asia.

2. Decentralised healthcare at clinics

The second area of decentralisation is taking place at primary care clinics with the advent of Clinical Decision Support Solutions (CDSS). CDSS is defined as any application that analyses data to help healthcare providers make decisions and improve patient care. CDSS use cases in Southeast Asia include TeleMedC for Diabetic Retinopathy screening and Singapore's eHINTS. As competition to better serve and attract patients heats up, CDSS will be the differentiating factor among healthcare providers.

One prominent example of CDSS in Southeast Asia is TeleMedC, which helps healthcare providers perform preliminary eye-health screening without having to purchase expensive telemetry equipment. It combines advanced hardware technology with AI targeted specifically at patients with high propensity for eye damage caused

by chronic diseases, including diabetes, glaucoma, AIDS/HIV, or high myopia and cataract. Primary screening is done using TeleMedC’s portable hardware, which is then processed and interpreted through its AI model. Diagnostic results are generated within minutes with surprising level of accuracy – close to 97 per cent sensitivity and 92 per cent specificity in Diabetes Retinopathy grading. TeleMedC then links patients to suitable eye treatment from optometrists, eye clinics, and hospitals.

TeleMedC brings new capabilities to general practitioners (GPs) and primary care clinics, allowing them to perform a wider array of healthcare service, to intervene early, and to diagnose using multiple data sources. CDSS effectively brings selected eye hospital services downstream, delegating a narrow subset of medical care to clinics and thereby decentralising healthcare. It benefits high-risk patients by lowering cost through early diagnosis.

TeleMedC is one form of CDSS that relies on visual-based indicators for screening for early intervention. Another

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HEALTHCARE MANAGEMENT

form of CDSS that helps healthcare providers make better decisions through data is Singapore's eHINTS, a data repository providing decision making analytics for healthcare institutions.

An acronym for Electronic Health Intelligence System, eHINTS integrates clinical and operational patient data from multiple systems to provide medical professionals with comprehensive selfservice analytics capabilities and better clinical data documentation. eHINTS cleanses, consolidates and standardises data for day-to-day use and can be applied across healthcare institutions.

In the past, consumers relied on hospitals to serve as central hubs for delivery of specialised care, ranging from eye check-ups to consultations and treatment. The market has now softly turned towards a scaled and distributed model thanks to access to easy-tooperate screening technology, inclusive ecosystem, and improved "final-mile" linkages between patients and service providers. Segments of healthcare services are pulling away from hospitals and into homes as well as GPs in clinics.

3. Insurance providers getting serious about decentralisation

The role of insurance providers as payers of healthcare effectively grants them control of the flow of money in healthcare industry. By extension, this implies that any real change in healthcare consumer behaviour would require insurance providers to be onboard. Today in Southeast Asia, there are clear signs that insurance companies are navigating consumers to adopt newer technology and decentralised care to better manage healthcare budget. This enables healthtech to work and for decentralisation – healthcare away from hospital and into homes or clinics – to truly take effect.

In Thailand, Bangkok-based Muang Thai Life Assurance (MTL) group has developed a set of insurance product solutions specifically targeting diabetes patients to manage their health through at-home self-monitoring device. The

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A SI A N H O S P I T A L & H EA LT HCAR E M A N AGE M E N T

Before and after

Whereas hospitals used to be the centre for all healthcare services, ranging from diagnosis to treatment, the new decentralised reality will see stronger involvement from players such as clinics, pharmacies, insurance groups and HMOs. While healthcare providers used to wait for sickness to occur, players in the new decentralised model will aim to prevent and intervene before sickness occurs in order to manage cost. In bringing about a more affordable healthcare for the population, different stakeholders in the healthcare ecosystem will step up their involvement at home and at clinics. Ever more than ever, health-tech will play a key role in enabling the transformation of healthcare ecosystem.

As the incumbents in the market, how should hospitals respond to new entrants? What role will Asian conglomerates occupy in the new decentralised healthcare ecosystem? The coming decade will bring about distinctive changes in how healthcare takes place in the region. This is still an early stage, but soon our conversation about roles and responsibilities in healthcare will surely change, and all players need to prepare.

suite of solutions includes blood sugar self-monitoring Roche Accu-Chek and a dedicated app called BetterCare for health consultation with diabetes specialist. In combination with the suite of health-tech solutions, MTL has implemented a dynamic pricing scheme that grants each diabetic paid insured a discounted premium whenever a patient's HbA1c shows improvement.

Over in the Philippines, HMO Maxicare integrates digital health with physical in-house care service to achieve cost containment and membership expansion, primarily through their own network of Maxicare Primary Care Center (PCC). PCC is operated as a 24/7 offline clinic for Maxicare members with available physicians as well as kiosks for online consultation and blood temperature sensors. The accessibility of PCC retail operation has helped consumers to save 80 per cent of claim cost compared to private hospitals expenses and reduce average wait time to only 30 minutes at peak hours. Maxicare also stepped in to partner with major manufacturers and distributors such as Zuellig Pharma to gain cost benefit and large procurement discounts for their insurance holders.

IS S UE - 47, 2020

This allows them to provide free medicine to at-risk members, thereby minimizing risk of patients contracting chronic rest-of-life diseases which will result in expensive claims and costly hospital visits.

In Singapore, leading insurance and HMO companies such as Cigna, Prudential, AXA and AIA are collaborating with online consultation platform MyDoc. For no additional fees, policyholders can receive free on-demand virtual consultation remotely for health screening. It also offers members an e-prescription that can be processed by 24/7 virtual pharmacists. The impact has been noticeable, with close to 50 per cent drop in Rx cases and cost-savings of at least 28 per cent. Similarly in Indonesia, Allianz has partnered with healthcare network platform HaloDoc in its effort to navigate members towards getting online medical consultation instead of visiting GPs or specialists.

Overwhelmingly, HMOs and insurance providers across Southeast Asia are orientating towards decentralising healthcare services for sustainable medical cost containment. Other HMOs and insurance groups too will need to prepare themselves for the future with a decentralised healthcare ecosystem.

HEALTHCARE MANAGEMENT

Graphic: Model of a healthcare business network in a decentralized ecosystem 4. Conglomerates' response to decentralisation

AUT HOR BI O

Conglomerate groups have been the dominant force in Southeast Asia's healthcare ecosystem. As the ecosystem gets decentralised, new players will emerge and conglomerates will need to assess their position in order to continue capturing the lion's share of this industry. Asian conglomerates that used to enjoy specific 'sweet spot' areas within the healthcare ecosystem will be tasked to re-evaluate their portfolio.

A key trigger of decentralisation is the unsustainability of rising medical cost when where healthcare is concentrated in hospitals. Increasingly, different stakeholders will play key roles to meet the demand for a more affordable healthcare throughout the patient's journey. This framework can assist conglomerates in

assessing their strategic position in this new decentralised ecosystem.

Across Southeast Asia, local conglomerates with involvement in the healthcare industry include Indonesia's Sinarmas and Lippo Group, Thailand's BDMS, Philippines' Ayala group, Vietnam's Vingroup, Malaysia's IHH group, and Singapore's Raffles Medical Group. To a varying degree, these conglomerate groups will take notice of other stakeholders in the value chain who are beneficiaries of growing decentralisation, namely primary clinics, pharmacies, HMOs, insurance companies and health-tech enterprises. Ultimately, as conglomerate groups expand their holdings across the value chain, the integrated business network will produce more affordable healthcare for the society.

After graduating from Kyoto University School of Law, Yoshihiro joined global strategy consultancy Roland Berger. He has substantial experience in projects for growth strategies, overseas business strategies, marketing strategies, and market entry strategies with a diverse array of clients. In his current leadership role, he supports the needs of an extensive range of healthcare clients, with primary focus on pharmaceuticals, medical devices, hospitals and consumer goods.

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HEALTHCARE MANAGEMENT

E T Y U R C A S PRIMA E R V A C

H T L A HE O

There has been a significant investment made within the acute healthcare sector in Australia. However, it is known that large communities which reside within regional and rural areas do not have easy access to hospitals. Primary healthcare is often the first point of call for these patients.

There has been a recent change in direction by both the state and federal governments.

A greater investment has been made in a national healthcare record that can be contributed to by general practitioners and community healthcare providers. However, a greater impetus is required for increased communication between the acute care and primary care sectors and easier methods of information exchange are necessary.

Payal Barde, Benefits Manager Queensland Public Sector

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ften patients must travel a long distance to access healthcare services that may not be available close to their place of residence. To add to this, there is the complexity of an ageing population profile which makes travel a less attractive proposition for this group.

1 In Queensland, the Patient Travel Subsidy Scheme (PTSS) provides financial assistance for patients who are referred to specialist medical services not available at their local public hospital or health facility. Patients approved for PTSS will receive a subsidy to attend the closest public hospital or health facility where the specialist medical treatment is available. There are similar subsidies provided to one or more patient groups in other states and territories of Australia.

The above scenario makes a compelling case for investment of government funding in primary and community healthcare services. If healthcare was brought to the patients instead of the patients having to travel long distances to access it, then it would result in better outcomes for the community.

Tertiary care hospitals are most likely concentrated in larger, metro cities that are more densely populated than their regional counterparts. However, if funds were injected into primary healthcare settings such that specialised care was not concentrated to metro areas and made available in rural and remote regions, seriously ill patients could remain within the comfort of their own homes and where they are supported by their families and loved ones.

2 The PTSS provides travel and accommodation subsidies for patients who need to travel more than 50 km from their nearest hospital to attend specialist medical appointments. The overall amount of assistance is significant. In 201516, more than 72,000 patients received assistance, totalling over AUD $80 million. Many regional, rural and remote Queensland residents rely on the subsidy provided through the PTSS to access specialist healthcare that is not available locally.

If the money spent towards PTSS was redirected towards creating lucrative employment opportunities and incentives for medical professionals and services to be made available in regional settings, then the outcomes are expected to be positive on multiple fronts.

Firstly, there would be lesser pressure on the acute healthcare services 1 https://www.qld.gov.au/health/services/travel/subsidies/about.

2 https://www.ombudsman.qld.gov.au/ArticleDocuments/495/PTSS%20report%20final.pdf.aspx

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HEALTHCARE MANAGEMENT

that are already exploding at the seams to accommodate more patients. This is augmented by the fact that there exists a large proportion of the ageing population. 3The current Australian health landscape reflects an ageing population, an increasing prevalence and burden of chronic disease, and decreasing mortality rates amongst more common diseases. The combination of these three factors have meant that there is a rapidly growing need for the long-term management of many health conditions, which is resulting in increasing pressure and financial burden for the Australian health system.

Secondly, the affected families would have the necessary reassurance by not having to move away from the comfort of their homes. This applies to both patients and their carers who are often subject to this uncomfortable situation.

This becomes particularly difficult for the senior population group who might not be able to undertake frequent travel. And most importantly, the money spent on subsidising travel and accommodation (a one-off return) could be reinvested to yield recurring returns if the funds were redirected at a more permanent solution of catering to the needs of the patient population in their local areas.

An increased emphasis on the health of the Indigenous people

the mortality gap between Indigenous and non-Indigenous people) • endocrine, metabolic and nutritional disorders (21 per cent of the mortality gap, with diabetes alone explaining 19 per cent of the gap) • respiratory diseases (12 per cent of the gap) • cancer (11 per cent of the gap) • Based on the findings above, it is evident that Indigenous people have a higher disease profile than non-indigenous people and there exists a greater gap in health outcomes between the two groups.

5 At 30 June 2016, over one-third of all Aboriginal and Torres Strait Islander people lived in Major Cities of Australia (298,400 people), compared with around three-quarters of the Non-Indigenous population (17,013,400). A further 189,400 Aboriginal and Torres Strait Islander people (24 per cent) and 4,153,900 Non-Indigenous people (18 per cent) lived in Inner Regional Australia. There were 161,800 Aboriginal and Torres Strait Islander people (20 per cent) who lived in Outer Regional Australia compared with 1,879,100 Non-Indigenous people (8.0 per cent).

The 53,500 remaining Aboriginal and Torres Strait Islander people (7 per cent) lived in Remote Australia and Very Remote Australia (95,200 or 12.0 per cent), while 239,900 Non-Indigenous people (1.0 per cent) lived in Remote Australia and 106,300 or 0.5 per cent in very remote Australia.

Given this geographical distribution of the Indigenous people and the gap to be bridged in health outcomes for them, there is a pressing need to funnel funding in health services and resources for indigenous populations in rural, regional and remote areas.

6 There are two key targets specific to health performance in Indigenous people that are not on track for the ‘Closing the Gap’ agenda that is in place for the Australian Government. These are: • To halve the gap in child mortality rates by 2018 • To close the gap in life expectancy by 203 Most of the bigger hospitals offering tertiary levels of care are concentrated in the metro cities of Queensland.

In the regional and rural areas of the state, health services are provided in the form of primary healthcare centres

5 https://www.abs.gov.au/ausstats/abs@.nsf/ mf/3238.0.55.001

6 https://ctgreport.niaa.gov.au/sites/default/files/ctgreport-20193872.pdf?a=1

While there have been some improvements in mortality rates for Indigenous people over recent decades, a notable gap between Indigenous and non-Indigenous people remains. This difference results in lower estimated life expectancies for Indigenous Australians. The largest gaps between Indigenous and non-Indigenous people in age-standardised death rates in 2008– 2012 were due to: • cardiovascular disease (24 per cent of 4

3 https://www1.health.gov.au/internet/main/publishing. nsf/Content/F520A0D5EDEA0172CA257BF0001D7B4 D/$File/DAA%20PMP%20Report.pdf 4 hhttps://www.aihw.gov.au/getmedia/cb719825-4e63468a-bc91-5ba220d98254/18175-chapter6.pdf.aspx

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HEALTHCARE MANAGEMENT

The importance of a National Health Record Every visit to a healthcare professional, or a hospital or other medical facility, may result in important information about their health being created and stored at that specific location. Digital health allows this information to be much more easily shared between the healthcare providers involved in their care. My Health Record is an online summary of a person’s key health information.

9 Research indicates that as many as 13 per cent of primary care visits have missing clinical information. A patient’s health information is potentially distributed across a wide range of locations including their GP, hospitals, imaging centres, specialists and allied health practices.

8

This means that the National Health Record is an enabler to better caring for patients in the community as it allows greater information to be made available, about what happened to them in the hospital and any known conditions, medical history, allergies and other problems. However, there is still a further requirement for specialists to be located in these regions and better equipment, facilities and healthcare technology to be made available so that specialist care can be provided at the point of patient contact rather than having to move the patient to another location.

8 https://www.digitalhealth.gov.au/get-started-withdigital-health/benefits 9 Smith, PC, Araya-Guerra, R et al 2005, Missing Clinical Information During Primary Care Visits, JAMA, 293(5):565-571

circumstances. Also, based on region and location, telehealth may or may not be available everywhere. This is where the gap to complement this service with in person consultations needs to be filled. In these scenarios, the need for specialist services in regional settings remains, as well as for suitable technology and infrastructure to be provided to support this provision.

The relationship with telehealth

Conclusion

Queensland’s telehealth programme enables patients to receive quality care closer to home via telecommunication technology, improving access to specialist healthcare for people in regional communities and reducing the need to travel for specialist advice.

However, not all healthcare conditions can be managed remotely and telehealth while helpful to reduce the strain on face to face consultations cannot be applied universally to all patients, based on their individual

In summary, the geographical dispersion of Indigenous communities coupled together with a less equivalent distribution of advanced care hospital services in regional and remote areas means that patients do not always have ease of access to the greater level of

7

AUTHOR BIO

and community outreach clinics. These facilities are not equipped with medical specialists and do not offer the services that are provided by advanced care hospital sites. The injection of funds into primary healthcare services to improve their service capability and provision of consultants is expected to make a positive impact to this critical government objective.

7 https://www.health.qld.gov.au/telehealth

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healthcare required. This in turn has an impact on the monies that might be spent on patient transport to healthcare facilities and result in inconvenience to the patient and their carer in living away from home. On the other hand, travel may not always be an optimal solution for a large proportion of the ageing patient population.

There has been a significant investment in healthcare services over a longitudinal period. This has included services like telehealth, the availability of a national healthcare record that can be contributed to by multiple healthcare providers, and investments in ICT to improve the information exchange between hospitals and primary healthcare settings.

However, there remains a case for both medical specialists and specialist healthcare to be stationed in primary healthcare settings so that existing gaps in serving patients with critical health needs are filled in at the first point of a patient’s visit. Ongoing investment of funds has been made in the Acute Care sector within hospital settings. There remains a significant requirement for an increased allocation of funds into primary healthcare services. Offering medical specialists’ better incentives and competitive monetary returns for relocating to non-metropolitan locations should serve as a move in the right direction. Furthermore, procuring necessary modern medical equipment and standing it with the necessary infrastructure will aid to assist with healthcare services being provided in these regions. The funds invested in regional areas are expected to boost the local economy in those regions.

Payal has been closely involved with identifying benefits of ICT Health projects for over seven years and has worked for Queensland Government agencies for an impressive period of eleven years.

It would be fair to say that she has a sound understanding and appreciation of the opportunities within this sector.

Download Dubai Health Authority's mobile application and register your details to benefit from the Doctor For Every Citizen service

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Books

Operative Techniques In Breast Surgery Trunk Reconstruction And Body Contouring

A Manual of the Operations of Surgery

Author: DISA J J

No of Pages: 218

Author: Tanya Hodge

No of Pages: 488

Year of Publishing: 2019

No of Pages: 260

Year of Publishing: 2020

Description:

Year of Publishing: 2019

Description:

A Manual of the Operations of Surgery Joseph Bell A Manual of the Operations of Surgery By Joseph Bell My aim has been to describe as simply as possible those operations which are most likely to prove useful, and especially those which, from their nature, admit of being practised on the dead body.

Description:

The book comprehensively covers reconstruction of trunk defects; breast reconstruction for cancer treatment, augmentation and reduction; other trunk problems such as hernias, body contouring after weight loss and buttock deformities; and much more. Succinct text, bulleted points, and quick-reference tables allow you to review information quickly and understand best practices and potential problems for each procedure. Hundreds of full-color intraoperative photographs and illustrations, as well as numerous high-quality videos, capture procedures step by step and help you immediately apply your knowledge.

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Author: Joseph Bell

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Fast Facts for the Cardiac Surgery Nurse: Caring for Cardiac Surgery Patients

This concise clinical guide provides cardiac care nurses with speedy access to information and guidelines they use daily. Heavily updated with the newest clinical practice information, the third edition emphasizes postoperative complications and the nursing interventions designed to prevent and treat them. It includes updated coverage of risk factors for stroke and congenital heart disease and discusses new antithrombotics and antiplatelet medications. Bulleted information, brief paragraphs, boxed indicators highlighting key information, and Fast Facts "Pearls" are included in each chapter. The book's consistent organization facilitates quick access to information on equipment, procedures, and pre- and post-op speciality care. Ideal for new graduates and nurses considering a switch to cardiac or critical care, this resource reinforces existing knowledge and provides a foundation for developing additional skills.

27 - 30 January, 2020

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Connecting Travellers for Medical Treatment

International Assistance Group globalised approach More and more people are travelling internationally every year, which means there are also rising instances of travellers becoming ill or injured on foreign soil. International Assistance Group is helping bridge the gap between these travellers and medical service providers to enable assistance to reach people quickly, effectively and affordably.

What should people do if they become sick or suffer an injury whilst working, holidaying or travelling overseas?

When you are far from home and your trusted medical service providers, it can be a daunting experience finding help abroad.

There are many challenges, including language barriers, the reputation and levels of service provided by different vendors and the costs associated with treatment.

Every nation across the globe has different standards, costs and availability of healthcare which can make it challenging for tourists to find help when they most help.

That is where the International Assistance Grouplooks to assist, connecting travellers to a global network of high-quality assistance companies and qualified and vetted service providers.

These partnerships are helping travellers stay safe while also enabling assistance service providers greater global scope to help those in need - which is becoming essential in an era of massive international travel.

Ouraim is to close the gap between medical service providers across the globe and international travellers, getting services to where they are needed and removing the anxiety out of falling ill or becoming injured abroad.

And as global trends are showing, this connection between service providers and travellers is becoming more and more essential - especially across Asian nations.

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Global tourism is on the rise The volume of people taking to the skies and travelling internationally for business or leisure has grown dramatically in recent years.

Improved technology, lower travel prices, a globalised business world and a range of other factors are prompting people from all over the world to travel internationally more and more each year.

In 1990, there were 435 million international visits across the globe, a number that spiked to 1.4 billion in 2018 and is expected to keep rapidly rising in the near future.

According to the World Tourism Organisation, Asian nations including the likes of China (61 million visitors annually) and Thailand (36 million visitors) are some of the most popular destinations in the world for international travellers.

Asian residents are also the most likely to travel internationally, in their own region or outside, with 143 million Chinese tourists hitting the skies in 2017 alone.

With so many more people travelling to and from Asian countries, this means that there is going to be an ever-growing demand for medical services for travellers in the future.

Sickness and injuries abroad are more common than you think While the risk of illness or injury changes depending on where you visit and the physical condition and behaviours of the individual concerned, data has shown that around eight per cent of all international travellers will require medical assistance.

On top of that, around all international travellers

have around a fifty per cent chance of suffering a travel-related illness, which includes minor ailments all the way up to severe sicknesses that will require hospitalisation and could be life-threatening.

Visitors to south-east Asia are 1.6 times more likely to suffer an injury-related death or drowning than visitors to the United States, for example.

Each region has its own medical challenges as well, with visitors to India 18 times more likely to contract typhoid fever while other nations like Pakistan and Afghanistan have yet to completely eradicate polio.

Creating the link between travellers and medical service providers is critical for rapid response times, trusted and reliable care and affordable outcomes for all international visitors.

And medical service providers can rely on this link to be connected to where their services are needed most in a rapid timeframe.

How you can prepare to prevent illness while travelling?

Like most things, the best cure for illness on the road is proper preparation and preventative measures.

Here are our tips for pre-travel prep that will give you

the best possible chance of resisting sickness on your travels: Get a pre-travel medical: Sometimes, we can feel perfectly healthy, but there are underlying medical issues beneath the surface that can present themselves when we are on the road. Book an appointment with your doctor to get a full medical before departure, so you aren't shocked with illness down the track.

Get your needles: Ensure all of your vaccinations and immunisations are up to date and also speak to your doctor about other preventative needles that may be required for specific regions you are travelling to.

Pack a basic first-aid kit: While we know that not every traveller has space or capacity to include a fullblown first aid kit in their bag at all times, you should have the basics available to you. This kit should include bandages and dressing, antiseptic, tweezers, scissors, antihistamines, sunburn treatment, insect repellent and bite treatment and any medications that you may require.

While you are travelling, though, there are also many measures you can take to prevent falling sick on your travels, including:

IT’S NOT WHERE YOU ARE GOING

IT’S WHO YOU GO WITH

In the field of global medical assistance for travellers and expatriates, we connect independent local partners and providers to forge worldwide solutions. It is a collaborative business, knowledge and operational advantage we have delivered for over 27 years.

Advertorial www.asianhhm.com

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Eating and drinking correctly: Gastrointestinal diseases are the most common travel-related illnesses, and they can really put the brakes your holiday or business trip in a hurry. These are usually contracted from poorly prepared foods or tainted water supplies, so ensure you only drink bottled water, avoid ice in drinks, avoid any foods washed by the local water source and that all food is prepared fresh, cooked thoroughly and served hot. It is best to resist the temptation of street vendors and shellfish as well, as these as common sources of gastro diseases.

Prepare against insect bites: Insects like mosquitos can transmit a range of different diseases, including malaria, Zika, yellow fever and dengue, which can have a serious impact on your health. Always wear insect repellent and ensure that your immunisations are up to date.

Pack protection: You may not be planning to be amourous on your trip, but these things have a way of just happening. There are higher rates of HIV and STIs in other countries around the world - particularly in southeast Asia and Africa. Always ensure you are practising safe sex using condoms.

How the International Assistance Group is bridging the gap between tourists and healthcare providers For over 27 years, the International Assistance Group has successfully brought together independent international medical assistance companies into a cohesive, working alliance of partners to assist business and leisure travellers, expatriate workers and corporate clients around the world.

During this time, the International Assistance Group's operations have grown to now reach over 118 million end-users in nations across the world, including assisting Asian tourists and global tourists in Asian nations.

The International Assistance Group has connected our partner organisations to 5.6 million international medical cases, including: 1.7 million roadside assistance cases Over 470,000 travel cases Over 620,000 medical cases and; Flying over 20,500 people back home when they are injured or unwell With a global staff of over 7500 people, the International Assistance Group has been able to arrange referrals and guarantee of payments, inpatient and outpatient cases and medical transfers on commercial airlines up to complex, dedicated air ambulances.

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"Our goal has always been to be able to provide the peace of mind of 24/7 assistance from quality service providers to tourists in trouble - no matter where they may be," International Assistance Group's General Manager, Louise Heywood said.

"This takes the guesswork out of health and other forms of assistance for customers who know they will be connected to reputable, well-credentialled providers that have been thoroughly vetted for quality assurance.

"And for service providers, the International Assistance Group presents an opportunity to expand their services into other countries, grow their business and rely on us to connect them to where their services are most needed."

The connection between medical service providers and end-users means greater time and cost efficiencies so those who need help can get it fast and partners have more streamlined operations without time wasted in peripheral or overlapping areas.

The International Assistance Group already has a strong presence in Asia, with core partners including AA International in Indonesia and Taiwan,Bharti Assist Global in India,Cover-More Assistance Online and HealthLink Services in China, WellBe in Hong Kong.

These partner companies access the International Assistance Group's operational database Globus which has been developed over the last 15 years with significant input from the increasing number of users with regular improvements implemented.

This allows for rapid identification of contacts and resources and the necessary processes to reduce stumbling blocks and errors - speeding up operational delivery and the often-overlooked needs of administrators.

The connection between service providers and international travels stricken by sickness or injury has provided mutual benefits to both parties for over two decades, and now your enterprise can join the network in the Asian region to provide greater scope for assistance and more streamlined operations.

To learn more about International Assistance Group and their operations, visit www.internationalassistance-group.com Author bio: Josh Alston is the Communications Manager for Ionyx, a global software solutions company based in Australia. He holds a Bachelor of Journalism degree from James Cook University and has worked extensively for media organisations across Australia for over 15 years as well as content production, marketing and social media management for a range of companies.

In a world of competition.

Stand out.

In an increasingly globalised world it is astonishing how many solutions seem the same.

We all know that challenges vary depending on cultures and countries. Standing out is not just about processes but having passionate people with the right local knowledge, experience and the independence to think freely.

That is why we exist and excel.

International Assistance Group has been federating assistance companies since 1992. We have grown from a small non-profit association into the world’s largest alliance of independent assistance companies and accredited providers.

We make global world-class solutions a reality. That’s because we vet and select companies with local expertise, skills and knowledge delivering quality services 24/7.

Local partners. Global solutions. www.international-assistance-group.com + 33 1 55 30 09 10 netiag@netiag.com M E D I C A L & T R AV E L A S S I S TA N C E • R O A D S I D E A S S I S TA N C E • C O S T C O N TA I N M E N T • T PA • S E C U R I T Y S E R V I C E S www.asianhhm.com

29

MEDICAL SCIENCES

CAN CENTRAL NERVOUS SYSTEM BE A TARGET FOR TREATMENT OF CHRONIC HEART FAILURE AND AMELIORATION OF EXERCISE PERFORMANCE IN ATHLETES?

From physiology to clinical setting

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MEDICAL SCIENCES

Exercise capacity and its determinants in humans are still a matter of debate.

Exercise performance is modulated by many physiologic factors controlled by brain. The goal of this article is to show relevance of brain, neuromuscular system and hypothalamus for exercise performance mechanisms in heart failure patients, healthy athletes and perspectives for new therapeutic methods for a melioration of exercise performance.

Robert Skalik, Consultant Cardiologist, Senior Lecturer Medical University of Wroclaw

T

he huge progress in cardiovascular science and physiology has contributed to the development of highly advanced diagnostic and treatment technologies in cardiology for last three decades.

However, a reliable assessment of exercise capacity and the precise definition of all factors determining aerobic capacity in health and Chronic Heart Failure (CHF) are still a matter of debate. The profound understanding of the physiologic and pathophysiologic mechanisms controlling exercise — induced breathlessness sensations and exercise capacity may giverise to the brandnew treatment methods aiming at the alleviation of symptoms, relevant reduction in mortality rate in CHF patients and also physiologic techniques to ameliorate exercise performance in top athletes.

Even though the portfolio of the diagnostic tools and treatment methods of CHF is today truly impressive, there is still a respectable group of patients refractory to the guidelines-based conventional therapeutic methods. According to the latest data, mortality rate in CHF patients is still high.

Subsequently, the alternative curative methods of the disease are urgently needed. Moreover, enormous rivalry between top athletes and elite sport clubs also forces sport physicians and physiologists to look for brand-new, alternative or non-conventional pathways to enhance exercise performance for attainment of prestige and top position during competition.

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MEDICAL SCIENCES

Brain – superior regulatory centre for exercise performance in health and heart failure

Growing evidence shows the relevant role of brain, its various structures (brain motor cortex, hypothalamus, autonomic nervous system) and peripheral nervous system (neuromuscular system) in regulation of cardiopulmonary capacity and severity of symptoms in heart failure, but also exercise performance in athletes.

Exercise capacity submits to numerous determinants such as a structure of skeletal muscle fibres, skeletalmuscle fascial system, mitochondrial capacity to produce energy (ATP) for working muscles during exercise, hormonal and immunological factors, ergoreceptors (muscle receptors that increase breath and heart rate during exercise), chemoreceptors (receptors located in the brain stem and cervical arterial vessels responsible for enhanced breathing during exercise) and heat stress. In fact, all these abovementioned entities are controlled by the brain (cortex, subcortical sturctures, hypothalamus, brain stem) and the peripheral nervous system.

DETERMINANTS OF EXERCISE PERFORMANCE IN HUMANS Brain - Cortex, Hypothalamus, Brain stem, Pituitary gland (Breathing, Circulation, Thermoregulation, Hormonal control)

Ergoreceptors, Chemoreceptors, Metaboreceptors (Signalling to brain during exercise)

Heart and blood (Oxygen carrier)

Hypothalamus –from cinderella to key player in exercise

There is more and more evidence that confirms the contribution of central thermoregulatory mechanisms (hypothalamus), core body temperature (heat stress) during exercise and brain cortex – controlled psychomotor performance to exercise capacity.

Manteuffel-Szoege suggested that the blood’s kinetic energy resulting from the thermal conditions of the tissues might affect circulatory flow. The rate of circulatory flow that is responsible for delivering oxygen from lungs to working skeletal muscles (limb and respiratory muscles) during exercise is one of the main determinants of exercise capacity in health and heart failure.

This eminent Polish cardiac surgeon’s observations owing to his innovative animal experiments performed in 1960

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Respiration skeletal muscles genetic properties

Sweating (Heat excess expulsion)

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MEDICAL SCIENCES

and published in prestigious medical journal Thorax favoured the conception that there exists, besides the work of the heart, another, additional source of circulatory energy. The additional energy of the circulation is strictly connected with the temperature in various organs at rest and also during exercise controlled by hypothalamus. Some present investigations, which demonstrate the relevant discrepancy between cardiac function and functional capacity as measured by cardiopulmonary exercise testing (CPX) in patients with advanced heart failure, create continuum with this unique report and indicate the importance of extra-cardiac factors for exercise performance The hypothalamus, located in the brain, is the supreme regulatory centre of core body temperature in humans and works in a close relationship with the cerebral cortex, brain stem cardiovascular and respiratory centres, and the hormonal system that control cardiopulmonary system and exercise performance (Figure 1). Hypothalamus plays an essential role in the central regulation of the heart rate and kidney functions, water and electrolyte balance and its changed activity is observed in heart failure. Moreover, the inflammatory process evidently implicated in the pathophysiology of heart failure can affect the heart rate through hypothalamus.

Various hormones (growth hormone, thyroxine) controlled by hypothalamus and the mechanical forces transmitted to the heart by the flowing blood during exercise are known to be largely responsible for signalling which leads to physiologic (athlete’s heart) or pathologic cardiac enlargement (heart dysfunction and heart failure). The heart cells (myocytes) contain a number of receptors (mechanotransducers) which respond to and convert blood flow stimuli to biochemical events in the heart. These biochemical sensors have been identified chiefly as proteins at the level of cardiac muscle fibres. They act as triggers for adaptive or maladaptive

remodelling that may lead to heart dysfunction or heart failure.

The hypothalamus (locomotor region in hypothalamus – HTLR) as well as the brain cortex participate in the regulation of hyperventilation during physical effort in the physiologic conditions. Nonetheless, it is still unclear how strongly cerebral structures can influence exercise performance in the clinical milieu. It was previously demonstrated that brain structural injuries in CHF patients emerge in areas involved in the physiologic control of core body temperature (hypothalamus) and breathlessness sensations (anterior insula of brain cortex) in healthy humans.

The neuromuscular system that controls the electrical impulses from brain motor cortex to drive skeletal muscles during exercise plays a paramount role in the maintenance of muscle physiology and its dysfunction can contribute to muscle wasting and exacerbation of symptoms in heart failure.

Brain – heart interaction:a way towards understanding of exercise capacity and new treatment methods

The Central Nervous System (CNS) processing that controls human heat conditions and determines neural drive for cardiovascular system can be altered both in patients with heart failure and healthy humans with reduced exercise capacity. It can also be changed in patients with left-univentricular cardiac assist device (LVAD). Recent advances in neurosciences have provided new insights into the understanding of heartbrain interaction. Cardiac information to the brain relies on two pathways, terminating in the insular cortex and anterior cingulate cortex, along with the somato sensory cortex. Some investigations indicate the important role of anterior insula of brain cortex for dyspnoea perception or breathlessness sensations and changed activity of this part of brain in patients with heart failure. A decrease in premotor brain cortex activity is also linked with the termination of exercise in healthy athletes. These observations are another evidence that there is a strict relationship between physiologic and pathologic mechanisms of exercise tolerance.

Hence, modulation of physiologic

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MEDICAL SCIENCES

nervous centres controlling fatigue and breathlessness sensations might be a potential way to alleviate symptoms of heart failure in patients refractory to conventional therapy.

The maximal exercise performance (both in healthy athletes and heart failure) is a resultant of interdependence and mutual interactions between cardiopulmonary function, thermal response to exercise regulated by hypothalamus, brain cortex, autonomic controls, neuromuscular systemcontrolled psychomotor performance (signalling from brain cortex that stimulates skeletal muscles during exercise), hormonal system, metabolic and heat receptors (chemoreceptors, muscle metaboreceptors, thermoreceptors), the capacity of skeletal muscle mitochondria to produce energy (ATP) and heat stress resistance of skeletal muscle enzymes — in particular, muscle pyruvate kinase (MPK) — involved in energy production during physical effort.

The prevalence of these particular physiologic determinants of exercise capacity may vary in individuals, which probably is a key to understanding of differences in physical fitness both in chronic heart failure and athletes.

Central nervous system, neuromuscular system and heat stress – new targets for amelioration of exercise performance in heart failure and athletes

of the invasive vagal nerve stimulation is still controversial, the preliminary results of clinical studies in CHF patients treated with BAT are very promising.

In addition, the recently reported cases of effective non-invasive stimulation of auricular branch of vagal nerve in heart failure confirm the fact that the in-depth knowledge of complicated and sometimes intricate physiologic interactions between various parts of autonomic, central and peripheral nervous system is indispensable for the further development of alternative treatment methods of heart failure and avoidance of therapy-related adverse effects or poor clinical outcomes.

The neuromuscular system that controls the electrical impulses from brain motor cortex to drive skeletal muscles during exercise plays a paramount role in the maintenance of muscle physiology and its dysfunction can contribute to muscle wasting and exacerbation of symptoms in heart failure. The recent clinical studies have validated the positive impact of electrical stimulation of skeletal muscles in CHF patients.

Miyamoto et al. demonstrated the relevant positive effect of the controlled heat exposure (sauna, steam bathing) in CHF patients. Recent studies show

The pathways presented above, responsible for fatigue or breathlessness during physical effort, can be used to regulate exercise performance and weariness symptoms both in heart failure and healthy athletes during competition.

The physiology-based novel treatment methods of heart failure involving manipulation of autonomic nervous system (vagal nerve stimulation and baroreflex activation therapy - BAT) and stimulation of spinal cord have been developing for some time. Even though the safety and clinical efficacy

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that thermal therapy is safe for patients with chronic heart failure and might be applied for the adjuvant treatment of decompensated heart failure. There are also some preliminary reports confirming the positive impact of body heat extraction by means of the innovative techniques (cooling glove) on improvement of exercise performance, muscle fatigue in athletes, patients with neurological disabilities and firefighters.

The cyclically repeated heat exposure or heat stress reduction during training period in healthy athletes or cardiac rehabilitation program in CHF patients may cause habituation of cerebral cortex to the enhanced thermal load during exercise, resetting of the hypothalamic responsiveness to heat stress, amelioration of neuromuscular system, muscular metabolism, function of respiratory and leg muscles during exercise and subsequently exercise capacity. The respiratory muscle warm-up in athletes before exercises contributes to less reduction in muscle oxygenation during exercise, which is a fundamental physiologic factor for the attainment of high exercise performance.

Future studies on the amelioration of exercise performance in heart failures could focus on brain structures

MEDICAL SCIENCES

The better understanding of the physiologic central and peripheral mechanisms controlling exercise capacity and the recent advances in neurosurgery, neuromodulation with use of neurostimulators and physiotherapy create a potential platform for

cooperation between cardiologists, neurosurgeons, neurologists, exercise physiologists and physiotherapists in the cardiovascular research, which may establish new frontiers in the treatment of heart failure in the nearest future.

References are available at www.asianhhm.com

AUTHOR BIO

(cerebral cortex and hypothalamus) and neuromuscular system as potential targets for manipulation. The electrical stimulation or inhibition of selected areas in the brain cortex (insular cortex, motor and premotor cortex) or subcortical structures (hypothalamus) in the experimental heart failure models might explain the factual role of these entities for exercise tolerance in CHF patients.

Moreover, the combination of various innovative and experimental treatment methods (invasive and noninvasive neurostimulation, baroreflex activation, thermal therapy, controlled heat exposure, fascial manipulation therapy within skeletal muscle system) with wellestablished therapies (pharmacology, revascularisation, valve repair or replacement, resynchronisation, conventional cardiac rehabilitation) creates an opportunity to build a new multimodality therapeutic models in patients with refractory chronic heart failure.

Robert Skalik is a consultant for Specialist Hospital with Outpatients Clinics, „Ventriculus�, Leszno, Poland, former Director of Department of Cardiac Rehabilitation in Saint John Paul IIHospital in Wroclaw, Poland. From 1998 to 2007, physician and cardiologist in Department of Cardiac Surgery and Cardiology, Medical University of Wroclaw, Poland. Author and co-author of numerous articles, abstracts, congress communications on cardiology and human physiology. He specialises in general and sports cardiology, echocardiography and cardiopulmonary exercise testing. He is an invited Overseas Fellow of Royal Society of Medicine in London.

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MEDICAL DEVICE INTEGRATION ESSENTIAL TO PROACTIVE PATIENT SAFETY

Continuous surveillance, which combines advanced data analysis and real-time data distribution, empowers hospitals to deliver proactive patient safety capabilities.

This article will demonstrate how continuous surveillance helps clinicians anticipate the early signs of deterioration, distribute actionable notifications to mobile care teams and ensure the highest level of patient safety.

Mary Jahrsdoerfer, Director, Healthcare Informatics Graduate Studies Adelphi University

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H

igh-risk patients, who require respiratory support or monitoring, are found not only in high-acuity areas. Identifying the patients who are vulnerable to deterioration is critical to patient safety measures that emphasise timely interventions over costly emergency rescues. Ubiquitous data in a predetermined clinical workday demands streamlined workflow through

TECHNOLOGY, EQUIPMENT & DEVICES

device interoperability, transparency, algorithmic trends, rule-based theorems, and data standardisation. These are the necessary tools for today’s clinical toolbox. Without Meaningful Device Integration (MDI) in the contemporary complex hospital setting, safe patient care is relinquished to a second priority, as the clinician attempts to place all the disparate vital data points together, first.

Continuous clinical surveillance applies advanced analytics to real-time medical device data. Surveillance is evaluated against previous benchmark indices from the Electronic Health Record (EHR) and is used to intercept adverse events and prevent costly care escalations. For this, continuous streams of data is captured through MDI from multiple sources, such as ventilators, physiological bedside monitors, livestreaming ECG waveforms, even patient alerts from the bed itself. These data streams combined with retrospective data stored in EHRs and then filtered through an intelligent, rules-based engine that uncovers clinically relevant trends and deviations in the patient’s condition. This evaluation is presented in a significant way for health systems to integrate real-time patient safety into clinical workflow.

There are seven attributes to using clinical surveillance in the MDI model; attention, timeliness, recognition, intuition, analysis, action, collaboration1. This rigorous clinical 1 https://www.mddionline.com/medical-device-integrationworld-possibilities

approach to delivery of safe patient care can only be implemented if the technology at hand is integrated for the purpose of drawing meaningful data.

In other words, the action from the clinician is only as good as the data at hand.

Continuous clinical surveillance, advanced analytics and timely intervention based upon evolving trends in a patient’s condition is attainable in today’s hospital care setting.

MDI and Continuous Surveillance

Continuous surveillance is an integrated, systematic, goal-directed process in which clinicians apply streaming live patient data, bench-marked against the average hospital EHR disclosed data to prompt real-time decision-making based upon evolving patient trends.

One of the objectives of analytics is to surveil (a reconnaissance quietly taking place in the background) of seemingly unrelated sources of data to prevent the onset of an adverse event that would not normally be visible by observing a single parameter or multiple parameters individually. Predictive models and rules-based algorithms using multiple sources of data can help clinicians anticipate adverse events more reliably than data from a single source, bringing the unique clinical picture into focus. It is a realtime/prospective approach versus a retrospective response to patient care.

Data collection and analysis is further enhanced when both the

benchmarked data and the smart alarm signals are placed in the analytical equation. The strength in the newly combined algorithm facilitates patient care management and clinical workflow.

However, creating the environment to facilitate continuous surveillance and intervention is challenged by the fact that medical device data is often isolated, with each siloed device having unique communication protocols, physical connections, update rates, and terminology.

Data from MDIs helps in decision making, in the standard patient care management processes, such as charting, and proactive continuous surveillance. Enabling medical devices for continuous surveillance requires three primary capabilities which should be included in any MDI initiative.

Assured delivery of data. To support continuous surveillance, the communication pathway from the bedside medical device to the recipient must guarantee delivery of the data within a specified time frame. In order to guarantee delivery, the system must continuously monitor that communication pathway and report any delivery impediments.

Two-way communication. This capability ensures that data delivery and verification does not impede or otherwise interfere with the medical device operation. This is of particular importance when exploring external control of medical devices or when alarm data are communicated per continuous surveillance.

Ensuring data integrity.

Algorithms cleared for continuous surveillance or data interpretation must be validated for all intended operational scenarios of the medical device. Data security, hostile attacks on data, medical device, denial of service, and ransom ware all have the potential to impact data integrity and these requirements must be identified and detailed through specific scenarios and validated through testing .

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Clinical Value from Device Integration

Clinical surveillance utilises multivariate, continuous, real-time data from multiple monitoring devices; applies advanced analytics to provide a quantitative and qualitative estimate of a patient’s condition over time; and communicates clinically relevant alerts to the appropriate clinician .

The EHR in the Medical Device Integration model While the widespread adoption of EHRs has largely resolved the challenges of independent data capture and have mitigated issues related to clinicians’ access to critical information, its attributes lack real-time trend capability.

The central role the EHR plays in the day-to-day clinical operations practically requires that peripheral technologies— ranging from medical devices and telehealth to financial and administrative solutions—integrate with the system.

Although EHRs were never designed to accommodate real-time data analytics, investing in a proactive MDI solution makes these systems an ideal hub for continuous surveillance.

Clinical surveillance compliments hospitals’ EHR capabilities by providing bi-directional integration features through middleware that resides in the space between point-of-care devices and the EHR. For example, a clinical surveillance solution can capture historical data from the EHR and correlate it with real-time streaming data from streaming devices, including heart rate, heart rhythm variation, oxygenation levels and blood pressure.

The combination of high-fidelity data with multivariate, EHR information provides a holistic and complete source of objective information on a patient that can be used for prediction and clinical decision making prospectively.

Analytics in Medical Device Integration The transformative power of MDI mitigates the shortcomings of conventional monitoring practices, including alarm fatigue, significant

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The Future of Medical Device Integration

Universal medical device standards won’t happen overnight, though it has been interesting to note manufacturer’s slow migration to a more standardised approach. Logistics and practicality rule the day in a world with steep costs in investment, development, acquisition, and regulation.

This reinforces the need to have a comprehensive and forward-looking approach to selecting an MDI and middleware provider that can support the technical and clinical needs of your healthcare organisation6. A broader clinical view of the future solution is to include laboratory blood work, radiological findings, and pharmaceutical interventions, into the device integration model, to provide a total operational framework for the clinician.

6 https://www.mddionline.com/medical-device-integration-world-possibilities

monitoring gaps, and data delivery delays.

Analytics based on multiple sources of physiological data can help offset the problem of alarm fatigue by filtering out false or artifact signals that typically invade the high-fidelity data at the core of continuous surveillance. The use of data for display and analysis, predictive analytics, rules-based algorithms, as well as the ability to process data collected at the point of care to create new information also drives data collection rates. The ability to retrieve data at variable rates, including at the sub-seconds level, requires the vendor to demonstrate that it has mitigated the risk associated with communicating higher frequency data for alarms and analysis—even patient monitoring and intervention.

This raises critical questions that pertain to patient safety and the level of risk assumed by the hospital. How do patient documentation needs differ from real-time patient intervention needs?

What is real-time data flow and what is not? Because data used for real-time intervention, like clinical alarms, impact patient safety, any delay in their delivery to the correct individuals can have deleterious effects. Thus, it is important to understand the implications of requirements on data delivery latency, response and integrity2.

2 https://www.mddionline.com/medical-device-integration-

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Data Delivery, Communication and Integrity “High Reliability: The Path to Zero Patient Harm”3, presents a root challenge that lies with frequent clinical interruptions affecting the consistency and reliability of patient care. Siloed data makes it difficult for the clinician to draw meaningful conclusions for a patient care plan. Complexity of disparate devices warrants consistent integration of the right information to be delivered to the right person at the right time.

How can hospital leaders expect clinical providers to meet patients’ needs and perform their work proficiently if the system provides only fragmented, episodic data to work with? Clinicians must have real-time, continuous data flow and analysis for accurate trending to occur. Surveillance infers that no clinical anomaly channels the acknowledgement/intervention filter; in this case, the resources are knowledge and technology4. To support active patient monitoring and verified delivery of data, the communication pathway from the bedside medical device(s) to the recipient must guarantee delivery of the data within a specified time frame. world-possibilities 3 https://www.himss.org/library/clinical-surveillanceconcept-analysis-leveraging-real-time-data-and-advancedanalytics-anticipate 4 https://www.himss.org/library/clinical-surveillanceconcept-analysis-leveraging-real-time-data-and-advancedanalytics-anticipate

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on data, medical device, and denial of service, and ransomware all have the potential to impact data integrity and these requirements must be fleshed out through specific scenarios and validated through testing5.

Conclusion

For hospitals and health systems, especially those that are breaking ground on a net-new MDI program, the formidable task list that comes with any MDI initiative requires the input and

B IO

5 https://www.beckershospitalreview.com/healthcareinformation-technology/medical-device-integration-fromcharting-to-intervention.html

AU TH O R

In order to guarantee delivery, the system must continuously monitor that communication pathway and report when data are impeded or otherwise delayed beyond a maximum acceptable limit on latency and throughput.

Communication through Middleware Two-way communication of data ensures that data delivery and verification does not impede or otherwise interfere with the medical device operation. This is of importance when exploring external control of medical devices or when alarm data are communicated per active patient.

In middleware systems cleared for active patient monitoring, the ability to transform the data is possible. Algorithms for performing transformations, calculation of tertiary results, and otherwise interpreting data must pass muster and be validated for all intended operational scenarios of the medical device, including failure modes. Data security, hostile attacks

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expertise of a project team, which ideally, should be comprised of leadership from myriad departments, including IT, networking, facilities, clinical staff, and biomedical engineering.

References Jahrsdoerfer, M. (2019). Clinical Surveillance. A Concept Analysis: Leveraging real-time data and advanced analytics to anticipate patient deterioration. Bringing Theory into practice. https://www.himss.org/ library/clinical-surveillance-concept-analysisleveraging-real-time-data-and-advancedanalytics-anticipate DuPree, E. (2016). High reliability: the path to zero harm. Healthcare Executive (Jan/Feb), 66-69. http://www.jcrinc.com/ assets/1/7/PathToZeroHarm.pdf

Mary Jahrsdoerfer is a clinical authority in emerging industry healthcare technology, bridging the gap to safe clinical practice and patient safety in the acute care setting. As well as her role as Chief Nursing Informaticist at Capsule Technologies, Jahrsdoerfer is Director of Healthcare Informatics Graduate Studies, Adelphi University, NY.

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Medical Device IP strategies "In the future, IP will be all that matters — except when it doesn’t. Protection vide Intellectual Property Rights will always precede commercialisation, in that, spend will always precede gains. It may seem irrelevant if we mathematically equate intangibles with growth, but we need to remember that ‘big companies can do to startups what startups with IP can do to big companies.’

If a growth story is compelling enough to truly differentiate, then that story will continue to resonate. If it doesn’t, it won’t. But what, most definitely, doctors, medical practitioners, start-ups, academicians, and researchers need to remember how to pace IPR filings with various phases of a product / company."

B Ravi, Founder, BETiC Chirag Tanna, Regd. Patent Agent and Founder, INK IDEE

W

ith access to healthcare being a major challenge in countries like India, networks like BETiC at IIT Bombay, start-ups and enterprises have been combining engineering principles to medical science to create innovations and breakthroughs in medical technologies.

The global medical devices market alone is estimated to be worth US$381bn,

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according to medical market research company Kalorama.

Intellectual property naturally has become an important topic in this context.

Medical devices have become a critical subset of healthcare. The relevant intellectual property needs to be protected by adopting suitable strategies, enabling commercialisation, and being competitive with minimal hindrance.

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Research, in healthcare, has always been spearheaded, in no particular order, by: multi-national companies, universities, and doctors. And there has always been a thin line between ‘obtaining credit’ via publications and ‘gaining ownership’ via Intellectual Property Rights (IPR). While multinational companies have always known what to picket fence their research by way of IPR filing, universities and doctors have always pursued the other path (of credit over ownership).

Doctors and academicians have always traversed a reckless path of publishing their research before filing for their IPR; perhaps because ‘publishing original research’ before ‘filing IPR’ results in an immediate loss of IPR due to loss of novelty (even if the publication is by the doctor / academician themselves). Moreover, such disclosure sans protection results in public dissemination of know-how with no possibility of licensing or exclusivity

TECHNOLOGY, EQUIPMENT & DEVICES

whatsoever. Essentially, what the gamut of Intellectual Property Rights (i.e. Patents, Trademarks, Copyrights, Designs) provide is exclusivity and wholesome ownership of the research.

Publication can always follow formal IP filings. IP filings can never follow publications.

MEdTech sector is growing

An article in Singapore’s ‘The Business Times’ this October highlights an important facet – how, in spite it being a tough year for the manufacturing sector, its sub-sector – medical technology – has had a standout performance. In 2018, the medtech sector contributed S$ 13.3 billion to Singapore’s economy, from just S$3.1 billion in 2008. The number of people it employs has also grown by more than 80 per cent over the same period to reach 14,806 in 2018. For these numbers to make sense, it is important to consider that ‘Singapore’s vision to make the biomedical industry a key pillar of its economy took shape about two decades ago, when the government began building up its human and industrial capabilities in biomedical research and life sciences.’ 50 regional headquarters from the world’s leading medtech firms are based in Singapore.

It wasn't always about patents

In the United States of America, in the year 1980, the Bayh-Dole Act permitted universities that received federal funding to elect to pursue ownership of an invention, rather than obligating inventors to assign inventions to the federal government. Before the Act, fewer than 5 per cent of US government’s patents were commercially licensed. This paved the way for commercialisation and, sure enough, following the passage of the act, the number of patents granted to universities increased exponentially.

Since 1980 there has been a ten-fold increase in the number of universities actively engaging in patenting their research. Today, about thirty billion dollars of economic activity per year

In the future, IP will be all that matters — except when it doesn’t.

If a growth story is compelling enough to truly differentiate, then that story will continue to resonate.

and 250,000 jobs can be attributed to technologies born in academic institutions. Also, over 2200 new companies have been formed since 1980 that were based on the licensing of an invention from an academic institution.

Additionally, the USA Small Business Innovation Research (SMIR) was deployed to help certain small businesses conduct Research and Development (R&D). In the words of program founder Roland Tibbetts: "to provide funding for some of the best early-stage innovation ideas-ideas that, however promising, are still too high risk for private investors, including venture capital firms." This allowed businesses to take risks.

As per a recent US Bureau of Labor Statistics (The Atlantic, 2018), healthcare and social assistance is now the largest employer with nearly 20 million employed, surpassing manufacturing and retain, and also growing the fastest.

In particular, the number of non-doctor workers is rapidly increasing.

The Indian scenario… evolving rapidly

The Indian healthcare spending is currently estimated at US$40 billion per year. Of this, over 50 per cent is spent by hospitals (numbering over 15,000), and 30 per cent for pharmaceuticals.

Medical devices represent nearly 20 per

cent of the total healthcare spending.

The Indian medical device market is valued at US$7 billion (Rs.50,000 crores) per year, and growing at over 15 per cent CAGR. Nearly 80 per cent of this market is fulfilled by imports from Western MNCs. Given that the per capita expenditure on healthcare in India is less than 1 per cent of that in USA, most of the imported devices are unaffordable to the local population.

Further, imported devices are designed considering the anatomy and range of motions of people in the West, thereby making them often unsuitable for Indian patients and doctors.

To expand healthcare delivery and reduce the cost burden, the Government is facilitating research, development, startup incubation and manufacturing of medical devices, as well as strengthening the regulatory framework. The research projects are mainly funded by DST, DBT, MEITY and MHRD. Most of the IITs have prioritised healthcare research and innovation. Prominent med-tech and bio-tech incubators include C-CAMP Bangalore, IKP Hyderabad, KIIT Bhubaneshwar, SINE IIT Bombay and Venture Centre, Pune.

Many entrepreneurs in the above and other business incubators have been supported through equity-free grants from DST, DBT and BIRAC. The Biotechnology Ignition Grant (BIG) provides up to Rs.50 lakh award per project for transition from ideation to POC, creation of startup company and field validation. In the last ten years, about 450 bio-tech and med-tech innovators received the BIG award, out of which about 60 products or technologies have been commercialised so far.

The regulatory framework has been strengthened, through Medical Device Rules, 2017, separating the certification and licensing of medical devices from drugs. The devices are classified based on risk to life, and the corresponding regulatory processes are defined.

At present, there are only a few

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The BETiC example

Supported by the Science & Technology Council of Maharashtra Government, a Biomedical Engineering & Technology incubation Centre was established in 2014 at IIT Bombay to bring doctors and researchers together for medical device innovation. Two satellite centers were set up at COE Pune and VNIT Nagpur, followed by BETiC cells in four other engineering colleges and seven medical institutes, making it the largest such network in the country.

BETiC has evolved an innovation path ‘bedside-bench-business-bedside’, traversing the ‘valleys of death’ between ideation, invention, innovation and impaction. There are four major stages: defining an unmet clinical need, developing a novel solution, delivering a tested device, and deploying it in clinical practice. The process received ISO 13485 (Quality Management System for Medical Devices) certification in 2018.

Protection of IPR is a key step; BETiC innovators file a provisional patent as soon as the detailed concept is ready, and full specifications within an year, by which time the product prototypes and lab tests are underway.

Clinicians contributing to the design are named in the patent and share the revenue generated from licensing.

In the last five years, BETiC team gathered over 400 unmet clinical needs from different hospitals, developed proof-of-concepts of 200 different medical devices in close collaboration with over 50 expert doctors, and filed more than 50 patents. Of these, 25 products have been developed, including screening & diagnostic devices; surgical instruments; implants, prostheses

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and assistive devices. Team members incubated 15 start-up companies and licensed 5 products to industry.

IP strategy- in a nutshell

Our innovators have realised with time that protection vide Intellectual Property Rights will always precede commercialisation, in that, spend will always precede gains. It may seem irrelevant if we mathematically equate intangibles with growth, but we need to remember that ‘Big companies can do to startups what startups with IP can do to big companies.

In the future, IP will be all that matters — except when it doesn’t. If a growth story is compelling enough to truly differentiate, then that story will continue to resonate. If it doesn’t, it won’t. But what, most definitely, doctors, medical practitioners, start-ups, academicians, and researchers need to remember how to pace IPR filings with various phases of a product / company.

Always: AUTHOR BIO

hundred manufacturers of medical devices in India. Most of them are engaged in manufacturing low technology products (like surgical textiles, blood bags and syringes). Some of them are switching to trading, unable to compete with cheaper imports from China and South-East countries.

1. diligently carry out market research and find theoretical differentiators; 2. scour the patent and non-patent literature to find theoretical differentiators; 3. no public / private / conference / paper disclosure, at all, before provisional patent filings; 4. judiciously use time-lines provided by the Patent Offices to build the IPR; 5. learn from market feedback – incorporate into product and IPR, simultaneously; 6. scale across jurisdictions – productwise and IPR-wise, simultaneously; 7. keep a watch on competition’s products and IPR filings to predict market strategies.

If a smart company / start-up and their patent attorney look out for market landmarks and crosses them with their IPR regime, the resultant company / start-up will almost always get a bang for their buck.

Ravi is an innovator, educationist and mentor who wears many hats. At IIT Bombay, he is the Institute Chair Professor of Mechanical Engineering. He is the founder of BETiC- Biomedical Engineering & Technology incubation Centre- an ecosystem that has developed 50 low cost medical devices, incubated 15 startup companies and licensed 5 products to industry.

He is also professor-in-Charge of Desai Sethi Centre for Entrepreneurship at IIT Bombay that nurtures entrepreneurship among the students.

His unique mastery is to steer inter-disciplinary multiinstitute translational research projects leading to advanced yet affordable products, startup companies and social impact.

Chirag Tanna is the founder of INK IDEE which is a boutique Intellectual Property Rights firm based out of India and Singapore. He has more than 15 years of experience in Intellectual Property Rights and is licensed to practice Intellectual Property Rights’ law in India and Singapore. He has prepared and filed thousands of new patent applications, prepared and filed Responses to Office Actions, represented clients at hearings at the Indian Patent and Trademark Office (IPO), Intellectual Property Office of Singapore (IPOS), and the US Patent & Trademark Office (USPTO).

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MEDICAL MANUFACTURING ASIA 2020

Strategic platform for medical technology solutions Mark your calendar for the 5th Manufacturing Processes for Medical Technology Exhibition and Conference from 9 to 11 September 2020

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he Asian medical market is booming. According to management consulting firm, McKinsey & Company, the company predicts that Asia will account for a third of global sales by 2025. In the ASEAN countries, with its population of over 600 million people and a GDP of 2.76 trillion U.S. dollars, there is a rapid growth of the middle class and expansion in

healthcare coverage. Both of which are factors driving the use of medical devices across Southeast Asia.

Such products are likely to see growth of between 8 to 10 percent in most markets, led by the consumables, diagnostic imaging and lab devices segments.

As a specialist exhibition on manufacturing processes for medical technology, the 5th edition of MEDICAL MANUFACTURING ASI Amakes a return to Singapore as the region's leading specialist trade fair for Asia's MedTech and medical manufacturing processes sectors. Jointly organised by SPETA and Messe Düsseldorf Asia, MEDICAL MANUFACTURING ASIA 2020 will feature an extensive product range covering the upstream and downstream processes in MedTech sectors, including new materials, components, intermediate products, packaging and services, to micro and nanotechnology, testing systems and services, as well as materials, substance and components for medical technology.

Singapore: The heart of MedTech in Asia

As Singapore continues to grow as a competitive economic hub for the region in terms of, ease of doing business, best labour force, strong IP protection and robust logistics infrastructure, it has also presented itself as a competitive MedTech manufacturing hub.

The 3-day exhibition therefore strongly reflects Singapore’s focus on moving upstream to not just production but also value engineering. For companies keen on engaging global MedTech companies and see Singapore as an ideal base to develop products for the Asian region, MEDICAL MANUFACTURING ASIA 2020 provides a highly relevant springboard.

This sentiment is also seen in Singapore’s continued growth in manufacturing, where MedTech output has grown annually by 11 per cent versus 6.3 per cent in general manufacturing for the past 5 years. Backing this is Singapore’s strong supplier base – with 6 of the world’s Top 10 EMS companies undertaking activities from the entire value chain, in medical imaging equipment, analytical lab instruments, medical consumables, patient care devices and diagnostics equipment in the Lion City and the government’s commitment to R&D capabilities, having set aside US$ 19 billion for Research, Innovation and Enterprise (RIE) activities. Singapore is also home to a growing community of start-ups thanks to the availability of public funding and a favourable infrastructure for early stage innovation.

Against this industry landscape, MEDICAL MANUFACTURING ASIA 2020 continues to attract a highly

international exhibitor base coming mainly from Asia and Europe and a trade visitor base that is predominantly represented by the medical devices and instruments, medical and healthcare, and electrical and electronic sectors from around the region.

Industry-focused, knowledge-based business conferences and forums

Headlining MEDICAL MANUFACTURING ASIA 2020 areindustry-relevant conferences and forums including: High-Tech for Medical Devices 9 Sep 2020 | 1pm to 5pm Forum Stage, Hall F, Basement 2 Organised by IVAM Microtechnology Network, the forum will bring together leading companies in the specialised fields of the micro- and nanotechnology sectors, providing insights on the latest innovations and share best practices through presentations.

Main topics covered are: Modules and components for medical technology, Lab-on-a-chip technology, Inspection equipment and testing services, Assembly, automation and production technology, Process technology, Biocompatible materials, Sensors and more.

Medtech in Focus Seminar 10 Sep 2020 | 1pm to 5pm Forum Stage, Hall F, Basement 2 Jointly organised by SPETA and Messe Düsseldorf Asia, this seminar will bring together industry experts, government, academics and trade professionals to discuss the latest trends and challenges in redefining modern manufacturing in the Medtech industry.

MEDICAL MANUFACTURING ASIA 2020 is also synergistically co-located with the region’s leading medical and healthcare exhibition, MEDICAL FAIR ASIA – thus providing an end-to-end solutions and business sourcing platform across the entire value chain for the medical, healthcare, medical manufacturing and medtech sectors. Both MEDICAL FAIR ASIA and MEDICAL MANUFACTURING ASIA 2020 are part of the MEDICAlliance’s network of trade fairs – sharing the global expertise of MEDICA, REHACARE and COMPAMED – by the Messe Düsseldorf Group in Germany.

For booth space booking and more information on MEDICAL MANUFACTURING ASIA 2020, please visit www.medmanufacturing-asia.com.

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FACILITIES & OPERATIONS MANAGEMENT

LEAN MANAGEMENT

Lean is an ideal way of life, be it in the business world or personal lives. In its most basic form, it means making your assets work more productively, productivity being the tombstone of efficiency. This easily gets ignored in the surge of activities, especially in service operations when with the enthusiasm of completing those or the need to touch the end of line, an easier way of doing things gets lost. All that is required is to stop and think for a moment: how can we better this? Of course, the various techniques of lean working always help, more so with statistical analysis.

But the essence remains – how can we achieve more with less or more easily?.

Gurrit K Sethi, Hospital Chief Operating Officer, Care Hospitals; Strategic Advisor for Global Health Services, Global Strategic Analysis

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ean is indeed an interesting concept to apply in almost all facets of life, be it weight management, service management, or manufacturing. In a nutshell, to be lean we need to lean towards lean working, and lean living.

Leanness of healthcare practices can hugely benefit many a pocket – the organisations’ itself, the government’s as well as the patient’s, the payer’s. And a lot of the meat depends on the thought process and the way these thoughts are ultimately processed.

Lean in healthcare is ‘critically’ needed at this juncture of the overall civic cycle – in India as well as many other countries. Different illnesses rage us, the ageing population is heavily dependent on government or out of pocket expenses, the health insurance companies are struggling to survive, as are hospitals themselves. The government is heavily dependent on the private sector for widespread provision of this sector, especially in India, thus figuring innovative ways to partner. And at the same time, as a dichotomy, the private sector struggles to match upto the price expectations, especially given the hidden costs.

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The scope for better cost management in Indian healthcare is huge: The basics of setting up a facility and its functioning Lean and efficient service delivery processes – trained manpower is critical The archaic rules have a scope for major cost reduction The interconnects between the credit providers – government as well as insurance – insurance delays, government approval loopholes drain a lot of money I have spoken about the first two points extensively in my earlier series on ‘ ‘The Science of Healthcare Deliver’ y’. While these aspects of the facility layout, internal work flows, employee training and engagement, and, service management is what is largely focused on in the regular models of hospital lean management, there is a huge 0scope is there to introduce leanness in the other two areas as well. Let us examine the costs of these in this paper.

For example, documentation is one of the main requirements to keeping up with statutory compliance for healthcare facilities are documentation.

To be precise this involves paper documentation. The laws and statutory

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regulations mandate that all patient records of every patient be maintained for a minimum amount of time. All out patient department prescriptions are required to be maintained for two years, all in-patient medical records for a minimum of five years, life long lifelong for death cases and MLC cases.

All diagnostics records — laboratory investigation as well as radiology need to be maintained lifelong, billing records for five years, in pharmacies prescriptions and receipts for five years.

All authenticated books of accounts also need to be maintained for a period of eight years.

Now imagine this: the average approximate footfall for a small sized 100 bed hospital is 200 - 250 out patients in a day. Here they would meet the doctors and get prescriptions. These prescriptions would advice diagnostics and medicines, which creates billing records, diagnostics records, and pharmacy records. Even if we take a low average of five sheets of paper per patient, in a day for only the out-patient department, this entails about 1250 sheets of paper a day. Now, in the in-patient department, each new patient file contains 22 sheets for record keeping by the nurses and doctors on the

FACILITIES & OPERATIONS MANAGEMENT

Lean in healthcare is ‘critically’ needed at this juncture of the overall civic cycle – in India as well as many other countries.

In fact, this will also help improve the productivity of our medical staff.

When filling out paper forms, each form needs to have clearly written patient details to ensure clear identification.

Thus, there happens to be a lot of repeat entries that our nurses and doctors have to do. With digitisation and usage of EMRs, this can be easily avoided and time saved. This saved time can go into better patient care at the patient bedsides. Of course, the efficiency in build of the softwares is critical here.

Coming to the payers’ side, a lot of waste happens while patients wait for approvals for treatments – largely from the insurance and the government bodies. This entails extra payments for both the payers as well as the hospitals, apart from the inconvenience to the patients. On this front, the hospital suffers. While more patients are waiting

AUTHOR BIO

first day of admission. Approximately 8-10 sheets a day get added on to this file. If a patient stays in the hospital for four days on an average in a hospital, the patient record at time of discharge is approximately 50 paper sheets. These records are for initial assessment by the doctor, drug charts, progress sheet, patient consent, diagnostic requisitions, daily hand over sheets by doctors and nurses etc. Even if this hospital treats 500 in-patients a month, the in-patient records will come to 25000 sheets.

Therefore, only for patient records this hospital generates approximately 62000 sheets for storage per month. Add to this the administrative documents, the various mandatory registers etc.

Can we imagine if we could digitise these records, how much paper could be saved? How many trees could be saved?

And above all, how much storage space could be saved? In a country struggling to add hospital beds, this space could well be used for additional patient services.

Then why are we still following such archaic norms? Various healthcare laws and regulations have emerged over the years as newer aspects of healthcare have developed. Despite this, there are some that are from the pre-independence era and haven’t been re-looked at. Also, most of our laws are centred around the manufacturing sector. The service sector has come up in just the past two decades. There is a strong case and need for looking at restructuring these regulations to make them work better for the service sector. Meanwhile, the digitisation of healthcare is one area which holds immense potential to resolve such issues. In fact, the digitised records are tamper proof compared to the physical ones. The adoption and usage of Hospital Information Systems (HIS), the Electronic Medical Records (EMRs) and Electronic Health Records (EHRs) need to be speeded up by law, and related laws that mandate documentation should also be upgraded to recognised digital documentation.

for admissions, there are many waiting to go home while awaiting approvals.

Hospitals don’t have holidays and illness does not understand them. This problem gets accentuated on such days – while the world enjoys, the hospitals and patients suffer. Needless to say that the hospitals bear the costs of these delays. An efficient approval process that works at all times needs to be instituted to build better partnerships.

A pointer to these agencies will also be the payor wise data on the average length of stay of patients in hospitals.

Another aspect that the government health schemes need to look at is how many times their beneficiaries get admitted to the hospitals. There are times that people get admitted, they happily pay their own bills and then miraculously generate low income certificates to avail schemes for the more expensive parts of the treatment.

In all this it is the very needy that suffers (and, of course, the tax payers) It is indeed high time that these inter-connects be looked at so as to get more efficient, in terms of provision of good services as well as the monetary schemes.

This article is meant to throw light on the lesser discussed metrics which are overlooked. To make our healthcare more viable and efficient, we do need to cast a light here.

Gurrit K Sethi Hospital Chief Operating Officer, Care Hospitals; Strategic Advisor for Global Health Services, Global Strategic Analysis, contributes to healthcare by helping providers build and better business efficiencies and concept development, also strives to contribute socially through the Swiss Foundation, Global Challenges Forum as Strategic Advisor, through conception of sustainable health initiatives. She started her career from the shop floor working her way up to lead and set up different healthcare businesses. In her words, her significant achievements have been in bringing to life different SMEs and SBUs signifying a change in the Indian healthcare scenarios, as the opportunity paved the way along the healthcare growth curve in the country. With over 18 years in healthcare under her belt, across different healthcare verticals, she has carried transformational changes in the projects she has led, four of those being early stage start-ups. Gurrit is an avid traveller and voracious reader of varied genres, attributes which she says, provide her with incisive insights about people and systems and what drives them.

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INFORMATION TECHNOLOGY

Transforming Healthcare Delivery through Connected Patient Rooms This paper presents the execution of a smart hospital environment in form of ‘Connected Room’ that employs ‘Ambient Intelligence technologies’ for augmenting a typical hospital room with smart and connected features that assist both patients and medical staff. In it, various wireless, wired sensor technologies, voice command IoT, IoM have been integrated, allowing the patient to control the environment and interact with the hospital facilities, while a clinically oriented interface allows for vital sign monitoring through ‘Connected Devices’ with EMR integration.

Sangita Reddy, Jt. Managing Director, Apollo Hospitals

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oday’s technologies combine critical resources, technology, and gadgets targeted at patients across the continuum of care. However, this vision for patient-centric technology extends across hospital systems and, truly, all healthcare organisations that make up the patient care community.

One way to make this vision a reality is to focus on the technologies used in patient rooms in order to measurably enhance the patient experience before, during, and after their stay. Effectively, this implies re-modelling patient rooms into “connected rooms” that take technology utilisation to the next level.

This transformation has already begun, and we as Apollo Hospitals Group anticipate it to grow in the coming years in India. With 72 hospitals and

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more than 10,000 beds, our aim is to provide world-class patient experience to our patients with ease of operability and patient centric care from “Illness to Wellness”.

Role of smart technologies in healthcare

It is a well-known fact now that technological advancements in healthcare have helped save countless lives and in improving the quality of care and ensuring substantial cost savings, very much in line with the goals of most of the healthcare provider organisations.

Healthcare technology has enabled the professionals to connect with the patients in a more efficiently than ever before.

Remote patient monitoring (vital sign monitoring, softcopy radiological film

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review, condition specific diagnostics and treatment) were the first set of applications appearing in the domain, mainly addressing the need to support diverse clinical requirements. Also, in the field, much work has been conducted to provide assistive environments, e.g., smart homes or hospitals, using RFID, monitoring cameras, and environmental sensors. Through the above efforts, the need to provide integrated services able to interconnect all the fragmented available e-health systems and automation systems and sensors by a binding architecture became imperative. Wireless technologies and smart environments play a fundamental role in achieving this vision by providing natural and user-friendly ways of coping with the surrounding environment. Such

INFORMATION TECHNOLOGY

technologies and approaches further promote clinical quality of care and operational efficiency in the healthcare processes, while sustaining at the same time the patient’s independence and quality of life. Furthermore, enabling the “virtual visit” of a medical doctor has the potential to reach a larger patient base and reduce costs for the healthcare system, avoiding unnecessary patient travelling, and social costs for the families and relatives of the patient.

Technology means utilising more gadgets and smart devices: on the other hand, it is important that the care givers such as nurses and doctors attend to their patients and not the technology.

Therefore, the smart environment should ease their workload and not bring additional administrative tasks.

The goldmine of structured data generated through this will further pave way to creating/ enhancing multiple AI/ ML algorithms in the near future to bring in more efficiency in the process.

We at Apollo Hospitals have always been looking to utilise innovative technologies, be it the in the clinical areas or in areas where it helps to enhance the patient safety and experience. One such initiative is the “connected patient room”.

What can connected rooms deliver to patients?

What does it mean to create smart and connected spaces in healthcare? It means leveraging technologies, such as internet of things (IoT) devices, tablets, smartphones, smart TVs and more, both inside and outside the walls of the hospital, in order to deliver care and resources to the patient at any time in a care journey. It not only includes Non-Medical room automation devices

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INFORMATION TECHNOLOGY

with ambient intelligence technologies but also includes medical point of testing and monitoring devices with IoT, IoM, artificial intelligence (AI) with electronic medical records integrated to have end-to-end continuum of care.

We have utilised the concepts of ambient intelligence (AmI) environments. AmI supports the pervasive diffusion of intelligence in the surrounding environment, through various wireless technologies (Zigbee, Bluetooth, RF, IR blasters, WiFi) and intelligent sensors. This environment integrates various hardware and software technologies, allowing users to control electrical and electronic devices automatically or manually. Besides, it also works through an app or voice

assistants like Alexa, and Siri. For issues such as nurse on call, emergency call, and other alarms for patients and nurses.

It also means thinking differently about patient care; being proactive versus reactive in how hospitals “see” a patient. Patients’ healthcare journeys do not begin and end within the four walls of their hospital rooms or last for only the amount of time they are there. They often have a considerable healthcare history well before their admission and have a healthcare future that extends beyond the moment of discharge.

It’s time to leverage technology and information in smarter, more significant ways to better engage patients and transform their expectations when it comes to their experience. How

do healthcare organizations embrace patients before they even arrive? And how do they more thoughtfully engage patients during and after their stay?

With sensors, infra-red blasters, motion sensors and voice command devices and cloud-enabled medical devices, live data in reference to patient’s medical and environmental history can be mapped to ease the stay in hospitals for both the patient as well as the care providers.

Connected rooms deployment

Easy access to allied services like food and beverages (F&B) and housekeeping coupled with nurse call and emergency alert ensures the right set of people in the system are activated based on the specific needs of the patients and their attendants, taking the efficiency in the process a level up and ensuring nursing is more focused on the “tender loving care” that Apollo is known for.

Smart sensors in the room, bathroom and the patient bed prevent patient falls and alert the care givers in case of risks in time. The wireless, hassle-free vitals monitoring smart patch coupled with an AI algorithm to detect and send early warning signs to care givers ensures that

even the patients outside the ICU are monitored 24X7 by trained doctors in a connected command centre, taking the level of patient safety to new heights in healthcare.

The connected room makes sure that care givers have all the information regarding the patient handy during visits to the room and even before in order to enable not just the ease of point of care clinical documentation but also provide access to information to take relevant clinical decisions.

The extension of this initiative also enables the patients through their own smart devices to help monitor their condition post-discharge, ask questions of their care team and further read up on recovery instructions. Now the smart device has become a care platform (inclusive of virtual care features) that supports the ongoing nature of the patient’s healthcare journey. This would be the best possible patient experience scenario: leveraging connected technology outside of hospital confines to help a patient achieve a more successful transition back into daily living and to help reduce their chance of readmission.

In connected rooms, the patient/ attendant gets a tablet/smart device that interfaces with the in-room TV. Both the patient and the physician can call up information on their respective tablets and mirror it on the TV screen or between tablets, apart from the easy access to in room automation of lights, fans, AC and the in room entertainment system.

Patients can also use tablets to access educational materials about their illness, surgical procedure and discharge/ aftercare instructions, all to prepare for what the coming days and weeks will involve.

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Patient empowerment tools prove key to satisfaction

It begins by leveraging technology to access patient records. The right tools and gadgets at the patient’s side can help physicians and clinicians get a clearer image of patient history, current needs

INFORMATION TECHNOLOGY

and mobile apps on hospital-provided tablets to help them relax and take their mind off their illness.

Conclusion- level up the patient experience

This scenario only scratches the surface of the potential technology has to transform the quality, speed, accuracy, and experience of patient care. The goldmine of structured data generated through this will further pave way to creating/enhancing multiple AI/ML algorithms in the near future to bring in more efficiency in the process. As tele-health, m-Health and other leading-

AUTHOR BIO

and discussion points to making each interaction more productive and less difficult on patients.

But access to patient records is just the beginning. Patients themselves must also be able to use technology to access educational content and in-room entertainment. The days of five-channel TVs with rabbit ears mounted on a wall are quickly disappearing. Flatscreen monitors that are tied to hospital networks and to devices within the patient room are becoming the norm.

This technology can inform the patient and authorised care team members about the patient’s health while in the hospital, and it can prepare the patient to better adhere to care plans prescribed at discharge. With motion sensors and bed side rail sensors, chances of patient falls can be reduced as the alarm can go off, informing the nurses/care providers to monitor the same.

Tablets provide even greater flexibility. Patients access cable, internet

edge technologies evolve further, so will innovation at all points in the care continuum.

But transformation takes time. It doesn’t happen overnight. The key is to be aware of the changing landscape from patient engagement to patient empowerment and to recognize how this transition is unfolding as the market itself transforms from encounter-based care to value-based care models. We have made a start and will follow the path towards innovating and utilising technology to keep raising the bar for the care we provide to our patients.

Sangita Reddy is a Global Healthcare Influencer, Healthcare Technocrat, Social Entrepreneur and Humanitarian. She has been conferred with an Honorary Doctorate by Macquarie University Australia, in recognition transformative changes in healthcare and development of Health IT. She is an Honorary Consul of Brazil in Hyderabad. Sangita Reddy has been a recipient of numerous prestigious awards for business and leadership in the healthcare industry.

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INFORMATION TECHNOLOGY

CLINICAL DECISION SUPPORT SOFTWARE FDA’s Risk-based approach

On September 27, 2019,the U.S. Food and Drug Administration (FDA) issued several guidances that will impact innovation in the digital health space, the draft guidance, Clinical Decision Support Software and the final guidances: Policy for Device Software Functions and Mobile Medical Applications, General Wellness: Policy for Low Risk Devices, Off-The-Shelf Software Use in Medical Devices, and Medical Device Data Systems, Medical Image Storage Devices, and Medical Image Communications Devices.

Taken together, these guidances define FDA’s position on regulatory oversight and enforcement of devices commonly developed and used in digital health. This paper will explore FDA’s framework for regulatory oversight and discretion as well as what does not constitute a device in accordance with the recently released guidances.

Kyle Y Faget, Special Counsel and Business Lawyer, Foley & Lardner LLP

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linical Decision Support (CDS) software has become an integral tool used By Healthcare Professionals (HCPs) when treating patients and by patients and caregivers when trying to understand the contours of a given ailment.CDS provides healthcare professionals and patients with knowledge and personspecific information, intelligently filtered or presented at appropriate times, to enhance health and healthcare. Examples of CDS include: computerised alerts and reminders for providers and patients, conditionspecific order sets, focused patient data reports and summaries, diagnostic support, and contextually relevant reference information.

On December 8, 2017, the U.S. Food & Drug Administration (FDA)

INFORMATION TECHNOLOGY

published a draft guidance titled “Clinical and Patient Decision Support Software” that aimed to provide clarity on the scope of the FDA’s oversight of clinical decision support software intended for healthcare professionals, and patient decision support software intended for patients and caregivers who are not healthcare professionals.

On October 27, 2019, FDA issued an updated guidance document applicable to clinical decision support software that takes a risk-based approach to regulation of CDS. Recognising that digital health is playing an ever-increasing role in healthcare, FDA’s stated position is to encourage innovation. By taking a riskbased approach to its oversight of CDS, FDA hopes to strike a balance between encouraging developers to create, adapt and expand the functionalities of their software to support providers in diagnosing and treating diseases, while also ensuring the software doesn’t introduce unacceptable risk to the patient. The CDS guidance was issued alongside a suite of final guidance documents that, taken together, illustrates FDA’s commitment to providing clarity to developers operating in the digital health space.

CDS software, inter alia, provides HCPs and patients with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and healthcare. CDS includes technologies such as computerised alerts and reminders for providers and patients; clinical guidelines; conditionspecific order sets; focused patient data reports and summaries; documentation templates; diagnostic support; and contextually relevant reference information. In its guidance, FDA attempted to clarify which types of CDS software are not devices, which types of CDS software may be devices but, based on FDA’s current understanding of the risks posed by the devices, FDA intends to exercise enforcement discretion, and CDS software that are

Software developers should take notice that FDA oversight focus is applicable to almost every form of CDS software except when an HCP can independently review the basis for the recommendation being made by the software.

devices and on which FDA intends to focus its regulatory oversight.

When determining whether CDS software is a device or a non-device, FDA intends to evaluate who the intended user of the CDS software is and whether the user can independently review the basis for the recommendation made by the software. The user’s ability to independently review the basis for the software’s recommendation asks whether the function is intended for the purpose of enabling the user to independently review the basis for the recommendations so that it is not the intent that user rely primarily on any such recommendation.

If the CDS software is intended for use by an HCP, whether the CDS software is a device hinges upon whether the HCP can independently review the basis for the recommendation made by the software. If so, the software is non-device CDS. If not, the software is device CDS. Whether FDA exercises enforcement discretion or exercises oversight focus depends upon the risk associated with the situation or condition at issue.

Drawing from the International Medical Device Regulators Forum, Software as a Medical Device: Possible Framework for Risk Categorization and Corresponding Considerations (IMDRF Framework), In the guidance, FDA categorises risk associated with patient conditions

as non-serious, serious, and critical.

In general, non-serious situations or conditions are situations or conditions where an accurate diagnosis and treatment is important but not critical for interventions to mitigate longterm irreversible consequences on an individual patient's health condition or public health. In general, serious situations or conditions means situations or conditions where accurate diagnosis or treatment is of vital importance to avoid unnecessary interventions or timely interventions are important to mitigate long-term irreversible consequences on an individual patient’s health condition or public health. In general, critical situations or conditions means situations or conditions where accurate and/or timely diagnosis or treatment action is vital to avoid death, long-term disability or other serious deterioration of health of an individual patient or to mitigating impact to public health.

In addition to a risk assessment based on the impact of the software output on a patient’s situation or condition, FDA assesses the risk associated with a device CDS function in terms of whether the information provided by the software will be used to inform clinical management, drive clinical management, or treat or diagnose. Informing clinical management means that the information provided by the software will not trigger an immediate or near-term action and will inform the intended user of options for treating, diagnosing, preventing, or mitigating a disease or will provide clinical information by aggregating relevant information (e.g., disease, condition, drugs, medical devices, population, etc.). Driving clinical management means that the information provided by the software will be used by the end user (to aid in treatment, aid in diagnoses, to triage or identify early signs of a disease or condition) will be used to guide next diagnostics or next treatment interventions: to aid in treatment by providing enhanced support to safe and effective use of medicinal products or a

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INFORMATION TECHNOLOGY

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Intended User is HCP IMDRF Risk Categorization

Inform X Critical

Inform X Serious

Inform X Non-Serious

Can the User Independently Review the Basis?*

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FDA Requlation

Intended User is Patient / Caregiver FDA Requlation

NO

Oversight Focus

Oversight Focus

YES

Not a Device

Oversight Focus

NO

Oversight Focus

Oversight Focus

YES

Not a Device

Oversight Focus

NO

Enforcement Discretion**

Oversight Focus

YES

Not a Device

Enforcement Discretion**

Software developers should take notice that FDA oversight focus is applicable to almost every form of CDS software except when an HCP can independently review the basis for the recommendation being made by the software. If an HCP cannot independently review the basis for the recommendation being made by the software, the condition at issue must be non-serious for FDA to exercise enforcement discretion. In contrast, where the end user is a patient or a caregiver, FDA will engage in oversight focus unless the condition at issue is non-serious and the end use patient or caregiver can independently review the basis for the recommendation being made by the software.

AUTHOR BIO

medical device; to aid in diagnosis by analysing relevant information to help predict risk of a disease or condition or as an aid to making a definitive diagnosis; or to triage or identify early signs of a disease or condition.

Treating and diagnosing means that the information provided by the software will be used to take an immediate or near-term action: to treat/prevent or mitigate by connecting to other medical devices, medicinal products, general purpose actuators or other means of providing therapy to a human body; or to diagnose/screen/detect a disease or condition (i.e., using sensors, data, or other information from other hardware or software devices, pertaining to a disease or condition.

Software that drives clinical management and treats or diagnoses patient conditions are not CDS; such software goes beyond supporting or providing recommendations to an HCP, patient, or caregiver. Whereas CDS software provides support by offering recommendations and informing clinical management, software that drives clinical management goes beyond simply supporting or providing a recommendation about prevention, diagnosis, or treatment of a disease or condition. Drive functions are relied on to guide next diagnostics or treatment interventions, and therefore are not CDS. Similarly, software that treats or diagnoses prompt an immediate or nearterm action, which are functions that are well beyond the scope of supporting or providing recommendations. FDA’s focus in the instant guidance is on CDS solely.

Whether FDA will engage in oversight focus of software that informs clinical management depends on the seriousness of the patient’s condition, the intended end user, and whether the end user can independently review the basis for the recommendation being made by the software. The table below summarises FDA’s approach to oversight focus and enforcement discretion.

Although FDA’s risk-based approach to regulation of CDS software is a practical and flexible approach to regulatory oversight, developers will still find themselves seeking FDA clearance for their software innovations. The complexity of many digital health innovations do not lend themselves to HCPs independently reviewing the basis for the recommendation being made by the software. Developers targeting patients and caregivers will almost certainly need a regulatory clearance in advance of commercialisation unless the software is coupled with a way for users to independently review the basis for the recommendation being made by the software.

Kyle Faget is a special counsel and business lawyer with Foley & Lardner LLP. She is a member of the firm’s Health Care and Life Sciences Practice Groups. Kyle advises suppliers, physician practices, consultants and vendors, and a variety of other healthcare entities on a range of business, legal and regulatory issues affecting the telemedicine industry. She handles matters involving contracting fraud and abuse compliance, Medicare and Medicaid reimbursement, self-disclosures and overpayments, the Anti-Kickback Statute, physician self-referrals (the Stark Law), healthcare marketing rules, HIPAA, corporate compliance programs, contracting, confidentiality and information sharing, and policies and procedures.

A SHORT NOTE

AI Set To Revolutionise Medical Device Technology and Distribution

Artificial Intelligence and related technologies have already become a major draw in healthcare industry with the potential to transform patient care as well as administrative processes by automating tasks and achieving faster results.

Sanjay Jha, Director, ColMed

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rtificial intelligence (AI) systems are evolving at a breakneck pace, and have already made remarkable advances in successfully replicating repetitive and complex tasks, offering unique insights making it possible for product developers to focus on the more nuanced aspects. AI based programmes can acquire information, sort and process the data logically, use known variables to form solutions, recognise the mistakes, and correct them, improving the quality of product design.

AI and related technologies have already become a major draw in healthcare industry with the potential to transform patient care as well as administrative processes by automating tasks and achieving faster results. According to a report by Zion Market Research, the global AI in healthcare Market

is likely to reach US$17.8 billion by 2025. Algorithms in disease diagnosis, clinical trials and predictive analysis for disease outbreaks have the potential to dramatically change the way healthcare is planned, executed and delivered. The medical device industry is no exception.

AI can not only be used to design and test new devices, but also for diagnostics, surgery and as a therapeutic aid. • Diagnosis – AI already has a considerable presence in diagnostic medicine. AI technologies reduce the diagnostic workload for physicians, most of whom are overworked to the point of complete exhaustion. It helps bring down the rates of wrong diagnosis.

If algorithms can diagnose medical maladies with complete accuracy in just half of the patients, professionals can end up saving a lot of time. Medical device

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A SHORT NOTE

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The future looks bright

According to a report by Zion Market Research, the global AI in healthcare Market is likely to reach US$17.8 billion by 2025.

With the government signalling its intention to institute a separate body for the regulation of medical devices, the competition in the industry is only set to go up. The quality of manufacturing is only set to go up and device manufacturers will have to do everything they can to stay ahead of their peers. If they fail to embrace technologies like artificial intelligence that improve the state of healthcare delivery, then they are going to find it difficult to stay relevant in the market.

surgical systems will also reduce surgical variations, eliminate inefficiencies and improve the patient outcomes.

Disruption of distribution

Let us also take a broad look at how artificial intelligence will impact the distribution of medical devices. It allows device manufacturers from becoming order takers to order makers. Demand forecasting will be significantly better due to disease state forecasting. Based on the pattern of disease state and previous purchases, artificial intelligence software can be used to suggest medical supplies before the end user runs out of stock. Even distributors stand to gain from the use of artificial intelligence due to availability for consumption forecast. Artificial Intelligence will help identify when products need to be sent to distribution centres and when the products with low shelf life need to be promoted to reduce inventory waste. In short, an artificial intelligence equipped distribution manager can help optimise the inventory as well as the supply chain management.

AUTHOR BIO

manufacturers should keep up with the integration of Ai in diagnostics. Wearable devices powered by artificial intelligence have a wide variety of applications from medical imaging and gene sequencing to studying drug interaction and pre-surgical planning. The better patients are able to monitor their vitals and have the information delivered to doctors and specialists, the more it eliminates the need to visit a clinic or hospital.

This will help bring down overhead healthcare costs and reduce the load on overburdened healthcare facilities.

• Invention – Technologies that are built using artificial intelligence can help refine the development process of medical devices. AI software can solve complicated equations, help refine modelling, and improve product testing.

Algorithms can help generate hundreds of product designs based on parameters such as weight and size, raw materials, and the intended functionality.

From there, it can provide suitable candidates for the purposes of testing.

Add 3D printing into the mix and the possibilities become more obvious. The entire product pipeline can be AI driven, beginning with building multiple models, rapid prototyping using a 3D printer, and testing multiple variants at the same time. Device manufacturers can also embed sensors and trackers into the 3D printed devices, broadening the durability, ergonomics, and usefulness of these designs.

• Robotics and monitoring – Automated surgery is also fast becoming a ubiquitous reality. It might be a little difficult to convince the public at large to hand over the surgical duties to a robot, but once they are made to understand how much more efficient it is, they will be more than convinced. AI has a big role to play in next generation robotic surgery. They can help augment the perception capabilities and dexterity of surgeons using machine learning algorithms. Surgeons will be able to make use of such systems to make more well-informed decisions. AI-based

Sanjay Jha, IIT Kharagpur and INSEAD alumni , presently a director at Colmed, is an experienced entrepreneur with a decorated history in the medical device industry, aiming towards bringing the quality of healthcare up and cost of healthcare down. In his past stints at various reputed companies like Johnson and Johnsons and GE Healthcare, he is known for his unparalleled skills in business strategy and business development, market analysis, operations, innovation and entrepreneurship.

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Bridging Gaps in Healthcare Industry with Technology As an internet-based technology and cultural enterprise in China, Tencent has been exploring the healthcare industry over the past five years with the mission of ‘Tech for Good’. This article will share with you how Tencent leverage powerful technology to build bridges between hospitals and the public to help hospitals meet the challenges in China due to a huge patient demand for doctors and limited medical resources.

As global population ageing and limited medical resources become alarming issues, the healthcare industry is facing many challenges and obstacles.

One of them is how efficiency can be improved given the geographical, space, time and resource constraints.

Smart technology is the answer Today, we have seen an uptick in cross-sector convergence within global healthcare industry, with a view to enhancing the quality of medical services with the help of technology. Various states in the US have been researching the potential of emerging technologies such as Artificial Intelligence (AI); the UK is promoting telemedicine; South Korea is expediting the building of hospitals with 5G network, while Finland has launched a pilot medical project in a 5G network environment. Not surprisingly, smart technol-

ogy has been identified as a key driver in healthcare development in China.

As one of the world's most populous countries, China's healthcare industry has an even more daunting task: China's population accounts for 22 per cent of the world's total, but available medical resources are merely 2 per cent of the world's total. As a result of insufficient medical resources and its uneven distribution, difficulty in seeking treatment and expensive medical costs were evident while gaps are identified in areas of operational efficiency, provision of information and services.

In the past five years, Tencent has been exploring ways to improve the quality and efficiency of healthcare industry through digital technology. In line with its Industrial Internet strategy, Tencent’s exploration in the healthcare industry focuses on three areas, namely, Tencent Medipedia, Smart Hospital and Medical AI.

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Tencent Medipedia: Addressing Knowledge Gaps in Healthcare

In the era of mobile Internet, more people look for healthcare information online. However, the quality and accuracy of such information is not easy to identify, as erroneous or deficient information is not uncommon on internet. Tencent Medipedia is the specially-designed solution to this issue.

Launched in 2017, Tencent Medipedia is designed as an authoritative, professional and practical platform sharing common healthcare information. Users are provided with knowledge from the prevention, diagnosis, treatment of disease to rehabilitation. Through text, photo, video, interactive and AI assistant, and 3D visualisation, Tencent Medipedia brings high-quality original healthcare content from around the globe and localises it to best suit the Chinese audience.

It is a medical information platform with systematic and in-depth content that translates obscure medical knowledge into more reader-friendly information for the general public.

To ensure the creditability of the platform, Tencent Medipedia collaborated with WebMD, a reputable international healthcare information platform, to obtain access to over 60,000 Chinese research papers on medical and healthcare. Tencent Medipedia also partnered with the Chinese Medical Doctor Association (CMDA) and over 1,000 specialists from hundreds of renowned hospitals nationwide to present healthcare content covering over 8,000 common diseases (including detailed information on 50 diseases).

“As a company well-known for its strengths in Internet and digital technology, Tencent aims to present Tencent Medipedia as a recognised authority on healthcare services, which gives patients proper guidance and eliminates information gaps between doctors and patients. By building Tencent Medipedia, Tencent is fulfilling its mission and vision of ‘Tech For Good’.” said Zhang Meng, Vice President of Tencent Medical.

Smart Hospital: Boosting Efficiency in Hospital Operation to Better Accommodate Public Demand for Medical Care Despite the substantial increase in China’s total medical resources in recent years, accessibility to quality medical treatment and services remains a common complaint amongst patients. This accessibility gap is fundamentally attributed to the imbalance in medical resources distribution. Therefore, it is crucial to set up

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an efficient medical service system. Tencent Smart Hospital provides the solution to optimise and accelerate the process. By integrating WeChat Healthcare Security Pay and Digital Healthcare Card as well as Tencent Health, a service platform on WeChat, this solution helps hospitals enhance operational efficiency and provides patients with an improved medical service experience.

Through WeChat, Tencent can reach out to the insured totaling to over 500 million. Nearly 10,000 medical institutions support medical insurance payments by WeChat. Hence, users can pay for medical consultation and medication via WeChat The Digital Healthcare Card is equivalent to a ‘health ID card’ in China, which records a person’s medical records from different hospitals in different regions. It is a key link between the public and medical institutions, amongst such institutions, as well as the institutions and social public services departments. Tencent actively promotes the issuance and use of Digital Healthcare Cards to enable the public to experience the best online and offline patient care.

Tencent Health, a service platform on WeChat, is Tencent's latest contribution to healthcare. Starting from March 2019, residents in Shenzhen - an emerging city in China, can experience Tencent Health service via WeChat to obtain timely online medical consultation, arrange appointments, access healthcare information, and other useful services. Tencent Health will be rolled out to other cities gradually.

With these, Tencent’s Smart Hospital solution connects all stakeholders with technology. It does not

only help medical institutions to enhance their operational efficiency but also spares patients from long waiting time for medical consultation. It has effectively connected medical services, healthcare services, and personal health management and created a new healthcare ecosystem.

Medical AI: Assisting Doctors in Diagnosis by Making AI Technology More Accessible

Today, cancer remains the No.1 killer to mankind.

At the moment, China has less than 20,000 licensed pathologists, with an estimated shortfall of over 90,000 licensed pathologists. Such a resource-constraint seriously affects the quality and standard of clinical medicine in China.

Though there is no shortcut in training medical professionals, technology, however, can speed up the process from screening, diagnosis, treatment to recovery. In the field of ‘AI + Medicine, AI can carry out simple but cumber some tasks to save doctors’ time. It also learns from big data to perform medical image analysis, increasing the efficiency and accuracy in diagnosis while providing personalized medical services recommendation by combining imaging and pathological genetic testing.

Currently, Tencent has three major AI labs which champion breakthrough medical AI research in different application scenarios, they are Tencent Medical AI Lab, Tencent YouTu Lab and Tencent AI Lab. Tencent Medical AI Lab has embarked on research on a new digital biomarker that could be applied to the interpretation or prediction of disease or health outcomes. For patients with Parkinson's disease, for instance, their motion information and audio signals are captured by video and mobile sensors and mobile phones respectively. AI will then analyse such information. The information coupled with professional opinions will produce a comprehensive evaluation of the patients, thus enables accurate and objective treatment.

Tencent Youtu has all along been committed to medical AI. Not long ago, the team just set two records in the global medical imaging competition LiTS, wining two world's first places in liver segmentation and liver tumor segmentation. By deepening its technological R&D, Tencent Youtu has launched its first medical imaging product ‘Tencent Miying’.

Currently, this system has supported cancer screening for ophthalmic diseases, esophageal cancer, colorectal cancer, lung cancer, breast cancer, cervical cancer, cooperating with more than 100 top 3A

hospitals in China. It not only reduces the workload of doctors, but also plays an important role in improving diagnostic accuracy and efficiency.

Tencent AI Lab concentrates on the entire process of medical services. It offers products from disease diagnosis to treatment, including guided consultation, AI pre-diagnosis, AI-assisted diagnosis, and guided medication. According to Yao Jianhua, the Chief Scientist of Tencent AI Lab Medical Center, Tencent AI Lab will further probe into pathology from three angles: AI-based pathological diagnosis models, AI-based pathological prognosis prediction models, and quantitative analytics in pathological omics.

In the field of Medical AI, Tencent hopes to assist doctors in diagnosis but never replace the human touch. As the healthcare industry advances, there are many areas where efficiency could be improved with technology. Tencent firmly believes that by helping doctors, it is helping the patients. It will continue to cooperate with medical institutions to further explore and contribute AI technology solutions to address the problems caused by insufficient medical resources.

Tech for Good, Providing More Customised Medical Services

“Those in the medical profession have a heavy responsibility. To ensure sustainable development in the healthcare industry, first we need to resolve the problem of uneven distribution,”said Ding Ke, Tencent’s Vice President, “If this problem is not resolved, it will be hard to make any progress. It is easy to launch individual pilot projects, but the world will only truly benefit from the Internet to function as a whole.”

Published data shows that till May 2019, over 38,000 medical institutions in China have set up official accounts or Mini Programs at Tencent’s WeChat platform. 60 per cent of the hospitals provide various smart healthcare services to patients through WeChat, and about 110 million WeChat users subscribe to these healthcare services.

Tencent firmly believes in ‘serving patients, helping doctors and assisting hospitals,’ and sees itself as a ‘digital assistant’ in providing digital ‘toolkit’ for healthcare partners. Nowadays, the Internet has penetrated all aspects of life. By applying mobile Internet, AI, big data and other technologies in the healthcare industry, it can better cope with the challenges arising out of the uneven allocation of resources and improve the efficiency and quality of medical services.

“Indeed, ‘Tech For Good’ has been fully practiced in the healthcare industry in its true sense,” Ding Ke added.

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